Periprosthetic knee joint infection caused by Sneathia sanguinegens

Sneathia sanguinegens is a fastidious, Gram-negative, rod-shape organism rarely isolated from human specimens. In the present report, we describe a case of periprosthetic knee joint infection due to the organism, which occurred in a female patient receiving immunosuppressants for underlying lupus nephritis. The causative organism was isolated from the synovial fluid in the affected knee joint through inoculating the material on chocolate agar and incubation for 15 days under 5% CO₂. Moreover, the organism was capable to be subcultured on chocolate agar with incubation for a few days under 5% CO₂, demonstrating that this uncommon organism, although generally considered as a strict anaerobe, is culturable in aerobic condition if appropriate media and a sufficient incubation time are given. The patient was treated with intravenous cefepime, an antibiotic highly active to the isolated organism in an in vitro study, in addition to intraarticular debridement and exchanging a polyethylene insert in the affected joint. The antimicrobial therapy with cefepime was given for 19 days and, thereafter, changed with oral levofloxacin. Although the patient showed full recovery after administration of levofloxacin for 100 days, an in vitro study conducted later revealed that levofloxacin was inactive to the isolated organism.     

Diagnosing Periprosthetic Joint Infection: a Scoping Review

Purpose of ReviewThe goal of this review is to provide an up to date understanding of the utility and limitations of the current tests utilized in the diagnosis of periprosthetic joint infection (PJI) in total knee and hip arthroplasty.Recent FindingsDespite the growth in literature surrounding PJI diagnosis, there remains challenges in establishing a diagnosis of PJI. A combination of clinical, serum, and synovial tests and microbiologic and histologic examinations can yield a diagnosis in the majority of cases. Novel molecular and imaging studies may be beneficial for indeterminant cases. A number of emerging diagnostic tests have been proposed and may be incorporated into diagnostic algorithms in the future. Recently proposed stepwise diagnostic algorithms have shown high sensitivity and specificity.SummaryThe diagnosis of PJI remains challenging due to a lack of tests that can definitively rule out infection. Diagnosis and investigations should occur in a stepwise fashion. There has been a plethora of new diagnostic tests introduced in attempts to improve the accuracy of diagnostic algorithms. The definition and algorithms for the diagnoses of PJI will continue to evolve as new techniques and tests are introduced.     

关节置换术后假体周围感染的实验室诊断

关节假体周围感染(PJI)是关节置换术后发生的严重并发症,需尽快明确诊断、积极治疗,以避免产生严重的不良后果。由于实验室传统检查方法敏感性和特异性的限制,PJI的诊断至今仍面临巨大挑战。近年来,一些兼具高敏感性和高特异性的检测方法,包括生物标志物检测和病原学检测方法在PJI诊断方面具有良好的应用前景。文章对关节置换术后PJI早期诊断的研究进展作一综述,以便为临床诊治提供参考。     

Delayed presentation of prosthetic joint infection due to Listeria monocytogenes

Infection with Listeria monocytogenes is rare and has been described in prosthetic valves, stent grafts and prosthetic joints. The route of infection appears to be haematogenous. The choice between conservative treatment with antibiotics or surgical treatment with debridement and revision of the components remains controversial. The best antibiotic treatment is not known with ampicillin being the first choice in most cases. Prosthetic infections with Listeria monocytogenes usually occur in patients with malignancy, diabetes mellitus, chronic renal disease, liver disease, elderly patients and patients receiving immunosuppressive therapy. The hip is the commonest prosthetic joint affected followed by the knee. We report the seventh case of Listeria monocytogenes infection in a non-immunocompromised patient involving a prosthetic joint.     

Synovial fluid multiplex PCR is superior to culture for detection of low-virulent pathogens causing periprosthetic joint infection

Introduction

Analysis of joint aspirate is the standard preoperative investigation for diagnosis of periprosthetic joint infection (PJI). We compared the diagnostic performance of culture and multiplex polymerase chain reaction (PCR) of synovial fluid for diagnosis of PJI.

Postcesarean wound infection by Mycoplasma hominis in a patient with persistent postpartum fever

Mycoplasma hominis was isolated in pure culture from a wound infection following delivery by cesarean section. The importance of recognizing this organism as a potential pathogen of the female genital tract is emphasized. Two commercially available isolation systems that allow the recovery of this organism are also described.     

Cervical dysplasia in a patient with multiple sclerosis treated with natalizumab

We describe one report of a cervical dysplasia in a patient receiving natalizumab for multiple sclerosis. Other cases were identified in the WHO's global individual case safety report database, VigiBase^®. These data underline the importance of monitoring HPV infection in patients with MS treated with natalizumab.     

Analysis of the clinical efficacy of two-stage revision surgery in the treatment of periprosthetic joint infection in the knee: A retrospective study

BACKGROUNDPeriprosthetic joint infection (PJI) is a catastrophic complication that can occur following total knee arthroplasty (TKA). Currently, the treatment for PJI mainly includes the use of antibiotics alone, prosthetic debridement lavage, primary revision, secondary revision, joint fusion, amputation, etc.AIMTo explore the clinical effect of two-stage revision surgery for the treatment of PJI after TKA.METHODSThe clinical data of 27 patients (3 males and 24 females; age range, 47–80 years; mean age, 66.7 ± 8.0 years; 27 knees) with PJI treated with two-stage revision surgery in our hospital between January 1, 2010 and December 31, 2020 were analyzed retrospectively. The following outcomes were compared for changes between preoperative and last follow-up results: Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analogue scale (VAS) scores, Hospital for Special Surgery (HSS) scores, knee range of motion (ROM), and infection cure rates. RESULTSAll 27 patients were followed up (range, 13–112 mo). The ESR (14.5 ± 6.3 mm/h) and CRP (0.6 ± 0.4 mg/dL) of the patients at the last follow-up were significantly lower than those at admission; the difference was statistically significant (P < 0.001). The postoperative VAS score (1.1 ± 0.7), HSS score (82.3 ± 7.1), and knee ROM (108.0° ± 19.7°) were significantly improved compared with those before the surgery; the difference was statistically significant (P < 0.001). Of the 27 patients, 26 were cured of the infection, whereas 1 case had an infection recurrence; the infection control rate was 96.3%.CONCLUSIONTwo-stage revision surgery can effectively relieve pain, control infection, and retain good joint function in the treatment of PJI after TKA.     

Assessment of confirmed urinary tract infection in patients treated with dalfampridine for multiple sclerosis

Urinary tract infections (UTIs) were reported frequently with dalfampridine extended-release (dalfampridine-ER) 10 mg relative to placebo in previous multiple sclerosis (MS) studies. The objective of this study was to determine whether dalfampridine-ER is associated with increased incidence of confirmed UTIs in MS patients. This post hoc analysis used UTI data from a study comparing the 4-week safety and efficacy of 5 mg (n = 144) and 10 mg (n = 142) twice-daily dalfampridine-ER versus placebo (n = 143). To confirm UTIs, three clinical assessments were used: standard urinalysis (leukocytes > 5/high-power field); urine culture (≥ 100,000 and ≥ 10,000 colony-forming units [CFUs]/mL) for those who reported UTIs as adverse events (AEs) or had positive urinalysis; and UTI symptomatology. Fisher’s exact test assessed statistical significance. The proportion of patients who reported UTIs as AEs in the placebo and dalfampridine-ER 5 mg and 10 mg groups were 5.6%, 6.3%, and 9.9%, respectively. In comparison, those with laboratory-confirmed UTIs were lower: ≥ 100,000 CFUs/mL: 4.2%, 2.8%, and 2.8%; and ≥ 10,000 CFUs/mL: 4.2%, 3.5%, and 4.9%, respectively (no significant statistical difference across treatments). The proportion of patients with confirmed UTI was similar between dalfampridine-ER and placebo, thus suggesting that the treatment does not increase the risk of UTIs.     

Atypical molluscum contagiosum on multiple sclerosis patients treated with fingolimod: A case report

Molluscum contagiosum (MC) is a skin infection caused by a virus of the DNA poxvirus family that has already been reported by Fingolimod. We report two cases. MC can resist standard therapy and discontinuation of the fingolimod may be the only way to treat it.     

Mycoplasma hominis septic thrombophlebitis in a patient with multiple trauma: a case report and literature review

Mycoplasma hominis was recovered from the site of a septic thrombophlebitis on the left cephalic veins of a patient with pelvic and other multiple trauma. The organisms were initially isolated from routine cultures in conventional blood agar media incubated anaerobically. The absence of other demonstrable pathogens and the patient's serologic response to the isolate support the role of the organism as the cause of this previously unreported mycoplasmal infection. M. hominis should be considered a possible cause of sepsis in selected cases of infections following pelvic trauma or manipulations of the genitourinary tract.     

Quantitative evaluation of periprosthetic infection by real-time polymerase chain reaction: a comparison with conventional methods

Several recent studies have demonstrated the limited accuracy of conventional culture methods for diagnosing periprosthetic infections. We have applied real-time polymerase chain reaction (PCR) assays for the rapid identification of bacteria around implants and reported its utility. However, the capability of quantification is also a useful feature of this type of assay. The aim of our study was to validate the usefulness of quantitative analyses using real-time PCR of cases with clinical periprosthetic infections in comparison with more established tests, such as C-reactive protein (CRP) levels, microbiologic cultures, and histopathology. Fifty-six joints with suspected infections were reviewed retrospectively. A universal PCR assay was used to perform the quantitative analyses. The differences in the threshold cycles between clinical samples and a negative control (?Ct) in each case were calculated. The results of the quantitative PCR assay were compared with CRP levels, microbiologic cultures, and histopathology. There was a significant correlation found between the CRP and ?Ct values. There were also significant differences found in the ?Ct values according to CRP levels, with higher CRP levels showing higher ?Ct values. Similarly, there were significant differences in the ?Ct measurements in our culture results and among our pathologic evaluations. We confirmed that quantification by universal PCR based on the ?Ct correlated with preoperative CRP levels and was associated with the microbiologic culture results and pathologic severity. This quantification method may be valuable for assessing infection severity.     

成年患者人型支原体脑膜炎1例并文献复习

目的 分析人型支原体导致成年人中枢神经系统感染的临床特征、诊断及治疗,以期提高对此类感染的认识.方法 总结分析重庆市垫江县中医院收治的1例成年患者神经外科手术后继发人型支原体脑膜炎的诊疗经过,并以"Mycoplasma hominis"和"meningitis"或"encephalitis"或"nervous"或"ne...     

Succinylcholine-induced hyperkalemia in a patient with multiple sclerosis

Background

Succinylcholine administration is associated with hyperkalemia in patients with a variety of medical conditions, including many neuromuscular disorders. Nonetheless, there is a paucity of literature describing hyperkalemia after the administration of succinylcholine to patients with multiple sclerosis.

Case Report

This case report describes a 38-year-old woman with multiple sclerosis who developed life-threatening hyperkalemia after the administration of succinylcholine during rapid sequence intubation.

Conclusion

This case highlights the potential for iatrogenic hyperkalemia after succinylcholine in patients with neurologic diseases, including multiple sclerosis.     

Fatal disseminated infection due to Sarocladium kiliense in a diabetic patient with COVID‐19

Sarocladium kiliense is a soil saprophytic mold with worldwide distribution, which can infect humans and other mammals, sporadically. The clinical manifestations include mycetoma, onychomycosis, keratomycosis, pneumonia, and arthritis. Here, we present a disseminated infection due to S. kiliense in a diabetic patient infected to coronavirus disease 2019 (COVID‐19) from Isfahan, Iran.     

Septic arthritis of the sternoclavicular joint in a patient with human immunodeficiency virus infection

Septic arthritis is an unusual manifestation in patients with human immunodeficiency virus (HIV). The sternoclavicular joint is rarely affected, although it should be considered in immunosuppressed patients and users of intravenous drugs. Staphylococcus aureus is the most common pathogen detected and should be covered by empiric antibiotic therapy.     

Complete hemidiaphragmatic paralysis in a patient with multiple sclerosis

We present a case history of a patient with definite multiple sclerosis who developed an abrupt onset of unilateral diaphragmatic paralysis, minor increase in lower extremity spasticity and complaint of marked neck stiffness. Her vital capacity during this episode was 600 mL and she was in impending respiratory failure. The diaphragmatic paralysis was demonstrated by radiographic plain films and fluoroscopy. Phrenic nerve stimulation was performed during fluoroscopy and the evoked motor response from the diaphragm recorded. There was a normal amplitude diaphragmatic twitch observed with an evoked motor response latency of 1 ms and amplitude of 300 microV. After high dose intravenous steroids, her neck stiffness and spasticity improved, her vital capacity improved to 1500 mL and her diaphragm regained its normal position and movement confirmed by followup radiographic plain films and fluoroscopy. We postulate the presence of a demyelinating plaque in the brainstem fibers descending to the phrenic nucleus as the etiology of the diaphragmatic paralysis. We are unaware of any other case reports of unilateral "upper motor neuron" phrenic nerve paralysis secondary to multiple sclerosis.