Septic arthritis in adults

2013 ◽  
Author(s):  
Laura McGregor ◽  
Monica N. Gupta ◽  
Max Field
Keyword(s):  
Septic Arthritis ◽  
Inflammatory Responses ◽  
Joint Disease ◽  
Medical Emergency ◽  
British Society ◽  
Future Research ◽  
Mortality And Morbidity ◽  
Medical Disorders ◽  
Sources Of Infection ◽  
Joint Prostheses

Septic arthritis (SA) is a medical emergency with mortality of around 15%. Presentation is usually monoarticular but in more than 10% SA affects two or more joints. Symptoms include rapid-onset joint inflammation with systemic inflammatory responses but fever and leucocytosis may be absent at presentation. Treatment according to British Society of Rheumatology/British Orthopaedic Association (BSR/BOA) guidelines should be commenced if there is a suspicion of SA. At-risk patients include those with primary joint disease, previous SA, recent intra-articular surgery, exogenous sources of infection (leg ulceration, respiratory and urinary tract), and immunosupression because of medical disorders, intravenous drug use or therapy including tumour necrosis factor (TNF) inhibitors. Synovial fluid should be examined for organisms and crystals with repeat aspiration as required. Most SA results from haematogenous spread-sources of infection should be sought and blood and appropriate cultures taken prior to antibiotic treatment. Causative organisms include staphylococcus (including meticillin-resistant Staphylococcus aureus, MRSA), streptococcus, and Gram-negative organisms (in elderly patients), but no organism is identified in 43%, often after antibiotic use before diagnosis. Antibiotics should be prescribed according to local protocols, but BSR/BOA guidelines suggest initial intravenous and subsequent oral therapy. Medical treatment may be as effective as surgical in uncomplicated native SA, and can be cost-effective, but orthopaedic advice should be sought if necessary and always in cases of infected joint prostheses. In addition to high mortality, around 40% of survivors following SA develop limitation of joint function. Guidelines provide physicians with treatment advice aiming to limit mortality and morbidity and assist future research.

Septic arthritis in adults

2013 ◽  
pp. 745-752
Author(s):  
Laura McGregor ◽  
Monica N. Gupta ◽  
Max Field
Keyword(s):  
Septic Arthritis ◽  
Inflammatory Responses ◽  
Joint Inflammation ◽  
Rapid Onset ◽  
Joint Disease ◽  
Medical Emergency ◽  
Future Research ◽  
Mortality And Morbidity ◽  
Sources Of Infection ◽  
Gram Negative Organisms

Septic arthritis (SA) is a medical emergency with mortality of around 15%. Presentation is usually monoarticular but in more than 10% SA affects two or more joints. Symptoms include rapid-onset joint inflammation with systemic inflammatory responses but fever and leucocytosis may be absent at presentation. Treatment according to British Society of Rheumatology/British Orthopaedic Association (BSR/BOA) guidelines should be commenced if there is a suspicion of SA. At-risk patients include those with primary joint disease, previous SA, recent intra-articular surgery, exogenous sources of infection (leg ulceration, respiratory and urinary tract), and immunosupression because of medical disorders, intravenous drug use or therapy including tumour necrosis factor (TNF) inhibitors. Synovial fluid should be examined for organisms and crystals with repeat aspiration as required. Most SA results from haematogenous spread-sources of infection should be sought and blood and appropriate cultures taken prior to antibiotic treatment. Causative organisms include staphylococcus (including meticillin-resistant Staphylococcus aureus, MRSA), streptococcus, and Gram-negative organisms (in elderly patients), but no organism is identified in 43%, often after antibiotic use before diagnosis. Antibiotics should be prescribed according to local protocols, but BSR/BOA guidelines suggest initial intravenous and subsequent oral therapy. Medical treatment may be as effective as surgical in uncomplicated native SA, and can be cost-effective, but orthopaedic advice should be sought if necessary and always in cases of infected joint prostheses. In addition to high mortality, around 40% of survivors following SA develop limitation of joint function. Guidelines provide physicians with treatment advice aiming to limit mortality and morbidity and assist future research.

scholarly journals Acute Septic Arthritis

2002 ◽  
Vol 15 (4) ◽  
pp. 527-544 ◽  
Author(s):  
Mark E. Shirtliff ◽  
Jon T. Mader
Keyword(s):  
Septic Arthritis ◽  
Antimicrobial Therapy ◽  
Bacterial Species ◽  
Good Prognosis ◽  
Medical Emergency ◽  
Laboratory Findings ◽  
Mortality And Morbidity ◽  
Joint Infections ◽  
Prosthetic Joint Infections ◽  
Focus Of Infection

SUMMARY Acute septic arthritis may develop as a result of hematogenous seeding, direct introduction, or extension from a contiguous focus of infection. The pathogenesis of acute septic arthritis is multifactorial and depends on the interaction of the host immune response and the adherence factors, toxins, and immunoavoidance strategies of the invading pathogen. Neisseria gonorrhoeae and Staphylococcus aureus are used in discussing the host-pathogen interaction in the pathogenesis of acute septic arthritis. While diagnosis rests on isolation of the bacterial species from synovial fluid samples, patient history, clinical presentation, laboratory findings, and imaging studies are also important. Acute nongonococcal septic arthritis is a medical emergency that can lead to significant morbidity and mortality. Therefore, prompt recognition, rapid and aggressive antimicrobial therapy, and surgical treatment are critical to ensuring a good prognosis. Even with prompt diagnosis and treatment, high mortality and morbidity rates still occur. In contrast, gonococcal arthritis is often successfully treated with antimicrobial therapy alone and demonstrates a very low rate of complications and an excellent prognosis for full return of normal joint function. In the case of prosthetic joint infections, the hardware must be eventually removed by a two-stage revision in order to cure the infection.

scholarly journals The patient with haematemesis and melaena

2011 ◽  
Vol 10 (1) ◽  
pp. 45-49
Author(s):  
A J Kent ◽  
◽  
J O’Beirne ◽  
Rupert Negus ◽  
◽  
...  
Keyword(s):  
Age Groups ◽  
Antiplatelet Agents ◽  
Medical Emergency ◽  
British Society ◽  
Mortality And Morbidity ◽  
Admission Rates ◽  
Ulcer Haemorrhage ◽  
Coronary Syndromes ◽  
Peptic Ulcer Haemorrhage ◽  
Upper Gastrointestinal

Bleeding from the upper gastrointestinal (GI) tract is a common medical emergency, with an incidence of between 50-150 cases per 100,000 per year.1 A recent audit by the British Society of Gastroenterology showed the mortality rate from upper GI bleeds has fallen from 14%2 in 1993 to 10% in 2007.3 However, despite the use of proton pump inhibitors (ppis), admission rates for peptic ulcer haemorrhage have increased in older age groups,4 probably related to increased use of antiplatelet agents such as aspirin and clopidogrel and anticoagulants in acute coronary syndromes, stroke and atrial fibrillation. The rising age of the population may also have offset further reductions in mortality and morbidity that may have otherwise come about through improved supportive and endoscopic care.

scholarly journals Involvement of Microglia in the Pathophysiology of Intracranial Aneurysms and Vascular Malformations—A Short Overview

2021 ◽  
Vol 22 (11) ◽  
pp. 6141
Author(s):  
Teodora Larisa Timis ◽  
Ioan Alexandru Florian ◽  
Sergiu Susman ◽  
Ioan Stefan Florian
Keyword(s):  
Immune Cells ◽  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Immune Cell ◽  
Vascular Malformations ◽  
Cerebral Injury ◽  
Future Research ◽  
Mortality And Morbidity ◽  
The Central Nervous System ◽  
The Brain

Aneurysms and vascular malformations of the brain represent an important source of intracranial hemorrhage and subsequent mortality and morbidity. We are only beginning to discern the involvement of microglia, the resident immune cell of the central nervous system, in these pathologies and their outcomes. Recent evidence suggests that activated proinflammatory microglia are implicated in the expansion of brain injury following subarachnoid hemorrhage (SAH) in both the acute and chronic phases, being also a main actor in vasospasm, considerably the most severe complication of SAH. On the other hand, anti-inflammatory microglia may be involved in the resolution of cerebral injury and hemorrhage. These immune cells have also been observed in high numbers in brain arteriovenous malformations (bAVM) and cerebral cavernomas (CCM), although their roles in these lesions are currently incompletely ascertained. The following review aims to shed a light on the most significant findings related to microglia and their roles in intracranial aneurysms and vascular malformations, as well as possibly establish the course for future research.

scholarly journals Novel therapeutic interventions towards improved management of septic arthritis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jian Wang ◽  
Liucai Wang
Keyword(s):  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Clinical Success ◽  
Treatment Protocol ◽  
Current Treatment ◽  
Therapeutic Interventions ◽  
Medical Emergency ◽  
Success Rates ◽  
Joint Infections ◽  
Novel Therapeutic

AbstractSeptic arthritis (SA) represents a medical emergency that needs immediate diagnosis and urgent treatment. Despite aggressive treatment and rapid diagnosis of the causative agent, the mortality and lifelong disability, associated with septic arthritis remain high as close to 11%. Moreover, with the rise in drug resistance, the rates of failure of conventional antibiotic therapy have also increased. Among the etiological agents frequently isolated from cases of septic arthritis, Staphylococcus aureus emerges as a dominating pathogen, and to worsen, the rise in methicillin-resistant S. aureus (MRSA) isolates in bone and joint infections is worrisome. MRSA associated cases of septic arthritis exhibit higher mortality, longer hospital stay, and higher treatment failure with poorer clinical outcomes as compared to cases caused by the sensitive strain i.e methicillin-sensitive S. aureus (MSSA).In addition to this, equal or even greater damage is imposed by the exacerbated immune response mounted by the patient’s body in a futile attempt to eradicate the bacteria. The antibiotic therapy may not be sufficient enough to control the progression of damage to the joint involved thus, adding to higher mortality and disability rates despite the prompt and timely start of treatment. This situation implies that efforts and focus towards studying/understanding new strategies for improved management of sepsis arthritis is prudent and worth exploring.The review article aims to give a complete insight into the new therapeutic approaches studied by workers lately in this field. To the best of our knowledge studies highlighting the novel therapeutic strategies against septic arthritis are limited in the literature, although articles on pathogenic mechanism and choice of antibiotics for therapy, current treatment algorithms followed have been discussed by workers in the past. The present study presents and discusses the new alternative approaches, their mechanism of action, proof of concept, and work done so far towards their clinical success. This will surely help to enlighten the researchers with comprehensive knowledge of the new interventions that can be used as an adjunct therapy along with conventional treatment protocol for improved success rates.

scholarly journals Gut Microbiota, Fusobacteria, and Colorectal Cancer

Diseases ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. 109 ◽  
Author(s):  
Dervla Kelly ◽  
Liying Yang ◽  
Zhiheng Pei
Keyword(s):  
Colorectal Cancer ◽  
Gut Microbiota ◽  
Inflammatory Responses ◽  
Tumor Development ◽  
Host Responses ◽  
Future Research ◽  
Bacterial Microbiota ◽  
Promote Tumor Growth ◽  
Tumor Environment ◽  
Protective Strategies

The gut microbiota has emerged as an environmental contributor to colorectal cancer (CRC) in both animal models and human studies. It is now generally accepted that bacteria are ubiquitous colonizers of all exposed human body surfaces, including the entire alimentary tract (5). Recently, the concept that a normal bacterial microbiota is essential for the development of inflammation-induced carcinoma has emerged from studies of well-known colonic bacterial microbiota. This review explores the evidence for a role of fusobacteria, an anaerobic gram-negative bacterium that has repeatedly been detected at colorectal tumor sites in higher abundance than surrounding histologically normal tissue. Mechanistic studies provide insight on the interplay between fusobacteria, other gut microbiota, barrier functions, and host responses. Studies have shown that fusobacteria activate host inflammatory responses designed to protect against pathogens that promote tumor growth. We discuss how future research identifying the pathophysiology underlying fusobacteria colon colonization during colorectal cancer may lead to new therapeutic targets for cancer. Furthermore, disease-protective strategies suppressing tumor development by targeting the local tumor environment via bacteria represent another exciting avenue for researchers and are highlighted in this review.

scholarly journals Using in situ simulation to improve care of the acutely ill patient by enhancing interprofessional working: a qualitative proof of concept study in primary care in England

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e028572
Author(s):  
Amy Halls ◽  
Mohan Kanagasundaram ◽  
Margaret Lau-Walker ◽  
Hilary Diack ◽  
Simon Bettles
Keyword(s):  
Primary Care ◽  
Training Session ◽  
Medical Emergency ◽  
Future Research ◽  
Proof Of Concept ◽  
In Situ Simulation ◽  
Concept Study ◽  
Interprofessional Working ◽  
General Practices

ObjectiveAcutely unwell patients in the primary care setting are uncommon, but their successful management requires involvement from staff (clinical and non-clinical) working as a cohesive team. Despite the advantages of interprofessional education being well documented, there is little research evidence of this within primary care. Enhancing interprofessional working could ultimately improve care of the acutely ill patient. This proof of concept study aimed to develop an in situ simulation of a medical emergency to use within primary care, and assess its acceptability and utility through participants’ reported experiences.SettingThree research-active General Practices in south east England. Nine staff members per practice consented to participate, representing clinical and non-clinical professions.MethodsThe intervention of an in situ simulation scenario of a cardiac arrest was developed by the research team. For the evaluation, staff participated in individual qualitative semistructured interviews following the in situ simulation: these focused on their experiences of participating, with particular attention on interdisciplinary training and potential future developments of the in situ simulation.ResultsThe in situ simulation was appropriate for use within the participating General Practices. Qualitative thematic analysis of the interviews identified four themes: (1) apprehension and (un)willing participation, (2) reflection on the simulation design, (3) experiences of the scenario and (4) training.ConclusionsThis study suggests in situ simulation can be an acceptable approach for interdisciplinary team training within primary care, being well-received by practices and staff. This contributes to a fuller understanding of how in situ simulation can benefit both workforce and patients. Future research is needed to further refine the in situ simulation training session.

scholarly journals Multiple Risk Factors of Alcoholic and Non-Alcoholic Myocardial Infarction Patients

2015 ◽  
Vol 8 (1) ◽  
pp. 62 ◽  
Author(s):  
N. Harisharan ◽  
Awnish Kumar Singh ◽  
Nidhu Ram Dangal ◽  
Krishna Mohan Surapaneni ◽  
Ashish Joshi
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Premature Death ◽  
Current Smoker ◽  
Medical Emergency ◽  
Past Century ◽  
Sociodemographic Characteristics ◽  
Mortality Trends ◽  
Cross Sectional ◽  
Mortality And Morbidity

<p><strong>BACKGROUND: </strong>Myocardial infarction (MI) is one of the most critical medical emergency and contributor to morbidity and mortality worldwide. Myocardial infarction is the most common form of coronary heart disease and leading cause of premature death. Past century has seen substantial advancement in the field of medical sciences but still mortality trends due to myocardial infarction is increasing in developing countries including India. We have conducted this study to compare the Sociodemographic characteristics of alcoholic and non alcoholic MI patients admitted in coronary care unit of Saveetha Medical College, Chennai, India.<strong> </strong></p> <p><strong>METHODS: </strong>An exploratory cross sectional study was performed by enrolling a convenient sample of 100 Myocardial Infarction patients. Information about Sociodemographic characteristics, past medical history, alcohol and tobacco intake, physical activity, psychological stress and biochemical measurements was gathered.</p> <p><strong>RESULTS: </strong>The mean age of the respondents was 46 (SD=6) years and majority of them were male i.e. 82%. 100% married and 89% literate, there were 24% past and 22% present alcoholics. Consumption of alcohol on a monthly, weekly and daily basis was 8%, 11% and 5% respectively. Preference to brandy was 67%, rum was 21% and that the beer was 12%. Current smoker were 20% and former were 11%. 93% and 52% respondents were under medication of beta blocker and angiotensin-converting-enzyme (ACE) inhibitors respectively.</p> <p><strong>CONCLUSION: </strong>Worldwide, MI is the most common cause of mortality and morbidity and hence early diagnosis and management is most essential. Results from our study revealed that, participants had sedentary lifestyles where risk factors of MI such as alcohol consumption, and smoking does existed.</p>

scholarly journals A therapeutic combination of two small molecule toxin inhibitors provides pancontinental preclinical efficacy against viper snakebite

2020 ◽  
Author(s):  
Laura-Oana Albulescu ◽  
Chunfang Xie ◽  
Stuart Ainsworth ◽  
Jaffer Alsolaiss ◽  
Edouard Crittenden ◽  
...  
Keyword(s):  
Small Molecules ◽  
Enzyme Inhibitors ◽  
Interspecific Variation ◽  
Medical Emergency ◽  
Dual Inhibitor ◽  
Mortality And Morbidity ◽  
Venom Composition ◽  
Inhibitor Combination

AbstractSnakebite is a medical emergency causing high mortality and morbidity in rural tropical communities that typically experience delayed access to unaffordable therapeutics. Viperid snakes are responsible for the majority of envenomings, but extensive interspecific variation in venom composition dictates that different antivenom treatments are used in different parts of the world, resulting in clinical and fiscal snakebite management challenges. Here, we show that a number of repurposed Phase 2-approved small molecules are capable of broadly neutralizing distinct viper venom bioactivities in vitro by inhibiting different enzymatic toxin families. Furthermore, using multiple in vivo models of envenoming, we demonstrate that a single dose of a rationally-selected dual inhibitor combination consisting of marimastat and varespladib prevents lethality caused by venom from the most medically-important vipers of Africa, South Asia and Central America. Our findings strongly support the translation of combinations of safe and affordable enzyme inhibitors as novel broad-spectrum therapeutics for snakebite.

scholarly journals Hearing loss and cognition: a discussion for audiologists and hearing healthcare professionals

2020 ◽  
Vol 12 (3) ◽  
pp. 72-78
Author(s):  
Douglas L Beck ◽  
Sarah Bant ◽  
Nathan A Clarke
Keyword(s):  
Hearing Loss ◽  
Cognitive Decline ◽  
Hearing Aids ◽  
British Society ◽  
Future Research ◽  
People With Dementia ◽  
Challenges And Opportunities ◽  
The Status ◽  
Impact Patient Care ◽  
The Relationship

Among researchers, clinicians and patients, there is widespread and growing interest in the relationship between hearing and cognition. The Cognition in Hearing Special Interest Group (SIG) is part of the British Society of Audiology (BSA) and is uniquely positioned to explore the relationship between hearing loss, amplification and cognitive ability and cognitive decline. The multiplicity of emerging reports concerning hearing loss and cognition is increasing rapidly. In light of this vast growth, there is a risk that clinicians may be left uncertain regarding the nature and extent of the emerging evidence linking hearing and cognition. The trickle-down corollary of such uncertainty can negatively impact patient care. Answering challenging questions and disseminating complex information about the latest evidence-based hearing science are a daily part of any clinician’s role and those in audiology services may be asked “How does my hearing loss affect my chance of getting dementia?” or “can hearing aids help people with dementia?” This discussion is therefore, based on articles and information our committee members selected to represent the status quo. The Cognition in Hearing SIG aims, through this discussion article, to provide clinicians a contemporary understanding of research on this topic. We will discuss evidence concerning hearing loss and cognition and how it relates to people living with hearing loss and cognitive decline or dementia, and we shall pose some challenges and opportunities for future research and clinical practice evidence. Therefore, to address these aims in an accessible manner for clinicians, the Cognition in Hearing SIG shall address the following broad questions: What is the relationship between hearing loss and cognition? What do we know about hearing loss and cognitive performance? Is there a link between hearing loss, cognitive decline, and dementia? Can we intervene on the relationship between hearing loss and cognition?

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