Septic arthritis

About: Septic arthritis is a research topic. Over the lifetime, 6063 publications have been published within this topic receiving 106893 citations. The topic is also known as: infectious arthritis & Pyogenic arthritis.

Preliminary criteria for the classification of the acute arthritis of primary gout

Abstract: The American Rheumatism Association sub-committe on classification criteria for gout analyzed data from more than 700 patients with gout, pseudogout, rheumatoid arthritis, or septic arthritis. Criteria for classifying a patient as having gout were a) the presence of characteristic urate crystals in the joint fluid, and/or b) a topus proved to contain urate crystals by chemical or polarized light microscopic means, and/or c) the presence of six of the twelve clinical, laboratory, and X-ray phenomena listed in Table 5.

The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study.

Abstract: Background Over 20 years, from October 1989, the Darwin prospective melioidosis study has documented 540 cases from tropical Australia, providing new insights into epidemiology and the clinical spectrum. Principal Findings The principal presentation was pneumonia in 278 (51%), genitourinary infection in 76 (14%), skin infection in 68 (13%), bacteremia without evident focus in 59 (11%), septic arthritis/osteomyelitis in 20 (4%) and neurological melioidosis in 14 (3%). 298 (55%) were bacteremic and 116 (21%) developed septic shock (58 fatal). Internal organ abscesses and secondary foci in lungs and/or joints were common. Prostatic abscesses occurred in 76 (20% of 372 males). 96 (18%) had occupational exposure to Burkholderia pseudomallei. 118 (22%) had a specific recreational or occupational incident considered the likely infecting event. 436 (81%) presented during the monsoonal wet season. The higher proportion with pneumonia in December to February supports the hypothesis of infection by inhalation during severe weather events. Recurrent melioidosis occurred in 29, mostly attributed to poor adherence to therapy. Mortality decreased from 30% in the first 5 years to 9% in the last five years (p<0.001). Risk factors for melioidosis included diabetes (39%), hazardous alcohol use (39%), chronic lung disease (26%) and chronic renal disease (12%). There was no identifiable risk factor in 20%. Of the 77 fatal cases (14%), 75 had at least one risk factor; the other 2 were elderly. On multivariate analysis of risk factors, age, location and season, the only independent predictors of mortality were the presence of at least one risk factor (OR 9.4; 95% CI 2.3–39) and age ≥50 years (OR 2.0; 95% CI 1.2–2.3). Conclusions Melioidosis should be seen as an opportunistic infection that is unlikely to kill a healthy person, provided infection is diagnosed early and resources are available to provide appropriate antibiotics and critical care.

Predictors of infection in rheumatoid arthritis

Abstract: Objective Patients with rheumatoid arthritis (RA) have been shown to have an increased susceptibility to the development of infections The exact causes of this increased risk are unknown, but may relate to immunologic disturbances associated with the disease or to the immunosuppressive effects of agents used in its treatment This study was undertaken to identify predictors of serious infections among patients with RA Identification of such factors is the necessary first step in reducing the excess risk of infection in RA Methods Members of a population-based incidence cohort of Rochester, Minnesota residents ages >18 years, who had been diagnosed with RA between 1955 and 1994, were followed up longitudinally through their complete medical records until January 1, 2000 We examined potential risk factors for the development of all objectively confirmed (by microbiology or radiology) infections and for infections requiring hospitalization Potential risk factors included RA severity measures (rheumatoid factor positivity, elevated erythrocyte sedimentation rate, extraarticular manifestations of RA, and functional status), comorbidities (diabetes mellitus, alcoholism, and chronic lung disease), and other risk factors for infection (presence of leukopenia, smoking) Predictors were identified using multivariate timedependent Cox proportional hazards modeling Results The 609 RA patients in the cohort had a total followup time of 7,7297 person-years (mean 127 years per patient) A total of 389 patients (64%) had at least 1 infection with objective confirmation, and 290 (48%) had at least 1 infection requiring hospitalization Increasing age, presence of extraarticular manifestations of RA, leukopenia, and comorbidities (chronic lung disease, alcoholism, organic brain disease, and diabetes mellitus), as well as use of corticosteroids, were strong predictors of infection (P < 0004) in both univariate and multivariate analyses Notably, use of disease-modifying antirheumatic drugs was not associated with increased risk of infection in multivariate analyses, after adjustment for demographic characteristics, comorbidities, and disease-related variables Conclusion We identified a number of strong predictors of infections in a population-based cohort of patients with RA These results can be used to prospectively identify high-risk patients, who may benefit from closer followup and implementation of preventive strategies Concern about an increased risk of infection among patients with rheumatoid arthritis (RA) has become heightened with recent reports describing severe and opportunistic infections in patients treated with new biologic agents (1–4) Although an increase in the risk of septic arthritis in patients with RA has been reported (5), little is known about the rates of various other infections among these patients In a recent study reported elsewhere in this issue of Arthritis & Rheumatism (6), we found a higher rate of virtually all types of infection in an incidence cohort of patients with RA compared with an age- and sex-matched group of subjects without RA The objective of this companion study was to identify factors that are predictive of the observed increased risk of infection in RA patients The identification of determinants of the risk of infection in RA is the first step toward reducing the excess disease burden associated with infection in these patients

Infections Caused by Streptococcus pneumoniae: Clinical Spectrum, Pathogenesis, Immunity, and Treatment

Abstract: Virtually every attempt to rank bacterial causes of community-acquired pneumonia in adults has placed Streptococcus pneumoniae at the top of the list, although the actual proportion of cases of pneumonia proven to be caused by this organism has varied from 15% to 76% in representative series. In the absence of an epidemic of meningocococcal disease, S. pneumoniae is also the most common cause of bacterial meningitis in adults and the second most common in young children, ranking behind Haemophilus influenzae type b. Blood cultures are positive in 15%-30% of cases of pneumococcal pneumonia, depending upon the population under study and, to a lesser extent, the serotype. Bacteremia-so-called primary bacteremia-may occur without an apparent source; when the disease is associated with an acute, nonspecific febrile illness in young children, harmful consequences may result if antibiotic therapy is not given. Pneumococcal empyema, endocarditis, and pericarditis occur, albeit much less commonly now than in former years. Septic arthritis, osteomyelitis, and peritonitis are seen only infrequently. Other syndromes of serious infection, such as brain abscess, pyomyositis, and peritonitis, are rare. Among less serious disease states, such as otitis media or acute sinusitis, S. pneumoniae remains the most commonly isolated bacterial pathogen when carefully aspirated material is cultured.