Salmonella osteitis and septic arthritis

We reviewed 16 patients with salmonella osteitis or septic arthritis. All patients were immunologically normal and none had a history of typhoid fever. We discuss the importance of obtaining a bacteriological diagnosis and provide guidelines on the duration of antibiotic treatment.     

Bilateral septic arthritis of the hip with osteitis and psoas abcess in a 17-year-old adolescent

Septic arthritis remains an important and serious disease of the young because of its high potential to cause permanent sequelae. The hip is the most commonly involved joint in infants and in the young (35%). Most often, patients have a single joint involved. We report here a rare case of septic arthritis reaching both hips, shown by a severe septicemic shock and complicated unusually by a psoas abcess and osteitis in an immunocompetent adolescent.     

Psoas abscess with associated septic arthritis of the hip in infants

We describe psoas abscess with concomitant septic hip arthritis in 2 infants, 3 and 7 months old. The common clinical features were a palpable mass in the inguinal region, irritable hip, and delayed treatment. The diagnosis of septic hip was delayed in one child, and they both had residual hip deformity at follow-up. It is possible that initial delay in diagnoses resulted in the concurrent pathologic condition because of spread of infection. These 2 cases demonstrate the first known reports of concurrent psoas abscess and septic hip arthritis in infancy. Magnetic resonance imaging is a valuable method to identify these concurrent pathologic conditions. A proposed etiologic mechanism is also discussed in the article.     

Acute staphylococcal septic arthritis: the effect of cloxacillin therapy in an avian model

An experimental model of acute staphylococcal septic arthritis in chickens was used to study the effect of different therapeutic regimens of the antibiotic cloxacillin on the natural history of the disease. Three different therapeutic regimens were used in order to assess the effect of increasing the frequency and of delaying the commencement of administration. The results were assessed by measurement of animal growth rate, clinical condition, bacterial and leukocyte counts in synovial fluid, and histological appearance. An inadequate dosage regimen (a single daily dose) prevented spread of bacteria but did not control abscesses. Delay in commencing treatment permitted persistence and spread of abscesses with destruction of the secondary (epiphyseal) ossification center and even transphyseal spread into metaphyseal bone. Repair by fibroblasts was mainly seen in articular and epiphyseal cartilage but was not seen in the epiphyseal ossification center during the duration of the experiments (up to 18 days). Synovial fluid sampling with measurement of leukocyte and bacterial concentrations appears to be a useful guide to the effectiveness of treatment, because the numbers of cells correlate with the pathological process.     

Severe bone marrow necrosis associated with septic shock in the intensive care unit

Unexplained cytopenias can be related to bone marrow necrosis (BMN) in critically ill patients as it can be encountered in several diseases or life-threatening conditions. We present the case of a 39-year-old woman with pancytopenia revealing a BMN in the setting of an acute pyelonephritis with septic shock, multiple organ failure and sickle cell trait. After a short review on the subject, we suggest that various haematological abnormalities occurring in critically ill patients may be related to a mild to severe marrow necrosis.     

Slipped capital femoral epiphysis in a child with acute disseminated staphylococcal disease—a case report

We report a case of acute disseminated staphylococcal disease in an 11-year-old boy who had septic arthritis of the left hip, left iliac vein thrombosis and pulmonary embolism. Rapid deterioration was seen in this patient due to the development of disseminated intravascular coagulation. This was further complicated by chicken pox and slipping of the capital femoral epiphysis on the left side following attempted reduction of hip dislocation during follow-up. Closed reduction and percutaneous pinning were performed which failed, resulting in disability. Aggressive management by means of team approach and timely interventions are essential to prevent long-term complications in this life-threatening condition.     

Severe septic arthritis of the shoulder with an axillary nerve lesion in a 4-year-old child

Septic arthritis in children frequently affects the joints of the lower extremity, namely the hip and the knee [1–3]. Infection in the glenohumeral joint is rare [4–7], representing 4% of all joint infections [4, 5]. Arthralgia, joint swelling, fever and pseudoparalysis are the most commonly observed symptoms [1, 4, 5, 8]. Diagnosis and thus appropriate management are often delayed [4] and therefore early disease recognition and treatment play a significant role in minimising the risk of developing complications such as joint surface destruction, growth arrest, adjacent osteomyelitis, and loss of joint movement [1, 4–6]. Brachial plexopathy, is infrequently reported [13], and a lesion to the axillary nerve specifically has not yet been reported in literature to our knowledge. Treatment aims include adequate washout and debridement of the joint with the objective of relieving pain and restoring function [5]. This can be achieved either via arthrotomy or arthroscopically [2, 5]. However there is currently no clear consensus with regard to which management option leads to improved outcome [3, 8], because of the lack of studies describing the results of surgical intervention [9]. The case of a 4-year-old boy with a delayed diagnosis of septic arthritis of the right shoulder with massive abscess formation and an axillary nerve lesion is presented.     

Severe sepsis and septic shock

Sepsis and consequent multiorgan dysfunction syndrome are responsible for over 60% of deaths in patients receiving critical care in spite of improvements in patient management. We describe the pathophysiology, epidemiology, clinical picture, and biochemical markers that contribute to the diagnosis and assessment of infection severity and progression of infection to sepsis and from severe sepsis to septic shock. Our focus is on the guidelines of the Surviving Sepsis Campaign, complemented with additional information published since those guidelines appeared. The Ovid MEDLINE database was used for a search from 1997 through 2006.     

Anaerobic septic arthritis and osteomyelitis

Anaerobic septic arthritis and osteomyelitis are more common than previously believed. Recent experience suggests that because of the high morbidity associated with these conditions, a very aggressive surgical and medical treatment program is indicated.     

Salmonella septic and aseptic arthritis in sickle-cell disease. A case report

A 26-year-old black male with sickle-cell disease developed a Salmonella septic arthritis in one knee and an acute, aseptic arthritis in the other knee. Salmonella is showing increasing resistance to many antibiotics. In this patient, optimal antibiotic treatment of his uncommon infection was delayed by a rare resistance to trimethoprim-sulfamethoxazole. Two pathophysiologic mechanisms could account for his acute, aseptic arthritis: sickle-cell disease with presumed synovial ischemia from sickling and reactive arthritis precipitated by a remote Salmonella infection elsewhere in the body. The authors could find no previous discussion of either of these processes in the orthopedic literature. Acute arthritis in a patient with sickle-cell disease can be a complex diagnostic and therapeutic problem.     

Primary bacterial pyomyositis associated with septic arthritis caused by Streptococcus pyogenes: a case report

Pyomyositis is relatively rare in temperate climates. This is the first report of a case of calf pyomyositis associated with septic arthritis of the knee. This case illustrates that pyomyositis should be included in the differential diagnosis of a swollen, tender calf in an emergency setting. The other notable feature of this case is that the infective organism was not the usual Staphylococcus aureus but rather the relatively rarely involved Streptococcus pyogenes.     

Rapidly progressing polyarticular septic arthritis in a patient with rheumatoid arthritis

Septic arthritis is an orthopedic emergency that can lead to significant morbidity and mortality. Polyarticular involvement is a relatively rare phenomenon occurring primarily in high-risk patients. In this article, we report the rare case of a patient with rheumatoid arthritis presenting with an acute episode of septic arthritis involving most of the joints of the body. Surprisingly, his bilateral total hip arthroplasties were completely unaffected. Unusual polyarticular presentations of septic arthritis, though rare, must still be considered within the differential diagnosis by all healthcare providers when treating certain high-risk groups.     

Osteomyelitis and septic arthritis in children

Osteomyelitis is an infection in bone most frequently occurring in children. The current incidence is 1 in 5000. Septic arthritis is an infection of a synovial joint which may occur in all age groups in children but has a specific infantile form affecting the infant from birth to the first year of life. The majority of infections of bone or joint are caused by spread of bacteriae through the bloodstream or occasionally by entry of organisms through an open wound, by puncture or by extension of infection from adjacent tissue. The most common causative organism is Staphylococcus aureus but many other organisms may be responsible for a bone or joint infection. The treatment of both osteomyelitis and septic arthritis is based on antibiotic therapy in combination with surgical drainage if pus or infected tissue is present. Early diagnosis followed by adequate treatment gives good outcome. Inappropriate or delayed treatment may result in chronic osteomyelitis or irreversible joint destruction.