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1.
Surg Infect (Larchmt) ; 23(5): 458-464, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1901048

ABSTRACT

Background: The impact of the coronavirus 2019 (COVID-19) pandemic on the rate of primary total joint arthroplasty (TJA) peri-prosthetic joint infection (PJI) and superficial surgical site infections (SSI) is currently unknown. The purpose of this multicenter study was to evaluate any changes in the rates of 90-day PJI or 30-day SSI, including trends in microbiology of the infections, during the COVID-19 pandemic compared to the three years prior. Patients and Methods: An Institutional Review Board-approved, multicenter, retrospective study was conducted with five participating academic institutions across two healthcare systems in the northeastern United States. Primary TJA patients from the years 2017-2019 were grouped as a pre-COVID-19 pandemic cohort and patients from the year 2020 were grouped as a COVID-19 pandemic cohort. Differences in patient demographics, PJI, SSI, and microbiology between the two cohorts were assessed. Results: A total of 14,844 TJAs in the pre-COVID-19 pandemic cohort and 5,453 TJAs in the COVID-19 pandemic cohort were evaluated. There were no substantial differences of the combined 90-day PJI and 30-day superficial SSI rates between the pre-COVID-19 pandemic cohort (0.35%) compared with the COVID-19 pandemic cohort (0.26%; p = 0.303). Conclusions: This study did not find any change in the rates of 90-day PJI or 30-day superficial SSI in patients undergoing primary TJA between a pre-COVID-19 pandemic and COVID-19 pandemic cohort. Larger national database studies may identify small but substantial differences in 90-day PJI and 30-day superficial SSI rates between these two time periods. Our data may support continued efforts to maintain high compliance with hand hygiene, use of personal protective equipment, and limited hospital visitation whenever possible.


Subject(s)
Arthritis, Infectious , Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , COVID-19 , Prosthesis-Related Infections , COVID-19/epidemiology , Humans , Pandemics , Prosthesis-Related Infections/epidemiology , Retrospective Studies , Risk Factors , Surgical Wound Infection/epidemiology
2.
J Orthop Surg Res ; 17(1): 302, 2022 Jun 06.
Article in English | MEDLINE | ID: covidwho-1879248

ABSTRACT

PURPOSE: At present, concomitant avascular necrosis (AVN) of femoral head and septic arthritis (SA) as a sequel of COVID-19 infection has yet not been documented. By large-scale use of life-saving corticosteroids (CS) in COVID-19 cases, our aim is to warn of the occurrence of hip joint infection in these patients. METHODS: We report a series of five cases in which patients developed septic arthritis concomitant with AVN after being treated for COVID-19 infection. The mean dose of prednisolone used in these cases was 1695.2 mg. The time period of onset of hip symptoms in our cases from the beginning of the COVID-19 infection was 56 days in the first case, 43 days in the second case, 30 days in the third case, 29 days in the fourth case and 50 days in the last case, with an average time of 41.6 days. All patients underwent surgery depending on the extent of articular cartilage damage by direct anterior approach. RESULTS: Clinical and laboratory symptoms improved significantly in all patients. The mean visual analogue pain score of the patients decreased from 9.4 (9-10) before surgery to 2.8 (1-4) after 1 week of operation. CONCLUSION: In any patient with the history of COVID-19 infection specially those who have been treated with corticosteroid as one of the medications prescribed during the disease, any joint symptom specially in the hips should draw our attention to the joint infection, and with timely diagnosis and surgery, their hip joint can be saved.


Subject(s)
Arthritis, Infectious , Arthroplasty, Replacement, Hip , COVID-19 , Femur Head Necrosis , Arthritis, Infectious/complications , Arthritis, Infectious/diagnostic imaging , Arthritis, Infectious/drug therapy , COVID-19/complications , Femur Head/surgery , Femur Head Necrosis/diagnostic imaging , Femur Head Necrosis/etiology , Femur Head Necrosis/surgery , Hip Joint/diagnostic imaging , Hip Joint/surgery , Humans , Retrospective Studies , Treatment Outcome
3.
Am J Case Rep ; 23: e936034, 2022 May 12.
Article in English | MEDLINE | ID: covidwho-1841694

ABSTRACT

BACKGROUND COVID-19 is treated using antiviral and immunosuppressive drugs. Therefore, patients treated for COVID-19 may have an increased risk of secondary infection and a masked inflammatory response. We present a case of a deep neck abscess caused by pyogenic sternoclavicular arthritis during treatment for COVID-19. CASE REPORT A 55-year-old man with COVID-19 was admitted to the hospital with hypoxemia. He was then treated with remdesivir, tocilizumab, and dexamethasone and was placed in the prone position. When his condition stabilized, pain in the left shoulder appeared. There was no fever or elevation in inflammation markers, and he was administered analgesics. However, the pain worsened and redness of the left neck appeared. Plain computed tomography (CT) showed swelling of the left neck muscles. Because cellulitis was suspected, he was treated with antibiotics, but his symptoms did not improve. Three days after the plain CT, contrast-enhanced CT showed sternoclavicular arthritis, deep neck abscess, and mediastinal abscess. Therefore, an emergency incisional drainage was performed under general anesthesia. Wound cleaning and drainage were continued after surgery, and after drainage tubes were removed, the patient was discharged on postoperative day 17. CONCLUSIONS Cervical infections after COVID-19 treatment have been reported in a few cases. Particularly, deep neck abscesses require more attention since they could be fatal if not treated immediately. If a secondary infection is suspected in a patient treated with immunosuppressive drugs for COVID-19, a thorough physical examination should be performed to avoid misdiagnosis.


Subject(s)
Arthritis, Infectious , COVID-19 , Coinfection , Abscess/diagnosis , Abscess/etiology , Abscess/therapy , Arthritis, Infectious/therapy , COVID-19/drug therapy , Drainage , Humans , Male , Middle Aged , Pain
5.
JBJS Case Connect ; 11(3)2021 07 30.
Article in English | MEDLINE | ID: covidwho-1334838

ABSTRACT

CASE: We report a case of a 68-year-old woman who developed left shoulder glenohumeral joint septic arthritis within 1 week of receiving the COVID-19 Pfizer-BioNTech vaccine. CONCLUSION: Common vaccine complications include injection site pain, fever, chills, arthralgia, and hypersensitivity reactions. A less common and more serious complication of septic arthritis has been reported and requires invasive treatment of surgical irrigation and debridement, and culture-specific parenteral antibiotic therapy. The current report highlights the clinical presentation and significant potential for serious complication with the improper technique. We urge vaccine administrators to practice caution and aseptic technique when vaccinating patients to reduce the risk of complication and morbidity.


Subject(s)
Arthritis, Infectious/chemically induced , COVID-19 Vaccines/adverse effects , Shoulder Joint , Aged , Female , Humans
7.
BMC Infect Dis ; 21(1): 499, 2021 May 29.
Article in English | MEDLINE | ID: covidwho-1247579

ABSTRACT

BACKGROUND: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection is associated with various complications. PMA (primary meningococcal arthritis) is a rare meningococcus-associated disease causing arthritis of the knee usually, without any signs of invasive meningococcal disease. No case of PMA in a COVID-19 (coronavirus disease, 2019) patient has yet been described. PMA mainly strikes young adults. PMA is not associated with any immunocompromising condition. It has a better outcome than usual septic arthritis CASE PRESENTATION: Herein, we report an 18-year-old man diagnosed with COVID-19, later admitted with persistent fever, right knee arthralgia and maculopapular rash. Due to family history, psoriasis and Henoch-Schönlein purpura were hypothesized and ruled out. Finally, synovial fluid culture confirmed Neisseria meningitidis serogroup B arthritis without any other symptoms of invasive meningococcal disease. Healing was achieved quickly with surgery and antibiotics. We concluded in a PMA. CONCLUSION: We describe here the first primary meningococcal arthritis in a COVID-19 patient and we hope to shine a light on this rare but serious complication.


Subject(s)
Arthritis, Infectious/diagnosis , COVID-19/complications , Meningococcal Infections/diagnosis , Adolescent , Anti-Bacterial Agents , Arthritis, Infectious/microbiology , Exanthema/microbiology , Humans , Knee Joint/microbiology , Male , Neisseria meningitidis, Serogroup B/isolation & purification , Synovial Fluid/microbiology
8.
BMJ Case Rep ; 14(5)2021 May 25.
Article in English | MEDLINE | ID: covidwho-1243695

ABSTRACT

A 68-year-old woman presented for left shoulder pain, decreased range of motion (ROM) and fever 7 days following COVID-19 vaccination. Investigations showed a tender left deltoid mass, decreased shoulder ROM and elevated inflammatory markers. MRI demonstrated a large glenohumeral effusion with synovitis, and arthrocentesis confirmed septic arthritis (SA). She required subtotal bursectomy. Intraoperative joint cultures grew Streptococcus gordonii She completed 6 weeks of antibiotics and is undergoing physical therapy for post-infectious adhesive capsulitis. SA is most commonly due to Staphylococcus aureus and ß-haemolytic streptococci, and rarely due to viridans group streptococci including S. gordonii To avoid inadvertent injection into the glenohumeral joint, vaccination should be performed posteriorly and inferiorly into the deltoid musculature. Progressive pain, fever or decreased passive ROM following vaccination should raise concern for SA. Given its rarity, however, concern for secondary SA should not affect the general population's consideration for vaccination.


Subject(s)
Arthritis, Infectious , COVID-19 , Shoulder Joint , Aged , Arthritis, Infectious/etiology , COVID-19 Vaccines , Female , Humans , Range of Motion, Articular , SARS-CoV-2 , Shoulder Joint/diagnostic imaging , Shoulder Joint/surgery , Streptococcus gordonii , Vaccination/adverse effects
9.
BMJ Case Rep ; 14(4)2021 Apr 13.
Article in English | MEDLINE | ID: covidwho-1183309

ABSTRACT

Prompt recognition and treatment of septic arthritis are crucial to prevent significant morbidity and mortality in affected patients. During the current COVID-19 pandemic, anchoring bias may make an already challenging diagnosis like septic arthritis more difficult to diagnose quickly and efficiently. Musculoskeletal (MSK) point of care ultrasonography (POCUS) is an imaging modality that can be used to quickly and efficiently obtain objective findings that may help a clinician establish the diagnosis of septic arthritis. We report a case where MSK POCUS was a key element in establishing the diagnosis of glenohumeral joint septic arthritis and subdeltoid septic bursitis for a patient that presented to the emergency department with a fever during the era of the COVID-19 pandemic.


Subject(s)
Arthritis, Infectious/diagnostic imaging , Arthritis, Infectious/therapy , Ultrasonography , Aged , COVID-19 , Emergency Service, Hospital , Fever , Humans , Male , Point-of-Care Testing
11.
Acta Reumatol Port ; 45(4): 278-280, 2020.
Article in English | MEDLINE | ID: covidwho-1013718

ABSTRACT

Coronavirus disease 2019 (COVID-19) was reported in Europe in the beginning of February 2020. Typical symptoms included fever, cough and dyspnea, and not much was known about the clinical evolution of the disease. Herein, we report a case of a late complication of COVID-19 infection in a 41-year-old female. The patient presented with a 4-day history of myalgia, low fever, rhinorrhea and loss of smell. COVID-19 was confirmed by real-time polymerase chain reaction (PCR). The patient recovered with conservative treatment, and PCR for COVID-19 turned negative after 5 weeks. However, at 4 weeks after the beginning of the viral symptoms, the patient developed severe arthralgia of some interphalangeal joints of the hands, that lasted for 4 weeks. Laboratory workup revealed no significant changes, and the symptoms resolved with a short course of oral steroids. Reactive viral arthritis might be a late complication of COVID-19.


Subject(s)
Arthritis, Infectious/complications , COVID-19/complications , Adult , Female , Humans
12.
Trends Immunol ; 42(2): 91-93, 2021 02.
Article in English | MEDLINE | ID: covidwho-988125

ABSTRACT

Immunologists are central to fighting any pandemic. From pathogenesis to disease modeling, pharmaceuticals to vaccines, immunologists play a crucial role in translating basic science into effective response strategies. This article describes our view on how lessons from the coronavirus disease 2019 (COVID-19) pandemic can be developed into an immunologists' guide for preparedness for future pandemics.


Subject(s)
Allergy and Immunology/trends , COVID-19 Vaccines/immunology , COVID-19/immunology , SARS-CoV-2/physiology , Animals , Arthritis, Infectious/immunology , Humans , Immunity , Pandemics , Practice Guidelines as Topic , Public Health , Vaccination , Vaccines , World Health Organization
13.
JBJS Case Connect ; 10(3): e2000226, 2020.
Article in English | MEDLINE | ID: covidwho-646996

ABSTRACT

CASE: We report the case of a 64-year-old man who presented with a late onset of acute periprosthetic joint infection after total knee arthroplasty and a positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test. We describe our perioperative protocol and challenges for ensuring the safety of healthcare providers while operating on a coronavirus disease 2019 (COVID-19)-positive patient. CONCLUSIONS: Given the incredible spread of COVID-19 globally, hospitals should anticipate perioperative protocols for the surgical management of COVID-19-positive patients with concurrent pathology to ensure safety to healthcare providers.


Subject(s)
Arthritis, Infectious/surgery , Betacoronavirus , Coronavirus Infections , Infection Control/methods , Pandemics , Pneumonia, Viral , Prosthesis-Related Infections/surgery , Arthritis, Infectious/complications , COVID-19 , Humans , Knee Prosthesis/adverse effects , Male , Middle Aged , Prosthesis-Related Infections/complications , SARS-CoV-2
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