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Osteomyelitis, septic arthritis

André Grenho, Joana Arcângelo, Pedro Jordão, Catarina Gouveia
We present a 10-year-old boy with 2-month duration non-traumatic wrist pain and inflammatory signs. Due to elevated inflammatory markers on blood tests, with an increase in radiocarpal and intercarpal joints synovial fluid and no bony lesions, the patient was submitted to wrist arthrocentesis for the suspicion of septic arthritis. The patient did not improve on conventional treatment, however. An MRI showed synovitis around the carpus and a lytic lesion of the capitate bone due to osteomyelitis. A biopsy was able to identify the causative agent as Mycobacterium tuberculosis , and the patient was treated with antibiotics...
March 15, 2018: BMJ Case Reports
Elizabeth Wilson, Peter Cox, Karen Greaves, Siba Prosad Paul
Children with acute onset non-traumatic limp often present to emergency departments (EDs). The limp can occasionally be associated with medical emergencies such as septic arthritis and slipped upper femoral epiphysis but is often due to less severe conditions. This article discusses the common and self-limiting causes of acute onset of non-traumatic limp in children, such as transient synovitis, reactive arthritis, and benign acute childhood myositis. It also discusses more severe conditions, including septic arthritis, osteomyelitis, slipped upper femoral epiphysis, Perthes disease, malignancies and non-accidental injury...
March 9, 2018: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
Olugbenga Akinkugbe, Charles Stewart, Caoimhe McKenna
OBJECTIVE: The objective of this study was to evaluate the presenting features of bone and joint infections with a view to identify distinguishing trends that will be useful for pediatric emergency departments. METHODS: We performed a retrospective review of patient records over a 12-year period in the pediatric emergency department of a large regional pediatric teaching center serving a diverse population. RESULTS: There were 88 cases of osteoarticular infections during the study period...
March 5, 2018: Pediatric Emergency Care
Oscar Murillo, Imma Grau, Joan Gomez-Junyent, Celina Cabrera, Alba Ribera, Fe Tubau, Carmen Peña, Javier Ariza, Roman Pallares
PURPOSE: The relationship between infective endocarditis (IE) and osteoarticular infections (OAIs) are not well known. We aimed to study the characteristics of patients with IE and OAIs, and the interactions between these two infections. METHODS: An observational study (1993-2014) which includes two cohorts: (1) patients with IE (n = 607) and (2) patients with bacteremic OAIs (n = 458; septic arthritis of peripheral and axial skeleton, and vertebral and peripheral osteomyelitis)...
February 2, 2018: Infection
Benjamin D Welling, Lee S Haruno, Scott B Rosenfeld
BACKGROUND: Septic arthritis is frequently associated with adjacent infections including osteomyelitis and subperiosteal and intramuscular abscesses. While often clinically indiscernible from isolated septic arthritis, the diagnosis of adjacent infections is important in determining the need for additional surgical intervention. MRI has been used as the diagnostic gold standard for assessing adjacent infection. Routine MRI, however, can be resource-intensive and delay surgical treatment...
January 2018: Clinical Orthopaedics and related Research
J C Yombi, L Seyler, O Cornu, O Barbier, X Libouton, H Rodriguez-Villalobos, E Thienpont
Bone and joint infections are rare but often devastating. While bacteria are most commonly encountered organisms, mycobacteria and fungi are less frequent. Management of the latter is often more complex, especially in the presence of foreign material. We will increasingly be faced with mycobacterial and fungal bone infections, as medical conditions and newer therapeutics lead to more immunosuppression. In this article, we will review osteomyelitis, septic arthritis and peri-prosthetic joint infections related to mycobacteria and fungi...
March 2017: Acta Orthopaedica Belgica
Kelly L Vanderhave, Crystal A Perkins, Brian Scannell, Brian K Brighton
Sickle cell disease (SCD) is an autosomal recessive disorder that results in hemolytic anemia related to abnormal hemoglobin and erythrocyte levels. SCD is characterized by vascular occlusive episodes, visceral sequestration, and aplastic or hemolytic crises. These crises most commonly occur in bone. The orthopaedic manifestations of SCD comprise much of the morbidity associated with this disorder. Osteonecrosis and osteomyelitis are among the most disabling and serious musculoskeletal complications in patients with SCD...
February 1, 2018: Journal of the American Academy of Orthopaedic Surgeons
M Lorrot, Y Gillet, C Gras Le Guen, E Launay, R Cohen, E Grimprel
Acute hematogenous bone and joint infections (osteomyelitis, septic arthritis, osteoarthritis, and spondylodiscitis) affect more frequently children younger than 5 years of age. Early diagnosis and prompt treatment are needed to limit the risk of complications. Children with suspected bone and joint infections (BJI) should be hospitalized at the beginning of treatment. Surgical drainage is indicated in patients with septic arthritis and in those with periosteal abscess. Staphylococcus aureus is involved in BJIs in children at all ages; Kingella kingae is a very common causative pathogen in children under 4 years of age...
December 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Manish Kiran, Saffwan Mohamed, Ashley Newton, Harvey George, Neeraj Garg, Colin Bruce
AIMS: We present the largest series of paediatric pelvic pyomyositis from a temperate country, analyse the factors influencing long term prognosis and suggest a diagnostic protocol. MATERIALS AND METHOD: We included 41 patients diagnosed with primary paediatric pelvic pyomyositis between 1998 and 2016, in this study with a mean age of 7.5 years. Demographic, clinical, radiological and follow-up data were reviewed. Statistical analysis was performed to analyse the influence of early diagnosis and treatment on the final outcome...
December 30, 2017: International Orthopaedics
M M Elzohairy
BACKGROUND: Pyomyositis PM is defined as a primary pyogenic infection of the striated skeletal muscle; although it has many dystrophic musculoskeletal complications, it is always misdiagnosed by many orthopedic surgeons. HYPOTHESIS: PM is rare in temperate climates and usually considered to be a tropical disease, until recent times, after globalization, it is possible to occur in the subtropical climate as in our country. MATERIAL AND METHODS: In the present series, the results of 15 children patients with primary pyomyositis have been reviewed...
December 21, 2017: Orthopaedics & Traumatology, Surgery & Research: OTSR
Scott A McAninch, Clinton Smithson, Andrew L Juergens, Jason N Collins, Amrita Nanda
BACKGROUND: Sternoclavicular joint infection (SJI), to include septic arthritis (SA), is a rare cause of chest pain and is often found in patients with significant risk factors and sources for SA. Most acute care laboratory results lack significant sensitivity to rule out SA. Radiographic findings in common acute care imaging often does not reveal findings of SA and osteomyelitis in the acute phase of the infection. CASE REPORT: We present a patient without significant risk factors for SA, who initially presented with 3 days of pain to the left chest, left neck and shoulder...
December 14, 2017: Journal of Emergency Medicine
Ketan Sharma, Deng Pan, James Friedman, Jenny L Yu, Aaron Mull, Amy M Moore
PURPOSE: Diabetes has long been established as a risk factor for hand and forearm infections. The purpose of this study was to review the effect of glycemic factors on outcomes among diabetic patients with surgical upper-extremity infections. We hypothesized that diabetic inpatients may benefit from stronger peri-infection glycemic control. METHODS: A prospective cohort study enrolled diabetic and nondiabetic surgical hand and forearm infections over 3 years. Glycemic factors included baseline glycosylated hemoglobin, blood glucose (BG) at presentation, and inpatient BG...
February 2018: Journal of Hand Surgery
Joanne Dixon, Joshua Coulter, Michele Garrett, Rick Cutfield
AIMS: To review the characteristics, management and outcomes one year after diagnosis in patients with diabetes related charcot neuropathic osteoarthropathy (CN) treated at the Diabetes Podiatry service, Waitemata District Health Board (WDHB) between 2000-2014. METHODS: Patients with diabetes and recorded diagnosis of CN were identified from the podiatry service records. Clinical details were retrospectively obtained from WDHB databases and patient medical records...
December 15, 2017: New Zealand Medical Journal
D L Kerr, E K Loraas, A C Links, T V Brogan, G A Schmale
PURPOSE: The objective of this study was to compare the frequency of severe systemic, multi-organ involvement and toxic shock syndrome (TSS) in patients with Staphylococcus aureus (SA) and Group A β-haemolytic Streptococcus pyogenes (GABS) bone and joint infections. METHODS: We retrospectively reviewed patients treated for septic arthritis or osteomyelitis at one children's hospital between 2002 and 2009. The rates of intensive care unit (ICU) admission for methicillin-sensitive SA (MSSA), methicillin-resistant SA (MRSA) and GABS infections were compared, as were the lengths of stay, number of surgeries, operative procedures and cases of TSS...
October 1, 2017: Journal of Children's Orthopaedics
Kevin G Buell, Saira Ajmal, Jennifer A Whitaker
Empyema necessitans is a complication of a pleural space infection that dissects through the pleura into the soft tissues of the chest and skin. Due to the widespread availability of antibiotics, empyema necessitans is rare in modern medicine and is most commonly caused by Mycobacterium tuberculosis. A 38-year-old immunocompetent male presented with left shoulder pain and his chest radiograph revealed a mass in the upper left lung and/or pleural space. He underwent multiple debridements of the chest wall due to a left chest wall abscess and empyema necessitans...
August 22, 2017: Curēus
Mohammed S Al-Azri, Jazel Manarang, Yaqoub Al-Mufargi
To this day, tuberculosis (TB) continues to pose a significant global health burden. The World Health Organization's Expanded Programme on Immunization (EPI) recommends the bacille Calmette-Guérin (BCG) vaccine for infants to protect against the haematogenous spread of primary TB and other more severe types of TB infection. We report an eight-month-old boy who presented to the Armed Forces Hospital, Muscat, Oman, in 2015 with a one-month history of intermittent fever associated with a limited range of motion in the right hip area...
August 2017: Sultan Qaboos University Medical Journal
Nicolas V Vardiabasis, John A Schlechter
BACKGROUND: Children who present to the emergency department (ED) with complaint of fever and new-onset joint or extremity pain can be a diagnostic dilemma for many emergency and consulting physicians. OBJECTIVES: The purpose of our study was to identify the etiologies of pediatric fever and extremity pain presenting to a tertiary care pediatric ED and to define factors that were associated with advanced imaging, admission, and surgical intervention. METHODS: The electronic medical records of children presenting to our institution's pediatric ED with fever and extremity pain were retrospectively reviewed...
September 2017: Journal of Emergency Medicine
Balasubramaniam Balakumar, Sangeet Gangadharan, Nithya Ponmudi, Satish Kumar, John Jude Prakash, Thomas Palocaren
OBJECTIVE: Salmonella osteomyelitis in immunocompromised individuals with sickle cell anaemia is well documented. Its occurrence in immunocompetent children is rare. METHODS: All pus culture positive cases of salmonella typhi between the period 2009 to 2014 were reviewed and only those children without sickle cell disease or trait were considered further. RESULTS: Eighty five patients had positive cultures. Of these only three children had culture positive Salmonella septic arthritis in the absence of sickle cell disease...
July 2017: Journal of Clinical Orthopaedics and Trauma
F Gravot, J Hébert, A Robert-Dehault, R Bouttier, F Le Gall, G Blondin, P Vic
Pyomyositis is a term used to denote primary pyogenic infection of a skeletal muscle. It is a rare disease that was first described in immunodeficient patients living in tropical climates. Lately, however, cases involving healthy children have been described in temperate climates. The origin of primary pyomyositis remains unclear, although it is thought to be caused by seeding from transient bacteremia. Onset of disease is insidious, therefore necessitating rapid diagnosis to successfully select appropriate antibiotic therapy and avoid complications...
September 15, 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Pablo Yagupsky
Kingella kingae is currently recognized as the prime etiology of skeletal system infections in children aged 6-48 months. The organism is notoriously fastidious, its growth is inhibited by synovial fluid and bone exudates, and its presence in clinical specimens is commonly missed by traditional culture methods. Areas covered: The present review discusses the use of improved laboratory methods to detect the organism in normally sterile body fluids, exudates, and upper respiratory tract specimens. Expert commentary: While inoculation of joint and bone exudates into blood culture vials dilutes the concentration of detrimental factors and significantly improves the isolation of the organism, novel PCR-based assays have enhanced sensitivity, shortened the time-to-detection of K...
October 2017: Expert Review of Anti-infective Therapy
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