Invasive Nontypeable Haemophilus influenzae Infection Among Adults With HIV in Metropolitan Atlanta, Georgia, 2008-2018.

Importance: Invasive nontypeable Haemophilus influenzae (NTHi) infection among adults is typically associated with bacteremic pneumonia. Nontypeable H influenzae is genetically diverse and clusters of infection are uncommon. Objective: To evaluate an increase in invasive NTHi infection from 2017-2018 among HIV-infected men who have sex with men in metropolitan Atlanta, Georgia. Design, Setting, and Participants: A population-based surveillance study with a cohort substudy and descriptive epidemiological analysis identified adults aged 18 years or older with invasive NTHi infection (isolation of NTHi from a normally sterile site) between January 1, 2008, and December 31, 2018 (final date of follow-up). Exposures: Time period, HIV status, and genetic relatedness (ie, cluster status) of available NTHi isolates. Main Outcomes and Measures: The primary outcome was incidence of invasive NTHi infection (from 2008-2016 and 2017-2018) among persons with HIV and compared with NTHi infection from 2008-2018 among those without HIV. The secondary outcomes were assessed among those aged 18 to 55 years with invasive NTHi infection and included epidemiological, clinical, and geographic comparisons by cluster status. Results: Among 553 adults with invasive NTHi infection (median age, 66 years [Q1-Q3, 48-78 years]; 52% male; and 38% black), 60 cases occurred among persons with HIV. Incidence of invasive NTHi infection from 2017-2018 among persons with HIV (41.7 cases per 100 000) was significantly greater than from 2008-2016 among those with HIV (9.6 per 100 000; P < .001) and from 2008-2018 among those without HIV (1.1 per 100 000; P < .001). Among adults aged 18 to 55 years with invasive NTHi infections from 2017-2018 (n = 179), persons with HIV (n = 31) were significantly more likely than those from 2008-2018 without HIV (n = 124) to be male (94% vs 49%, respectively; P < .001), black (100% vs 53%; P < .001), and have septic arthritis (35% vs 1%; P < .001). Persons with HIV who had invasive NTHi infection from 2017-2018 (n = 31) were more likely than persons with HIV who had invasive NTHi infection from 2008-2016 (n = 24) to have septic arthritis (35% vs 4%, respectively; P = .01). Pulsed-field gel electrophoresis of 174 of 179 NTHi isolates from 18- to 55-year-olds identified 2 genetically distinct clonal groups: cluster 1 (C1; n = 24) and cluster 2 (C2; n = 23). Whole-genome sequencing confirmed 2 clonal lineages of NTHi infection and revealed all C1 isolates (but none of the C2 isolates) carried IS1016 (an insertion sequence associated with H influenzae capsule genes). Persons with HIV were significantly more likely to have C1 or C2 invasive NTHi infection from 2017-2018 (28/31 [90%]) compared with from 2008-2016 among persons with HIV (10/24 [42%]; P < .001) and compared with from 2008-2018 among those without HIV (9/119 [8%]; P < .001). Among persons with C1 or C2 invasive NTHi infection who had HIV (n = 38) (median age, 34.5 years; 100% male; 100% black; 82% men who have sex with men), 32 (84%) lived in 2 urban counties and an area of significant spatial aggregation was identified compared with those without C1 or C2 invasive NTHi infection. Conclusions and Relevance: Among persons with HIV in Atlanta, the incidence of invasive nontypeable H influenzae infection increased significantly from 2017-2018 compared with 2008-2016. Two unique but genetically related clonal strains were identified and were associated with septic arthritis among black men who have sex with men and who lived in geographic proximity.

[Profile of non-traumatic osteoarticular diseases in elderly black Africans: about 157 cases seen in Abidjan]. / Profil des affections ostéoarticulaires des sujets ages noirs africains : A propos de 157 cas vus à Abidjan.

BACKGROUND: The aging of the world population is a phenomenon that is growing progressively. Specific knowledge of osteoarticular disorders in the elderly in black Africa seems limited. AIM: Describe the epidemiological, clinical and etiological characteristics of non-traumatic osteoarticular disorders in elderly black Africans. METHODS: Retrospective and descriptive study concerning black africans patients aged 60 years and over hospitalized in the department of Rheumatology of hospital center of Cocody (Abidjan) in a period of 7 years from January 2000 to December 2007. Were included, 157 records of black africans patients, suffering from a osteoarticular disorder non traumatic with an accurate diagnosis. A structured questionnaire was used to gather epidemiological, clinical and etiological characteristics. RESULTS: The prevalence of elders was 5% of all patients seen in the period of study. The average age was 67 years with the predominance of women (59,7%) and sex-ratio was 0,68. Housewives were predominant (40,6%). The reason for hospitalization was a pain from spine (85,8%) dominated by common low back pain (84,4%). Fever (51,9%) and impaired general health (53.4%) were dominant extraarticular signs. The main etiologies were degenerative (50.5%) with a predominance of common low back pain (38.2%), followed by bacterial osteitis and/or bacterial arthritis (20.5%) and malignancies (hematologic malignancies and metastasis of cancer) in 15.9% of cases. Degenerative pathology was significantly observed in females (p=0.004). CONCLUSION: Non-traumatic osteoarticular diseases in elderly black africans are little frequent in Abidjan and are dominated by degenerative diseases of spine.

A 42-year-old farmer from Bangladesh with respiratory failure, septic arthritis, and multiple cavitating consolidations.

A 42-year-old man was directly admitted to the ICU with respiratory failure and hypotension. Two weeks prior and just after returning from Bangladesh, he presented to a polyclinic with fever, right knee pain, and generalized aches, for which he received oral antibiotics. He was a farmer, had diabetes, never smoked, and consumed alcohol occasionally.

A novel de novo PSTPIP1 mutation in a boy with pyogenic arthritis, pyoderma gangrenosum, acne (PAPA) syndrome.

Autoinflammatory disorders are a group of Mendelian disorders characterized by seemingly unprovoked inflammatory bouts without high-titer autoantibodies or antigen-specific T-cells and are probably due to defects in the innate immunity. We here report on a 4-year-old Arabic boy with the clinical presentation of an autoinflammatory disorder, namely Pyogenic Arthritis, Pyoderma Gangrenosum and Acne (PAPA) syndrome. The presentation includes abscess formation after immunization and recurrent mono-articular acute arthritis in various joints that responded favourably to systemic glucocorticosteroids, albeit without acne or pyoderma gangrenosum. The mutation analysis of the boy identified a novel de novo mutation in PSTPIP1, the gene responsible for PAPA syndrome. We recommend that the diagnosis of PAPA syndrome should be entertained in the differential diagnosis of patients with recurrent sterile pyogenic arthritis prior to the development of pyoderma gangrenosum or acne in order to initiate a timely management of the disorder.

Outpatient parenteral antimicrobial therapy-treated bone and joint infections in a tropical setting.

BACKGROUND: Osteoarticular infections are a primary indication for outpatient parenteral antimicrobial therapy (OPAT). The climate and geographical diversity of tropical Australia, together with the prevalence of melioidosis, disseminated gonococcal disease and community-acquired methicillin-resistant Staphylococcus aureus renders this a challenging environment in which to manage such infections. We evaluated patients managed by the Royal Darwin Hospital Hospital in the Home service for bone and joint infections. METHODS: A retrospective analysis of the therapeutic outcomes at the end of intravenous therapy was carried out for patients treated between 1 January 2006 and 15 September 2007. RESULTS: Fifty-five patients were treated, including 21 (38%) indigenous Australians and 18 (33%) from remote communities. Baseline characteristics were similar to other published data, but there were two cases each of gonococcal septic arthritis and melioidosis. During treatment, 39 (71%) lived at home, with five (9%) of these receiving treatment at community clinics. Thirteen (24%) resided in self-care units in the hospital grounds. Three (5%) were managed at hostels or in prison. Median duration of parenteral therapy was 42 days, with a median of 22 days outside hospital, providing a total saving of 1307 bed-days. Clinical success at end of therapy was 84%, with no significant difference between indigenous and non-indigenous cohorts. CONCLUSION: OPAT for osteoarticular infections is both feasible and effective in a tropical environment, including for indigenous patients. Extension of treatment to remote-dwelling patients is facilitated by the innovative use of self-care units and administration of treatment at remote clinics.

National trends in health care utilization and racial and socioeconomic disparities in pediatric pyogenic arthritis.

PURPOSE: To determine national trends and putative racial and socioeconomic disparities in health care utilization in pediatric patients with pyogenic arthritis over a 13-year period. STUDY DESIGN: We assessed trends in length of hospital stay, hospital disposition, and inflation-adjusted charges for pediatric patients hospitalized with pyogenic arthritis based on 13 consecutive years (1988-2000) of the Nationwide Inpatient Sample. Patients with an International Classification of Diseases, Ninth Revision code of pyogenic arthritis were selected for this study. Trends in health care utilization were analyzed, stratified by age, prematurity, joint location, socioeconomic status, and race. RESULTS: The median length of stay (LOS) decreased from 10 to 5 days in 1988 and 2000, respectively (P < 0.05). Whites had a shorter mean LOS (7.8 days) than nonwhites (10.7 days; P < 0.05). For both whites and nonwhites, LOS decreased significantly (P < 0.05), but the difference between the 2 groups remained constant. For patients with a higher socioeconomic status, LOS was shorter (P'< 0.05). The percentage of patients discharged to home'health care increased from 3.8% in 1988 to 18.9% in 2000 (P'< 0.05), but the increase was much greater for whites than nonwhites (P < 0.05). Inflation adjusted total charges increased over time, from a median total charge of 10,098 dollars in 1988 to a median total charge of 11,155 dollars in 2000 (P < 0.05). CONCLUSIONS: There was a trend toward decreased health care utilization, but no decrease in charges for pediatric pyogenic arthritis from 1988 to 2000. Racial disparities still exist, with little improvement over time.

Septic arthritis after arthroscopic anterior cruciate ligament reconstruction.

INTRODUCTION: A retrospective review of postoperative infected anterior cruciate ligament (ACL) reconstruction was done on 472 consecutive cases in one institution. The purpose was to assess the incidence, diagnosis, treatment and outcome factors. MATERIALS AND METHODS: Out of 472 arthroscopic-assisted ACL reconstructions performed between 1999 and 2002, 7 (1%) postoperative deep intra-articular infections were detected. Seven males with a mean age of 23 years (range, 19 to 30 years) formed the study group; 3 had undergone prior knee surgery. RESULTS: Four patients had acute infection (<2 weeks), 3 had subacute infection (2 weeks to 2 months) and none had late infection (>2 months). All were admitted within 24 hours of onset of symptoms and underwent immediate arthroscopic lavage, incision and drainage of abscess, debridement with graft retention and intravenous (8 to 31 days) followed by oral (4 to 6 weeks) antibiotics. Staphylococcus aureus was present in 4 patients, Peptostreptococcus in 3, Klebsiella in 1, and Enterobacter in 1. The patients underwent an average of 1.4 arthroscopic procedures (range, 1 to 3 procedures), with an average hospital stay of 17.3 days per patient. All were evaluated at an average of 11.7 months (range, 5 to 26 months). In all cases, the infection resolved with stable knees and with all grafts and implants retained. Although rare, early diagnosis and prompt treatment of infection can result in successful eradication without sacrificing the graft.

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.