Septic arthritis caused by Bacteroides fragilis

As improvements in bacteriologic techniques have enhanced the recovery of anaerobic bacteria from clinical specimens, there has been an increasing awareness of the role of anaerobes in disease. Bacteroides fragilis is the most common anaerobic organism found in clinical specimens. Although it is the anaerobe most frequently associated with bacteremia and a common isolate in intraabdominal infections, infections of the female genital tract, wounds, and abscesses, B. fragilis is a rare cause of septic arthritis. The isolation of this organism from four patients with septic arthritis in three Cleveland hospitals between 1978 and 1982 suggests that septic arthritis due to B. fragilis may be a more common clinical entity than previously appreciated. In this report we describe these cases and review the pertinent literature.     

Septic arthritis caused by Corynebacterium amycolatum following vascular graft sepsis.

A case of septic arthritis caused by Corynebacterium amycolatum in a native hip joint occurred in an adult man following contralateral vascular graft sepsis, and was successfully treated with intravenous vancomycin followed by oral doxycycline and rifampicin. To the authors' knowledge, this is the only reported case of septic arthritis due to C. amycolatum.     

Septic arthritis caused by haemophilus influenzae associated with endocarditis

Septic arthritis withHaemophilus influenzae is infrequent in adults and often associated with an extraarticular septic focus. We report the case of a septic arthritis caused byH. influenzae in an elderly (89-year-old) female patient in whom an transoesophageal echocardiogram showed an aortic valve endocarditis.     

Septic arthritis caused by Corynebacterium xerosis following vascular surgery

A case of septic arthritis due to Corynebacterium xerosis occurred after vascular surgery and was successfully treated with intravenous cefotaxime followed by oral erythromycin. The only previously reported case of C. xerosis arthritis developed in a patient with a history of similar recent surgery. The possible association of this infection with such a postsurgical setting is discussed.     

Nosocomial respiratory infection caused by Pseudomonas cepacia in immunocompromised hosts]

Pseudomonas cepacia is a gram negative rod, having no fermentative activity on glucose. This organism was detected in the sputum, throat swab, or throat washing of 22 inpatients treated between January, 1990, and December, 1990, at the First Department of Internal Medicine, Kagawa Medical School. The primary diseases for which these 22 patients were hospitalized were leukemia in 12, malignant lymphoma in 5, lung cancer in 2, myelodysplastic syndrome in 1, and embryonal cell carcinoma in 1. Twelve of the 22 patients had episodes of pneumonia which complied clinically with the diagnostic criteria provided to facilitate the National Nosocomial Infection Study. The complication of pneumonia occurred in 7 patients with leukemia, 2 with malignant lymphoma, 2 with lung cancer, and 1 with myelodysplastic syndrome. In 10 of these 12 patients, the organism was detected before the onset of pneumonia. All 22 patients in whom the organism was demonstrated had received antibiotics. The antibiotics which was most frequently used to treat these patients 1 month before detection of Pseudomonas cepacia were amikacin and ceftizoxime, which were used in 13 patients. Of the antibiotics in which the susceptibility to Pseudomonas cepacia was, evaluated, minocycline was effective in 100% (21/21), ceftazidime in 50% (11/22), and ofloxacin in 27.3% (6/22). Physicians should be especially aware of the possibility of colonization and nosocomial respiratory infection by Pseudomonas cepacia in patients with severe underlying diseases.     

Septic arthritis caused by Chryseobacterium meningosepticum in an immunocompetent male

This is the first report of septic arthritis of the knee caused by Chryseobacterium meningosepticum. The infection was associated with a penetrating injury to the joint. The patient was cured by flushing of the joint and antibiotic treatment.     

Septic arthritis caused by Streptococcus suis serotype 2

A case of septic arthritis and septicaemia due to Streptococcus suis serotype 2 is reported. To our knowledge, this is the first case in which the causative organism has been isolated from the joint-fluid. Involvement of joints is a feature of S. suis infection in pigs, and may be more common in human beings than previously realised. Infectious arthritis caused by beta-haemolytic streptococci may be due to S. suis and result from contact with pigs or raw pork.     

Septic arthritis.

Septic arthritis is a direct invasion of the joints by pathogenic micro-organisms. These micro-organisms and their products stimulate the release of pro-inflammatory cytokines and proteolytic enzymes that induce an inflammatory response and degradation of the cartilage. Staphylococcus aureus remains the most prevalent micro-organism, and the most important aetiological change has been the decreased incidence of gonorrhoea, which is related to changes in sexual behaviour as a result of the HIV epidemic. Diagnostic suspicion is based on clinical symptoms, imaging findings and examination of synovial fluid. Scintigraphy and magnetic resonance imaging are useful methods for localizing and defining the extent of infection. The definitive diagnosis is based on the isolation and culture of the pathogen from synovial fluid. Optimal cultures are obtained by inoculating the synovial fluid immediately into blood culture bottles. Treatment includes initial empirical antibiotics, which are modified according to the synovial fluid culture. It is recommended that 3-4 weeks of intravenous antibiotic therapy are followed by 2 or 3 more weeks of an oral regimen. Adequate drainage may be performed by means of repeated needle aspiration, arthroscopy or surgery. Recent studies on the pathogenic mechanisms of septic arthritis have led to the simultaneous use of intra-articular steroids and antibiotics in order to reduce articular damage.