Management of an outbreak of invasive Kingella kingae skeletal infections in a day care center.

BACKGROUND: Kingella kingae (Kk) is frequently responsible for invasive skeletal infections in children aged 3-36months. However, few outbreaks of invasive Kk infections in day care centers have been reported. The objective of the present study was to describe (a) the clinical and laboratory data recorded during an outbreak of invasive Kk skeletal infections, and (b) the management of the outbreak. METHOD: Four children from the same day care center were included in the study May and June 2019. We retrospectively analyzed the children's clinical presentation and their radiological and laboratory data. We also identified all the disease control measures taken in the day care center. RESULTS: We observed cases of septic arthritis of the wrist (case #1), shoulder arthritis (case #2), knee arthritis (case #3) ans cervical spondylodiscitis (case #4). All cases presented with an oropharyngeal infection and concomitant fever prior to diagnosis of the skeletal infection. All cases were misdiagnosed at the initial presentation. The mean (range) age at diagnosis was 10.75months (9-12). The three patients with arthritis received surgical treatment. All patients received intravenous and then oral antibiotics. In cases 1 and 2, Kk was detected using real-time PCR and a ST25-rtxA1 clone was identified. The outcome was good in all four cases. Four other children in the day care center presented with scabies during this period and were treated with systemic ivermectin. The Regional Health Agency was informed, and all the parents of children attending the day care center received an information letter. The day care center was cleaned extensively. CONCLUSION: Our results highlight the variety of features of invasive skeletal Kk infections in children and (given the high risk of transmission in day care centers) the importance of diagnosing cases as soon as possible.

Miliary tuberculosis with delayed-onset total knee arthroplasty Mycobacteria tuberculosis infection successfully treated with medical therapy alone: A case report and literature review.

Tuberculosis (TB) affecting a prosthetic knee is an unusual and diagnostically challenging presentation of this disease. This study reported a case of an 80-year-old man with a left total knee arthroplasty (TKA) performed eight years before his presentation. He presented with left knee swelling and pain for one month. Knee X-rays showed a normal joint space with no loosening of his prosthesis. His chest X-ray showed miliary disease, and microbiological studies of his sputum and synovial fluid aspirate grew Mycobacteria tuberculosis complex. He was successfully medically treated with anti-tuberculous therapy alone for one year. His knee hardware was retained, and he did not require debridement, resection, or revision. It is believed that this is the first reported case of miliary TB with delayed-onset TKA prosthetic joint infection (PJI) in which the prosthesis was successfully retained. Thirty-eight published TB TKA PJI cases in medical literature were also reviewed.

An unusual case of Erysipelothrix rhusiopathiae prosthetic joint infection from the Canadian Arctic: whole genome sequencing unable to identify a zoonotic source.

BACKGROUND: Erysipelothrix rhusiopathiae is a zoonotic pathogen that causes erysipeloid and is most frequently associated with exposure to domestic swine. Infection of native and prosthetic joints is a rarely reported manifestation. CASE PRESENTATION: We describe a case of E. rhusiopathiae prosthetic joint infection in a woman with a history of exposure to wild animals in the Canadian Arctic. Patient management involved a 1-stage surgical revision exchange with an antibiotic impregnated cement spacer and 6 weeks of intravenous penicillin G followed by 6 weeks of oral amoxicillin. Ten previously reported cases of E. rhusiopathiae joint infection are reviewed. Recent increases in mortality due to infection with this organism among host animal populations in the Canadian Arctic have generated concern regarding a potential increase in human infections. However, whole genome sequencing (WGS) of the organism was unable to identify a zoonotic origin for this case. CONCLUSIONS: Consideration should be given to E. rhusiopathiae as a cause of joint infections if the appropriate epidemiologic and host risk factors exist. Expanded use of WGS in other potential animal hosts and environmental sources may provide important epidemiologic information in determining the source of human infections.

Occurrence of purulent arthritis broilers vertically infected with Salmonella enterica serovar Enteritidis in Korea.

Salmonella enterica serovar Enteritidis (Salmonella Enteritidis) has been associated with morbidity and mortality in broiler chickens worldwide. The present study described purulent arthritis of broilers infected with Salmonella Enteritidis and investigated antibiograms and genetic characteristics of Salmonella Enteritidis isolates from epidemiologically related properties such as a hatchery and breeder farm in an attempt to elucidate the source of contamination. Clinical disease and mortality were observed in the affected broiler flock. Mortality was 5.8% until 12 d of age. The birds typically showed lameness with moderately swollen hock joints and footpads. The most prevalent lesions were severely purulent arthritis with polyserositis. Histopathology revealed moderate to severe inflammation in the synovial membrane of leg joints and visceral organs. When the antimicrobial susceptibility test was performed against 7 isolates of Salmonella Enteritidis from broilers, and relevant hatchery and breeder farms by the disk diffusion method using 18 antimicrobial agents, isolates from broiler and breeder farms had the same antibiogram characterized by multiple drug resistance to ampicillin, ceftiofur, cephalothin, gentamycin, nalidixic acid, streptomycin, sulfisoxazole, and tetracycline, whereas isolates from the hatchery were differently resistant to only nalidixic acid. Through the genetic analysis with pulsed-field gel electrophoresis using the restriction enzyme XbaI, Salmonella Enteritidis isolates from both broiler and breeder farms also showed the same PFGE pattern compared with the hatchery isolates resistant to nalidixic acid. As a result, the same PFGE profiles and antibiogram patterns among isolates from broilers and breeder farms provided direct evidence of vertical Salmonella Enteritidis transmission from the contaminated breeder farm to commercial broiler.

Sindbis viruses and other alphaviruses as cause of human arthritic disease.

Amongst the arthritis-causing arboviruses, i.e. those spread by insects, the alphavirus group is of special interest. These viruses occasionally cause vast outbreaks, such as O'nyong-nyong in Africa in 1959. In Fennoscandia, Sindbis-related Ockelbo, Pogosta, or Karelian fever viruses have been found to cause significant morbidity. The major symptoms in addition to joint inflammation are fever, fatigue, headache and rash. The joint symptoms may persist for weeks, even months. The diagnosis is based on the clinical picture and serology. The causative viruses are closely related but not identical. It appears that at least in Finland the Pogosta disease is more common than thought, and the symptoms may often be overlooked. Several factors related to the viruses, their hosts, and global environmental changes may affect the spread of these viruses. All over the world arbovirus-caused diseases have increased, because of global changes.

Nosocomial neonatal septic arthritis.

Between August 1993 and August 1994, 17 cases of neonatal septic arthritis occurred at the intensive care baby unit of Princess Badia' Teaching Hospital in Northern Jordan. Klebsiella species was the causative pathogen in 10 patients (59%), which indicates a nosocomial acquired infection. The hip was the main joint involved in 94% of cases. An epidemiological survey showed that the spread of Klebsiella occurred via contaminated covered sheets of both delivery and resuscitation tables. Control measures resulted in a decrease in cross contamination and a dramatic slowing of the outbreak. The clinical features, risk factors, outcome and bacteriology are also discussed.

An outbreak of epidemic polyarthritis (Ross River virus disease) in the Northern Territory during the 1990-1991 wet season.

OBJECTIVE: To describe the epidemiology of a large outbreak of epidemic polyarthritis in the Northern Territory during the wet season of 1990-1991. DESIGN, SETTING AND PARTICIPANTS: Arbovirus cases notified to the Northern Territory Department of Health and Community Services by general practitioners and local laboratories between 1 July 1990 and 30 June 1991. MAIN OUTCOME MEASURES: Date and place of infection, age, sex and symptoms. RESULTS: Doctors in the Northern Territory notified 368 cases; another 14 were infected interstate. The epidemic started in September, peaked in January and tailed off in April. The highest attack rates occurred in the rural areas of Jabiru, Litchfield Shire and Katherine. Those most affected were 30-34 year olds. Children, the elderly and Aboriginal people were under-represented. CONCLUSIONS: Epidemic polyarthritis is a wet season problem in the Northern Territory, affecting the rural towns and districts more than the cities. Pre-planned mosquito control measures (effective water drainage and larval control) limited the extent of the 1990-1991 epidemic in Darwin City and Palmerston. The low attack rate in children reflects asymptomatic and less clinically severe infections. The under-representation of Aboriginal people may be the result of infection occurring earlier in life. A related cross-sectional seroprevalence survey has shown that rural Aboriginal people across all age groups have a significantly higher seropositive rate than urban non-Aboriginal residents.

B19 parvovirus and blood transfusion.

B19 parvovirus, a non-enveloped DNA virus about 20 nm diameter, is responsible for benign illness in children (fifth disease) or in adult (arthritis). Nevertheless some acute or chronic anaemia may occur following the lysis of its target cell, the erythroid progenitors. Such clinical manifestations may be observed in blood transfused patients under circumstances which will be studied.

[Lyme borreliosis in South Germany. Epidemiologic data on the incidence of cases and on the epidemiology of ticks (Ixodes ricinus) carrying Borrelia burgdorferi]. / Lyme-Borreliose in Süddeutschland. Epidemiologische Daten zum Auftreten von Erkrankungsfällen sowie zur Durchseuchung von Zecken (Ixodes ricinus) mit Borrelia burgdorferi.

Among 2403 ticks (Ixodes ricinus) tested in 1985 for Borrelia 328 (13.6%) were carriers (adults about 20%, nymphs about 10%, larvae about 1%). The highest prevalence of infected ticks was among adult ticks in the Isar region north of Munich (33.8%). Among 9383 persons whose serum had been examined by fluorescence serology in 1985 and 1986, 1035 (11%) had raised Borrelia-specific IgG and/or IgM antibodies greater than or equal to 1:64. In 18.7% only IgM antibodies were demonstrated. Among 375 proven cases there were 78 with erythema migrans, 211 with neurological signs, 48 with Lyme arthritis and 36 with acrodermatitis. Seasonal incidence peaks were in June-August for erythema migrans, July-September for neurological signs, with no clear-cut seasonal peaks with Lyme arthritis and acrodermatitis. The incubation time for 80% of cases of each abnormality was 5-29 days for erythema migrans, 20-59 for neurological signs and 2-8 months for Lyme arthritis. Erythema migrans was most frequent among those aged 30-60 years, neurological signs among children and juveniles up to 20 years and those aged 40 to 70 years, Lyme arthritis among those aged 30-60 years, and acrodermatitis among those aged 40-80 years. Significantly more women than men developed acrodermatitis.

Septicemia and septic arthritis caused by Streptococcus pneumoniae in a cat: possible transmission from a child.

Streptococcus pneumoniae serotype 23F was isolated from the blood and synovial fluid of an acutely ill, 15-year-old castrated male cat and from the nasopharynx of that regularly played with it, an infant child. Information presented supports the hypothesis that the infection was transmitted from child to cat.

The effect of colostrum-derived antibody on neo-natal transmission of caprine arthritis-encephalitis virus infection.

Two groups of 6 newborn goat kids were artificially fed colostrum containing antibody to caprine arthritis-encephalitis (CAE) virus, obtained from clinically affected does. Kids in group A were fed the colostrum from birth until 7 days of age, while kids in group B were fed colostrum from 1 to 3 days after birth for 7 days. Kids were fed cow's milk at all other times. Serum antibody resulting from the consumption of colostrum, detected by agar gel immunodiffusion (AGID) tests, lasted for up to 8 weeks in group A, but none was detected in group B. Four kids from each group became infected with CAE virus as demonstrated by the emergence of active immunity and by virus isolation procedures. It appeared that uptake of colostral antibody by group A did not prevent viral transmission, interfere with development of active immunity, or modify the outcome of the CAE virus infection.

Amblyomma americanum: a potential vector of Lyme disease in New Jersey.

Amblyomma americanum is a likely secondary vector of Lyme disease in New Jersey. Ticks of this species were removed from the site of the characteristic skin lesion known as erythema chronicum migrans on two patients with the disease, and the Lyme disease spirochete was isolated from nymphs and adults of this species. That A. americanum is a potential vector is supported by its similarities to Ixodes dammini, the known tick vector, in seasonal distribution and host utilization. The extensive range of A. americanum may have great implications for potential Lyme disease transmission outside known endemic areas.