Bone and Joint Infections

2019 ◽  
Author(s):  
Jayshree Dave ◽  
Rohma Ghani
Keyword(s):  
Septic Arthritis ◽  
Group A Streptococcus ◽  
Clinical History ◽  
Liver Function Tests ◽  
Joint Disease ◽  
Joint Fluid ◽  
Response To Treatment ◽  
Range Of Movement ◽  
Joint Infections ◽  
Bone And Joint Infections

Patients with bone and joint infections can present with native joint septic arthritis, osteomyelitis, or implant-associated bone and joint infections. Patients often present with an acute onset of hot, swollen, painful joint with restricted function in one or more joints over a couple of weeks. On examination the affected joint is painful with a limited range of movement, and fever is present. Risk factors for septic arthritis include an abnormal joint architecture due to pre-existing joint disease, e.g. patients with rheumatoid arthritis, or patients on haemodialysis, with diabetes mellitus, or older than 80 years of age. The differential diagnosis includes reactive arthritis, pre-patellar bursitis, gout, Lyme disease, brucellosis, and Whipples disease. Staphylococcus aureus is the most common cause of septic arthritis, followed by Group A streptococcus and other haemolytic streptococci including B, C and G. Gram-negative rods such as Escherichia coli are implicated in the elderly, immunosuppressed, or patients with comorbidities. Pseudomonas aeruginosa is implicated in intravenous (IV) drug users and patients post-surgery or intra-articular injections. Kingella kingae causes septic arthritis in children younger than four years of age. Neisseria gonorrhoeae, Neisseria meningitidis, and Salmonella species can also cause septic arthritis as part of a disseminated infection. Septic monoarthritis commonly occurs in patients with disseminated gonococcal infection. Blood cultures, white blood cell count, C reactive protein (CRP), electrolytes, and liver function tests are indicated. Serial CRP is useful in monitoring response to treatment. If there is a history of unprotected sexual intercourse, gonococcal testing is recommended. Brucella serology and Tropheryma whippei serology may be considered based on the clinical history. Joint fluid aspiration should be performed by a specialist within the hospital. Joint fluid aspirate is processed in the laboratory for microscopy, culture, and sensitivity. Gram stain can show an increase in neutrophils and presence of bacteria. The guidelines provided by the British Society for Rheumatology on the management of hot swollen joints in adults has provided advice for empirical treatment for suspected septic arthritis, but the local antibiotic policy should also be considered. Initial treatment is with intravenous flucloxacillin 2g four times daily, or 450– 600mg four times daily of intravenous clindamycin to cover S. aureus.

scholarly journals Bone and Joint Infections among Hematopoietic Stem Cell Transplant Recipients

2019 ◽  
Vol 4 (5) ◽  
pp. 209-215
Author(s):  
Cybele Lara Abad ◽  
Vania Phuoc ◽  
Prashant Kapoor ◽  
Pritish K. Tosh ◽  
Irene G. Sia ◽  
...  
Keyword(s):  
Stem Cell ◽  
Septic Arthritis ◽  
Hematopoietic Stem Cell ◽  
Joint Infection ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
Prosthetic Joint ◽  
Increased Risk

Abstract. Background: Hematopoietic stem cell transplantation (HSCT) recipients are at increased risk for infection. This study describes bone and joint infections (BJI) among HSCT recipients.Methods: We reviewed 5861 patients who underwent HSCT at Mayo Clinic, Rochester, MN from January 1, 2005 through January 1, 2015 for study inclusion. BJI was defined as native septic arthritis, prosthetic joint infection, osteomyelitis, and orthopedic implant infection. All adults with BJI after HSCT were included in the analysis.Results: Of 5861 patients, 33 (0.6%) developed BJI. Native joint septic arthritis was the most common BJI occurring in 15/33 (45.4%) patients. Patients were predominantly male (24/33, 72.7%), with median age of 58 (range 20-72) years. BJI was diagnosed a median of 39 (range 1-114) months after allogeneic (14/33, 42.4%) or autologous (19/33, 57.6%) HSCT. Organisms were recovered via tissue (24/27, 88.9%), synovial fluid (13/17, 76.5%), and/or blood cultures (16/25, 64%). Most underwent surgical debridement (23/33, 69.7%). Patients were followed a median of 78.3 months (range 74-119). Therapy was unsuccessful in 4/33 (12.1%), with death related to the underlying BJI in two (50%). Failure occurred a median of 3.4 (0.1-48.5) months from diagnosis. At last follow up, 7/33 (21.2%) patients were alive. Median overall survival was 13 months (0.07-70.6).Conclusion: BJI among HSCT recipients is infrequent. The most common infection is native joint septic arthritis. Pathogens appear similar to patients without HSCT. Treatment involving surgical-medical modalities is successful, with most patients surviving >1 year after BJI.

scholarly journals Bone and Joint Infections: The Role of Imaging in Tailoring Diagnosis to Improve Patients’ Care

2021 ◽  
Vol 11 (12) ◽  
pp. 1317
Author(s):  
Andrea Sambri ◽  
Paolo Spinnato ◽  
Sara Tedeschi ◽  
Eleonora Zamparini ◽  
Michele Fiore ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Response To Treatment ◽  
Diagnostic Strategy ◽  
Imaging Diagnosis ◽  
Infectious Process ◽  
Radiological Features ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
Extent Of Disease

Imaging is needed for the diagnosis of bone and joint infections, determining the severity and extent of disease, planning biopsy, and monitoring the response to treatment. Some radiological features are pathognomonic of bone and joint infections for each modality used. However, imaging diagnosis of these infections is challenging because of several overlaps with non-infectious etiologies. Interventional radiology is generally needed to verify the diagnosis and to identify the microorganism involved in the infectious process through imaging-guided biopsy. This narrative review aims to summarize the radiological features of the commonest orthopedic infections, the indications and the limits of different modalities in the diagnostic strategy as well as to outline recent findings that may facilitate diagnosis.

scholarly journals Degenerative Joint Damage Is Not a Risk Factor for Streptococcal Sepsis and Septic Arthritis in Mice

Life ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 794
Author(s):  
Johann Volzke ◽  
Brigitte Müller-Hilke
Keyword(s):  
Risk Factor ◽  
Septic Arthritis ◽  
Bone Structure ◽  
Group A Streptococcus ◽  
Cruciate Ligament ◽  
Clinical Signs ◽  
Joint Damage ◽  
Joint Disease ◽  
Micro Computed Tomography ◽  
Bone Morphology

Septic arthritis (SA) is an aggressive joint disorder causing invalidity and mortality. Although epidemiological studies suggest osteoarthritis (OA) as a risk factor for SA, experimental insights into the relatedness of both diseases are lacking. We therefore sought to investigate whether pre-existing OA indeed promotes SA frequency or severity. We used STR/ort mice that spontaneously develop OA and, in addition, induced OA via anterior cruciate ligament transection (ACLT) in C57BL/6J mice. Mice were infected with Group A Streptococcus (GAS) and then were monitored for clinical signs of sepsis and SA. Sepsis was confirmed via elevated inflammatory cytokines in plasma, while bone morphology was assessed by micro-computed tomography. Cartilage integrity was evaluated histologically. Mice with spontaneous OA developed life-threatening SA, with GAS only moderately affecting the femoral bone structure. Surgically induced OA neither impacted on SA incidence nor on mortality when compared to infected mice without the preceding joint disease. Furthermore, only insignificant differences in bone morphology were detected between both groups. Our data indicate that degenerative joint damage due to ACLT, by itself, does not predispose mice to SA. Hence, we propose that other factors such as prosthetic joint replacement or high age, which frequently coincide with OA, pose a risk for SA development.

scholarly journals Bone and Joint Infections in Children and Adolescents in Luanda, Angola

Osteology ◽  
2021 ◽  
Vol 1 (2) ◽  
pp. 80-85
Author(s):  
Markus Pääkkönen ◽  
Tuula Pelkonen ◽  
Guilhermino Joaquim ◽  
Luis Bernandino ◽  
Tiina Pöyhiä ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Blood Transfusion ◽  
Septic Arthritis ◽  
Surgical Procedures ◽  
Chart Review ◽  
Pathological Fracture ◽  
Retrospective Chart Review ◽  
Cell Disease ◽  
Joint Infections ◽  
Bone And Joint Infections

We reviewed the characteristics of children hospitalized for bone and joint infections in Luanda, Angola. In a retrospective chart review of 45 patients with childhood osteomyelitis or septic arthritis, 51% of the patients had sickle cell disease, and these patients presented with lower hemoglobin and needed blood transfusion more frequently (p < 0.05). Out of all patients, 64% underwent surgical procedures; a pathological fracture occurred in 31% of the patients.

Bone and Joint Infections in Children: Septic Arthritis

2015 ◽  
Vol 83 (8) ◽  
pp. 825-833 ◽  
Author(s):  
Anil Agarwal ◽  
Aditya N. Aggarwal
Keyword(s):  
Septic Arthritis ◽  
Joint Infections ◽  
Bone And Joint Infections

scholarly journals Radiologic Mimics of Osteomyelitis and Septic Arthritis: A Pictorial Essay

2021 ◽  
Vol 2021 ◽  
pp. 1-18
Author(s):  
Wanyin Lim ◽  
Christen D. Barras ◽  
Steven Zadow
Keyword(s):  
Septic Arthritis ◽  
Imaging Techniques ◽  
Routine Practice ◽  
Imaging Features ◽  
Cross Sectional ◽  
Musculoskeletal Infection ◽  
Neoplastic Processes ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
Pictorial Review

Various imaging techniques may be employed in the investigation of suspected bone and joint infections. These include ultrasound, radiography, functional imaging such as positron emission tomography (PET) and nuclear scintigraphy, and cross-sectional imaging, including computed tomography (CT) and magnetic resonance imaging (MRI). The cross-sectional modalities represent the imaging workhorse in routine practice. The role of imaging also extends to include assessment of the anatomical extent of infection, potentially associated complications, and treatment response. The imaging appearances of bone and joint infections are heterogeneous and depend on the duration of infection, an individual patient’s immune status, and virulence of culprit organisms. To add to the complexity of radiodiagnosis, one of the pitfalls of imaging musculoskeletal infection is the presence of other conditions that can share overlapping imaging features. This includes osteoarthritis, vasculopathy, inflammatory, and even neoplastic processes. Different pathologies may also coexist, for example, diabetic neuropathy and osteomyelitis. This pictorial review aims to highlight potential mimics of osteomyelitis and septic arthritis that are regularly encountered, with emphasis on specific imaging features that may aid the radiologist and clinician in distinguishing an infective from a noninfective aetiology.

scholarly journals Streptococcus pyogenes Infection Induces Septic Arthritis with Increased Production of the Receptor Activator of the NF-κB Ligand

2003 ◽  
Vol 71 (10) ◽  
pp. 6019-6026 ◽  
Author(s):  
Atsuo Sakurai ◽  
Nobuo Okahashi ◽  
Ichiro Nakagawa ◽  
Shigetada Kawabata ◽  
Atsuo Amano ◽  
...  
Keyword(s):  
Septic Arthritis ◽  
Streptococcus Pyogenes ◽  
Group A Streptococcus ◽  
Bone Destruction ◽  
Joint Disease ◽  
Enzyme Linked Immunosorbent Assay ◽  
Bacterial Arthritis ◽  
Receptor Activator ◽  
Number Of Microorganisms ◽  
Causative Agents

ABSTRACT Bacterial arthritis is a rapidly progressive and highly destructive joint disease in humans, with Staphylococcus aureus and Neisseria gonorrhoeae the major causative agents, although beta-hemolytic streptococci as well often induce the disease. We demonstrate here that intravenous inoculation of CD-1 mice with the group A streptococcus (GAS) species Streptococcus pyogenes resulted in a high incidence of septic arthritis. Signs of arthritis emerged within the first few days after injection, and bacterial examinations revealed that colonization of the inoculated GAS in the arthritic joints persisted for 21 days. Induction of persistent septic arthritis was dependent on the number of microorganisms inoculated. Immunohistochemical staining of GAS with anti-GAS antibodies revealed colonization in the joints of infected mice. Cytokine levels were quantified in the joints and sera of infected mice by using an enzyme-linked immunosorbent assay. High levels of interleukin-1β (IL-1β) and IL-6 were detected in the joints from 3 to 20 days after infection. We noted that an increase in the amount of receptor activator of NF-κB ligand (RANKL), which is a key cytokine in osteoclastogenesis, was also evident in the joints of the infected mice. RANKL was not detected in sera, indicating local production of RANKL in the infected joints. Blocking of RANKL by osteoprotegerin, a decoy receptor of RANKL, prevented bone destruction in the infected joints. These results suggest that GAS can colonize in the joints and induce bacterial arthritis. Local RANKL production in the infected joints may be involved in bone destruction.

scholarly journals Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Antinfective Therapy

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 486 ◽  
Author(s):  
Giovanni Autore ◽  
Luca Bernardi ◽  
Susanna Esposito
Keyword(s):  
Septic Arthritis ◽  
Laboratory Data ◽  
Underlying Disease ◽  
Narrative Review ◽  
Empiric Antibiotic Therapy ◽  
Evidence Based ◽  
First Line ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
Empiric Antibiotic

Acute bone and joint infections (BJIs) in children may clinically occur as osteomyelitis (OM) or septic arthritis (SA). In clinical practice, one-third of cases present a combination of both conditions. BJIs are usually caused by the haematogenous dissemination of septic emboli carried to the terminal blood vessels of bone and joints from distant infectious processes during transient bacteraemia. Early diagnosis is the cornerstone for the successful management of BJI, but it is still a challenge for paediatricians, particularly due to its nonspecific clinical presentation and to the poor specificity of the laboratory and imaging first-line tests that are available in emergency departments. Moreover, microbiological diagnosis is often difficult to achieve with common blood cultures, and further investigations require invasive procedures. The aim of this narrative review is to provide the most recent evidence-based recommendations on appropriate antinfective therapy in BJI in children. We conducted a review of recent literature by examining the MEDLINE (Medical Literature Analysis and Retrieval System Online) database using the search engines PubMed and Google Scholar. The keywords used were “osteomyelitis”, OR “bone infection”, OR “septic arthritis”, AND “p(a)ediatric” OR “children”. When BJI diagnosis is clinically suspected or radiologically confirmed, empiric antibiotic therapy should be started as soon as possible. The choice of empiric antimicrobial therapy is based on the most likely causative pathogens according to patient age, immunisation status, underlying disease, and other clinical and epidemiological considerations, including the local prevalence of virulent pathogens, antibiotic bioavailability and bone penetration. Empiric antibiotic treatment consists of a short intravenous cycle based on anti-staphylococcal penicillin or a cephalosporin in children aged over 3 months with the addition of gentamicin in infants aged under 3 months. An oral regimen may be an option depending on the bioavailability of antibiotic chosen and clinical and laboratory data. Strict clinical and laboratory follow-up should be scheduled for the following 3–5 weeks. Further studies on the optimal therapeutic approach are needed in order to understand the best first-line regimen, the utility of biomarkers for the definition of therapy duration and treatment of complications.

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