ABSTRACT
We report a case of septic arthritis in a 43-year-old female patient. Despite initial treatment with ceftriaxone for Nontyphoidal Salmonella based on blood and joint fluid culture results, the shoulder joint pain worsened. Suspected systemic lupus erythematosus associated synovitis did not respond to immunosuppressive therapy including methylprednisolone, hydroxychloroquine and methotrexate. Subsequent radiograph revealed a shoulder joint abscess, leading to arthroscopic joint debridement. Ceftriaxone was administered post-operatively until analgesic efficacy was attained. This case highlights the significance of accurate diagnosis and appropriate treatment for nontyphoidal Salmonella septic arthritis.
Subject(s)
Anti-Bacterial Agents , Arthritis, Infectious , Lupus Erythematosus, Systemic , Salmonella Infections , Humans , Female , Arthritis, Infectious/microbiology , Arthritis, Infectious/drug therapy , Arthritis, Infectious/diagnosis , Adult , Lupus Erythematosus, Systemic/complications , Salmonella Infections/microbiology , Salmonella Infections/diagnosis , Salmonella Infections/drug therapy , Salmonella Infections/complications , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Treatment Outcome , Debridement , Shoulder Joint/microbiology , Shoulder Joint/surgery , Salmonella/isolation & purificationABSTRACT
In this study we performed preliminary experiments using Raman spectroscopy as an evolving technology in biofluid and microbial characterization, to explore its potential for rapid diagnosis of pathogenic bacteria in an in-vitro synovial fluid infection model. Normal human synovial fluids samples were collected from patients undergoing knee surgery and the three most common pathogenic bacteria introduced in-vitro into the samples. The bacterial growth was systematically monitored using a Raman spectroscopy. Multivariate regression analysis of acquired spectra showed bacterial characteristic Raman bands related to bacterial cell membranes and DNA structures to increase continuously as the incubation period was increased. Spectra signature recorded from cultured synovial fluid samples showed a significant loss in synovial quality and protein morphology over time compared to control samples. In this study, Raman spectroscopy shows promise for rapid pathogenic bacteria identification in synovial fluid. Marker peaks distinguished inoculated bacteria, while chemical changes reveal infection dynamics.
Subject(s)
Arthritis, Infectious , Spectrum Analysis, Raman , Synovial Fluid , Humans , Spectrum Analysis, Raman/methods , Arthritis, Infectious/microbiology , Arthritis, Infectious/diagnosis , Synovial Fluid/microbiology , Synovial Fluid/chemistry , Bacteria/isolation & purification , Bacteria/classificationABSTRACT
Septic arthritis (SA) is a serious infection of the joint which can lead to irreversible destruction of the joint.We report a case of right hip SA with septic pulmonary embolism following a complicated dental extraction in a woman in her early 40s with sickle cell trait (SCT).The patient presented with severe right thigh pain and left jaw pain.Initial workup revealed raised C reactive protein and positive blood cultures. Right hip joint SA was confirmed following intraoperative joint aspiration. The patient had right hip debridement with long-term intravenous antibiotics.The incidence of SA in adults with sickle cell disease is low: 0.3% in a study in France and Brazil and 10.3% incidence of haematogenous osteoarticular infection in children with SCT in West Africa.
Subject(s)
Arthritis, Infectious , Hip Joint , Pulmonary Embolism , Sickle Cell Trait , Tooth Extraction , Humans , Tooth Extraction/adverse effects , Female , Arthritis, Infectious/microbiology , Arthritis, Infectious/diagnosis , Pulmonary Embolism/etiology , Adult , Sickle Cell Trait/complications , Hip Joint/microbiology , Hip Joint/diagnostic imaging , Anti-Bacterial Agents/therapeutic use , DebridementABSTRACT
Acute nontraumatic joint pain has an extensive differential. Emergency physicians must be adept at identifying limb and potentially life-threatening infection. Chief among these is septic arthritis. In addition to knowing how these joint infections typically present, clinicians need to be aware of host and pathogen factors that can lead to more insidious presentations and how these factors impact the interpretation of diagnostic tests.
Subject(s)
Arthritis, Infectious , Humans , Arthritis, Infectious/diagnosis , Arthritis, Infectious/therapyABSTRACT
BACKGROUND: The existing diagnostic criteria for septic wrist are nonspecific, exposing patients with noninfectious etiologies to surgical morbidity. This study aimed to identify predictors differentiating septic wrist from other etiologies. METHODS: An institutional review board-approved retrospective review was conducted on patients with a presumed diagnosis of septic wrist (2003-2022). Bivariate and multiple regression analyses were performed to identify correlation between confirmed septic wrist and comorbidities (autoimmune diseases, immunosuppression, crystalline arthropathy, intravenous [IV] drug use, smoking), penetrating trauma, fever, multi-joint involvement, inflammatory markers (erythrocyte sedimentation rate [ESR]/C-reactive protein [CRP]/white blood cells [WBC]), serum uric acid level, blood cultures, imaging findings, and synovial fluid analysis. Categorical data were reported as median [interquartile range]. RESULTS: Hundred and sixty-eight (58 females and 110 males) patients were included. The median length of hospitalization and follow-up were 6[7] days and 1[3] months. Eighty-nine (53%) patients had septic wrist confirmed with Gram stain/culture, 48 (29%) patients received alternative diagnoses, and 31 (18%) patients had undetermined diagnoses. Concomitant septic wrist and crystalline arthropathy were identified in 9 patients (6.6% of total patients). Out of the 48 patients who received alternative diagnoses, 12 (25%) underwent open drainage. Elevated synovial WBC count (95,409.4 ± 85,926.2) showed a trend of association with septic wrist (p = 0.08). Negative synovial crystals (p = 0.01), positive blood culture (p = 0.04), negative history of crystalline arthropathy (p = 0.08), and multi-joint involvement (p = 0.05) were identified as predictors of septic wrist with a combined sensitivity of 87.5%, specificity of 86.2%, and area under the curve 0.93. CONCLUSIONS: Current diagnostic criteria for septic wrist have low specificity. Negative history of crystalline arthropathy, multi-joint involvement, absence of synovial crystals, and positive blood culture are helpful indicators for predicting septic wrist in patients presenting with a painful, erythematous, and swollen wrist.
Subject(s)
Arthritis, Infectious , Wrist Joint , Humans , Male , Female , Retrospective Studies , Middle Aged , Arthritis, Infectious/diagnosis , Adult , Aged , Diagnosis, Differential , Synovial FluidABSTRACT
INTRODUCTION: Distinguishing between septic arthritis and crystal arthropathy flares can be challenging. The purpose of this study was to determine how the presence of synovial crystals affects the diagnostic criteria of septic arthritis. METHODS: A retrospective review identified patients undergoing joint aspirations to rule out native septic arthritis. Differences between septic arthritis presenting with and without synovial crystals were analyzed. A receiver-operating characteristic curve was plotted for laboratory markers to determine the area under the curve, or diagnostic accuracy, for septic arthritis and to evaluate thresholds that maximized sensitivity and specificity. RESULTS: There were 302 joint aspirations in 267 patients. Septic arthritis was diagnosed in 17.9% (54/302). Patients with synovial crystals were less likely to have septic arthritis (4.2% [5/119] vs. 26.8% [49/183], P < 0.0001). Septic arthritis in patients with no synovial crystals was associated with fever and a higher synovial white blood cell (WBC) count, synovial polymorphonuclear cell percentage (PMN%), serum WBC, and C-reactive protein (CRP) ( P < 0.05). Septic arthritis in patients with synovial crystals was only associated with inability to bear weight and a higher synovial WBC and CRP ( P < 0.05). Synovial PMN% was considered nondiagnostic of septic arthritis (area under the curve 0.56) in patients with crystals while synovial WBC and CRP had acceptable (0.76) and excellent (0.83) diagnostic utility, respectively. The WBC and CRP value thresholds that maximized sensitivity and specificity for septic arthritis were greater in patients with crystals (21,600 vs. 17,954 cells/µL and 125 vs. 69 mg/L, respectively). DISCUSSION: The presence of synovial crystals reduced the likelihood of septic arthritis and altered the laboratory diagnostic criteria. PMN% was nondiagnostic in the setting of synovial crystals.
Subject(s)
Arthritis, Infectious , C-Reactive Protein , Crystal Arthropathies , Humans , Arthritis, Infectious/diagnosis , Retrospective Studies , Male , Female , Aged , Crystal Arthropathies/diagnosis , Middle Aged , C-Reactive Protein/analysis , Diagnosis, Differential , Sensitivity and Specificity , Synovial Fluid/chemistry , Synovial Fluid/cytology , Leukocyte Count , ROC Curve , Aged, 80 and over , AdultABSTRACT
Septic sacroiliitis is one of the infectious causes of sacroiliitis and it is seen rarely. In current literature, cases of septic sacroiliitis caused by several microorganisms have been reported so far. This case report presents the first case of septic sacroiliitis caused by Staphylococcus xylosus and also complicated with an abscess formation.
Subject(s)
Abscess , Sacroiliitis , Staphylococcal Infections , Staphylococcus , Humans , Staphylococcal Infections/microbiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/complications , Staphylococcal Infections/drug therapy , Sacroiliitis/microbiology , Sacroiliitis/diagnosis , Staphylococcus/isolation & purification , Abscess/microbiology , Abscess/diagnosis , Male , Anti-Bacterial Agents/therapeutic use , Arthritis, Infectious/microbiology , Arthritis, Infectious/diagnosis , Arthritis, Infectious/drug therapy , FemaleABSTRACT
BACKGROUND: Septic sacroiliitis is an uncommon disease which represents approximately 1-4% of all joint infections, therefore it is difficult to make the right diagnosis and to start early treatment. CASE REPORT: A 18 year old woman was admitted to the emergency room with a fever and pain in the left gluteal region. The patient was considered healthy and had no risk factors for septic arthritis. Edema and a small abscess was found in and around the left sacroiliac joint on pelvic MRI. The patient had positive blood cultures with Staphylococcus Aureus. Antibiotic treatment was initiated and lasted 7 weeks. She recovered completely and had no remaining complaints. CONCLUSION: Physical exam and clinical suspicion are important to consider the diagnosis of septic sacroiliitis. In addition a MRI of the pelvic is the best radiographic exam to conform the diagnosis.
Subject(s)
Anti-Bacterial Agents , Arthritis, Infectious , Magnetic Resonance Imaging , Physical Examination , Sacroiliitis , Staphylococcal Infections , Humans , Female , Sacroiliitis/diagnosis , Sacroiliitis/drug therapy , Anti-Bacterial Agents/therapeutic use , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Adolescent , Arthritis, Infectious/diagnosis , Arthritis, Infectious/drug therapy , Arthritis, Infectious/microbiology , Treatment Outcome , Staphylococcus aureus/isolation & purificationABSTRACT
Objective: This study aimed to assess the diagnostic value of metagenomic next-generation sequencing (mNGS) across synovial fluid, prosthetic sonicate fluid, and periprosthetic tissues among patients with periprosthetic joint infection (PJI), intending to optimize specimen selection for mNGS in these patients. Methods: This prospective study involved 61 patients undergoing revision arthroplasty between September 2021 and September 2022 at the First Affiliated Hospital of Zhengzhou University. Among them, 43 cases were diagnosed as PJI, and 18 as aseptic loosening (AL) based on the American Musculoskeletal Infection Society (MSIS) criteria. Preoperative or intraoperative synovial fluid, periprosthetic tissues, and prosthetic sonicate fluid were collected, each divided into two portions for mNGS and culture. Comparative analyses were conducted between the microbiological results and diagnostic efficacy derived from mNGS and culture tests. Furthermore, the variability in mNGS diagnostic efficacy for PJI across different specimen types was assessed. Results: The sensitivity and specificity of mNGS diagnosis was 93% and 94.4% for all types of PJI specimens; the sensitivity and specificity of culture diagnosis was 72.1% and 100%, respectively. The diagnostic sensitivity of mNGS was significantly higher than that of culture (X2 = 6.541, P=0.011), with no statistically significant difference in specificity (X2 = 1.029, P=0.310). The sensitivity of the synovial fluid was 83.7% and the specificity was 94.4%; the sensitivity of the prosthetic sonicate fluid was 90.7% and the specificity was 94.4%; and the sensitivity of the periprosthetic tissue was 81.4% and the specificity was 100%. Notably, the mNGS of prosthetic sonicate fluid displayed a superior pathogen detection rate compared to other specimen types. Conclusion: mNGS can function as a precise diagnostic tool for identifying pathogens in PJI patients using three types of specimens. Due to its superior ability in pathogen identification, prosthetic sonicate fluid can replace synovial fluid and periprosthetic tissue as the optimal sample choice for mNGS.
Subject(s)
Arthritis, Infectious , Prosthesis-Related Infections , Humans , Prospective Studies , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/microbiology , Arthritis, Infectious/diagnosis , Sensitivity and Specificity , High-Throughput Nucleotide SequencingABSTRACT
In the United States, rates of Mycobacterium tuberculosis infection have been declining for decades. Osteoarticular tuberculosis of the ankle is rarely observed. We present the case of a 65-year-old man who immigrated to the United States from India 24 years before the onset of symptoms. The patient initially reported atraumatic swelling and pain of the left ankle and foot and was treated for venous insufficiency. Later, the patient was referred to a nonsurgical orthopaedic clinic for additional workup and was found to have elevated inflammatory markers. MRI showed septic arthritis and osteomyelitis of the talus, distal tibia, and calcaneus. Joint aspiration revealed elevated white blood cell counts with predominately PMNs. The patient was then referred to an orthopaedic foot and ankle surgeon and underwent extensive irrigation and débridement. The patient was discharged on empiric antibiotics. Culture results from the original joint aspirate returned 14 days after surgery as positive for acid-fast bacillus, later identified as M tuberculosis by sequencing. Empiric antibiotics were discontinued, and the patient was started on appropriate antituberculotic therapy. This case report illustrates the challenge in the diagnosis of skeletal tuberculosis and the importance of including this condition on the differential for patients with atypical foot and ankle presentations.
Subject(s)
Arthritis, Infectious , Mycobacterium tuberculosis , Subtalar Joint , Tuberculosis, Osteoarticular , Male , Humans , Aged , Ankle , Arthritis, Infectious/drug therapy , Arthritis, Infectious/surgery , Arthritis, Infectious/diagnosis , Tuberculosis, Osteoarticular/diagnostic imaging , Tuberculosis, Osteoarticular/drug therapy , Anti-Bacterial Agents/therapeutic useABSTRACT
RATIONALE: Pseudomonas aeruginosa-induced septic arthritis is a relatively uncommon phenomenon. It has been documented in children with traumatic wounds, young adults with a history of intravenous drug use, and elderly patients with recent urinary tract infections or surgical procedures. PATIENT CONCERNS: Fifty-nine year-old female had no reported risk factors. The patient sought medical attention due to a 6-month history of persistent pain and swelling in her right ankle. DIAGNOSES: Magnetic resonance imaging and a 3-phase bone scan revealed findings suggestive of infectious arthritis with concurrent osteomyelitis. Histopathological examination of the synovium suggested chronic synovitis, and synovial tissue culture confirmed the presence of P aeruginosa. INTERVENTION: Arthroscopic synovectomy and debridement, followed by 6 weeks of targeted antibiotic therapy for P aeruginosa. OUTCOMES: Following treatment, the patient experienced successful recovery with no symptom recurrence, although she retained a mild limitation in the range of motion of her ankle. LESSONS: To our knowledge, this is the first reported case of chronic arthritis and osteomyelitis caused by P aeruginosa in a patient without conventional risk factors. This serves as a crucial reminder for clinicians to consider rare causative organisms in patients with chronic arthritis. Targeted therapy is imperative for preventing further irreversible bone damage and long-term morbidity.
Subject(s)
Arthritis, Infectious , Osteomyelitis , Pseudomonas Infections , Humans , Child , Female , Middle Aged , Young Adult , Aged , Ankle , Pseudomonas Infections/complications , Pseudomonas Infections/diagnosis , Pseudomonas Infections/drug therapy , Tomography, X-Ray Computed , Anti-Bacterial Agents/therapeutic use , Arthritis, Infectious/complications , Arthritis, Infectious/diagnosis , Arthritis, Infectious/drug therapy , Osteomyelitis/complications , Osteomyelitis/diagnosis , Osteomyelitis/therapy , Pseudomonas aeruginosaABSTRACT
Primary tropical pyomyositis, commonly caused by Staphylococcus aureus, is characterised by suppuration in skeletal muscles, which manifests as single or multiple abscesses. Another rare causative organism is Mycobacterium tuberculosis in endemic areas. Here, we report a case of primary tuberculous pyomyositis presenting as septic arthritis of the right knee and multiple site pyomyositis of the right thigh and chest wall. A tuberculous aetiology was overlooked at first, which resulted in a diagnostic delay. The patient was initially diagnosed, using ultrasonography, MRI and an absence of systemic symptoms of tuberculosis, with bacterial pyomyositis and treated with broad-spectrum antibiotics. However, further investigations performed on knee joint aspirate yielded negative cultures and a positive cartridge-based nucleic acid amplification test, which, along with a non-resolution of his symptoms, suggested a primary tuberculous pyomyositis. He was successfully managed with incision and drainage of the lesions and completion of anti-tubercular therapy.
Subject(s)
Arthritis, Infectious , Pyomyositis , Staphylococcal Infections , Tuberculosis , Male , Humans , Pyomyositis/diagnosis , Delayed Diagnosis , Staphylococcus aureus , Staphylococcal Infections/diagnosis , Arthritis, Infectious/diagnosis , Anti-Bacterial AgentsABSTRACT
Prosthetic joint infections (PJIs) are commonly diagnosed via culture-based methods, which may miss hard-to-grow pathogens. This study contrasts amplicon metagenomic sequencing (16S AS) with traditional culture techniques for enhanced clinical decision-making. We analyzed sonicate fluid from 27 patients undergoing revision arthroplasty using both methods, emphasizing the distinction between contaminants and true positives. Our findings show moderate agreement between the two methods, with a Cohen's kappa of 0.490, varying across bacterial genera (Cohen's kappa -0.059 to 1). The sensitivity of 16S AS compared to culture was 81% (95% CI, 68% to 94%). Sequencing revealed greater microbial diversity, including anaerobic genera like Anaerococcus and Citrobacter. Interestingly, several culture-negative PJI samples showed diverse bacteria via 16S AS. Despite rigorous controls and algorithms to eliminate contaminants, confirming bacteria presence with 16S AS remains a challenge. This highlights the need for improved PJI diagnostic methods, while also pointing out the limitations of next-generation sequencing (NGS) as a clinical diagnostic tool.
Subject(s)
Arthritis, Infectious , Prosthesis-Related Infections , Humans , Arthritis, Infectious/diagnosis , Bacteria/genetics , Prostheses and Implants , Arthroplasty , High-Throughput Nucleotide Sequencing , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/microbiology , Sensitivity and Specificity , RNA, Ribosomal, 16S/geneticsABSTRACT
Septic arthritis of the wrist can have severe deleterious effects on cartilage and bone if not promptly addressed. Expedient diagnosis and early medical intervention are important. The most effective strategy involves immediate arthrocentesis of the infected joint, enabling precise antibiotic selection based on joint fluid analysis. Diagnostic imaging is important in excluding fractures and identifying abscesses. This review explores the etiologic factors underlying septic wrist joint, identifying risk factors, and delineating optimal diagnosis and treatment approaches. The overarching goal is to impart valuable insights and guidance in the management of septic wrist joint, ensuring the highest quality patient care and optimal clinical outcomes.
Subject(s)
Arthritis, Infectious , Wrist , Humans , Arthritis, Infectious/diagnosis , Arthritis, Infectious/etiology , Arthritis, Infectious/therapy , Debridement , Risk Factors , Wrist JointABSTRACT
Enrichment of periprosthetic tissue samples in blood culture bottles (BCBs) for microbiological diagnosis of periprosthetic joint infections (PJI) is more reliable than the use of an enrichment broth. Nevertheless, the extremely time-consuming homogenization of the samples for BCB processing has so far limited its use, especially in high-throughput settings. We aimed to establish a highly scalable homogenization process of tissue samples for long-term incubation in BCBs. A protocol for homogenization of tissue samples using bead beating was established and validated. In a second step, the use of the homogenate for enrichment in BCBs was compared to the use of thioglycolate broth (TB) in terms of diagnostic accuracy using clinical tissue samples from 150 patients with suspected PJI. Among 150 analyzed samples, 35 samples met the microbiological criteria for PJI. Using BCB, 32 of 35 (91.4%) PJI were detected compared to 30 of 35 (85.7%) by TB. The use of BCB had a lower secondary contamination rate (2/115; 1.7% vs 4/115; 3.5%) but the trend was not significant due to low numbers of samples (P = 0.39). The time to process a batch of 12 samples using the established homogenization method was 23 ± 5 min (n = 10 batches). We established and validated a homogenization workflow that achieves the highest sensitivity in the microbiological diagnostic of PJI. The enrichment of the tissue homogenate in BCBs showed equally good results as the use of enrichment broth and allows semi-automated high-throughput processing while demonstrating lower contamination rates in our study.
Subject(s)
Arthritis, Infectious , Prosthesis-Related Infections , Humans , Sensitivity and Specificity , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/microbiology , Prospective Studies , Arthritis, Infectious/diagnosisSubject(s)
Arthritis, Infectious , Osteomyelitis , Humans , Osteomyelitis/microbiology , Osteomyelitis/drug therapy , Osteomyelitis/diagnosis , Arthritis, Infectious/microbiology , Arthritis, Infectious/drug therapy , Arthritis, Infectious/diagnosis , Male , Child , Female , Mucorales/isolation & purification , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Mucormycosis/microbiologyABSTRACT
Management of joint infection is an evolving topic. This article reviews the literature on the management of native and prosthetic joint infection and suggests some areas of improvement in short- and long-term management which could lead to better patient outcomes. Surgical management is the mainstay of treatment for native or prosthetic knee infection and aspiration should only be used for diagnostic purposes. A multidisciplinary team approach and compliance with national guidelines, alongside referral networks and pooling of expertise, should be mandatory to improve patient outcomes.