Neisseria meningitidis serogroup C causing primary polyarthritis in an octogenarian.

A man in his 80s presented to the hospital with a 36-hour history of fever, myalgia, bilateral shoulder and right knee pain. Joint fluid aspirates from his shoulders and right knee isolated Gram-negative diplococci. After failing to grow on standard and selective media, Neisseria meningitidis was identified by 16s PCR and subsequently typed as serogroup C. He had no clinical features of meningitis or meningococcaemia. Blood cultures were negative and an EDTA blood sample was negative for meningococcal ctrA gene. Urine PCR was negative for Neisseria gonorrhoeae He was treated successfully with two arthroscopic joint washouts of his right knee, aspirates of both shoulders, 40 days of intravenous ceftriaxone and intensive physiotherapy as both an inpatient and outpatient. In the literature, we have not found any previously documented cases of serogroup C meningococcus causing polyarticular primary septic arthritis in this age group or guidance on duration of antibiotic treatment. Literature on the impact of rehabilitation to baseline function was also found to be lacking. Although rare, primary meningococcal arthritis (PMA) should be considered as a differential diagnosis in cases of acute polyarticular septic arthritis. Polyarticular PMA in older adults may require prolonged rehabilitation before one might expect to return to premorbid function.

Acute haematogenous septic arthritis of a lumbar facet joint in an otherwise healthy adolescent / Artritis séptica hematógena aguda de una articulación facetaria lumbar en un adolescente sano

Facet joint septic arthritis is a rare cause of spinal infection in children with only four cases reported. The transmission pathway is believed to be haematogenous in 72% of cases. The authors present the case of a 13-year-old boy hospitalised for acute lumbosciatalgia, limp and fever, with pain upon palpation of the paravertebral muscles, a positive Laségue signal and elevated serum inflammatory markers. The initial lumbar computerised tomography (TC) scan revealed no abnormalities in the interapophyseal joints. After improving on treatment with analgesics and antibiotics, he was readmitted one month later due to clinical deterioration, and septic arthritis of left facet joint L3-L4 was confirmed by magnetic resonance imaging (MRI). The patient experienced a full recovery after treatment with systemic antibiotics (cefotaxime-cloxacilin) and rehabilitation

La artritis séptica facetaria es una infección raquídea excepcional en niños, con solo cuatro casos publicados. Se cree que en el 72% de los casos el mecanismo de transmisión es hematógeno. Se presenta el caso de un varón de 13 años que fue hospitalizado por lumbociatalgia aguda, cojera y fiebre, con contractura y dolor a la palpación de la musculatura paravertebral, signo de Laségue positivo y elevación de los marcadores séricos inflamatorios. La tomografía axial computarizada (TAC) inicial no mostró anomalías en las articulaciones interapofisarias lumbares. Tras haber mejorado con analgésicos y antibióticos, el paciente reingresó un mes más tarde por deterioro clínico de los síntomas, y la resonancia magnética (RMN) mostró artritis séptica de la articulación interfacetaria izquierda de L3-L4. El paciente obtuvo una recuperación completa con tratamiento antibiotico (cefotaxima-cloxacilina) y rehabilitación. Se requiere un alto grado de sospecha para poder diagnosticar esta localización anatómica como manifestación de lumbociática y/o cojera en niños. Se requiere TAC o, preferiblemente, RMN para confirmar el diagnóstico

Acute haematogenous septic arthritis of a lumbar facet joint in an otherwise healthy adolescent.

Facet joint septic arthritis is a rare cause of spinal infection in children with only four cases reported. The transmission pathway is believed to be haematogenous in 72% of cases. The authors present the case of a 13-year-old boy hospitalised for acute lumbosciatalgia, limp and fever, with pain upon palpation of the paravertebral muscles, a positive Laségue signal and elevated serum inflammatory markers. The initial lumbar computerised tomography (TC) scan revealed no abnormalities in the interapophyseal joints. After improving on treatment with analgesics and antibiotics, he was readmitted one month later due to clinical deterioration, and septic arthritis of left facet joint L3-L4 was confirmed by magnetic resonance imaging (MRI). The patient experienced a full recovery after treatment with systemic antibiotics (cefotaxime-cloxacilin) and rehabilitation. A high index of suspicion is necessary to diagnose this localization as a manifestation of lumbosciatalgia and/or limp in children. CT-scan or, preferably, MRI is mandatory to confirm this diagnosis.

Meniscus repairs can be saved in the event of postoperative septic arthritis.

PURPOSE: No systematic studies on optimal treatment of postoperative septic arthritis following arthroscopic meniscus repair are available. The purpose of this study was to retrospectively evaluate the fate of repaired menisci in cases of postoperative septic arthritis, with treatment for infection focused on arthroscopic irrigation and debridement (I&D) and intention to maintain the meniscus. METHODS: Data of two sports orthopedics centers of the last 10 years were pooled (approximately 25,000 arthroscopic procedures of the knee). All cases of septic arthritis following arthroscopic meniscus repair were identified. These cases were retrospectively evaluated with regard to clinical course and management, especially the number of necessary I&Ds, if eradication was achieved, and if the repaired meniscus was retained or a partial resection was necessary ('early failure'). Patients with initially maintained meniscus repairs were contacted if further meniscus surgery was performed in further follow-up ('late failure'). RESULTS: 20 patients with 23 repaired menisci were included. In 65% (13 cases), a concomitant anterior cruciate ligament reconstruction was performed. A mean of 2.0 ± 1.0 (1-4) arthroscopic I&Ds were performed in the treatment of septic arthritis. In two cases, additional open surgery was performed (after outside-in sutures). Eradication was achieved in all cases. Four repaired menisci (17.4%) showed loosened fixation or substantial degradation and were consequently partially resected within treatment for septic arthritis (early failures). The follow-up rate for the 19 initially maintained menisci was 94.7% after 3.0 ± 2.2 years (median 2.8, 0.4-7.8). Three of these underwent further partial resection (13.0%). Cumulative 3-year survival rate (Kaplan-Meier method) of all repairs was 70.7% (95% CI 50.3-91.1%), and for the subgroup of initially maintained menisci 85.6% (95% CI 67.0-100.0%), respectively. CONCLUSION: Septic arthritis following meniscus repair can be successfully treated with (sequential) arthroscopic I&Ds. There is a considerable rate of early failures, however, in a mid-term follow-up the failure rate of initially retained menisci is low and comparable to what we know from the literature for cases without infection. Therefore, it is generally recommended to try to save the repaired menisci in these cases. LEVEL OF EVIDENCE: IV, therapeutic case series.

Shock séptico secundario a artritis séptica de cadera por Staphylococcus aureus: tratamiento en la Unidad de Reanimación / Septic shock secondary due to Staphylococcus aureus-induced hip arthritis: treatment in the Recovery Unit

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Use of a lumbosacral orthosis in the management of septic arthritis of the hip.

INTRODUCTION: Septic arthritis can lead to loss of joint motion and permanent mobility deficits because of infection and inflammatory response damaging articular structures. METHODS: A 13-year-old boy underwent five left hip surgeries after diagnosis of septic arthritis. He participated in 14 months of physical therapy, including hip stretching and manipulation. A lumbosacral orthosis (LSO) was applied to immobilize the lumbar region and isolate motion at the left hip. Treatment was divided into three phases: initial treatment, after manipulation under anesthesia, and after application of the LSO. Hip flexion range of motion (ROM) improved by 100 degrees and extension by 20 degrees. The patient returned to a high level of function, including athletics, but continued to have limited ROM and gait deviations. CONCLUSIONS: Improvement in hip ROM after application of the LSO suggests that this intervention may have applicability in treatment of hip dysfunctions.

[Infection of the shoulder joint. Etiology, diagnosis and therapy]. / Der Schultergelenkinfekt. Atiologie, Diagnostik und Therapie.

Acute infections of the shoulder joint have to be considered as an emergency and must be treated immediately. The significance of an infected glenohumeral joint is demonstrated by the functional results, which are poorer than other in joint infections. Irreversible cartilage damage is already observable after one week, and impairment of motion resulting in invalidity may result. Early functional physiotherapy is necessary to avoid shoulder ankylosis. The etiology, characteristic clinical findings, radiologic examinations and different forms of therapy are summarized. By early diagnosis, with immediate and adequate therapy, it is possible to avoid devastating results.

Artritis septica de la rodilla: artrotomia - drenaje - movilizacion / Septic arthritis of the knee joint: arthrotomy - drainage - mobilization

Se trataron 72 pacientes con artritis septica de la rodilla, utilizando una artrotomia lateral unica y rehabilitacion precoz. La herida quirurgica se dejo abierta y en la mayoria de los casos se utilizo un dren de Penrose intra-articular. La rehabilitacion incluyo contracciones isometricas del cuadriceps, movilizacion articular pasiva suave, activa asistida y activa resistida. El apoyo se permitio a tolerancia y la antibioterapia se prolongo por 6 semanas. El resultado final fue satisfactorio en 94.4% de los casos; malo, en 2 pacientes que consultaron tardiamente. Otros 2 pacientes murieron en severa septicemia no atribuible al metodo quirugico utilizado. Se incluyen los hallazgos epidemiologicos, clinicos y quirurgicos, bacteriologicos, patologicos y de laboratorio. Este metodo de tratamiento es sencillo, simplifica el cuidado postoperatorio y recupera la funcion articular