Pneumococcal Septic Arthritis: Review of 190 Cases

Ross, John J.; Saltzman, Charles L.; Carling, Philip; Shapiro, Daniel S.

doi:10.1086/345954

Cited by 200 publications

(172 citation statements)

References 79 publications

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“…5 The management of septic arthritis after initiation of parenteral antibiotics involves surgical drainage or repeated aspiration of the infected joint. 10 This approach is difficult with the SC joint. There is often very little fluid to aspirate, and incision and drainage often has poor outcomes.…”

Section: Discussionmentioning

confidence: 99%

Septic Arthritis of the Sternoclavicular Joint

Womack

2012

The Journal of the American Board of Family Medicine

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Septic arthritis is a medical emergency that requires immediate action to prevent significant morbidity and mortality. The sternoclavicular joint may have a more insidious onset than septic arthritis at other sites. A high index of suspicion and judicious use of laboratory and radiologic evaluation can help solidify this diagnosis. The sternoclavicular joint is likely to become infected in the immunocompromised patient or the patient who uses intravenous drugs, but sternoclavicular joint arthritis in the former is uncommon. This case series describes the course of 2 immunocompetent patients who were treated conservatively for septic arthritis of the sternoclavicular joint. Case 1A 50-year-old man presented to his primary care physician with a 1-week history of nausea, vomiting, and diarrhea. His medical history was significant for 1 episode of pseudo-gout. He had no chronic medical illnesses. He was noted to have a heart rate of 60 beats per minute and a blood pressure of 94/58 mm Hg. His heart rate increased to 72 beats per minute while seated. He had presumed gastroenteritis. He was given 2 L intravenous 0.9% normal saline in the outpatient setting, with an increase in blood pressure to 100/68 mm Hg. He was seen 2 days later and was beginning to feel better but had a new complaint of tenderness at the left sternum. The patient began a 5-day course of prednisone. Blood was collected at this time. The next day, blood analysis revealed a critical laboratory value for creatine phosphokinase level of 9005 U/L and an erythrocyte sedimentation rate of 120 mm/hour. The patient was asked to go to the hospital to receive further evaluation. At the time of admission, he continued to complain of left clavicular pain, and the course of prednisone failed to provide any pain relief. The patient denied any current fevers or chills. He was afebrile, and examination revealed a swollen and tender left sternoclavicular (SC) joint. The prostate was normal in size and texture and was not tender during palpation. Laboratory analysis showed a white blood cell count of 19.3 thousand/microliter, with 92% segmented neutrophils and no bands (Table 1). Urinalysis was significant for blood and leukocyte esterase. Blood and urine cultures were obtained. A radiograph of the clavicle was normal. The patient was started on intravenous fluids for the elevated creatine phosphokinase level. Ceftriaxone (1 g intravenous daily) was started for the leukocytosis, pyuria, and history of fever. On hospital day 1, blood and urine cultures yielded Gram-negative bacilli that were later identified as Escherichia coli. It was believed that the E. coli bacteremia seeded the SC joint, leading to septic arthritis. A computed tomography (CT) scan of the sternum was performed to assist with diagnosis and showed no fluid in the SC joint and no sign of bony erosion or sclerosis at the manubrium or medial end of the clavicle. The antibiotic was changed to intravenous ciprofloxacin for better tissue penetration of the urinary tract because the prostate was a concer...

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Section: Discussionmentioning

confidence: 99%

Septic Arthritis of the Sternoclavicular Joint

Womack

2012

The Journal of the American Board of Family Medicine

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“…2 Gramnegative enteric species, such as Escherichia coli and Pseudomonads, are much less common and affect neonates and people with immunodeficiencies. N. gonorrhea is the most common cause in young adults.…”

Section: Discussionmentioning

confidence: 99%

“…N. gonorrhea is the most common cause in young adults. 2 Despite a 64% decline of all gonococcal disease from 1985 to 1997, emerging fluoroquinolone resistance may play a role in the re-emergence of this infection. 3 It is associated with rash, migratory polyarthritis, and tenosynovitis.…”

Section: Discussionmentioning

confidence: 99%

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Primary Meningococcal Arthritis

Harwood

Womack

Kapur

2008

The Journal of the American Board of Family Medicine

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Meningitis and the clinical syndrome of acute meningococcemia are well-described sequelae from infections caused by Neisseria meningitidis. Within the realm of this syndrome, secondary sites of infection are not uncommon. There is a concomitant septic arthritis in 11% of cases of meningococcemia. 1 We describe below the rare clinical scenario of a 29-year-old woman with primary meningococcal arthritis without the clinical syndrome associated with meningococcemia. Case ReportA 29-year-old woman presented to the outpatient office with a chief complaint of an acutely painful and swollen left knee. On awaking that morning, she noted a decreased ability to flex and extend her left knee and extreme pain during ambulation. She had no medical or surgical history and was not on any medications. When doctors inquired about sexual contacts, she stated she had not been sexually active in the past 3 months. Three weeks before, she had a negative screening test for Neisseria gonorrhea and Chlamydia trachomatis during an annual gynecologic examination. She was afebrile and other vital signs were normal. She appeared to be well, but an erythematous, warm, swollen left knee that was diffusely tender to palpation was found. Active and passive range of motion was severely limited secondary to pain. An erythematous, macular rash was noted on the bilateral lower extremities. She was promptly transferred to the hospital with the diagnosis of septic arthritis.Orthopedic surgery consultation was obtained on arrival to the emergency department. Aspiration of the left knee yielded grossly purulent synovial fluid. It was sent for evaluation by Gram stain, culture, cell count, and crystal analysis. Serum laboratory testing for C-reactive protein, complete blood cell count, and 2 sets of blood cultures was performed (see Table 1). The patient was started on Vancomycin 1 g intravenously every 12 hours for Gram-positive bacteria, given the initial gram stain result. She was taken to the operating room for urgent arthroscopic incision, drainage, and lavage of the left knee. During transportation to the operating room, the patient developed pain in the left shoulder. Examination at that time revealed decreased range of motion secondary to pain. Arthrocentesis of the left shoulder, while the patient was under anesthesia, yielded grossly purulent fluid. Open incision and drainage of the left shoulder was performed, followed by arthroscopic incision and drainage of the left knee.On postoperative day 1, blood cultures and synovial fluid cultures collected from operative intervention revealed Gram-negative diplococci. Ceftriaxone 1 g intravenously every 24 hours was initiated for presumed gonococcal arthritis. Soon thereafter, the organisms were identified as Neisseria meningitides; vancomycin was discontinued. Two sets of blood cultures revealed N. meningitidis. The patient had fever of 102.9°F on postoperative day 2, but she remained stable and never showed signs or symptoms of meningitis or the clinical syndrome of meningococcemia during her hosp...

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“…Group B streptococci are an increasing cause of bacterial arthritis in adults with diabetes, malignancy, and genitourinary structural abnormalities [18]. Streococcus pneumonia, traditionally thought of as a rare cause of hematogenous septic arthritis in the antibiotic era, was found to cause 6% of cases in a comprehensive systemic review [19]. Streotococcus suis an emerging zoonotic pathogen in China, Southeast Asia and to lesser extent Europe, has been reported to cause septic arthritis in people exposed to pigs or improperly cooked pork [20].…”

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confidence: 99%