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[Infectious arthritis in a patient with rheumatoid arthritis].

Patients with rheumatoid arthritis are at greater risk of developing joint infections than any other group of patients. Diagnosis is often delayed because of the difficulties in distinguishing between a flare-up and a septic affection of the joint. A case of septic arthritis with multiple joint involvement and lethal outcome despite extensive antibiotic treatment and successive surgical procedures is presented. The patient developed osteomyelitis and multiple organ failure. In order to reduce morbidity and mortality from septic arthritis, early joint puncture and subsequent antibiotic treatment is essential.

Aged↗

Synovial leukocytosis in infectious arthritis.

The clinical presentation of 41 adult patients with infectious arthritis has been reviewed with special emphasis on initial synovial fluid leukocytosis. Fifty percent of the patients with culture-proven joint-space infections had synovial fluid leukocyte counts below 28,000/mm3. Comparison of this investigation with previous studies of similar magnitude demonstrates a striking difference in the mean and median synovial fluid white cell counts. The population reviewed had a higher incidence of patients with potentially immunocompromising medical conditions than previous reports. Similarities between this and previous reports include predisposing conditions, the spectrum of pathogens cultured, associated clinical findings on admission, hospital course, and mortality. The data presented here document the magnitude of potential overlap between the synovial fluid leukocytosis in infected joints and in joints afflicted with other forms of inflammatory arthropathy. Three patients populations (malignant neoplasms, steroid use, and intravenous drug abuse) with positive cultures from synovial fluid aspirates but initial synovial fluid white cell counts averaging below 50,000 cells/mm3 were identified. Patients with moderate synovial fluid leukocytosis, especially those potentially immunocompromised, must be considered to have infectious arthritis unless other causes of inflammatory arthropathies are demonstrated.

Adult↗

Pasteurella multocida infectious arthritis.

Pasteurella multocida, a small gram-negative rod, is a domestic animal saprophyte that occasionally causes disease in humans. Infectious arthritis may develop from a superficial animal bite or scratch. Nine previous cases of infectious arthritis due to this organism have been documented in the literature, and a tenth case is reported here. Most patients had recent animal exposure, and half the patients had underlying chronic rheumatoid arthritis. Clinical signs of inflammation were consistently present; however, systemic infection was infrequent. The lack of positive synovial fluid gram-stain smears may make differentiation from other forms of infectious arthritis difficult. Penicillin in moderate doses is effective therapy, with osteomyelitis developing in only two patients. The tendency for this syndrome to affect patients with rheumatoid arthritis may reflect deficient local defense mechanisms, chronic steroid therapy, or increased ownership of pets. The mechanism of spread of infection to the joint space appears to be through contiguous spread from a skin site rather than by the hematogenous route in most cases.

Aged↗

Infectious arthritis due to Hemophilus influenzae.

A healthy 51-year-old male developed multiarticular infectious arthritis due to Hemophilus influenzae, a rare cause of infectious arthritis in adults. Previous case reports are reviewed. Predisposing factors include chronic illness, underlying joint disease, joint trauma, and respiratory infection. H. influenzae is frequently misidentified on Gram stain, being mistaken for gonococci or pneumococci. Infections due to H. influenzae may occur in normal adults. Aspects of immunity are discussed.

Adult↗

Non-gonococcal infectious arthritis: a retrospective study.

In a retrospective study the outcome of non-gonococcal infectious arthritis was evaluated in 76 adult patients admitted to the Leiden University Hospital between 1970 and 1984. The mortality rate was 12%, and complete recovery was achieved in only 19 of the 76 patients (25%). Each of the following had a significantly unfavourable influence on the residual joint function: duration of infection more than 14 days, female sex, presence of rheumatoid arthritis, and presence of a joint prosthesis.

Adolescent↗

Infectious arthritis: tailoring initial treatment to clinical findings.

Infectious arthritis causes substantial morbidity and mortality. In patients with monoarticular involvement, careful history taking and attention to the clinical presentation aid in timely diagnosis. Certain factors (eg, patient age, structural changes in the joint, presence of chronic disease) provide clues to the likely infectious agent. Antibiotic treatment should be instituted immediately after culture specimens are obtained, and the choice of agent can be modified when antibiotic sensitivities are known. Surgical intervention may be necessary if medical therapy fails. An aggressive approach to evaluation and treatment is warranted when polyarticular infection is suspected.

Adult↗

Infectious arthritis in the neonate caused by Haemophilus influenzae.

Two newborns had hematogenous pyarthrosis due to Haemophilus influenzae. One infant had signs of sepsis and dactylitis involving several fingers and toes. She also developed a soft tissue abscess, meningitis, and a septic hip, and was found to be infected with a nontypable organism. In the second infant, a shoulder traumatized at birth became infected with a type b strain. In both cases, the patients were successfully treated, but delays occurred in selecting the optimal therapeutic agent because of failure to appreciate that Haemophilus may cause systemic infection in the newborn. In the first infant the source of the infection was identified as the mother's endocervical canal. This patient is also of interest because in contrast to previous reports of Haemophilus infection in the newborn, bactericidal activity was present in the maternal serum.

Anti-Bacterial Agents↗

The effects of local administration of lactoferrin on inflammation in murine autoimmune and infectious arthritis.

OBJECTIVE: To determine whether lactoferrin can modify articular inflammation in murine models of autoimmune and septic arthritis. METHODS: Collagen arthritis was induced in DBA/1 mice and Staphylococcus aureus septic arthritis in Swiss mice. Joints with established inflammation were injected periarticularly with 0.5 mg or 1 mg of human lactoferrin, and arthritis was monitored for 3 days. RESULTS: DBA/1 mice injected with lactoferrin showed significantly suppressed local inflammation for up to 3 days, achieving up to 71% of the effect of corticosteroid. Periarticular injection of 125I-lactoferrin confirmed that 25% of lactoferrin was retained in paws after 6 hours. Serum levels of interleukin-6, however, were not significantly reduced, suggesting a predominantly local antiinflammatory effect. Similarly, local, periarticular administration of lactoferrin into S aureus-infected Swiss mice significantly suppressed paw inflammation and did not enhance bacterial survival. CONCLUSION: Lactoferrin may have clinical utility in reducing articular inflammation, particularly in septic arthritis, in which antiinflammatory effects may be achieved without promoting bacterial survival.

Administration, Topical↗