Pyomyositis of the pectineus muscle in an adolescent male

The ‘irritable hip’ continues to pose a challenge for clinicians. Even with predictive clinical algorithms, decision making can be difficult. Emergency treatment is required if septic arthritis is suspected. Other differential diagnoses such as transient synovitis, pyomyositis of the pelvic girdle muscles and osteomyelitis must be considered in order to help guide appropriate investigations and allow early treatment. We report the case of a 13-year-old boy presenting to our institution with an acutely painful left hip but still able to weight bear. Despite a fever and raised inflammatory markers, the clinical examination did not correspond to that of an infected hip joint. Urgent magnetic resonance imaging (MRI) confirmed pyomyositis of the pectineus muscle. To our knowledge, this is the first reported case in the literature. The child was treated with seven days of intravenous antibiotics. There was a good clinical response as well as normalisation of the C-reactive protein level and white cell count. The patient was discharged home with a further week of oral antibiotics. Follow-up MRI at two weeks demonstrated a dramatic reduction in the inflammation of the pectineus. At the clinic follow-up appointment, the child was asymptomatic and back to normal function. Pyomyositis is typically found in tropical areas but its rates in temperate climates have been rising. It usually affects large groups of muscles such as the quadriceps and gluteal muscles. MRI is the gold standard investigation. If diagnosed early, the condition can be treated successfully with intravenous antibiotics alone. Given the widespread availability of MRI, we recommend its increased use to distinguish between pyomyositis and other paediatric hip pathologies.

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Inflammation and psychopathology in children following PICU admission: an exploratory study

Evidence-Based Mental Health ◽

10.1136/ebmental-2018-300027 ◽

2018 ◽

Vol 21 (4) ◽

pp. 139-144 ◽

Cited By ~ 5

Author(s):

Giorgia Caspani ◽

Georgina Corbet Burcher ◽

M Elena Garralda ◽

Mehrengise Cooper ◽

Christine M Pierce ◽

...

Keyword(s):

Lymphocyte Count ◽

Exploratory Study ◽

Psychiatric Symptoms ◽

White Cell Count ◽

Post Traumatic Stress ◽

Reactive Protein ◽

Behavioural Difficulties ◽

And Gender ◽

Emotional And Behavioural Difficulties

BackgroundSurvivors of critical illness in childhood commonly display subsequent psychiatric symptoms including emotional and behavioural difficulties, and manifestations of post-traumatic stress disorder (PTSD). Anomalies in inflammatory profiles are an established finding in these childhood psychiatric conditions.ObjectiveThis exploratory study aimed to investigate whether abnormal peripheral blood inflammatory markers measured during paediatric intensive care unit (PICU) admission were associated with psychiatric symptoms after discharge.MethodsWe performed a prospective observational cohort study on 71 children with septic illness, meningoencephalitis and other critical disorders admitted to two PICUs between 2007 and 2010. 3–6 months following discharge, subjects were assessed for global psychiatric risk (ie, presence of emotional and behavioural difficulties on the parental Strengths and Difficulties Questionnaire (SDQ)), and for PTSD risk using the child-rated Impact of Events Scale (IES-8). Inflammatory and related biological markers were transcribed from PICU admission notes (white cell count, lymphocytes, neutrophils, C reactive protein (CRP), platelets, fibrinogen and lactate).FindingsGlobal psychiatric risk at follow-up was associated with abnormal lymphocyte count during admission (χ2=6.757, p=0.014, n=48). In children with sepsis, partial correlation analyses controlling for age and gender highlighted associations between (i) SDQ scores and low lymphocyte count (r=−0.712; p=0.009, n=14), and (ii) IES-8 score and high CRP levels (r=0.823; p=0.006, n=11). These associations remained after correction for multiple comparisons.ConclusionThese results support the hypothesis that acute inflammation may play a role in determining the development of psychopathology following PICU admission.Clinical implicationsIf the findings are replicated, they may help to better highlight which children are at risk of post-PICU psychopathology and appropriately target follow-up.

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Septic Hip Arthritis in Patients with Osteonecrosis of Femoral Head: Two Cases Report and Review of the Literature

10.21203/rs.3.rs-112850/v1 ◽

2020 ◽

Author(s):

Zhiping Zhao ◽

Xiangyu Wang ◽

Changyao Wang ◽

Yingzhen Wang ◽

Yongtao Zhang

Keyword(s):

Femoral Head ◽

Septic Arthritis ◽

Clinical Manifestations ◽

Joint Fluid ◽

Osteonecrosis Of Femoral Head ◽

Reactive Protein ◽

Intravenous Antibiotics ◽

Hip Infection ◽

Septic Focus ◽

Magnetic Resonance Imaging Mri

Abstract Background: In patients with osteonecrosis of femoral head (ONFH), septic arthritis of the hip is rare, especially in the absence of factors likely to cause infection, which are often ignored by surgeons. Methods: Two patients seen at our hospital who had ONFH and concomitant septic arthritis of the hip joint were selected for inclusion in the study. Results: The clinical course suggests that ONFH developed prior to the hip infection. The two patients were not immune-compromised, and no remote septic focus was identified. The 2 patients, clinical manifestations of infection included fever and elevated white blood cell count. Elevated levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were observed in all 2 patients. In all patients, the results of hip magnetic resonance imaging (MRI) indicated hip infection. For 1 patients, culturing joint fluid revealed the presence of bacteria. In the second case, joint fluid was not cultured. In each case, the hip was debrided, and a spacer made of bone cement and containing vancomycin was implanted in the hip. Intravenous antibiotics were administered for 6 weeks postoperatively. There was no recurrence of infection, and total hip arthroplasty (THA) was performed 6 months after the operation. Conclusions: Septic hip is rare but exist in patients with ONFH. Elevated ESR and CRP contributed to the initial diagnosis; the results of hip MRI help to confirm the diagnosis. Overall, THA was an effective treatment.

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Resistance of Pseudomonas to ciprofloxacin: implications for the treatment of malignant otitis externa

The Journal of Laryngology & Otology ◽

10.1017/s0022215106002775 ◽

2006 ◽

Vol 121 (2) ◽

pp. 118-123 ◽

Cited By ~ 31

Author(s):

J M Bernstein ◽

N J Holland ◽

G C Porter ◽

A R Maw

Keyword(s):

Pseudomonas Aeruginosa ◽

Otitis Externa ◽

White Cell Count ◽

Antibiotic Sensitivity ◽

Response To Treatment ◽

Reactive Protein ◽

Intravenous Antibiotics ◽

Cranial Nerve Palsies ◽

Malignant Otitis Externa ◽

Oral Ciprofloxacin

For fifteen years oral ciprofloxacin has been the standard treatment for malignant otitis externa, a sometimes fatal osteomyelitis of the skull base usually caused by Pseudomonas aeruginosa. Resistance to ciprofloxacin is developing. Over a 16-month period, we saw five cases where malignant otitis externa progressed, with the development of cranial nerve palsies in four cases, despite oral ciprofloxacin. Prolonged intravenous antibiotic therapy became necessary. One case was managed largely as an out-patient, but four patients spent many weeks in hospital. Only two cases had diabetes and this was monitored and controlled. Pseudomonas aeruginosa was isolated in four of the five cases, but antibiotic sensitivity to ciprofloxacin was not determined. In one case a later isolate was tested and found to be ciprofloxacin resistant. Progress was monitored by serial C-reactive protein (CRP) and white cell count. For diagnosis and assessing response to treatment we considered serial magnetic resonance imaging or computed tomography more useful than isotope bone scan. There must be a readiness to use intravenous antibiotics, as a response to ciprofloxacin can no longer be assumed. Bacterial isolates must be tested for sensitivity to antibiotics including ciprofloxacin, and further biopsy and culture are essential if treatment fails.

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The Promising Role of Dynamic 18F-NaF PET-CT in Diagnosing Symptomatic Joint Prosthesis

Integrative Biomedical Sciences ◽

10.18314/gjbs.v1i2.40 ◽

2015 ◽

Vol 1 (2) ◽

Author(s):

Olu Adesanya ◽

Pedro Foguet ◽

Charles Hutchinson

Keyword(s):

Cell Count ◽

White Cell Count ◽

Joint Prosthesis ◽

C Reactive Protein ◽

Septic Loosening ◽

Reactive Protein ◽

Pet Ct

Our purpose was to establish proof of principle case study for the use of dynamic 18F-NaF PET-CT in the assessment of knee and hip prostheses. Approval was granted by the research ethics committee and informed<br />consent was obtained. This is a case study investigating the role of dynamic 18F NaF PET-CT in a patient with ilateral knee prostheses (1 symptomatic/painful and 1 asymptomatic). Both knees were studied with dynamic 18F-NaF PET-CT technique to demonstrate the different pattern of uptake in normal/asymptomatic joint as well as painful joints with aseptic loosening. In addition, a knee aspirate was obtained from the symptomatic knee and serum C-reactive protein and erythrocyte sediment rate levels as well as a peripheral white cell count were<br />obtained in addition to 12 month clinical follow up. Images were obtained with multi-sequential dynamic image acquisition in list mode using GE HealthcareÂ® volume imaging protocol (ViP) after an intravenous injection of 250 MBq 18F-NaF. The images were interpreted as normal, loosening or septic loosening based on the graphical pattern of tracer uptake produced at the bone-prosthesis interface. A final diagnosis was made by a combination of joint aspiration microbiology and clinical follow-up for 1 year; in addition to C-reactive protein and erythrocyte sediment rate levels as well as peripheral white cell count. NaF PET results were compared with 3-phase dynamic bone scan results and plain radiographs. The degree of uptake in the symptomatic joint exceeded background<br />levels and also levels of uptake in the asymptomatic knee. The pattern of uptake and curve slope in both the asymptomatic and symptomatic joints matched the pattern of uptake in our hypothesis. Dynamic 18F-NaF PET-CT is a useful imaging modality for assessing painful joint prosthesis. It can differentiate between asymptomatic joints and aseptic loosening. However, more work is required for the detection of septic loosening.

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Brucella prostatic abscess: a retrospective study of eight cases and a literature review

Journal of International Medical Research ◽

10.1177/03000605211027442 ◽

2021 ◽

Vol 49 (9) ◽

pp. 030006052110274

Author(s):

Siqin Lan ◽

Zhaoxing Guo ◽

Yuanlin He ◽

Wenya Liu ◽

Hui Guo

Keyword(s):

Clinical Manifestations ◽

Mri Findings ◽

Prostatic Abscess ◽

Small Nodule ◽

Reactive Protein ◽

Hyperintense Signal ◽

Laboratory Test Results ◽

Prostate Enlargement ◽

Magnetic Resonance Imaging Mri

Objective To present the clinical characteristics, diagnostics, and treatments for Brucella prostatic abscess (BPA). Methods We retrospectively analyzed eight BPA patients according to their vocations, age, clinical manifestations, laboratory test results, magnetic resonance imaging (MRI) findings, and treatments. Results The median age was 59 years. The most common clinical symptom was fever, followed by dysuria, erectile dysfunction, frequent urination, and urodynia. C-reactive protein (CRP) concentrations were significantly elevated in all patients, and in all by one patient, the erythrocyte sedimentation rate (ESR) was high. Prostate enlargement occurred in 87.5% of the patients. Lesions were located in the prostate peripheral (87.5%) and central zones (100%), with homogenous signals on T1-weighted imaging (T1WI) and a hyperintense signal on short tau inversion recovery (STIR). Patients had a small nodule or multiple nodules, with slight hyperintense to hyperintense signals on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI). Three patients had pelvic effusion, and seminal vesicle (37.5%), epididymis (12.5%), and bladder (12.5%) infections occurred. All patients received rifampicin and doxycycline with levofloxacin; all lesions had resolved at follow-up ultrasonography. Conclusion Even in epidemic areas, the incidence of BPA is relatively rare. Our findings may increase the understanding of BPA and reduce misdiagnosis and mistreatment.

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Rare case of extensive streptococcal myositis

BMJ Case Reports ◽

10.1136/bcr-2020-235400 ◽

2020 ◽

Vol 13 (8) ◽

pp. e235400

Author(s):

Weh Kiat Gan

Keyword(s):

Elbow Joint ◽

Blood Test ◽

Rare Case ◽

White Cell Count ◽

Pectoralis Major Muscle ◽

Oral Antibiotics ◽

Good Recovery ◽

C Reactive Protein ◽

Reactive Protein ◽

Intravenous Antibiotics

A rare case of extensive streptococcal myositis is reported. A 46-year-old man was admitted following acute swollen right elbow joint associated with localised pain, erythema and hypoaesthesia. Multiple tense blisters subsequently developed around the affected elbow joint extending to the axilla. He was treated for suspected soft tissue infection and septic arthritis. Blood test investigations demonstrated raised creatine kinase (894 U/L) and inflammatory markers (white cell count 21.1×109/L; C reactive protein 370 mg/L). Emergency CT scan reported extensive myositis affecting the triceps, latissimus dorsi and pectoralis major muscle with no fascial involvement. He was escalated to intensive care unit and treated for infectious myositis. Further investigation revealed positive streptococcal antibody (anti-streptodornase B titre >1600 U/mL). He was managed conservatively with microbiologist specialist input and supportive care. The patient made good recovery after receiving 10 days of intravenous antibiotics and subsequently switched to oral antibiotics. He was discharged on day 30 of admission after receiving intensive inpatient physiotherapy.

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Unusual presentation of acute pancreatitis following high tibial osteotomy

BMJ Case Reports ◽

10.1136/bcr-2018-227438 ◽

2019 ◽

Vol 12 (2) ◽

pp. e227438

Author(s):

Adam O’Connor ◽

Peter Asaad

Keyword(s):

High Tibial Osteotomy ◽

White Cell Count ◽

Taxi Driver ◽

Tibial Osteotomy ◽

Close Monitoring ◽

C Reactive Protein ◽

Reactive Protein ◽

First Case ◽

Intravenous Antibiotics ◽

Glasgow Score

We report a case of a 55-year-old man taxi driver admitted electively for high tibial osteotomy for relief of bilateral medial compartment osteoarthritis. He was obese and an ex-smoker but medical history was otherwise unremarkable. Day 1 postoperatively the patient started to suffer vomiting episodes and the abdomen was distended. C Reactive protein and white cell count were both elevated but other bloods were normal. CT abdomen and pelvis was performed which showed acute interstitial pancreatitis. Glasgow score was calculated as 2. He was treated aggressively with analgesia, intravenous fluid and intravenous antibiotics. He has made a good recovery following these conservative measures. To our knowledge, this is the first case in the literature reporting pancreatitis as a complication of high tibial osteotomy. This case highlights the importance of close monitoring for abdominal complications even in the setting of elective orthopaedic surgery where it is a rare phenomenon.

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Complementary Effects of Multivitamin and Omega-3 Fatty Acid Supplementation on Indices of Cardiovascular Health in Individuals with Elevated Homocysteine

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000093 ◽

2012 ◽

Vol 82 (1) ◽

pp. 41-52 ◽

Cited By ~ 5

Author(s):

P. Earnest ◽

S. Kupper ◽

M. Thompson ◽

Guo ◽

S. Church

Keyword(s):

Risk Factors ◽

Cardiovascular Health ◽

Omega 3 Fatty Acids ◽

Omega 3 ◽

C Reactive Protein ◽

Fatty Acid Supplementation ◽

Omega 3 Fatty Acid ◽

Reactive Protein ◽

Daily Ingestion

Homocysteine (HCY), C-reactive protein (hsCRP), and triglycerides (TG) are risk factors for cardiovascular disease (CVD). While multivitamins (MVit) may reduce HCY and hsCRP, omega-3 fatty acids (N3) reduce TG; yet, they are seldom studied simultaneously. We randomly assigned 100 participants with baseline HCY (> 8.0 umol/L) to the daily ingestion of: (1) placebo, (2) MVit (VitC: 200 mg; VitE: 400 IU; VitB6: 25 mg; Folic Acid: 400 ug; VitB12: 400 ug) + placebo, (3) N3 (2 g N3, 760 mg EPA, 440 mg DHA)+placebo, or (4) MVit + N3 for 12 weeks. At follow-up, we observed significant reductions in HCY (umol/L) for the MVit (- 1.43, 95 %CI, - 2.39, - 0.47) and MVit + N3 groups (- 1.01, 95 %CI, - 1.98, - 0.04) groups, both being significant (p < 0.05) vs. placebo (- 0.57, 95 %CI, - 1.49, 0.35) and N3 (1.11, 95 % CI, 0.07, 2.17). hsCRP (nmol/L) was significantly reduced in the MVit (- 6.00, 95 %CI, - 1.04, - 0.15) and MVit + N3 (- 0.98, 95 %CI, - 1.51, - 0.46) groups, but not vs. placebo (- 0.15, 95 %CI, - 0.74, 0.43) or N3 (- 0.53, 95 %CI, - 1.18, 0.12). Lastly, we observed significant reductions in TG for the N3 (- 0.41, 95 %CI, - 0.69, - 0.13) and MVit + N3 (- 0.71, 95 %CI, - 0.93, - 0.46) groups, both significant vs. placebo (- 0.10, 95 %CI, - 0.36, 0.17) and MVit groups (0.15, 95 %CI, - 12, 0.42). The co-ingestion of MVit + N3 provides synergistic affects on HCY, hsCRP, and plasma TG.

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No relation between biomarkers at age 47–49 and aortic diameter after 14–19 years of follow-up – a population-based study

VASA ◽

10.1024/0301-1526/a000632 ◽

2017 ◽

Vol 46 (4) ◽

pp. 291-295 ◽

Cited By ~ 2

Author(s):

Soumia Taimour ◽

Moncef Zarrouk ◽

Jan Holst ◽

Olle Melander ◽

Gunar Engström ◽

...

Keyword(s):

Population Based ◽

Aortic Diameter ◽

Aortic Dilatation ◽

Population Based Study ◽

Reactive Protein ◽

Abdominal Aortic ◽

Long Term Follow Up ◽

Old Men

Abstract. Background: Biomarkers reflecting diverse pathophysiological pathways may play an important role in the pathogenesis of abdominal aortic aneurysm (aortic diameter ≥30 mm, AAA), levels of many biomarkers are elevated and correlated to aortic diameter among 65-year-old men undergoing ultrasound (US) screening for AAA. Probands and methods: To evaluate potential relationships between biomarkers and aortic dilatation after long-term follow-up, levels of C-reactive protein (CRP), proneurotensin (PNT), copeptin (CPT), lipoprotein-associated phospholipase 2 (Lp-PLA2), cystatin C (Cyst C), midregional proatrial natriuretic peptide (MR-proANP), and midregional proadrenomedullin (MR-proADM) were measured in 117 subjects (114 [97 %] men) aged 47–49 in a prospective population-based cohort study, and related to aortic diameter at US examination of the aorta after 14–19 years of follow-up. Results: Biomarker levels at baseline did not correlate with aortic diameter after 14–19 years of follow up (CRP [r = 0.153], PNT [r = 0.070], CPT [r = –.156], Lp-PLA2 [r = .024], Cyst C [r = –.015], MR-proANP [r = 0.014], MR-proADM [r = –.117]). Adjusting for age and smoking at baseline in a linear regression model did not reveal any significant correlations. Conclusions: Tested biomarker levels at age 47–49 were not associated with aortic diameter at ultrasound examination after 14–19 years of follow-up. If there are relationships between these biomarkers and aortic dilatation, they are not relevant until closer to AAA diagnosis.

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C-reactive protein as a marker of progression of carotid atherosclerosis in subjects with type 2 diabetes mellitus

VASA ◽

10.1024/0301-1526/a000614 ◽

2017 ◽

Vol 46 (3) ◽

pp. 187-192 ◽

Cited By ~ 7

Author(s):

Aleš Pleskovič ◽

Marija Šantl Letonja ◽

Andreja Cokan Vujkovac ◽

Jovana Nikolajević Starčević ◽

Katarina Gazdikova ◽

...

Keyword(s):

Diabetes Mellitus ◽

Carotid Atherosclerosis ◽

Inflammatory Marker ◽

Progression Rate ◽

C Reactive Protein ◽

Reactive Protein ◽

Hs Crp ◽

Unstable Plaques

Abstract. Background: This prospective study was designed to evaluate the effect of inflammatory markers on the presence and progression of subclinical markers of carotid atherosclerosis in a 3.8-year follow-up period in patients with type 2 diabetes mellitus (T2DM). Patients and methods: A total of 595 subjects with T2DM were enrolled. Subclinical markers of carotid atherosclerosis (carotid intima media thickness (CIMT), plaque thickness, and plaques presence) were assessed with ultrasound at the time of recruitment and again after 3.8 years. Subjects with T2DM were divided into 2 groups according to the plasma high sensitive C-reactive protein (hs-CRP) levels (subjects with hs-CRP ≥ 2 mg/L and subjects with hs-CRP below 2 mg/L). Results: Subjects with T2DM and hs-CRP levels ≥ 2 mg/L had higher CIMT in comparison with subjects with T2DM and hs-CRP levels below 2 mg/L, and higher incidence of plaques/unstable plaques in comparison with subjects with T2DM and hs-CRP levels below 2 mg/L. Multivariate logistic regression analysis found the association between the HDL cholesterol level and presence of plaques, whereas the inflammatory marker hs-CRP was not associated with subclinical markers of progression of carotid atherosclerosis. Multiple linear regression analysis found the association between the hs-CRP levels and either CIMT progression rate or a change in the number of sites with plaques in a 3.8-year follow-up. Conclusions: We demonstrated an association between the inflammatory marker hs-CRP and either CIMT or incidence of plaques/unstable plaques at the time of recruitment in Caucasians with T2DM. Moreover, we found the association between hs-CRP levels and either CIMT progression rate or a change in the number of sites with plaques in a 3.8-year follow-up in subjects with T2DM.

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