Early diagnosis of septic arthritis using synovial fluid presepsin: A preliminary study

Therapeutic outcomes for septic arthritis vary greatly depending on the span of time between disease-onset and surgery. The most important factor is making an early and definitive diagnosis; however, some cases may be difficult to diagnose. We investigated presepsin, a biomarker of sepsis, to determine whether or not presepsin in synovial fluid would be useful for the diagnosis of septic arthritis. We selected 18 patients with septic arthritis including periprosthetic joint infections (SA group) and 28 patients with osteoarthritis (OA group). We measured the concentrations of synovial fluid presepsin, blood presepsin and procalcitonin (PCT) in the two groups. We compared the sensitivities and specificities of synovial fluid presepsin, blood presepsin and PCT. Synovial fluid and blood presepsin and blood PCT were all significantly higher in the SA group. Synovial fluid presepsin exhibited both 100% sensitivity and 100% specificity in the SA group, which were higher rates than those for blood presepsin and PCT. We found that synovial fluid presepsin is markedly elevated in case of septic arthritis, and therefore, it has potential as a new biomarker of septic arthritis.     

婴幼儿下肢多关节化脓性感染临床分析

目的探讨婴幼儿下肢多关节化脓性感染的临床特点及治疗方法。方法回顾性分析3例下肢多关节化脓性感染患儿的病史特点、临床表现、治疗方法及预后。结果本组病变累及膝关节4个,髋关节3个;髋关节病变者患肢屈曲、外展,自主活动减少或无;膝关节病变者有关节肿胀,局部皮温增高,浮髌试验阳性;3例均行感染关节切开引流术并应用抗生素治疗,术后随访3~5a,2例下肢功能恢复良好,1例遗留双侧髋关节病理性脱位。结论婴幼儿出现多关节肿胀、活动受限、疼痛时应考虑有多关节化脓性感染可能,及时行关节腔穿刺及关节切开引流术可防止漏、误诊及病变关节的不可逆损害。     

16S rRNA基因荧光定量PCR与芯片杂交法快速诊断儿童化脓性脑膜炎

目的探索快速诊断儿童化脓性脑膜炎的新技术。方法通过设计细菌16SrRNA基因高度保守区的引物和探针,对疑似化脑的21份脑脊液(CSF)进行荧光定量PCR及基因芯片杂交检测,同时与脑脊液细菌培养结果比较。结果(1)荧光定量PCR发现21份脑脊液标本有8份阳性,阳性率为38.095%(8/21),明显高于脑脊液培养的阳性率19.047%(4/21),差异具有显著意义(P<0.01)。(2)基因芯片杂交结果8份阳性,其中大肠埃希菌探针阳性5份,肠道杆菌科探针阳性2份,金黄色葡萄球菌探针阳性1份;脑脊液培养4份阳性,分别为肺炎克雷伯菌培养阳性1份,阴沟肠杆菌阳性1份,大肠埃希菌阳性2份;基因芯片杂交阳性率为38.095%(8/21),芯片杂交阳性结果与荧光定量PCR大体一致。结论荧光定量PCR结合基因芯片杂交技术检测儿童化脑具有快速、敏感、特异的特点,对儿童化脓性脑膜炎的早期诊断有一定的应用价值。     

Endogenous endophthalmitis secondary to septic arthritis caused by group A Streptococcus infection: A case report and literature review

Streptococcus pyogenes is a rare pathogen that causes endogenous endophthalmitis (EE). A healthy 58-year-old woman was diagnosed with EE secondary to septic arthritis caused by S. pyogenes. She underwent enucleation after hospitalization for 14 days with appropriate antibiotic cover. A literature search for outcomes of this condition revealed reports on only 10 eyes among 8 cases identified: 8 eyes (80%) developed poor visual outcome and 5 eyes (50%) underwent enucleation. There were no cases with immunocompromise. Our case report and literature review suggest the importance of awareness of the occurrence of S. pyogenes infection in immunocompetent hosts, and thus early diagnosis and aggressive treatment may be required to improve visual outcome.     

采用PCR与RFLP方法快速诊断细菌感染

目的:探讨PCR与RFLP方法快速诊断细菌感染的临床应用价值.方法:选取14种下呼吸道常见病原茵制成DNA模板,用16S rRNA基因保守区建立一对通用引物对其进行PCR扩增,再分别用限制性内切酶Hae Ⅲ,Mnl Ⅰ,Alu Ⅰ,Dde Ⅰ和BstBⅠ酶切,根据RFLP分析鉴定细菌.结果:所有待测细菌经通用引物PCR扩增和HaeⅢ酶切后的电泳图谱呈现多态性,但有部分细茵图谱相同或相似,再分别用MnlⅠ、AluⅠ、DdeⅠ和BstBⅠ酶切,其产生的酶切图谱各异,可以相互区分,从而鉴定出痛原菌.结论:PCR与RFLP分析方法检测病原茵快速简便,是一种具有临床应用价值的快速诊断方法.     

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

Urinary tract infections (UTI) are one of the most common infections in both hospitalised and ambulant patients. Rapid diagnostic of UTIs is necessary to provide early information about the presence of bacteria and the indication to administer an antibiotic therapy. Here we report on a study comparing 3 different rapid automated systems with the semiquantitative plate culture reference method in a university hospital with a highly complex patient population. In total, 2230 urine samples were consecutively tested using the UroQuick (Alifax), the BACSYS-40i (Sysmex), and the UF-1000i (Sysmex) system. In comparison to the results obtained by culture techniques, the automated systems showed a sensitivity of 73.0-80.9% and a specificity ranging between 61.8% and 92.8%. Additionally, sensitivity and specificity for the most common UTI-causing microorganisms were analysed and showed that sensitivity and specificity correlate with the colony forming units of microorganisms in the urine, with a sensitivity of nearly 90% for Gram-negative rods, typical for community acquired UTIs, but a very low sensitivity for Gram-positive bacteria and yeasts. This led us to the conclusion that the currently available automated systems might be rather helpful to analyse a typical UTI in an ambulant patient population but not for rapid diagnosis of UTIs in a complex population of hospitalized patients.     

First report of methicillin-resistant Staphylococcus aureus septic arthritis complicating acupuncture: simple procedure resulting in most devastating outcome

We report the 1st case of methicillin-resistant Staphylococcus aureus (MRSA) septic arthritis after acupuncture, with articular cartilage destruction and chronic osteomyelitis. The patient responded to arthrotomy, synovectomy, and 6 months of antibiotics. The emergence of community-associated MRSA infections would further aggravate the problem. Strict adherence to proper infection control guidelines is mandatory.     

Rapid screening by real-time 16S rDNA PCR for bacterial contamination of blood products

Although blood component transfusion is currently regarded as safe, adverse events may occur in recipients of these products. Among those, blood borne viral, bacterial and parasitic infections are best known. For detection of bacterial contamination in platelet concentrates various methods are available or under investigation. One of these methods, real-time polymerase chain reaction (PCR) with particular focus on real-time 16S rDNA detection, will be discussed in this review.     

Moraxella lacunata infection associated with septicemia,endocarditis, and bilateral septic arthritis in a patient undergoing hemodialysis: A case report and review of the literature

We report the first case of both endocarditis and bilateral septic arthritis in a patient caused by Moraxella lacunata and successful management of the infection with antimicrobial therapy. The route of entry leading to bacteremia may have been the oral cavity given the poor oral hygiene of the patient as evidenced by bleeding gums. We hypothesize that the bacteremia led to septic arthritis and mitral valve infective endocarditis. In this case report, we also review the literature on M. lacunata infections and conclude that this organism should be considered in bilateral septic arthritis in a patient with underlying heart abnormalities and/or with renal failure.     

Rapid diagnosis of acute bacterial meningitis: role of a broad range 16S rRNA polymerase chain reaction

Background: Acute bacterial meningitis is a significant cause of morbidity and mortality throughout the world. It can be difficult to diagnose, as the symptoms and signs are often non-specific. Study Objective: To evaluate the performance of an in-house semi-nested polymerase chain reaction (PCR) assay targeting the 16S rRNA gene of Eubacteria for the rapid diagnosis of acute bacterial meningitis using cerebrospinal fluid (CSF) specimens. Methods: A total of 112 CSF samples from 112 patients were used in the study. Among these, 32 samples were obtained from confirmed cases of Streptococcus pneumoniae, six samples were obtained from confirmed cases of Haemophilus influenzae, one sample from a confirmed case of Neisseria meningitidis, and 10 cases of clinically suspected acute bacterial meningitis. The remaining 63 CSF samples were obtained from patients with non-infectious illnesses (n = 47) of the central nervous system (CNS) and autopsy-confirmed tuberculous meningitis (n = 16). Results: The assay had an overall sensitivity of 93% (95% confidence interval [CI] 0.81–0.98, negative predictive value = 95%) and a specificity of 98% (95% CI 0.92–1.0, positive predictive value = 98%). Conclusion: These preliminary findings suggest that the semi-nested PCR assay targeting the 16S rRNA gene may be used as a rapid test for the diagnosis of acute bacterial meningitis.     

新生儿及小婴儿化脓性髋关节炎的超声诊断：病例系列研究

目的探讨新生儿及小婴儿化脓性髋关节炎的超声表现,评估其在早期诊断、治疗及随访中的作用。 方法选取2015年1月至2021年1月经深圳市儿童医院确诊为化脓性髋关节炎,年龄＜6个月的婴儿及新生儿患者22例,回顾性分析化脓性髋关节炎的临床资料、主要超声表现及影像学特征,以及治疗结局和超声随访复查结果。 结果22例化脓性髋关节炎患儿,其中男8例,女14例;年龄中位数52 d（1~180 d）。累及单侧髋关节21例、双侧1例。髋关节超声表现：髋关节滑膜增厚、关节腔积液21例（22个髋关节）,其中14例（15个髋关节）积液伴点状回声、1例积液呈絮状回声;髋关节周围软组织增厚、回声增强22例;股骨头关节面软骨回声欠光滑9例;股骨头髋臼关系异常5例（3例髋关节不稳定、2例脱位）。患儿经保守治疗10例,行手术治疗12例。最终治愈18例,超声复查显示股骨头变小1例,3例仍存在关节腔积液伴点状回声,其中进展为股骨头坏死2例,异位骨化1例。 结论新生儿及小婴儿化脓性髋关节炎超声声像图以关节腔积液伴髋关节脱位为主要表现。髋关节超声有助于化脓性髋关节炎的诊断、随访复查以及改善患儿预后。     

Medial thigh abscess mimicking septic arthritis of the knee: a report of two cases

Background

Septic arthritis of the knee joint requires prompt diagnosis and treatment for optimal outcomes. Pyomyositis with abscess formation is uncommon but may present with similar symptoms in the vicinity of a joint.

Objective

This report describes two cases of medial thigh abscess initially diagnosed and treated as septic arthritis, and highlights the need to make an accurate diagnosis.

Case Report

Two patients presenting with knee pain secondary to pyomyositis and abscess formation in the medial thigh were investigated with aspiration and treated subsequently with knee surgery, resulting in contamination of the knee joint in one case and delayed diagnosis with significant morbidity in both.

Conclusion

Failure to identify a soft tissue infection may lead to delayed diagnosis, misdirected treatment, and contamination of a normal joint. Diagnosis is best confirmed with thorough physical examination and specific imaging where available.     

Rapid PCR amplification protocols decrease the turn-around time for detection of antibiotic resistance genes in Gram-negative pathogens

A previously designed end-point multiplex PCR assay and singleplex assays used to detect β-lactamase genes were evaluated using rapid PCR amplification methodology. Amplification times were 16–18 minutes with an overall detection time of 1.5 hours. Rapid PCR amplifications could decrease the time required to identify resistance mechanisms in Gram-negative organisms.     

Unilateral sternoclavicular arthritis: inflammatory arthritis or septic arthritis,that is the question – a case report

Sternoclavicular (SC) joint inflammatory arthritis and septic arthritis can have very similar presentations and can be indistinguishable if a joint fluid aspiration sample cannot be obtained. Septic arthritis of the SC joint accounts for less than 1% of all joint infections. Diagnosis is usually made on the basis of the clinical history combined with elevated infection markers in the blood, specific imaging findings, and most importantly, a positive joint aspiration bacterial culture. To make a diagnosis of SC joint septic arthritis, a high index of suspicion is generally necessary. We herein present the case of a previously healthy 52-year-old man with a 10-day history of left SC pain who improved transiently with anti-inflammatory oral medication; however, the pain subsequently increased over the next 10 days. Follow-up magnetic resonance imaging of the left SC area revealed fluid in the joint with an abscess adjacent to the joint, which was aspirated, and the sample yielded a positive Streptococcus agalactiae culture. Septic arthritis of the left SC joint was diagnosed, and the patient was treated surgically. This case highlights the initial challenges of distinguishing inflammatory from septic arthritis in joints in which a sample for bacterial culture cannot be easily obtained.     

Septic complications involving hand and wrist in patients with pre-existing rheumatoid arthritis: The role of magnetic resonance imaging and sonography

PurposeSeptic arthritis (SA), frequently involving hand and wrist, is common in rheumatoid arthritis (RA) patients due to immunomediated etiology of RA and immunosuppressive drug use. Clinical and laboratory features might not be useful to differentiate between RA relapse and superimposed SA. The role of magnetic resonance imaging (MRI) has been described in several studies. Our aim is to evaluate the role of ultrasonography (US).Material and methodsIn the last 4 years 31 MRI of hand and wrist has been performed in the suspect of SA complicating RA. A 1.5 T unit (Siemens Symphony, Erlangen, Germany) with standardized protocol, involving the administration of contrast medium, was used. Also US with power Doppler evaluation was performed. A Philips IU22 US scanner was used.ResultsEleven points (according to Graif's study) were analyzed for every MRI and US. At MRI joint effusion (37.5% of RA relapse vs 100% superimposed SA) and soft tissue edema (25% vs 100%) were indicative of SA. At US joint effusion (31.3% of RA relapse vs 73.3% superimposed SA) and soft tissue edema (12.5% vs 60%) were indicative of SA.ConclusionOur results suggest that joint effusion and soft tissue edema are markers suggestive for superimposed SA and that MRI is more sensitive in their evaluation. Although US is less sensitive than MRI, the former is important in guiding invasive procedure and evaluating patients that cannot undergo MRI.     

霍乱弧菌的PCR方法检测及耐药性分析

目的建立PCR检测霍乱弧菌的快速方法,应用于水源、海产品霍乱弧菌快速检测;了解霍乱弧菌的耐药性。方法根据霍乱弧菌的肠毒素基因A亚单位(ctxA)的保守序列,设计引物,以副溶血弧菌和沙门菌为对照,建立PCR检测霍乱弧菌的快速方法,用于霍乱弧菌的快速检测;应用美国德灵公司生产的Walkway40微生物鉴定和药敏分析系统对70株霍乱弧菌进行耐药性检测。结果70株霍乱弧菌出现特异性荧光,其他菌不出现荧光,灵敏度高、特异性强,可在8h内作出诊断。霍乱弧菌对大部分抗生素敏感,对复方新诺明耐药率较高。结论PCR检测霍乱弧菌灵敏度高特异性强可用于水源、海产品霍乱弧菌快速检测;霍乱弧菌对大部分抗生素敏感。     

Septic arthritis in children in resource limited and non-resource limited countries: an update on diagnosis and treatment

Introduction: Septic arthritis (SA) is an orthopedic emergency in childhood. It is uncommon in high resource settings. However, an incidence of 5–20 per 100,000 children has been reported in low-income countries.

Area covered: The predictive value of serum markers is still under debate and the proposed diagnostic algorithms for SA are not sufficiently validated in children. Recent data suggest that short-course intravenous treatment, followed by oral therapy, is as effective as traditional long-term treatment. Results from three randomized controlled trials suggest that the addition of systemic steroids may accelerate clinical improvement. Minimally invasive surgical techniques have been proposed for treatment in recent years.

Expert commentary: The causes and the epidemiology of septic arthritis will continue to mutate according to the changes in immunization practices, bacterial resistance patterns and the implementation of PCR techniques. Future research should focus on the assessment of appropriate antibiotic regimens and surgical procedures.     

Candida lusitaniae septic arthritis: case report and review of the literature

Candida lusitaniae is an infrequently encountered Candida species that has been associated with resistance to amphotericin B. We present a case of septic arthritis with C. lusitaniae and provide a brief review of the organism, especially in regard to current information about its pattern of resistance to antifungal agents.     

实时荧光PCR熔解曲线法快速鉴定嗜肺军团菌

摘要：目的：建立特异、快速、敏感的实时荧光PCR熔解曲线基因分型方法,并探讨该法在鉴定嗜肺军团菌中的应用价值。 方法：根据嗜肺军团菌16S rRNA基因保守序列设计引物和猝灭FRET探针建立实时荧光PCR熔解曲线方法,优化引物与探针浓度,用15株嗜肺军团菌、30株非嗜肺军团菌及7株其他病原菌标准菌株验证该方法的特异性、敏感性和重复性,用该法检测117例临床痰标本并进行基因测序。 结果：15株不同血清型的嗜肺军团菌Tm值均为57 ℃;7株非嗜肺军团菌Tm值为43 ℃,1株Tm值为45 ℃;其余22株非嗜肺军团菌和7株其他病原菌均无明显Tm值。该方法最低检出限可达0.1 pg/μL。检测117例痰标本发现3株嗜肺军团菌,与PCR基因测序法检测结果一致。 结论：实时荧光PCR熔解曲线法可特异、快速和敏感地检测嗜肺军团菌,适用于临床痰标本的嗜肺军团菌检测。