Artrocentesis en el tratamiento de artritis séptica en articulación temporomandibular: reporte de un caso / Arthrocentesis in the treatment of septic arthritis in the temporomandibular joint: a case report

Objetivo: El objetivo de este reporte de caso es presen- tar a la artrocentesis como una alternativa quirúrgica mínima- mente invasiva en el tratamiento de la artritis séptica tempo- romandibular. Caso clínico: Un paciente hombre de 26 años con an- tecedente de flegmón perimandibular derecho tratado, acude a la Unidad Hospitalaria de Cirugía Maxilofacial por dolor articular temporomandibular, impotencia funcional y trismus, a un mes de haber sido dado de alta de un primer cuadro infec- cioso. Luego de los exámenes clínicos y complementarios, se diagnostica artritis séptica de articulación temporomandibular derecha, la cual fue tratada quirúrgicamente mediante dos ar- trocentesis acompañadas de terapia farmacológica (AU)

Aim: The aim of this case report is to present arthrocen- tesis as a minimally invasive surgical alternative in the treat- ment of temporomandibular septic arthritis. Clinical case: A 26-year-old male patient, with a his- tory of treated right perimandibular phlegmon, came to the Maxillofacial Surgery Hospital Unit due to temporomandibu- lar joint pain, functional impairment and trismus, one month after having recovered from his first infectious process. After clinical and complementary examinations, septic arthritis of the right temporomandibular joint was diagnosed, which was treated surgically by means of two arthrocenteses and phar- macological therapy (AU)

Streptococcus agalactiae: causa de artritis séptica inusual a partir de los 3 meses de edad. Caso clínico / Streptococcus agalactiae: an unusual cause of septic arthritis beyond 3 months of age. Case report

La artritis séptica es una patología poco frecuente, pero con una alta morbilidad, debido a las importantes secuelas que puede originar. La etiología varía según la edad, y Staphylococcus aureus es el microorganismo más frecuente en todas ellas. Streptococcus agalactiae odel grupo B es una causa infrecuente de infección fuera del período neonatal; se asocia, a partir de los 3 meses de edad, con infecciones graves en pacientes inmunocomprometidos. El tratamiento de elección es penicilina G o ampicilina.Aquí se describe el caso de un niño de cuatro meses y medio de edad que desarrolló una artritis séptica por Streptococcus agalactiae odel grupo B, con inicio insidioso de la clínica. El diagnóstico etiológico obligó a descartar meningitis y una inmunodeficiencia asociada. La frecuencia extremadamente baja de dicha artritis a esta edad y la importancia de descartar una enfermedad diseminada son importantes puntos de aprendizaje en este caso.

Septic arthritis is not a very frequent disease, but with a high morbidity due to the important sequelae that it can cause. The etiology is age-specific, with Staphylococcus aureus being the most frequent microorganism in all ages. Streptococcus agalactiae or group B Streptococcus is an uncommon cause of infection outside the neonatal period. Beyond 3 months of age, infections by this pathogen are associated with serious infections in immunocompromised patients. The treatment of choice is penicillin G or ampicillin. A 4.5-month-old child who developed a group B Streptococcus septic arthritis is reported. The onset was insidious, and the etiological diagnosis prompted us to rule out meningitis and associated immunodeficiency. The extremely low frequency of group B Streptococcus septic arthritis at this age and the importance of ruling out a disseminated disease are crucial learning points in this case

Artroscopía de rodilla bajo bloqueos de nervios femoral y ciático en paciente COVID-19 con artritis séptica. Reporte de caso / Knee arthroscopy under femoral and sciatic nerve blocks in a COVID-19 patient with septic arthritis. A case report

Since the start of the COVID-19 pandemic, several anesthetic societies have generated clinical recommendations for the perioperative management of these patients, including the Chilean Society of Anesthesiology. Among these recommendations, the advantages of regional anesthesia have been highlighted. In this article, we report and discuss the case of a 59-year-old patient with diabetes mellitus II, Chronic Arterial Hypertension, Gout, and Stage IV Chronic Renal Failure admitted with a multifocal septic condition characterized by suppurative collections including a large subcutaneous lumbar abscess recently drained. The patient evolved with left knee septic arthritis and was scheduled for arthroscopic irrigation and debridement. As per protocol a SARS-COV2 PCR was tested and resulted positive. It was decided to proceed to surgery under anesthetic ultrasound-guided femoral and sciatic nerve blocks using an adrenalized (2.5 ug/mL) solution of 0.33% Levobupivacaine- 0.66% Lidocaine (15 mL each). Fifteen minutes later, the knee was mobilized passively without pain. Surgery started after 30 minutes. The surgical and anesthetic conditions were described as adequate by the surgeon and the patient, respectively. The postoperative evolution was satisfactory without presenting respiratory symptoms and the patient was discharged 17 days after under oral antibiotic treatment.

Desde el comienzo de la pandemia de COviD-19, varias sociedades de anestesia han generado recomendaciones clínicas para el tratamiento perioperatorio de estos pacientes, incluida la Sociedad Chilena de Anestesiología. Entre estas recomendaciones, se han destacado las ventajas de la anestesia regional. En este artículo, reportamos y discutimos el caso de un paciente de 59 años con diabetes mellitus tipo 2, hipertensión arterial, gota e insuficiencia renal crónica en etapa IV, admitido por una sepsis multifocal caracterizada por colecciones supurativas que incluyen un gran absceso lumbar subcutáneo drenado recientemente. El paciente evolucionó con artritis séptica de rodilla requiriendo de una exploración y aseo artroscópico. Por protocolo perioperatorio COviD-19, se solicitó PCR para SARS-COv2 con un resultado positivo. Se decidió proceder a la cirugía bajo bloqueos anestésicos guiados por ultrasonido de nervios femoral y ciático utilizando una solución adrenalizada (2,5 ug/mL) de levobupivacaína al 0,33% lidocaína al 0,66% (15 mL en cada uno). Quince minutos después, la rodilla se movilizó pasivamente sin dolor. La cirugía se inició tras media hora empleando una ligera sedación con propofol. Las condiciones quirúrgicas y anestésicas fueron descritas como adecuadas por el cirujano y el paciente. Este último evolucionó favorablemente, sin síntomas respiratorios y fue dado de alta 17 días después con tratamiento antibiótico oral.

A rare cause of vertebral osteomyelitis: the first case report of rat-bite fever in Portugal

Abstract Rat-bite fever is a rarely diagnosed illness caused by Streptobacillus moniliformis . Although this disease is distributed worldwide, there have been few cases reported in Europe. Here, we report a case of vertebral osteomyelitis and sternoclavicular septic arthritis caused by S. moniliformis in a Portuguese patient previously bitten by a rat. Laboratory diagnosis was performed using molecular identification. This is the first case report of rat-bite fever in Portugal. The case described here serves as a reminder for physicians to consider this diagnosis in patients who have developed fever syndromes after being in contact with rodents.

Acometimento pulmonar e articular secundário à síndrome de Lemierre: relato de caso e revisão de literatura / Pulmonary and joint involvement secondary to Lemierre syndrome: case report and literature review

A síndrome de Lemierre caracteriza-se por uma rara entidade que gera tromboflebite da veia jugular interna e embolismo séptico em história da infecção recente da orofaringe, além de sinais radiológicos e isolamento de patógenos anaeróbicos, principalmente Fusobacterium necrophorum. Relatamos o caso de uma paciente do sexo feminino, 13 anos de idade, com histórico de carcinoma de nasofaringe associado ao vírus Epstein-Barr (estadiamento T4N2M0), submetida a procedimentos cirúrgicos e quimiorradioterapia. Iniciou com queixa de mialgia intensa, diplopia, lesões infectadas em membros e choque séptico. Por meio de exames de ultrassonografia cervical com Doppler colorido e tomografia computadorizada de pescoço com contraste endovenoso, foram identificados trombos intraluminais na veia jugular interna, além de trombos sépticos pulmonares, por meio da tomografia computadorizada de tórax. Posteriormente, ainda evoluiu com artrite piogênica coxofemoral esquerda. Foi isolada, por hemocultura, a bactéria Klebsiella pneumoniae Carpemenase, e o tratamento se deu pela associação entre vancomicina, amicacina, meropenem, metronidazol e anfotericina B. Conclui-se que, após o diagnóstico de SL e, embora com múltiplas complicações e diagnóstico tardio, a paciente encontra-se bem e assintomática, além do relato comprovar a dificuldade diagnóstica e de seu tratamento

Lemierre's syndrome is a rare condition that leads to thrombophlebitis of the internal jugular vein and septic embolism following recent oropharyngeal infection, being characterized by radiological signs and isolation of anaerobic pathogens, especially Fusobacterium necrophorum. We report the case of a 13-year-old female patient with history of nasopharyngeal carcinoma associated with Epstein-Barr virus (T4N2M0 staging), who underwent surgical procedures and chemoradiotherapy. Her initial complaint was severe myalgia, diplopia, infected limb injuries, and septic shock. Cervical color Doppler ultrasound and computed tomography scan of the neck with intravenous contrast showed intraluminal thrombi in the internal jugular vein, and chest computed tomography showed pulmonary septic thrombi. Subsequently, she progressed with left coxofemoral pyogenic arthritis. The bacterium Klebsiella pneumoniae Carpemenase was isolated in blood culture, and the patient was treated with the association of vancomycin, amikacin, meropenem, metronidazole, and amphotericin B. It is concluded that, despite the multiple complications and late diagnosis, the patient is well and asymptomatic after the diagnosis of Lemierre's syndrome; in addition, the report proves the difficulty of diagnosis and treatme

Arthroscopic Treatment of Septic Arthritis of Acromioclavicular Joint

Septic arthritis requires an early diagnosis and proper treatment to prevent the destruction of articular cartilage and joint contracture. This paper presents a rare case of septic arthritis of the acromioclavicular joint that was treated with arthroscopic debridement and resection of the distal clavicle.

[Septic arthritis in the elderly: about 21 cases]

Septic arthritis [SA] is a serious disease especially if occurring in elderly debilitated by frequent comorbidities and diminished immunity. The authors discuss diagnosis difficulties, prognosis and, therapeutic consequences of the occurrence of septic arthritis in elders It is a retrospective study about 21 cases of septic arthritis [SA] occurring in the elderly aged 65-year-old or more, hospitalized over a ten year period [1994-2005] at the department of Rheumatology of Charles Nicolle's Hospital of Tunis. Mean age was 70.8 years [65y-83y] with a sex-ratio of 1.1 .A history of rheumatologic and/or systemic diseases was present in 62%of cases. Clinic presentation was atypical explaining the long mean diagnosis delay; 23 days for pyogenic SA, 9.3 months for tuberculous arthritis. The germ involved, isolated in 11 cases, was a Staphylococcus Aureus in most ones. Tuberculous arthritis represented 28.6%of cases. The outcome was favourable in 19 cases [90%] after antibiotherapy. Because of its seriousness, SA should be evocated in front of any articular inflammation occurring in elderly. Adequate management must be started as soon as possible

Arthrography in the assessment of septic hip joints in children

Acute septic arthritis of the hip joint in the pediatric patient is an emergency in which a satisfactory outcome hinges on an early and accurate diagnosis. The diagnosis is made primarily on clinical grounds and confirmed by finding pus on aspiration of the hip joint. Failure to obtain fluid on aspiration does not rule out the presence of pus in the joint, as in a small child it is difficult to be certain that the needle is indeed within the joint. In recognition of this difficulty, arthrograms were utilized at the Aga Khan University Hospital to obtain confirmatory evidence of the intra-articular position of the aspiration needle. From February 1989 to October 1990, ten children age range from 2 weeks to 10 years, presented to the Aga Khan University Hospital with symptoms suggestive of a septic hip. Five of these had a positive tap and underwent arthrotomy and drainage. In the other five, following a negative tap, an arthrogram was performed with the aspirating needle in situ. In three of these patients the arthrogram confirmed correct position of the needle within the joint and the diagnosis of septic hip was ruled out in these patients. In the remaining two, dye injection revealed the needle tip to be outside the joint cavity. The needle was successfully repositioned in one, pus aspirated and an arthrotomy and drainage performed. In the last patient, the needle was not repositioned and the surgeon proceeded with the arthrotomy. No pus was found in the joint. If arthrography had been pursued according to the protocol this negative arthrotomy could have been avoided. Our experience indicates that arthrography is a simple technique which improves the accuracy of hip aspiration in the diagnosis of septic hip disease in the child