Septic arthritis of the hand due to Mycobacterium marinum

Mycobacterium marinum infections of the hand are very rare in the United Kingdom and we found only one case of involvement of deep structures (tenosynovitis) in the British literature. We report a case of septic arthritis due to the organism.     

Septic arthritis caused by Aeromonas hydrophila

Septic arthritis caused by Aeromonas hydrophila is a rare clinical entity in common practice. Herein, we describe one case of A. hydrophila-associated septic knee after a traumatic injury. The clinical condition gradually improved after appropriate antibiotic and surgical debridement.     

Septic arthritis of the hip caused by Neisseria gonococcae

In two patients septic monoarthritis of the hip was caused by Neisseria gonococcae. Treatment by parenteral penicillin in the first patient and oral erythromycin in the second resulted in complete recovery without residual loss of function in the affected hips. Gonococcal arthritis of the hip appears to respond favorably to appropriate antibiotic therapy, and immediate surgical drainage is probably unnecessary. This is in contrast to bacterial arthritis of the hip due to other organisms, for which surgical intervention and drainage are mandatory.     

Septic monoarthritis of the first carpo-metacarpal joint caused by Mycobacterium kansasii

A case of septic carpal monoarthritis due to Mycobacterium kansasii developing 16 months after accidental inoculation in a healthy laboratory technician is reported. No predisposing factor such as immunosuppression, preexisting degenerative, inflammatory arthritis or cortisone injection was present. Treatment with antituberculous oral medication alone resulted in resolution of the disease. Synovectomy was unnecessary. Ten years after the initial causative event, the patient remains free of symptoms.     

Septic arthritis caused by Nocardia asteroides in a renal transplant recipient

Although articular complications are common following renal transplantation, septic arthritis is not frequent. Previous bacterial infection in an another site is a consistent finding and the knee is the most often affected joint. We present a 30-year-old female renal transplant recipient with recurrent pulmonary infiltrates preceding septic arthritis of her left knee. Cultures of the aspirated synovial fluid yielded a gram-positive, rod-shaped bacterium later identified as Nocardia asteroides. The patient was treated with oral trimethoprim-sulfamethoxazole without any side effect. Nocardia is a rare but serious cause of infection in renal transplant recipients but there is no well-known predisposing factor. Recently mycophenolate mofetil has been implicated as a factor associated with Nocardia infections. Prolonged courses of treatment with sulphonamides are recommended.     

Septic arthritis of a lumbar facet joint caused by Staphylococcus aureus

STUDY DESIGN: Case report of a 35-year-old woman with septic arthritis of a lumbar facet joint. OBJECTIVES: To report a rare case of severe low back pain and the specific differential diagnostic problems. SUMMARY OF BACKGROUND DATA: Differential diagnosis between spondylodiscitis and facet joint septic arthritis on a clinical basis is very difficult. The lesions of the joint appear on a plain film only approximately 1.5 months after onset of the symptoms. Although the radionuclide bone scan is sensitive and shows a more laterally and vertically localized uptake than in spondylodiscitis, this technique is not very specific. Computed tomography scan and magnetic resonance imaging are the most reliable investigations even at the very early stages of the disease. Confirmation of the diagnosis has to be obtained by blood cultures or, in exceptional cases, by direct puncture of the joint. Appropriate antibiotic treatment is in most cases sufficient to heal this lesion. METHODS: The etiology, clinical presentation, technical examinations, and treatment are reviewed. RESULTS: Computed tomography scan and magnetic resonance imaging complemented by positive blood cultures led to the very early diagnosis of septic arthritis of the lumbar facet joint in this relatively young patient. CONCLUSIONS: With our case report we confirm the very small number of data reported in the literature, indicating that infections of the facet joint can be detected at a very early stage using magnetic resonance imaging and computed tomography scan.     

Mycobacterium marinum flexor tenosynovitis

Four culture-positive cases of flexor tenosynovitis of the hand caused by Mycobacterium marinum are reported. The organisms were cultured at 32 degrees. All patients were treated with a combination of flexor tenosynovectomy and antimycobacterial treatment with ethambutol and rifampin. The length of antimycobacterial treatment ranged from nine to 22 months. All four patients responded to treatment with cessation of signs of infection, increased range of motion, and complete wound healing.     

Septic arthritis of the hip caused by Yersinia enterocolitica: a case report

We report a case of bacteriologically documented hip infection caused by Yersinia enterocolitica. A 67-year-old male with a history of valvular disease was admitted for pain and motion range limitation in the left hip with a fever. No organisms were recovered by needle aspiration, but Yersinia enterocolitica grew in joint fluid obtained by surgical arthrotomy. Investigations of the gastrointestinal tract were normal, and there was no evidence of endocarditis. After 6 weeks of appropriate antibiotic therapy and immobilization with transtibial traction, the clinical and laboratory test abnormalities improved. However, the patient died from an intercurrent condition. Y. enterocolitica, a well-known cause of reactive arthritis, can cause septic arthritis.     

Septic arthritis

Hematogenous septic arthritis causes pain and effusion and begins with inoculation of the joint with bacteria from the intravascular space. The degradation of ground substance by enzymes released and activated by the acute inflammatory response, toxins and enzymes produced by the bacteria, and T lymphocytes stimulated during the delayed immune response, leads to destruction of the articular cartilage. Whether a given patient will develop a septic joint or a less severe form of infection is dependent upon characteristics of the bacterial strain and of the individual's host defenses. Management consists of systemic antibiotic therapy and decompression of the joint. Synovectomy, salicylate administration, and continuous passive motion are adjuvant therapies that have not as yet not been proved to be of benefit.     

Mycobacterium marinum infections of the hand

Fifteen patients had culture proven Mycobacterium marinum infections of the hand; 11 had injured their hands while fishing in water around Long Island. No patient had type I lesions (verrucal), six patients had type II lesions (subcutaneous granulomas), and nine patients had type III lesions (deep). Histologic examination showed noncaseating granulomas in all cases. A specific defect in the patients' lymphocytes ability to respond to M. marinum antigens was identified. A combination of surgery and tetracycline provided effective treatment. Follow-up averaged 2 1/2 years.     

Invasive Mycobacterium marinum infection of the hand

Abstract

Mycobacterium marinum infection of the hand is rare. We report the case of a 39-year-old man with M marinum infection that resulted in a chronic soft tissue infection, extensor tendon synovitis, and arthritis of the metacarpophalangeal (MCP) joints. The cause was probably tropical freshwater fishes.     

Mycobacterium marinum osteomyelitis of a long bone

Mycobacterium marinum can uncommonly cause osteomyelitis of small bones of extremities. The reported cases in literature are reviewed. We report a rare case of long bone osteomyelitis which as far as we are aware, has never been described before. Even though this organism normally causes infection in the superficial cooler regions of the body, clinicians should be aware of the possibility of long bone osteomyelitis in patients with a history of immune compromise and the appropriate treatment strategy in such cases.