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Sample records for joint infection due

  1. Treatment of prosthetic joint infections due to Propionibacterium

    PubMed Central

    Van Hooff, Miranda L; Meis, Jacques F; Vos, Fidel; Goosen, Jon H M

    2016-01-01

    Background and purpose Currently, Propionibacterium is frequently recognized as a causative microorganism of prosthetic joint infection (PJI). We assessed treatment success at 1- and 2-year follow-up after treatment of Propionibacterium-associated PJI of the shoulder, hip, and knee. Furthermore, we attempted to determine whether postoperative treatment with rifampicin is favorable. Patients and methods We conducted a retrospective cohort study in which we included patients with a primary or revision joint arthroplasty of the shoulder, hip, or knee who were diagnosed with a Propionibacterium-associated PJI between November 2008 and February 2013 and who had been followed up for at least 1 year. Results We identified 60 patients with a Propionibacterium-associated PJI with a median duration of 21 (0.1–49) months until the occurrence of treatment failure. 39 patients received rifampicin combination therapy, with a success rate of 93% (95% CI: 83–97) after 1 year and 86% (CI: 71–93) after 2 years. The success rate was similar in patients who were treated with rifampicin and those who were not. Interpretation Propionibacterium-associated PJI treated with surgery in combination with long-term antibiotic administration had a successful outcome at 1- and 2-year follow-up irrespective of whether the patient was treated with rifampicin. Prospective studies are needed to determine whether the use of rifampicin is beneficial in the treatment of Propionibacterium-associated PJI. PMID:26414972

  2. Bone and Joint Infections due to Haemophilus parainfluenzae: Case Report and Review of the Literature

    PubMed Central

    Wilson, Evan; Missaghi, Bayan

    2016-01-01

    Haemophilus parainfluenzae is a normal inhabitant of the human respiratory tract. However it is an increasingly recognized pathogen in invasive infections, particularly in the immunocompromised host and where there is disruption of the normal skin or mucosal barriers. We present a case of a 56-year-old female with a history of asplenia who developed H. parainfluenzae septic arthritis of the hip following an intra-articular steroid injection. We also summarize previously reported cases of bone and joint infections caused by H. parainfluenzae. PMID:27516778

  3. Characteristics of prosthetic joint infections due to Enterococcus sp. and predictors of failure: a multi-national study.

    PubMed

    Tornero, E; Senneville, E; Euba, G; Petersdorf, S; Rodriguez-Pardo, D; Lakatos, B; Ferrari, M C; Pilares, M; Bahamonde, A; Trebse, R; Benito, N; Sorli, L; del Toro, M D; Baraiaetxaburu, J M; Ramos, A; Riera, M; Jover-Sáenz, A; Palomino, J; Ariza, J; Soriano, A

    2014-11-01

    The objective of this study was to review the characteristics and outcome of prosthetic joint infections (PJI) due to Enterococcus sp. collected in 18 hospitals from six European countries. Patients with a PJI due to Enterococcus sp. diagnosed between January 1999 and July 2012 were retrospectively reviewed. Relevant information about demographics, comorbidity, clinical characteristics, microbiological data, surgical treatment and outcome was registered. Univariable and multivariable analyses were performed. A total of 203 patients met the inclusion criteria. The mean (SD) was 70.4 (13.6) years. In 59 patients the infection was diagnosed within the first 30 days (29.1%) from arthroplasty, in 44 (21.7%) between 31 and 90 days, in 54 (26.6%) between 91 days and 2 years and in 43 (21%) after 2 years. Enterococcus faecalis was isolated in 176 cases (89%). In 107 (54%) patients the infection was polymicrobial. Any comorbidity (OR 2.53, 95% CI 1.18-5.40, p 0.01), and fever (OR 2.65, 95% CI 1.23-5.69, p 0.01) were independently associated with failure. The only factor associated with remission was infections diagnosed later than 2 years (OR 0.25, 95% CI 0.09-0.71, p 0.009). In conclusion, prosthetic joint infections due to Enterococcus sp. were diagnosed within the first 2 years from arthroplasty in >70% of the patients, almost 50% had at least one comorbidity and infections were frequently polymicrobial (54%). The global failure rate was 44% and patients with comorbidities, fever, and diagnosed within the first 2 years from arthroplasty had a poor prognosis.

  4. Complex prosthetic joint infections due to carbapenemase-producing Klebsiella pneumoniae: a unique challenge in the era of untreatable infections☆

    PubMed Central

    de Sanctis, Jorgelina; Teixeira, Lucileia; van Duin, David; Odio, Camila; Hall, Geraldine; Tomford, J. Walton; Perez, Federico; Rudin, Susan D.; Bonomo, Robert A.; Barsoum, Wael K.; Joyce, Michael; Krebs, Viktor; Schmitt, Steven

    2015-01-01

    SUMMARY Objectives Limited clinical experience exists regarding the management of prosthetic joint infection (PJI) due to multidrug-resistant (MDR) Gram-negative organisms. We review three cases of carbapenem-resistant Klebsiella pneumoniae (CRKP) complicating PJI. Methods This was a retrospective study of all patients at a tertiary care institution with CRKP complicating PJI between January 2007 and December 2010. Demographic data, procedures, organisms involved, length of stay, antibiotic treatments, and outcomes were collected. Antimicrobial susceptibility testing was performed on CRKP isolates, and the mechanism of resistance was ascertained by PCR. Results This analysis demonstrated that: (1) the CRKP possessed blaKPC and were difficult to eradicate (persistent) in PJI; (2) multiple surgeries and antibiotic courses were undertaken and patients required a prolonged length of stay; (3) resistance to colistin and amikacin emerged on therapy; (4) the same strain of CRKP may be responsible for relapse of infection; (5) significant morbidity and mortality resulted. Conclusions These cases highlight the opportunistic and chronic nature of CRKP in PJIs and the need for aggressive medical and surgical treatment. Further investigations of the management of CRKP PJI and new drug therapies for infections due to MDR Gram-negative organisms are urgently needed. PMID:24813874

  5. Periprosthetic Joint Infections

    PubMed Central

    Lima, Ana Lucia L.; Oliveira, Priscila R.; Carvalho, Vladimir C.; Saconi, Eduardo S.; Cabrita, Henrique B.; Rodrigues, Marcelo B.

    2013-01-01

    Implantation of joint prostheses is becoming increasingly common, especially for the hip and knee. Infection is considered to be the most devastating of prosthesis-related complications, leading to prolonged hospitalization, repeated surgical intervention, and even definitive loss of the implant. The main risk factors to periprosthetic joint infections (PJIs) are advanced age, malnutrition, obesity, diabetes mellitus, HIV infection at an advanced stage, presence of distant infectious foci, and antecedents of arthroscopy or infection in previous arthroplasty. Joint prostheses can become infected through three different routes: direct implantation, hematogenic infection, and reactivation of latent infection. Gram-positive bacteria predominate in cases of PJI, mainly Staphylococcus aureus and Staphylococcus epidermidis. PJIs present characteristic signs that can be divided into acute and chronic manifestations. The main imaging method used in diagnosing joint prosthesis infections is X-ray. Computed tomography (CT) scan may assist in distinguishing between septic and aseptic loosening. Three-phase bone scintigraphy using technetium has high sensitivity, but low specificity. Positron emission tomography using fluorodeoxyglucose (FDG-PET) presents very divergent results in the literature. Definitive diagnosis of infection should be made by isolating the microorganism through cultures on material obtained from joint fluid puncturing, surgical wound secretions, surgical debridement procedures, or sonication fluid. Success in treating PJI depends on extensive surgical debridement and adequate and effective antibiotic therapy. Treatment in two stages using a spacer is recommended for most chronic infections in arthroplasty cases. Treatment in a single procedure is appropriate in carefully selected cases. PMID:24023542

  6. Role of MRI in detecting early physeal changes due to acute osteoarticular infection around the knee joint: a pilot study

    PubMed Central

    Gill, Shivinder; Wardak, Mussa; Sen, Ramesh; Singh, Paramjeet; Kumar, Vishal; Saini, Raghav; Jha, Namita

    2008-01-01

    Physeal changes of any aetiology in children are usually diagnosed once the deformity is clinically evident. Between January 2006 and June 2007, 15 children who suffered from acute osteoarticular infection around the knee joint were studied. They were called up for follow-up six months after the onset of infection. All patients were evaluated by clinical and roentgenographic examination before undergoing magnetic resonance imaging (MRI) study of both knees “with the unaffected knee serving as control”. Abnormal findings in the physis, metaphysis and/or epiphysis on MRI were observed in five children. This group of five children was compared with the other ten children for clinical presentation and course of disease. We believe that MRI is a useful tool in the evaluation of growth plate insult in the early period following acute osteoarticular infection, and we can diagnose and prevent the catastrophic complications of the same. PMID:18670775

  7. Prosthetic Joint Infection

    PubMed Central

    Tande, Aaron J.

    2014-01-01

    SUMMARY Prosthetic joint infection (PJI) is a tremendous burden for individual patients as well as the global health care industry. While a small minority of joint arthroplasties will become infected, appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity. In this review, we describe the reported risk factors for and clinical manifestations of PJI. We discuss the pathogenesis of PJI and the numerous microorganisms that can cause this devastating infection. The recently proposed consensus definitions of PJI and approaches to accurate diagnosis are reviewed in detail. An overview of the treatment and prevention of this challenging condition is provided. PMID:24696437

  8. Prevention of Periprosthetic Joint Infection

    PubMed Central

    Shahi, Alisina; Parvizi, Javad

    2015-01-01

    Prosthetic joint infection (PJI) is a calamitous complication with high morbidity and substantial cost. The reported incidence is low but it is probably underestimated due to the difficulty in diagnosis. PJI has challenged the orthopaedic community for several years and despite all the advances in this field, it is still a real concern with immense impact on patients, and the healthcare system. Eradication of infection can be very difficult. Therefore, prevention remains the ultimate goal. The medical community has executed many practices with the intention to prevent infection and treat it effectively when it encounters. Numerous factors can predispose patients to PJI. Identifying the host risk factors, patients’ health modification, proper wound care, and optimizing operative room environment remain some of the core fundamental steps that can help minimizing the overall incidence of infection. In this review we have summarized the effective prevention strategies along with the recommendations of a recent International Consensus Meeting on Surgical Site and Periprosthetic Joint Infection. PMID:26110171

  9. Antimicrobial-related severe adverse events during treatment of bone and joint infection due to methicillin-susceptible Staphylococcus aureus.

    PubMed

    Valour, Florent; Karsenty, Judith; Bouaziz, Anissa; Ader, Florence; Tod, Michel; Lustig, Sébastien; Laurent, Frédéric; Ecochard, René; Chidiac, Christian; Ferry, Tristan

    2014-01-01

    Prolonged antimicrobial therapy is recommended for methicillin-susceptible Staphylococcus aureus (MSSA) bone and joint infections (BJI), but its safety profile and risk factors for severe adverse events (SAE) in clinical practice are unknown. We addressed these issues in a retrospective cohort study (2001 to 2011) analyzing antimicrobial-related SAE (defined according to the Common Terminology Criteria for Adverse Events) in 200 patients (male, 62%; median age, 60.8 years [interquartile range {IQR}, 45.5 to 74.2 years]) with MSSA BJI admitted to a reference regional center with acute (66%) or chronic arthritis (7.5%), osteomyelitis (9.5%), spondylodiscitis (16%), or orthopedic device-related infections (67%). These patients received antistaphylococcal therapy for a median of 26.6 weeks (IQR, 16.8 to 37.8 weeks). Thirty-eight SAE occurred in 30 patients (15%), with a median time delay of 34 days (IQR, 14.75 to 60.5 days), including 10 patients with hematologic reactions, 9 with cutaneomucosal reactions, 6 with acute renal injuries, 4 with hypokalemia, and 4 with cholestatic hepatitis. The most frequently implicated antimicrobials were antistaphylococcal penicillins (ASP) (13 SAE/145 patients), fluoroquinolones (12 SAE/187 patients), glycopeptides (9 SAE/101 patients), and rifampin (7 SAE/107 patients). Kaplan-Meier curves and stepwise binary logistic regression analyses were used to determine the risk factors for the occurrence of antimicrobial-related SAE. Age (odds ratio [OR], 1.479 for 10-year increase; 95% confidence interval [CI], 1.116 to 1.960; P = 0.006) appeared to be the only independent risk factor for SAE. In patients receiving ASP or rifampin, daily dose (OR, 1.028; 95% CI, 1.006 to 1.051; P = 0.014) and obesity (OR, 8.991; 95% CI, 1.453 to 55.627; P = 0.018) were associated with the occurrence of SAE. The high rate of SAE and their determinants highlighted the importance of the management and follow-up of BJI, with particular attention to be paid to

  10. Antimicrobial-Related Severe Adverse Events during Treatment of Bone and Joint Infection Due to Methicillin-Susceptible Staphylococcus aureus

    PubMed Central

    Valour, Florent; Karsenty, Judith; Bouaziz, Anissa; Ader, Florence; Tod, Michel; Lustig, Sébastien; Laurent, Frédéric; Ecochard, René; Chidiac, Christian

    2014-01-01

    Prolonged antimicrobial therapy is recommended for methicillin-susceptible Staphylococcus aureus (MSSA) bone and joint infections (BJI), but its safety profile and risk factors for severe adverse events (SAE) in clinical practice are unknown. We addressed these issues in a retrospective cohort study (2001 to 2011) analyzing antimicrobial-related SAE (defined according to the Common Terminology Criteria for Adverse Events) in 200 patients (male, 62%; median age, 60.8 years [interquartile range {IQR}, 45.5 to 74.2 years]) with MSSA BJI admitted to a reference regional center with acute (66%) or chronic arthritis (7.5%), osteomyelitis (9.5%), spondylodiscitis (16%), or orthopedic device-related infections (67%). These patients received antistaphylococcal therapy for a median of 26.6 weeks (IQR, 16.8 to 37.8 weeks). Thirty-eight SAE occurred in 30 patients (15%), with a median time delay of 34 days (IQR, 14.75 to 60.5 days), including 10 patients with hematologic reactions, 9 with cutaneomucosal reactions, 6 with acute renal injuries, 4 with hypokalemia, and 4 with cholestatic hepatitis. The most frequently implicated antimicrobials were antistaphylococcal penicillins (ASP) (13 SAE/145 patients), fluoroquinolones (12 SAE/187 patients), glycopeptides (9 SAE/101 patients), and rifampin (7 SAE/107 patients). Kaplan-Meier curves and stepwise binary logistic regression analyses were used to determine the risk factors for the occurrence of antimicrobial-related SAE. Age (odds ratio [OR], 1.479 for 10-year increase; 95% confidence interval [CI], 1.116 to 1.960; P = 0.006) appeared to be the only independent risk factor for SAE. In patients receiving ASP or rifampin, daily dose (OR, 1.028; 95% CI, 1.006 to 1.051; P = 0.014) and obesity (OR, 8.991; 95% CI, 1.453 to 55.627; P = 0.018) were associated with the occurrence of SAE. The high rate of SAE and their determinants highlighted the importance of the management and follow-up of BJI, with particular attention to be paid to

  11. Prosthetic Joint Infection due to Mycobacterium avium-intracellulare in a Patient with Rheumatoid Arthritis: A Case Report and Review of the Literature

    PubMed Central

    Schneider, Brenton; Alpern, Jonathan D.

    2017-01-01

    Nontuberculous mycobacteria (NTM) are a rare cause of prosthetic joint infections (PJI). However, the prevalence of NTM infections may be increasing with the rise of newer immunosuppressive medications such as biologics. In this case report, we describe a rare complication of immunosuppressive therapies and highlight the complexity of diagnosing and treating PJI due to NTM. The patient is a 79-year-old Caucasian male with a history of severe destructive rheumatoid arthritis on several immunosuppressive agents and right hip osteoarthritis s/p total hip arthroplasty 15 years previously with several complex revisions, presenting with several weeks of worsening right hip and abdominal pain. A right hip CT scan revealed periprosthetic fluid collections. Aspiration of three fluid pockets was AFB smear-positive and grew Mycobacterium avium-intracellulare. The patient was deemed a poor surgical candidate. He underwent a limited I&D and several months of antimycobacterial therapy but clinically deteriorated and opted for hospice care. PJI caused by NTM are rare and difficult to treat. The increased use of biologics and prosthetic joint replacements over the past several decades may increase the risk of PJI due to NTM. A high index of suspicion for NTM in immunosuppressed patients with PJI is needed. PMID:28280641

  12. A new model of experimental prosthetic joint infection due to methicillin-resistant Staphylococcus aureus: a microbiologic, histopathologic, and magnetic resonance imaging characterization.

    PubMed

    Belmatoug, N; Crémieux, A C; Bleton, R; Volk, A; Saleh-Mghir, A; Grossin, M; Garry, L; Carbon, C

    1996-08-01

    Partial knee arthroplasty was done in rabbits with a silicone-elastomer implant. Immediately after closing the surgical wound, 5 x 10(6) cfu of methicillin-resistant Staphylococcus aureus was injected into the joint. Disease evolution was studied at different stages of infection up to 8 weeks. Prosthetic infection developed in all animals. Gross pathology and histopathologic changes were characteristic of joint and bone infection. Quantitative bacterial counts from infected bone confirmed disease chronicity. The mean number of colony-forming units per gram of bone +/- SD 1 week after infection was 4.84 +/- 0.24 log10 cfu/g and remained stable from week 1 to week 8. Magnetic resonance imaging showed evidence of prosthetic infection as of week 1, while only mild radiologic changes of bone were seen 2 weeks after infection. This model produces a prosthetic infection that is reproducible and close to that of human prosthetic infection.

  13. Activation of Natural Killer Cells in Patients with Chronic Bone and Joint Infection due to Staphylococci Expressing or Not the Small Colony Variant Phenotype

    PubMed Central

    Viel, Sébastien; Rouzaire, Paul; Laurent, Frédéric; Walzer, Thierry; Bienvenu, Jacques; Valour, Florent; Chidiac, Christian; Ferry, Tristan; Group, The Lyon BJI Study

    2014-01-01

    Chronic bone and joint infections (BJI) are devastating diseases. Relapses are frequently observed, as some pathogens, especially staphylococci, can persist intracellularly by expressing a particular phenotype called small colony variant (SCV). As natural killer (NK) cells are lymphocytes specialized in the killing of host cells infected by intracellular pathogens, we studied NK cells of patients with chronic BJI due to staphylococci expressing or not SCVs (10 patients in both groups). Controls were patients infected with other bacteria without detectable expression of SCVs, and healthy volunteers. NK cell phenotype was evaluated from PBMCs by flow cytometry. Degranulation capacity was evaluated after stimulation with K562 cells in vitro. We found that NK cells were activated in terms of CD69 expression, loss of CD16 and perforin, in all infected patients in comparison with healthy volunteers, independently of the SCV phenotype. Peripheral NK cells in patients with chronic BJI display signs of recent activation and degranulation in vivo in response to CD16-mediated signals, regardless of the type of bacteria involved. This could involve a universal capacity of isolates responsible for chronic BJI to produce undetectable SCVs in vivo, which might be a target of future intervention. PMID:26464851

  14. [Infections due to Mycobacterium simiae].

    PubMed

    García-Martos, Pedro; García-Agudo, Lidia; González-Moya, Enrique; Galán, Fátima; Rodríguez-Iglesias, Manuel

    2015-10-01

    Mycobacterium simiae is a slow-growing photochromogenic environmental mycobacterium, first described in 1965. Rarely associated with human infections, possibly due to its limited pathogenicity, it mainly produces lung infection in immunocompetent elderly patients with underlying lung disease, and in disseminated infections in immunosuppressed young patients with AIDS. A microbiological culture is needed to confirm the clinical suspicion, and genetic sequencing techniques are essential to correctly identify the species. Treating M. simiae infections is complicated, owing to the multiple resistance to tuberculous drugs and the lack of correlation between in vitro susceptibility data and in vivo response. Proper treatment is yet to be defined, but must include clarithromycin combined with other antimicrobials such as moxifloxacin and cotrimoxazole. It is possible that M. simiae infections are undiagnosed.

  15. Management of Periprosthetic Hip Joint Infection

    PubMed Central

    Lee, Hee Dong; Prashant, Kumar

    2015-01-01

    Total hip joint replacement offers dramatic improvement in the quality of life but periprosthetic joint infection (PJI) is the most devastating complication of this procedure. The infection threatens the function of the joint, the preservation of the limb, and occasionally even the life of the patient due to long term hospitalization and high cost. For the surgeon it is a disastrous burden, which requires repeated, complicated procedures to eradicate infection and to provide a mobile joint without pain. Yet in the absence of a true gold standard, the diagnosis of PJI can be elusive. Synovial fluid aspiration, diagnostic imaging, traditional culture, peripheral serum inflammatory markers, and intraoperative frozen sections each have their limitations but continue to be the mainstay for diagnosis of PJI. Treatment options mainly include thorough irrigation and debridement with prosthesis retention, or a two-stage prosthesis exchange with intervening placement of an antibiotic-loaded spacer. Success in treating PJI depends on extensive surgical debridement and adequate and effective antibiotic therapy. Treatment in two stages using a spacer is recommended for most chronic PJI. Debridement, antibiotics and implant retention is the obvious choice for treatment of acute PJI, with good success rates in selected patients. This article presents an overview of recent management concepts for PJI of the hip emphasizing diagnosis and the clinical approach, and also share own experience at our institution. PMID:27536605

  16. Periprosthetic Joint Infections: Clinical and Bench Research

    PubMed Central

    Legout, Laurence; Senneville, Eric

    2013-01-01

    Prosthetic joint infection is a devastating complication with high morbidity and substantial cost. The incidence is low but probably underestimated. Despite a significant basic and clinical research in this field, many questions concerning the definition of prosthetic infection as well the diagnosis and the management of these infections remained unanswered. We review the current literature about the new diagnostic methods, the management and the prevention of prosthetic joint infections. PMID:24288493

  17. Pyogenic arthritis of native joints due to Bacteroides fragilis

    PubMed Central

    Nolla, Joan M.; Murillo, Oscar; Narvaez, Javier; Vaquero, Carmen Gómez; Lora-Tamayo, Jaime; Pedrero, Salvador; Cabo, Javier; Ariza, Javier

    2016-01-01

    Abstract Pyogenic arthritis of native joints due to Bacteroides fragilis seems to be an infrequent disease. We analyzed the cases diagnosed in a tertiary hospital during a 22-year period and reviewed the literature to summarize the experience with this infectious entity. In our institution, of 308 patients with pyogenic arthritis of native joints, B fragilis was the causative organism in 2 (0.6%) cases. A MEDLINE search (1981–2015) identified 19 additional cases. Of the 21 patients available for review (13 men and 8 women, with a mean age, of 54.4 ± 17 years), 19 (90%) presented a systemic predisposing factor for infection; the most common associated illness was rheumatoid arthritis (8 patients). Bacteremia was documented in 65% (13/20) of cases. In 5 patients (24%), 1 or more concomitant infectious process was found. Metronidazole was the most frequently used antibiotic. Surgical drainage was performed in 11 cases (52%). The overall mortality rate was 5%. Pyogenic arthritis of native joints due to B fragilis is an infrequent disease that mainly affects elderly patients with underlying medical illnesses and in whom bacteremia and the presence of a concomitant infectious process are frequent conditions. PMID:27336895

  18. [Joint infections. Known facts and new trends].

    PubMed

    Diefenbeck, M; Abitzsch, D; Hofmann, G O

    2012-06-01

    Acute septic arthritis is a surgical emergency because rapid septic destruction of articular cartilage can lead to impairment or even loss of joint function. Diagnosis consists of patient history, clinical examination, laboratory results, (sonography- guided) joint aspiration and radiography. Emergency therapy is based on arthroscopic or open joint debridement and lavage combined with systemic antibiotic therapy. No data are available for the recommendation of local antibiotics but antiseptic solutions are not recommended because of cartilage damage. New trends in diagnostics are positron emission tomography/computed tomography (PET/CT), urine sticks for analysis of joint fluid and molecular pathology. Chronic joint empyema is more diagnostically demanding and is difficult to treat. In cases of necrotic and infected articular cartilage, joint resection has to be performed for quiescence of infection. Options following successful treatment of empyema are arthroplasty, arthrodesis or permanent resection.

  19. Osteoarticular infections due to Kingella kingae in children.

    PubMed

    Lacour, M; Duarte, M; Beutler, A; Auckenthaler, R; Suter, S

    1991-07-01

    By the description of two cases of osteoarticular infections due to Kingella kingae in two young children we wish to draw the attention of clinicians to invasive infections due to this micro-organism. Since its biological characterization in 1976, K. kingae has been increasingly reported as a human pathogen. Most common presentations are endocarditis, bacteraemia, septic arthritis, osteomyelitis and spondylodiscitis. Interestingly, osteorticular involvement is largely predominant in previously healthy children. From the literature, we reviewed 51 cases of K. kingae bone and joint infections, representing 23 cases of septic arthritis, 17 of osteomyelitis and 11 spondylodiscitis. Of the cases 88% occurred in children below 5 years of age and in all cases only one bone or joint was involved. An underlying disorder could be found in only 4 patients. Since these infections have a favourable outcome with intravenous antibiotic treatment, proper isolation and identification of K. kingae is essential.

  20. The Diagnosis of Periprosthetic Joint Infection.

    PubMed

    Springer, Bryan D

    2015-06-01

    Periprosthetic joint infection remains one of the most common failure modes following total hip and total knee arthroplasty. As such, a systematic and cost effective approach to the evaluation and work-up of a patient with a suspected periprosthetic joint infection should be undertaken in every patient with a painful total joint. Although we have many diagnostic tools, a history and physical remain the most important. Many of the current laboratory tests are indirect measure of infection, lack specificity for diagnosis of infection, but serve as sensitive and cost effective screening tools. In addition, a new definition of periprosthetic infection helps to standardize the diagnosis. Biomarkers hold the promise of improved specificity and are becoming increasingly popular as a diagnostic tool.

  1. Granulicatella adiacens prosthetic hip joint infection after dental treatment

    PubMed Central

    Sundararajan, Sabapathy; Teferi, Abraham

    2016-01-01

    Introduction: Granulicatella adiacens is a Gram-positive bacteria and a normal component of oral flora. It is also found in dental plaques, endodontic abscesses and can rarely cause more serious infections. Case presentation: We describe a prosthetic hip joint infection in an 81-year-old fit and healthy man due to Granulicatella adiacens who underwent a prolonged dental intervention two days earlier without antibiotic prophylaxis. The infection was successfully treated with surgical intervention and a combination of antibiotics. The patient eventually succumbed to severe community-acquired pneumonia two months later. Conclusion: Current guidelines recommend avoidance of antibiotic prophylaxis prior to dental treatment in patients who have no co-morbidities and no prior operation on the index prosthetic joint. This case report indicates that infections of prosthetic joints may be associated with dental procedures even in fit and healthy patients without the recognized risk factors. PMID:28348763

  2. Pathogenic organisms in hip joint infections

    PubMed Central

    Geipel, Udo

    2009-01-01

    Infections of the hip joint are usually of bacterial etiology. Only rarely, an infectious arthritis is caused in this localization by viruses or fungi. Native joint infections of the hip are less common than infections after implantation of prosthetic devices. Difficulties in prosthetic joint infections are, (I) a higher age of patients, and, thus an associated presence of other medical risk factors, (II) often long courses of treatment regimes depending on the bacterium and its antibiotic resistance, (III) an increased mortality, and (IV) a high economic burden for removal and reimplantation of an infected prosthetic device. The pathogenic mechanisms responsible for articular infections are well studied only for some bacteria, e.g. Staphylococcus aureus, while others are only partially understood. Important known bacterial properties and microbiological characteristics of infection are the bacterial adhesion on the native joint or prosthetic material, the bacterial biofilm formation, the development of small colony variants (SCV) as sessile bacterial types and the increasing resistance to antibiotics. PMID:19834588

  3. Infections due to Lancefield group C streptococci.

    PubMed

    Salata, R A; Lerner, P I; Shlaes, D M; Gopalakrishna, K V; Wolinsky, E

    1989-07-01

    Our experience with group C streptococcal infection over the past 15 years demonstrates an important and emerging role for this hemolytic organism as an opportunistic and nosocomial pathogen. Significant risk factors in this predominantly male population included chronic cardiopulmonary disease, diabetes, malignancy, and alcoholism. Bacteremia occurred in 74% of cases seen in our series. Nosocomial acquisition of infection was observed in 26%, and infection was frequently polymicrobial in nature with gram-negative enteric bacilli isolated most commonly along with group C streptococci. We observed a broad spectrum of infections including puerperal sepsis, pleuropulmonary infections, skin and soft-tissue infection, central nervous system infection, endocarditis, urinary tract infection, and pharyngeal infections. Several cases of bacteremia of unknown source were observed in neutropenic patients with underlying leukemia. New syndromes of infection due to group C streptococci observed in our series included intra-abdominal abscess, epidural abscess, and dialysis-associated infection. Response to therapy and outcome was related to the underlying disease. While the literature suggests that patients with group C endocarditis respond better to synergistic penicillin-aminoglycoside regimens, patient numbers are too small to draw definite conclusions. The clinical significance of antibiotic tolerant group C streptococci remains uncertain. In patients with serious group C infections including endocarditis, meningitis, septic arthritis, or bacteremia in neutropenic hosts, we advocate the initial use of cell-wall-acting agents in combination with an aminoglycoside.

  4. Unusual case of paediatric septic arthritis of the lumbar facet joints due to Kingella kingae.

    PubMed

    Le Hanneur, M; Vidal, C; Mallet, C; Mazda, K; Ilharreborde, B

    2016-11-01

    A 32-month-old boy presented with febrile limping that had developed over 6days, associated with right lumbosacral inflammatory swelling. Magnetic resonance imaging (MRI) showed joint effusion of the right L5-S1 zygapophyseal joint, complicated by destructive osteomyelitis of the L5 articular process and paraspinal abscess. Surgery was decided to evacuate the fluid accumulation and rule out differential diagnoses. The diagnosis of septic arthritis of the facet joint was confirmed intraoperatively; real-time quantitative PCR analysis identified Kingella kingae. This is the first substantiated paediatric case of zygapophyseal joint septic arthritis due to K. kingae. K. kingae is the most common pathogen responsible for invasive osteoarticular infection in children under 4years of age. Since empiric antibiotics are effective in early stages, physicians should consider the possibility of spinal infections due to K. kingae when a limping child under 4years of age presents with a fever.

  5. Retinitis due to opportunistic infections in Iranian HIV infected patients.

    PubMed

    Abdollahi, Ali; Mohraz, Minoo; Rasoulinejad, Mehrnaz; Shariati, Mona; Kheirandish, Parastou; Abdollahi, Maryam; Soori, Tahereh

    2013-01-01

    We tried to evaluate prevalence and characteristics of Iranian HIV infected patients with retinitis due to opportunistic infections. In this cross sectional study, we evaluated 106 HIV infected patients via indirect ophthalmoscopy and slit lamp examination by 90 lens to find retinitis cases. General information and results of ophthalmologic examination were analyzed. Prevalence of retinitis due to opportunistic infections was 6.6%: cytomegalovirus (CMV) retinitis 1.88%, toxoplasmosis retinochoroiditis 1.88% and tuberculosis chorioretinitis 2.83%. CD4 count was higher than 50 cell/µlit in both cases with CMV retinitis. Along with increasing survival in the HIV infected patients, the prevalence of complications such as ocular manifestation due to opportunistic infections are increasing and must be more considered.

  6. Reducing periprosthetic joint infection: what really counts?

    PubMed Central

    SOLARINO, GIUSEPPE; ABATE, ANTONELLA; VICENTI, GIOVANNI; SPINARELLI, ANTONIO; PIAZZOLLA, ANDREA; MORETTI, BIAGIO

    2015-01-01

    Periprosthetic joint infection (PJI) remains one of the most challenging complications after joint arthroplasty. Despite improvements in surgical techniques and in the use of antibiotic prophylaxis, it remains a major cause of implant failure and need for revision. PJI is associated with both human host-related and bacterial agent-related factors that can interact in all the phases of the procedure (preoperative, intraoperative and postoperative). Prevention is the first strategy to implement in order to minimize this catastrophic complication. The present review focuses on the preoperative period, and on what to do once risk factors are fully understood and have been identified. PMID:26904527

  7. Prosthetic joint infection caused by Trueperella bernardiae.

    PubMed

    Gilarranz, Raul; Chamizo, Francisco; Horcajada, Iballa; Bordes-Benítez, Ana

    2016-09-01

    Trueperella bernardiae is a Gram-positive coryneform bacilli which role as human pathogen is unknown because it has been usually considered a contaminant. Furthermore its identification by biochemical test was difficult. We describe a prosthetic joint infection in a women who years ago underwent a total knee replacement with superinfection and necrosis of the patellar tendon as major complications. In the sample of synovial fluid collected grew a gram-positive bacilli which was identified by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) as T. bernardiae. The patient was treated with ciprofloxacin and currently preserves the prosthesis without signs of infection.

  8. Prosthetic vascular graft infection and prosthetic joint infection caused by Pseudomonas stutzeri.

    PubMed

    Bonares, Michael J; Vaisman, Alon; Sharkawy, Abdu

    2016-01-01

    Pseudomonas stutzeri is infrequently isolated from clinical specimens, and if isolated, more likely represents colonization or contamination rather than infection. Despite this, there are dozens of case reports which describe clinically significant P. stutzeri infections at variable sites. A 69-year-old man had a P. stutzeri infection of a prosthetic vascular graft infection, which he received in Panama City. He was successfully treated with a single antipseudomonal agent for 6 weeks and the removal of the infected vascular graft. A 70-year-old man had a P. stutzeri infection of a prosthetic joint, which was successfully treated with a single anti-pseudomonal agent for 6 weeks. There is only one other documented case of a prosthetic vascular graft infection secondary to P. stutzeri. There are 5 documented cases of P. stutzeri prosthetic joint infections. The previous cases were treated with antibiotics and variably, source control with the removal of prosthetic material. Most cases of P. stutzeri infection are due to exposure in health care settings. Immunocompromised states such as HIV or hematological and solid tumor malignancies are risk factors for P. stutzeri infection. Infections caused by P. stutzeri are far less frequent and less fatal than those caused by P. aeruginosa. The etiology of a P. stutzeri infection could be exposure to soil and water, but also contaminated material in the health care setting or an immunocompromised state. Iatrogenic infections that are secondary to health care tourism are a potential cause of fever in the returned traveler.

  9. Staphylococcus capitis isolated from prosthetic joint infections.

    PubMed

    Tevell, S; Hellmark, B; Nilsdotter-Augustinsson, Å; Söderquist, B

    2017-01-01

    Further knowledge about the clinical and microbiological characteristics of prosthetic joint infections (PJIs) caused by different coagulase-negative staphylococci (CoNS) may facilitate interpretation of microbiological findings and improve treatment algorithms. Staphylococcus capitis is a CoNS with documented potential for both human disease and nosocomial spread. As data on orthopaedic infections are scarce, our aim was to describe the clinical and microbiological characteristics of PJIs caused by S. capitis. This retrospective cohort study included three centres and 21 patients with significant growth of S. capitis during revision surgery for PJI between 2005 and 2014. Clinical data were extracted and further microbiological characterisation of the S. capitis isolates was performed. Multidrug-resistant (≥3 antibiotic groups) S. capitis was detected in 28.6 % of isolates, methicillin resistance in 38.1 % and fluoroquinolone resistance in 14.3 %; no isolates were rifampin-resistant. Heterogeneous glycopeptide-intermediate resistance was detected in 38.1 %. Biofilm-forming ability was common. All episodes were either early post-interventional or chronic, and there were no haematogenous infections. Ten patients experienced monomicrobial infections. Among patients available for evaluation, 86 % of chronic infections and 70 % of early post-interventional infections achieved clinical cure; 90 % of monomicrobial infections remained infection-free. Genetic fingerprinting with repetitive sequence-based polymerase chain reaction (rep-PCR; DiversiLab®) displayed clustering of isolates, suggesting that nosocomial spread might be present. Staphylococcus capitis has the potential to cause PJIs, with infection most likely being contracted during surgery or in the early postoperative period. As S. capitis might be an emerging nosocomial pathogen, surveillance of the prevalence of PJIs caused by S. capitis could be recommended.

  10. Of bugs and joints: the relationship between infection and joints.

    PubMed

    Espinoza, Luis R; García-Valladares, Ignacio

    2013-01-01

    The association between microbes and joints has existed since antiquity, and remains complex. Diagnosis is often times difficult to determine despite highly suspicious clinical characteristics for the presence of an underlying infection. Over the several past decades, considerable advances have occurred in diagnostic methodologies and therapy. However, the morbidity and mortality of septic arthritis remains high. Great advances have occurred in the diagnosis, pathogenesis, and therapeutic management of reactive arthritis, and there is evidence that when the responsible microorganism is Chlamydia trachomathis, complete remission and cure is possible. Emergent infections, especially viral, has been recognized, i.e. HIV, hepatitis C, and most recently Chikengunya virus, and in the case of HIV associated articular manifestations, the introduction of HAART has resulted in a decrease in the incidence and development of newer complications such as the immune reconstitution syndrome. The infectious etiology of rheumatoid arthritis is being strongly considered once again, and the exciting association with periodontal disease is at the forefront of intense research. The gut microbiota is also being investigated and new and most interesting data is being gathered of the potential role of commensal gut organisms and the pathogenesis of rheumatoid arthritis.

  11. Pneumonia due to Enterobacter cancerogenus infection.

    PubMed

    Demir, Tülin; Baran, Gamze; Buyukguclu, Tuncay; Sezgin, Fikriye Milletli; Kaymaz, Haci

    2014-11-01

    Enterobacter cancerogenus (formerly known as CDC Enteric Group 19; synonym with Enterobacter taylorae) has rarely been associated with human infections, and little is known regarding the epidemiology and clinical significance of this organism. We describe a community-acquired pneumonia case in a 44-year-old female due to E. cancerogenus. Identification and antimicrobial susceptibility of the microorganism was performed by the automatized VITEK 2 Compact system (bioMerieux, France). The clinical case suggests that E. cancerogenus is a potentially pathogenic microorganism in determined circumstances; underlying diseases such as bronchial asthma, empiric antibiotic treatment, wounds, diagnostic, or therapeutic instruments.

  12. The Prevention of Periprosthetic Joint Infections

    PubMed Central

    Küçükdurmaz, Fatih

    2016-01-01

    Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) adversely affects patient quality of life and health status, and places a huge financial burden on the health care. The first step in combating this complication is prevention, which may include implementation of strategies during the preoperative, intraoperative, or postoperative period. Optimization of the patient with appreciation of the modifiable and non-modifiable factors is crucial. Preoperative optimization involves medical optimization of patients with comorbidities such as diabetes, anemia, malnutrition and other conditions that may predispose the patient to PJI. Among the intraoperative strategies, administration of appropriate and timely antibiotics, blood conservation, gentle soft tissue handling, and expeditious surgery in an ultra clean operating room are among the most effective strategies. During the postoperative period, all efforts should be made to minimize ingress or proliferation of bacteria at the site of the index arthroplasty from draining the wound and hematoma formation. Although the important role of some preventative measures is known, further research is needed to evaluate the role of unproven measures that are currently employed and to devise further strategies for prevention of this feared complication. PMID:28144372

  13. Review article: Paediatric bone and joint infection.

    PubMed

    Stott, N Susan

    2001-06-01

    Paediatric musculoskeletal infection remains an important cause of morbidity. Methicillin sensitive Staphylococcus aureus is still the most common organism although the incidence of methicillin resistant S. aureus in the community is rising. Osteomyelitis and septic arthritis due to Haemophilus influenzae is decreasing in incidence secondary to immunisation and in some units has been replaced by infections with the gram negative bacillus, Kingella kingae. Recent prospective studies indicate that uncomplicated osteomyelitis can be treated by three to four weeks of antibiotics. However, there is still a small group of children who will have overwhelming disseminated infection. These children require aggressive surgical and medical intervention. Two recent reports have identified an increased incidence of septic arthritis in children who have hemophilia and are HIV positive.

  14. [Disability due to traumas and diseases of a knee joint].

    PubMed

    Strafun, S S; Kostogryz, O A; Rygan, M M; Ilyin, Yu V; Kostogryz, Yu O; Nechyporenko, R V

    2015-02-01

    The invalidism structure was analyzed for patients, suffering consequences of traumas and diseases of a knee joint (KJ). The primary invalidism level because of traumas and diseases of a KJ have constituted in 2013 yr 12.4%. The cause of invalidism in men is predominantly a one-side gonarthrosis, and in women--a bilateral one--due to concurrent aggravating causes (dishormonal changes, excessive body mass). The invalidism indices enhancement is caused by absence of a dispensary follow-up, insufficient treatment on various stages of the disease course, severity and irreversibility of pathological process in a KJ, socio-economic factors, low rehabilitational potential, prognosticated impossibility to conduct a professional-labour rehabilitation in a prepensionable and pensionable age.

  15. Prosthetic joint infections: radionuclide state-of-the-art imaging.

    PubMed

    Gemmel, Filip; Van den Wyngaert, Hans; Love, Charito; Welling, M M; Gemmel, Paul; Palestro, Christopher J

    2012-05-01

    Prosthetic joint replacement surgery is performed with increasing frequency. Overall the incidence of prosthetic joint infection (PJI) and subsequently prosthesis revision failure is estimated to be between 1 and 3%. Differentiating infection from aseptic mechanical loosening, which is the most common cause of prosthetic failure, is especially important because of different types of therapeutic management. Despite a thorough patient history, physical examination, multiple diagnostic tests and complex algorithms, differentiating PJI from aseptic loosening remains challenging. Among imaging modalities, radiographs are neither sensitive nor specific and cross-sectional imaging techniques, such as computed tomography and magnetic resonance imaging, are limited by hardware-induced artefacts. Radionuclide imaging reflects functional rather than anatomical changes and is not hampered by the presence of a metallic joint prosthesis. As a result scintigraphy is currently the modality of choice in the investigation of suspected PJI. Unfortunately, there is no true consensus about the gold standard technique since there are several drawbacks and limitations inherent to each modality. Bone scintigraphy (BS) is sensitive for identifying the failed joint replacement, but cannot differentiate between infection and aseptic loosening. Combined bone/gallium scintigraphy (BS/GS) offers modest improvement over BS alone for diagnosing PJI. However, due to a number of drawbacks, BS/GS has generally been superseded by other techniques but it still may have a role in neutropenic patients. Radiolabelled leucocyte scintigraphy remains the gold standard technique for diagnosing neutrophil-mediated processes. It seems to be that combined in vitro labelled leucocyte/bone marrow scintigraphy (LS/BMS), with an accuracy of about 90%, is currently the imaging modality of choice for diagnosing PJI. There are, however, significant limitations using in vitro labelled leucocytes and considerable effort

  16. Emergence of Persistent Infection due to Heterogeneity

    NASA Astrophysics Data System (ADS)

    Agrawal, Vidit; Moitra, Promit; Sinha, Sudeshna

    2017-02-01

    We explore the emergence of persistent infection in a closed region where the disease progression of the individuals is given by the SIRS model, with an individual becoming infected on contact with another infected individual. We investigate the persistence of contagion qualitatively and quantitatively, under increasing heterogeneity in the partitioning of the population into different disease compartments, as well as increasing heterogeneity in the phases of the disease among individuals within a compartment. We observe that when the initial population is uniform, consisting of individuals at the same stage of disease progression, infection arising from a contagious seed does not persist. However when the initial population consists of randomly distributed refractory and susceptible individuals, a single source of infection can lead to sustained infection in the population, as heterogeneity facilitates the de-synchronization of the phases in the disease cycle of the individuals. We also show how the average size of the window of persistence of infection depends on the degree of heterogeneity in the initial composition of the population. In particular, we show that the infection eventually dies out when the entire initial population is susceptible, while even a few susceptibles among an heterogeneous refractory population gives rise to a large persistent infected set.

  17. Emergence of Persistent Infection due to Heterogeneity

    PubMed Central

    Agrawal, Vidit; Moitra, Promit; Sinha, Sudeshna

    2017-01-01

    We explore the emergence of persistent infection in a closed region where the disease progression of the individuals is given by the SIRS model, with an individual becoming infected on contact with another infected individual. We investigate the persistence of contagion qualitatively and quantitatively, under increasing heterogeneity in the partitioning of the population into different disease compartments, as well as increasing heterogeneity in the phases of the disease among individuals within a compartment. We observe that when the initial population is uniform, consisting of individuals at the same stage of disease progression, infection arising from a contagious seed does not persist. However when the initial population consists of randomly distributed refractory and susceptible individuals, a single source of infection can lead to sustained infection in the population, as heterogeneity facilitates the de-synchronization of the phases in the disease cycle of the individuals. We also show how the average size of the window of persistence of infection depends on the degree of heterogeneity in the initial composition of the population. In particular, we show that the infection eventually dies out when the entire initial population is susceptible, while even a few susceptibles among an heterogeneous refractory population gives rise to a large persistent infected set. PMID:28145522

  18. Prevention of Infection Due to Clostridium difficile.

    PubMed

    Cooper, Christopher C; Jump, Robin L P; Chopra, Teena

    2016-12-01

    Clostridium difficile is one of the foremost nosocomial pathogens. Preventing infection is particularly challenging. Effective prevention efforts typically require a multifaceted bundled approach. A variety of infection control procedures may be advantageous, including strict hand decontamination with soap and water, contact precautions, and using chlorine-containing decontamination agents. Additionally, risk factor reduction can help reduce the burden of disease. The risk factor modification is principally accomplished though antibiotic stewardship programs. Unfortunately, most of the current evidence for prevention is in acute care settings. This review focuses on preventative approaches to reduce the incidence of Clostridium difficile infection in healthcare settings.

  19. Strategies for the prevention of periprosthetic joint infection.

    PubMed

    Adeli, B; Parvizi, J

    2012-11-01

    Periprosthetic joint infection (PJI) is a devastating complication which can follow a total joint arthroplasty (TJA). Although rare, this ongoing threat undermines the success of TJA, a historically reputable procedure. It has haunted the orthopedic community for decades and several ongoing studies have provided insights and new approaches to effectively battle this multilayered problem.

  20. Cutaneous infections due to Corynebacterium diphtheriae

    PubMed Central

    Cockcroft, W. H.; Boyko, W. J.; Allen, D. E.

    1973-01-01

    Toxigenic Corynebacterium diphtheriae was grown from skin lesions of 44 indigent patients seen at the emergency or out-patient departments of this hospital, 43 of them within the last 16 months of the study period. In all cases staphylococci or hemolytic streptococci were also present in the wounds. An increase in the incidence of clinical diphtheria occurred in the few months preceding and overlapping the period of recognition of the cutaneous infections. The gravis strains, which accounted for the majority of the infections, were sensitive to erythromycin and to penicillin, but were relatively resistant to cloxacillin. PMID:4632361

  1. Human infections due to Malassezia spp.

    PubMed Central

    Marcon, M J; Powell, D A

    1992-01-01

    The genus Malassezia contains three member species: Malassezia furfur and Malassezia sympodialis, both obligatory lipophilic, skin flora yeasts of humans, and Malassezia pachydermatis, a nonobligatory lipophilic, skin flora yeast of other warm-blooded animals. Several characteristics suggest the basidiomycetous nature of these yeasts, although a perfect stage has not been identified. Classically, these organisms are associated with superficial infections of the skin and associated structures, including pityriasis versicolor and folliculitis. Recently, however, they have been reported as agents of more invasive human diseases including deep-line catheter-associated sepsis. The latter infection occurs in patients, primarily infants, receiving parenteral nutrition (including lipid emulsions) through the catheter. The lipids presumably provide growth factors required for replication of the organisms. It is unclear how deep-line catheters become colonized with Malassezia spp. Skin colonization with M. furfur is common in infants hospitalized in neonatal intensive care units, whereas colonization of newborns hospitalized in well-baby nurseries and of older infants is rarely observed. Catheter colonization, which may occur without overt clinical symptoms, probably occurs secondary to skin colonization, with the organism gaining access either via the catheter insertion site on the skin or through the external catheter hub (connecting port). There is little information on the colonization of hospitalized patients by M. sympodialis or M. pachydermatis. Diagnosis of superficial infections is best made by microscopic examination of skin scrapings following KOH, calcofluor white, or histologic staining. Treatment of these infections involves the use of topical or oral antifungal agents, and it may be prolonged. Diagnosis of Malassezia catheter-associated sepsis requires detection of the organism in whole blood smears or in buffy coat smears of blood drawn through the infected

  2. Pyogenic arthritis of native joints due to Bacteroides fragilis: Case report and review of the literature.

    PubMed

    Nolla, Joan M; Murillo, Oscar; Narvaez, Javier; Vaquero, Carmen Gómez; Lora-Tamayo, Jaime; Pedrero, Salvador; Cabo, Javier; Ariza, Javier

    2016-06-01

    Pyogenic arthritis of native joints due to Bacteroides fragilis seems to be an infrequent disease. We analyzed the cases diagnosed in a tertiary hospital during a 22-year period and reviewed the literature to summarize the experience with this infectious entity.In our institution, of 308 patients with pyogenic arthritis of native joints, B fragilis was the causative organism in 2 (0.6%) cases. A MEDLINE search (1981-2015) identified 19 additional cases.Of the 21 patients available for review (13 men and 8 women, with a mean age, of 54.4 ± 17 years), 19 (90%) presented a systemic predisposing factor for infection; the most common associated illness was rheumatoid arthritis (8 patients). Bacteremia was documented in 65% (13/20) of cases. In 5 patients (24%), 1 or more concomitant infectious process was found. Metronidazole was the most frequently used antibiotic. Surgical drainage was performed in 11 cases (52%). The overall mortality rate was 5%.Pyogenic arthritis of native joints due to B fragilis is an infrequent disease that mainly affects elderly patients with underlying medical illnesses and in whom bacteremia and the presence of a concomitant infectious process are frequent conditions.

  3. Kikuchi-Fujimoto Disease Misdiagnosed as Relapse of the Infection after Treatment of Periprosthetic Hip Joint Infection

    PubMed Central

    Min, Kyung-Keun; Min, Byung-Woo; Choi, Jung-Hoon

    2016-01-01

    Periprosthetic joint infection (PJI) of the hip can be difficult to treat and can lead to a number of problems including: i) severe functional decline of the hip joint and ii) increasing financial burden for patients due to long treatment periods and the need for repeated surgical interventions. Because there is risk of inadequate control of infection or relapse of a preexisting infection following the treatment of PJI through surgery, it is important to closely observe clinical symptoms such as systemic fever. Kikuchi-Fujimoto disease is usually a self-limiting disease characterized by fever and cervical lymphadenopathy. We report one case of Kikuchi-Fujimoto disease, with literatures review, that was mistaken for an infection relapse after surgical treatment of the PJI due to sustained fever postoperatively. PMID:28097116

  4. Preceding trauma in childhood hematogenous bone and joint infections.

    PubMed

    Pääkkönen, Markus; Kallio, Markku J T; Lankinen, Petteri; Peltola, Heikki; Kallio, Pentti E

    2014-03-01

    Preceding trauma may play a role in the etiology and pathogenesis of hematogenous bone and joint infections. Among 345 children with an acute hematogenous bone and/or joint infection, 20% reported trauma during a 2-week period leading to infection. Blunt impact, bruises, or excoriations were commonly reported. The rate was similar to that in the general pediatric population obtained from the literature. In the study group, patients with and without trauma were similar in age, serum C-reactive protein and erythrocyte sedimentation rate, length of hospitalization, and late sequelae. Preceding minor trauma did not prove to be significant as an etiological or as a prognostic factor.

  5. Human Infections Due to Mycobacterium lentiflavum

    PubMed Central

    Tortoli, Enrico; Bartoloni, Alessandro; Erba, Maria Luigia; Levrè, Egle; Lombardi, Natalia; Mantella, Antonia; Mecocci, Lorenzo

    2002-01-01

    Three cases of human disease due to Mycobacterium lentiflavum are reported. In the first, the mycobacterium was responsible for chronic pulmonary disease in an elderly woman; in the second, it gave rise to cervical lymphadenitis in a child; and in the third, it caused a liver abscess in a young AIDS patient. PMID:11826009

  6. Septic arthritis due to tubercular and Aspergillus co-infection

    PubMed Central

    Kumar, Mukesh; Thilak, Jai; Zahoor, Adnan; Jyothi, Arun

    2016-01-01

    Aspergillus septic arthritis is a rare and serious medical and surgical problem. It occurs mainly in immunocompromised patients. Aspergillus fumigatus is the most common causative organism followed by Aspergillus flavus. The most common site affected is knee followed by shoulder, ankle, wrist, hip and sacroiliac joint. Debridement and voriconazole are primary treatment of articular aspergilosis. To the best of our knowledge, there are no reported cases of co-infection of tuberculosis (TB) and Aspergillus infecting joints. We report a case of co-infection of TB and A. flavus of hip and knee of a 60-year-old male, with type 2 diabetes mellitus. He was treated with debridement, intravenous voriconazole, and antitubercular drugs. PMID:27293296

  7. Acinetobacter Prosthetic Joint Infection Treated with Debridement and High-Dose Tigecycline.

    PubMed

    Vila, Andrea; Pagella, Hugo; Amadio, Claudio; Leiva, Alejandro

    2016-12-01

    Prosthesis retention is not recommended for multidrug-resistant Acinetobacter prosthetic joint infection due to its high failure rate. Nevertheless, replacing the prosthesis implies high morbidity and prolonged hospitalization. Although tigecycline is not approved for the treatment of prosthetic joint infection due to multidrug resistant Acinetobacter baumannii, its appropriate use may preclude prosthesis exchange. Since the area under the curve divided by the minimum inhibitory concentration is the best pharmacodynamic predictor of its efficacy, we used tigecycline at high dose, in order to optimize its efficacy and achieve implant retention in 3 patients who refused prosthesis exchange. All patients with prosthetic joint infections treated at our Institution are prospectively registered in a database. Three patients with early prosthetic joint infection of total hip arthroplasty due to multidrug resistant A. baumannii were treated with debridement, antibiotics and implant retention, using a high maintenance dose of tigecycline (100 mg every 12 hours). The cases were retrospectively reviewed. All patients signed informed consent for receiving off-label use of tigecycline. Tigecycline was well tolerated, allowing its administration at high maintenance dose for a median of 40 days (range 30-60). Two patients were then switched to minocycline at standard doses for a median of 3.3 months in order to complete treatment. Currently, none of the patients showed relapse. Increasing the dose of tigecycline could be considered as a means to better attain pharmacodynamic targets in patients with severe or difficult-to-treat infections. Tigecycline at high maintenance dose might be useful when retention of the implant is attempted for treatment for prosthetic joint infections due to multidrug resistant Acinetobacter. Although this approach might be promising, off-label use of tigecycline should be interpreted cautiously until prospective data are available. Tigecycline is

  8. Acinetobacter Prosthetic Joint Infection Treated with Debridement and High-Dose Tigecycline

    PubMed Central

    Pagella, Hugo; Leiva, Alejandro

    2016-01-01

    Prosthesis retention is not recommended for multidrug-resistant Acinetobacter prosthetic joint infection due to its high failure rate. Nevertheless, replacing the prosthesis implies high morbidity and prolonged hospitalization. Although tigecycline is not approved for the treatment of prosthetic joint infection due to multidrug resistant Acinetobacter baumannii, its appropriate use may preclude prosthesis exchange. Since the area under the curve divided by the minimum inhibitory concentration is the best pharmacodynamic predictor of its efficacy, we used tigecycline at high dose, in order to optimize its efficacy and achieve implant retention in 3 patients who refused prosthesis exchange. All patients with prosthetic joint infections treated at our Institution are prospectively registered in a database. Three patients with early prosthetic joint infection of total hip arthroplasty due to multidrug resistant A. baumannii were treated with debridement, antibiotics and implant retention, using a high maintenance dose of tigecycline (100 mg every 12 hours). The cases were retrospectively reviewed. All patients signed informed consent for receiving off-label use of tigecycline. Tigecycline was well tolerated, allowing its administration at high maintenance dose for a median of 40 days (range 30–60). Two patients were then switched to minocycline at standard doses for a median of 3.3 months in order to complete treatment. Currently, none of the patients showed relapse. Increasing the dose of tigecycline could be considered as a means to better attain pharmacodynamic targets in patients with severe or difficult-to-treat infections. Tigecycline at high maintenance dose might be useful when retention of the implant is attempted for treatment for prosthetic joint infections due to multidrug resistant Acinetobacter. Although this approach might be promising, off-label use of tigecycline should be interpreted cautiously until prospective data are available. Tigecycline is

  9. Experimental models of bone and prosthetic joint infections.

    PubMed

    Crémieux, A C; Carbon, C

    1997-12-01

    Bone and joint infections are difficult to cure. The difficulty is related to the presence of bacteria adherent to foreign material in many cases and also to the limited activity of antibiotics in infected bones. Clinical trials are difficult to design because of the heterogeneity of the disease and the number of factors that could influence the therapeutic response. To control for these multiple variables, attempts have been made to develop reliable animal models of osteomyelitis and prosthetic joint infections that closely mimic the different infections seen in orthopedic surgery and that allow evaluation of the efficacy of surgical procedures as well as local or systemic antibiotic therapy. These models will continue to provide us information on the pathogenesis and management of such infections.

  10. Bone and Joint Infections in Children: Septic Arthritis.

    PubMed

    Agarwal, Anil; Aggarwal, Aditya N

    2016-08-01

    The pathological invasion of a joint and subsequent inflammation is known as septic arthritis. The knee and hip are the most frequently involved joints. Staphylococcus aureus is the most common cause of septic arthritis in children. An acute onset of illness with an inflamed painful joint and restricted movements and inability to use joint (pseudoparalysis) clinically indicates septic arthritis. The diagnosis is difficult in a neonate or young child where refusal to feed, crying, discomfort during change of diaper (if hip is involved) or attempted joint movement may be the only findings. Fever and other systemic signs may also be absent in neonates. Septic arthritis is diagnosed clinically, supported by appropriate radiological and laboratory investigations. The peripheral blood white cell count is frequently raised with a predominance of polymorphonuclear cells. The acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are often markedly raised. Ultrasonography and MRI are preferred investigations in pediatric septic arthritis. Determination of infecting organism in septic arthritis is the key to the correct antibiotic choice, treatment duration and overall management. Joint aspirate and/or blood culture should be obtained before starting antibiotic treatment. Several effective antibiotic regimes are available for managing septic arthritis in children. Presence of large collections, thick pus, joint loculations and pus evacuating into surrounding soft tissues are main indications for surgical drainage. Joint aspiration can be a practical alternative in case the lesion is diagnosed early, with uncomplicated presentations and superficial joints.

  11. Outcome Predictors in Prosthetic Joint Infections--Validation of a risk stratification score for Prosthetic Joint Infections in 120 cases.

    PubMed

    Wimmer, Matthias D; Randau, Thomas M; Friedrich, Max J; Ploeger, Milena M; Schmolder, Jan; Strauss, Andreas C; Pennekamp, Peter H; Vavken, Patrick; Gravius, Sascha

    2016-03-01

    Prosthetic joint infections are a major challenge in total joint arthroplasty, especially in times of accumulating drug resistancies. Even though predictive risk classifications are a widely accepted tool to define a suitable treatment protocol a classification is still missing considering the difficulty in treating the -causative pathogen antibiotically. In this study, we present and evaluate a new predictive risk stratification for prosthetic joint infections in 120 cases, treated with a two-stage exchange. Treatment outcomes in 120 patients with proven prosthetic joint infections in hip and knee prostheses were regressed on time of infection, systemic risk factors, local risk factors and the difficulty in treating the causing pathogen. The main outcome variable was "definitely free of infection" after two years as published. Age, gender, and BMI were included as covariables and analyzed in a logistic regression model. 66 male and 54 female patients, with a mean age at surgery of 68.3 years±12.0 and a mean BMI of 26.05±6.21 were included in our survey and followed for 29.0±11.3 months. We found a significant association (p<0.001) between our score and the outcome parameters evaluated. Age, gender and BMI did not show a significant association with the outcome. These results show that our score is an independent and reliable predictor for the cure rate in prosthetic joint infections in hip and knee prostheses treated within a two-stage exchange protocol. Our score illustrates, that there is a statistically significant, sizable decrease in cure rate with an increase in score. In patients with prosthetic joint infections the validation of a risk score may help to identify patients with local and systemic risk factors or with infectious organisms identified as "difficult to treat" prior to the treatment or the decision about the treatment concept. Thus, appropriate extra care should be considered and provided.

  12. Pneumorachis associated with multiorgan infection due to Citrobacter koseri.

    PubMed

    Yamamoto, Norihisa; Takegawa, Ryosuke; Seki, Masafumi; Takahashi, Kyosuke; Tahara, Kenichi; Hirose, Tomoya; Hamaguchi, Shigeto; Irisawa, Taro; Matsumoto, Naoya; Shimazu, Takeshi; Tomono, Kazunori

    2013-12-01

    Pneumorachis rarely occurs after spreading from a contiguous site of infection or after a traumatic event. We describe an adult patient who developed sepsis and a renal abscess due to Citrobacter koseri, and computed tomographic imaging identified gas within the entire spinal canal as well as an iliopsoas abscess. This patient recovered from pneumorachis caused by disseminated infection.

  13. Headache due to an extra joint between head and neck.

    PubMed

    Stolt-Nielsen, A; Fredriksen, T A; Sjaastad, O

    1995-01-01

    A girl, born in 1973, started having headache in preschool age. After a head trauma in 1985, there was a clear worsening of the headache, and the headache became chronic at around 14 years, making regular school attendance impossible. The headache was "symptom poor," bilateral-occipital, but with a clear left-sided preponderance and occasionally spreading to the forehead. The headache was always worst in the morning hours, easing up by noontime. Neck rotation to the right could provoke long-lasting exacerbations. Neck movement was restricted on rotation to the left. A sore bony structure was discovered on palpation just underneath the mastoid process of the left side. This proved to correspond to a bony "bridge" with an extra joint between the first vertebra on the left side and the skull, medially to the mastoid process that could be demonstrated on x-ray tomography and CT scanning. This bony bridge was removed surgically more than 2 years ago, and the pain disappeared on the day of operation and has not recurred in the intervening time. Such bony bridges have in the past been considered to be innocuous and not symptom producing. Although this may be the general rule, the present case tends to show that even to this rule, there are exceptions.

  14. Multi-Disciplinary Antimicrobial Strategies for Improving Orthopaedic Implants to Prevent Prosthetic Joint Infections in Hip and Knee

    PubMed Central

    Getzlaf, Matthew A.; Lewallen, Eric A.; Kremers, Hilal M.; Jones, Dakota L.; Bonin, Carolina A.; Dudakovic, Amel; Thaler, Roman; Cohen, Robert C.; Lewallen, David G.; van Wijnen, Andre J.

    2016-01-01

    Like any foreign object, orthopaedic implants are susceptible to infection when introduced into the human body. Without additional preventative measures, the absolute number of annual prosthetic joint infections will continue to rise, and may exceed the capacity of health care systems in the near future. Bacteria are difficult to eradicate from synovial joints due to their exceptionally diverse taxonomy, complex mechanistic attachment capabilities, and tendency to evolve antibiotic resistance. When a primary orthopaedic implant fails from prosthetic joint infection, surgeons are generally challenged by limited options for intervention. In this review, we highlight the etiology and taxonomic groupings of bacteria known to cause prosthetic joint infections, and examine their key mechanisms of attachment. We propose that antimicrobial strategies should focus on the most harmful bacteria taxa within the context of occurrence, taxonomic diversity, adhesion mechanisms, and implant design. Patient-specific identification of organisms that cause prosthetic joint infections will permit assessment of their biological vulnerabilities. The latter can be targeted using a range of antimicrobial techniques that exploit different colonization mechanisms including implant surface attachment, biofilm formation, and/or hematogenous recruitment. We anticipate that customized strategies for each patient, joint, and prosthetic component will be most effective at reducing prosthetic joint infections, including those caused by antibiotic-resistant and polymicrobial bacteria. PMID:26449208

  15. Multi-disciplinary antimicrobial strategies for improving orthopaedic implants to prevent prosthetic joint infections in hip and knee.

    PubMed

    Getzlaf, Matthew A; Lewallen, Eric A; Kremers, Hilal M; Jones, Dakota L; Bonin, Carolina A; Dudakovic, Amel; Thaler, Roman; Cohen, Robert C; Lewallen, David G; van Wijnen, Andre J

    2016-02-01

    Like any foreign object, orthopaedic implants are susceptible to infection when introduced into the human body. Without additional preventative measures, the absolute number of annual prosthetic joint infections will continue to rise, and may exceed the capacity of health care systems in the near future. Bacteria are difficult to eradicate from synovial joints due to their exceptionally diverse taxonomy, complex mechanistic attachment capabilities, and tendency to evolve antibiotic resistance. When a primary orthopaedic implant fails from prosthetic joint infection, surgeons are generally challenged by limited options for intervention. In this review, we highlight the etiology and taxonomic groupings of bacteria known to cause prosthetic joint infections, and examine their key mechanisms of attachment. We propose that antimicrobial strategies should focus on the most harmful bacteria taxa within the context of occurrence, taxonomic diversity, adhesion mechanisms, and implant design. Patient-specific identification of organisms that cause prosthetic joint infections will permit assessment of their biological vulnerabilities. The latter can be targeted using a range of antimicrobial techniques that exploit different colonization mechanisms including implant surface attachment, biofilm formation, and/or hematogenous recruitment. We anticipate that customized strategies for each patient, joint, and prosthetic component will be most effective at reducing prosthetic joint infections, including those caused by antibiotic-resistant and polymicrobial bacteria.

  16. Clinical Guidelines for the Antimicrobial Treatment of Bone and Joint Infections in Korea

    PubMed Central

    2014-01-01

    There are many various diseases in the bone and joint infections, and we tried to make antimicrobial treatment guidelines for common infectious diseases based on available data for microbiology and clinical trials. This guidelines focused on the treatment of osteomyelitis and septic arthritis, which can be experienced by physicians at diverse clinical settings. This guidelines is not applicable to diabetic foot infections, postoperative infections or post-traumatic infections which need special considerations. The guidelines for those conditions will be separately developed later. Surgical treatment of bone and joint infections, pediatric bone and joint infection, tuberculous bone and joint infection, and prophylactic antibiotic use were not included in this guideline. PMID:25024877

  17. Long-term suppression of infection in total joint arthroplasty.

    PubMed

    Rao, Nalini; Crossett, Lawrence S; Sinha, Raj K; Le Frock, Jack L

    2003-09-01

    Optimal treatment for a chronic infected prosthesis is the removal of infected and necrotic tissue and all the components of the prosthesis with staged revision in conjunction with systemic antibiotics. If this is not possible because of the poor general condition of the patient, because of unacceptable functional results secondary to removal of the prosthesis, or because the patient refuses surgery in an attempt to salvage the infected prosthesis, a reasonable alternative is long-term oral suppressive antibiotic therapy for maintenance of a functioning prosthesis. Prompt recognition with rapid debridement and initiation of antibiotic therapy seems crucial. Our study confirms a favorable outcome of maintenance of functioning prostheses in 86.2% of patients after a mean followup of 5 years. All patients had initial debridement with 4 to 6 weeks of systemic antibiotic therapy. Advanced age did not seem to predict poor outcome. Joint location, duration of symptoms, and the time of onset of infection did not predict success or failure. The overall success rate for Staphylococcus aureus prosthetic joint infection was 69% after a mean followup of 5 years. The ideal regimen and optimal duration of oral suppressive therapy for a favorable outcome is not well-established and needs additional data with prospective multicenter studies.

  18. Prospective Evaluation of Criteria for Microbiological Diagnosis of Prosthetic-Joint Infection at Revision Arthroplasty

    PubMed Central

    Atkins, Bridget L.; Athanasou, Nicholas; Deeks, Jonathan J.; Crook, Derrick W. M.; Simpson, Hamish; Peto, Timothy E. A.; McLardy-Smith, Peter; Berendt, Anthony R.; Group, The Osiris Collaborative Study

    1998-01-01

    A prospective study was performed to establish criteria for the microbiological diagnosis of prosthetic joint infection at elective revision arthroplasty. Patients were treated in a multidisciplinary unit dedicated to the management and study of musculoskeletal infection. Standard multiple samples of periprosthetic tissue were obtained at surgery, Gram stained, and cultured by direct and enrichment methods. With reference to histology as the criterion standard, sensitivities, specificities, and likelihood ratios (LRs) were calculated by using different cutoffs for the diagnosis of infection. We performed revisions on 334 patients over a 17-month period, of whom 297 were evaluable. The remaining 37 were excluded because histology results were unavailable or could not be interpreted due to underlying inflammatory joint disease. There were 41 infections, with only 65% of all samples sent from infected patients being culture positive, suggesting low numbers of bacteria in the samples taken. The isolation of an indistinguishable microorganism from three or more independent specimens was highly predictive of infection (sensitivity, 65%; specificity, 99.6%; LR, 168.6), while Gram staining was less useful (sensitivity, 12%; specificity, 98%; LR, 10). A simple mathematical model was developed to predict the performance of the diagnostic test. We recommend that five or six specimens be sent, that the cutoff for a definite diagnosis of infection be three or more operative specimens that yield an indistinguishable organism, and that because of its low level of sensitivity, Gram staining should be abandoned as a diagnostic tool at elective revision arthroplasty. PMID:9738046

  19. Infected shoulder joint with loose Suture Anchor in the joint after Bankart’s Repair- A Case Report

    PubMed Central

    Kumar, Mukesh; Thilak, Jai

    2016-01-01

    Introduction: The glenoid labrum is frequently torn in traumatic glenohumeral dislocation; arthroscopic repair is the standard method of treatment. The complications associated with this repair are pulling out of metal suture anchors, chondrolysis and joint infection. The infection of joint after arthroscopy is less than 1%. Staphylococcus is most common organism and rarely followed by Pseudomonas aeruginosa. We report a case of infected shoulder with chondrolysis of the joint and pulled out metal suture anchor lying inside the joint after Bankart’s repair. Case Report: A 22-year-old gentleman came to us with complaints of shoulder joint pain & gross restriction of movements for one year, with history of intermittent fever and treatment in nearby hospital. He also gives past history of recurrent dislocation of shoulder with last episode 18 months back, which was diagnosed as Bankart’s lesion and arthroscopic Bankart’s repair was done 15 months back. He was evaluated at our institute and suspected to have infection of shoulder joint with pulled out metal suture anchor inside the joint. Arthroscopic removal of suture anchor and debridement of shoulder joint was done, Culture was obtained and culture specific antibiotics were given for six weeks, and significant improvement was observed with this line of treatment. At lyear follow up, the patient was able to perform his daily activities with terminal restriction of range of motion. Conclusions: Shoulder joint infection is rare after Bankart’s repair and required a high degree of suspicion. Any foreign materials inside the joint should be taken out & followed with aggressive treatment by debridement, irrigation and culture specific antibiotics. Suppression of joint infection with antibiotics should be avoided specially when there is foreign body inside the joint. PMID:27703928

  20. Infective endocarditis due to Citrobacter koseri in an immunocompetent adult.

    PubMed

    Dzeing-Ella, A; Szwebel, T A; Loubinoux, J; Coignard, S; Bouvet, A; Le Jeunne, C; Aslangul, E

    2009-12-01

    Citrobacter koseri (formerly Citrobacter diversus) is a motile gram-negative bacillus usually arising from urinary and gastrointestinal tracts. C. koseri rarely causes infection in immunocompetent patients and, thus far, has been considered an opportunistic pathogen. We report on a 30-year-old man, with no medical past, hospitalized for infective aortic endocarditis due to C. koseri. Four weeks of antibiotherapy led to a full recovery for this patient. However, this case is unusual, as previous history and 1 year of follow-up showed no features of intercurrent immunosuppression. Microbiological diagnosis was based on using 16S rRNA gene sequencing.

  1. Two Cases of Subcutaneous Infection Due to Phaeoacremonium spp.

    PubMed Central

    Guarro, Josep; Alves, Sydney Hartz; Gené, Josepa; Grazziotin, Neiva Aparecida; Mazzuco, Rosemari; Dalmagro, Cristiane; Capilla, Javier; Zaror, Luis; Mayayo, Emilio

    2003-01-01

    We describe two cases in Brazil of human subcutaneous infections due to Phaeoacremonium spp. The first case was caused by Phaeoacremonium aleophilum. The patient presented with a unique fistulized nodule on the left ankle. The fungus was detected by direct microscopic examination and was isolated repeatedly from material collected from the lesion. This is the first reported case of human infection caused by this fungus. The second case was caused by Phaeoacremonium rubrigenum. The patient presented with multiple nodules around the left ankle and foot. The fungus was detected by direct examination of pus and histological sections of the nodules. It was repeatedly isolated from the clinical specimens. This is the second reported case of human infection caused by this species. PMID:12624080

  2. Brain abscess due to odontogenic infection: a case report

    PubMed Central

    Park, Sung Yong; Suh, Dong Won; Park, Chul Min; Oh, Min Seok

    2014-01-01

    In this report, we describe a case of brain abscess due to odontogenic infection. A 53-year-old female who had been suffering from headache and trismus for two weeks visited the Department of Oral and Maxillofacial Surgery at the Sun Dental Hospital (Daejeon, Korea). Even after several routine tests, we still could not make a diagnosis. However, after the combined multidisciplinary efforts of oral surgeons and neurosurgeons, the patient was treated for odontogenic infection and made an uneventful recovery. Therefore, patients with infections in the head and neck region showing symptoms such as headache, changes in mental state, nausea, vomiting, seizures, hemiplegia, speech disturbance, and visual disturbance, a brain abscess should be included in the list of differential diagnoses. PMID:25045643

  3. New Zealand Joint Registry data underestimates the rate of prosthetic joint infection.

    PubMed

    Zhu, Mark; Ravi, Saiprasad; Frampton, Chris; Luey, Chris; Young, Simon

    2016-08-01

    Background and purpose - Recent studies have revealed deficiencies in the accuracy of data from joint registries when reoperations for prosthetic joint infections (PJIs) are reported, particularly when no components are changed. We compared the accuracy of data from the New Zealand Joint Registry (NZJR) to a multicenter audit of hospital records to establish the rate of capture for PJI reoperations. Methods - 4,009 cases undergoing total knee or hip arthroplasty performed at 3 tertiary referral hospitals over a 3-year period were audited using multiple hospital datasets and the NZJR. The number of reoperations for PJI that were performed within 2 years of the primary arthroplasty was obtained using both methods and the data were compared. Results - The NZJR reported a 2-year reoperation rate for PJI of 0.67%, as compared to 1.1% from the audit of hospital records, giving the NZJR a sensitivity of 63%. Only 4 of 11 debridement-in-situ-only procedures and 7 of 12 modular exchange procedures were captured in the NZJR. Interpretation - The national joint registry underestimated the rate of reoperation for PJI by one third. Strategies for improving the accuracy of data might include revising and clarifying the registry forms to include all reoperations for PJI and frequent validation of the registry data against other databases.

  4. [Dermatomycoses due to pets and farm animals : neglected infections?].

    PubMed

    Nenoff, P; Handrick, W; Krüger, C; Vissiennon, T; Wichmann, K; Gräser, Y; Tchernev, G

    2012-11-01

    Dermatomycoses due to contact with pets and livestock frequently affect children and young adults. Zoophilic dermatophytes are the main important causative agents. It has long been known that the often high inflammatory dermatophytoses of the skin and the scalp are caused mostly by Microsporum canis. Due to an absence of an obligation for reporting fungal infections of the skin to the Public Health Office in Germany, an unnoticed but significant change in responsible pathogens has occurred. Today an increasing number of infections due to zoophilic strains of Trichophyton interdigitale (formerly Trichophyton mentagrophytes) and Trichophyton species of Arthroderma benhamiae are found. The latter mentioned dermatophyte is the anamorph species of the teleomorph Arthroderma benhamiae, which originally was isolated in the Far East (Japan). Source of infection of these dermatophytes are small rodents, in particular guinea pigs. These animals are bought in pet shops by the parents of those children who later are affected by the fungal infection. The coincidental purchase of the relevant fungal pathogen is not obvious to the parents. As a consequence, highly contagious dermatophytoses occur, often tinea capitis sometimes with kerion formation. Further dermatophytes should be considered as cause of a zoophilic dermatomycosis. Both Trichophyton verrucosum, the cause of the ringworm in cattle, and Trichophyton erinacei following contact to hedgehogs are worthy of note. Yeasts cannot be ignored as cause of dermatomycosis, especially Malassezia pachydermatis, the only non-lipophilic species within the genus Malassezia, which can be transferred from dog to men. Cryptococcus neoformans also comes from animal sources. The mucous yeast occurs in bird's dropping, and it causes both pulmonary and central nervous system infections, but also primary and secondary cutaneous cryptococcosis in immunocompromised patients (HIV/AIDS) as possible consequence after contact to these animals.

  5. First Report of Ventriculoperitoneal Shunt Infection due to Cyberlindnera fabianii

    PubMed Central

    Baghdadi, Jonathan; Hemarajata, Peera; Humphries, Romney; Kelesidis, Theodoros

    2015-01-01

    Fungal infections in the central nervous system (CNS) are associated with significant morbidity and death. Transient fungemia in immunocompetent patients without any other risk factors for fungemia has been suggested as a possible mechanism that may lead to serious fungal ventriculoperitoneal (VP) shunt infections, but evidence is lacking. The clinical spectrum, diagnosis, and optimal therapy of Cyberlindnera fabianii infections remain to be determined. We describe the first case of CNS infection due to C. fabianii that occurred in an immunocompetent adult with a VP shunt. Spontaneous translocation with yeast that is not part of the normal gastrointestinal flora in the setting of ingestion of multiple servings of a fermentation product was the likely source from which Cyberlindnera fabianii gained entrance into the VP shunt system, causing meningitis in this patient. The authors conclude that, in view of the high morbidity associated with yeast infection of the CNS, long-term antifungal therapy should be strongly considered in cases where the VP shunt cannot be completely removed. Transient fungemia may lead to invasive disease in an immunocompetent host with VP shunt, even in the absence of any other risk factors for fungemia and even after remote placement of the VP shunt. PMID:26618013

  6. Lesions in canine stifle joints due to trochleoplasties as treatment for medial patellar luxation.

    PubMed

    van der Zee, Johannes Hans

    2015-07-01

    Lesions in canine stifle joints after previous trochleoplasty surgery were documented. In four clinical cases arthrotomies were performed due to stifle pain after previous trochlear deepening procedures. A small area of hyaline cartilage remained in the groove of the stifles in cases where previous wedge trochleoplasties had been performed. All of the stifles had significant areas of eburnation on the axial aspect of the medial trochlear ridge. The stifle joints of a dog that was euthanased due to severe irreversible osteoarthritis were photographed. The dog had undergone previous surgery for patellar luxation and cranial cruciate ligament ruptures. The trochlear grooves in this dog had almost no visible articular cartilage left.

  7. Prosthetic Valve Endocarditis and Bloodstream Infection Due to Mycobacterium chimaera

    PubMed Central

    Achermann, Yvonne; Rössle, Matthias; Hoffmann, Matthias; Deggim, Vanessa; Kuster, Stefan; Zimmermann, Dieter R.; Hombach, Michael; Hasse, Barbara

    2013-01-01

    Prosthetic valve endocarditis (PVE) due to fast-growing nontuberculous mycobacteria (NTM) has been reported anecdotally. Reports of PVE with slowly growing NTM, however, are lacking. We present here one case of PVE and one case of bloodstream infection caused by Mycobacterium chimaera. Randomly amplified polymorphic DNA (RAPD)-PCR indicated a relatedness of the two M. chimaera strains. Both patients had heart surgery 2 years apart from each other. A nosocomial link was not detected. PMID:23536407

  8. Prosthetic valve endocarditis and bloodstream infection due to Mycobacterium chimaera.

    PubMed

    Achermann, Yvonne; Rössle, Matthias; Hoffmann, Matthias; Deggim, Vanessa; Kuster, Stefan; Zimmermann, Dieter R; Bloemberg, Guido; Hombach, Michael; Hasse, Barbara

    2013-06-01

    Prosthetic valve endocarditis (PVE) due to fast-growing nontuberculous mycobacteria (NTM) has been reported anecdotally. Reports of PVE with slowly growing NTM, however, are lacking. We present here one case of PVE and one case of bloodstream infection caused by Mycobacterium chimaera. Randomly amplified polymorphic DNA (RAPD)-PCR indicated a relatedness of the two M. chimaera strains. Both patients had heart surgery 2 years apart from each other. A nosocomial link was not detected.

  9. Antibiotic-loaded bone cement and periprosthetic joint infection.

    PubMed

    Chen, Antonia F; Parvizi, Javad

    2014-01-01

    Antibiotic-loaded bone cement (ALBC) is commonly used for antibiotic delivery during total joint arthroplasty (TJA) for prevention or treatment of periprosthetic joint infection (PJI). ALBC is commonly used in two-stage exchange arthroplasty with static and dynamic spacers, beads, rods, and other custom spacers. The use of commercially available or hand-made ALBC for primary and revision TJA to prevent infection has also been studied. Commonly used antibiotics include gentamicin, tobramycin, and vancomycin powder, and these antibiotics can be used alone or in combination, depending on the organism present. ALBC can be prepared by hand mixing to increase porosity and improve antibiotic elution or by vacuum-mixing to improve tensile fatigue strength. Vacuum-mixed cement is predominantly used in primary TJA, whereas hand-mixed cement is often used in two-stage exchange arthroplasty for shaping spacers and beads. Inadequate strength of ALBC spacers can result in mechanical failure, including fracture or dislocation of spacers. Additionally, studies have demonstrated that the use of antibiotics in cement, especially aminoglycosides like gentamicin and tobramycin that can elute into the bloodstream, may result in acute renal failure. Using antibiotics in ALBC can also theoretically increase antibiotic resistance and the likelihood of obtaining a negative culture if subsequent aspirations are performed. Overall, ALBC is an effective medical implant tool that can be used for treating and preventing PJI.

  10. [Streptococcus equisimilis associated septic arthritis/prosthetic joint infection].

    PubMed

    Sipahi, Oğuz Reşat; Ozkören Calik, Sebnem; Pullukçu, Hüsnü; Işikgöz Taşbakan, Meltem; Arda, Bilgin; Tünger, Alper; Ulusoy, Sercan

    2008-07-01

    Group C streptococci are flora members of skin, nasopharynx, gastrointestinal and genitourinary systems. They are rare causes of human pharyngitis, arthritis, pneumonia, meningitis and bacteremia. In this report, a 71-years old male patient with Streptococcus equisimilis arthritis/prosthetic joint infection has been presented. The patient was admitted to the emergency service with the complaints of erythema, swelling and tenderness on right knee which had total knee prosthesis. Examination of synovial fluid punction sample yielded abundant amount of leukocytes (> 1000 cells/mm3). Empirical ampicillin-sulbactam (1 g q6h, parenterally) therapy was initiated. Bacteria which have been cultivated from synovial fluid specimen were identified as S. equisimilis. The isolate was found to be susceptible to penicilin, erythromycin and teicoplanin, and resistant to chloramphenicol and tetracycline. Although clinical presentation improved during the first ten days, symptoms recurred after the 10th day and the therapy was switched to teicoplanin. The recurrence was thought to be the result of antibiotic tolerence. The patient was treated successfully with teicoplanin, and no relapse or reinfection was observed during one year of follow-up. To our knowledge this is the first case of S. equisimilis arthritis reported from Turkey and first case of S. equisimilis associated prosthetic joint infection.

  11. Chikungunya Virus Infection: An Update on Joint Manifestations and Management

    PubMed Central

    Krutikov, Maria; Manson, Jessica

    2016-01-01

    The advent of sophisticated diagnostics has enabled the discovery of previously unknown arthropod-borne viruses like Chikungunya. This infection has become increasingly prevalent in the last 10 years across the Indian Ocean and has been brought to media attention by a recent outbreak in the Caribbean. The outbreak has been aided by a drastic rise in air travel, allowing infected individuals to transport the virus to previously unaffected regions. In addition, a recently documented viral mutation has allowed its transmission by the Aedes albopictus mosquito, therefore facilitating outbreaks in Southern Europe and the USA. The duration and extent of the arthritis seen peri- and post infection has become a topic of academic interest. Although published data are largely observational, there has been a definite increase in original research focusing on this. Symptoms can persist for years, particularly in older patients with pre-existing medical conditions. The etiology is still not fully understood, but viral persistence and immune activation within synovial fluid have been shown in mouse models. There have been no prospective clinical trials of treatment in humans; however, animal trials are in process. The mainstay of treatment remains anti-inflammatories and steroids where necessary. The clinical presentation seems to mimic common rheumatological conditions like rheumatoid arthritis; therefore recent recommendations suggest the use disease-modifying agents as a common practice for the specific syndrome. This review uses recent published data and draws on our own clinical experience to provide an overview of joint complications of Chikungunya infection. PMID:27824550

  12. Management of periprosthetic joint infection: the current knowledge: AAOS exhibit selection.

    PubMed

    Parvizi, Javad; Adeli, Bahar; Zmistowski, Benjamin; Restrepo, Camilo; Greenwald, Alan Seth

    2012-07-18

    Periprosthetic joint infection continues to frustrate the medical community. Although the demand for total joint arthroplasty is increasing, the burden of such infections is increasing even more rapidly, and they pose a unique challenge because their accurate diagnosis and eradication can prove elusive. This review describes the current knowledge regarding diagnosis and treatment of periprosthetic joint infection. A number of tools are available to aid in establishing a diagnosis of periprosthetic joint infection. These include the erythrocyte sedimentation rate, serum C-reactive protein concentration, synovial white blood-cell count and differential, imaging studies, tissue specimen culturing, and histological analysis. Multiple definitions of periprosthetic joint infection have been proposed but there is no consensus. Tools under investigation to diagnose such infections include the C-reactive protein concentration in the joint fluid, point-of-care strip tests for the leukocyte esterase concentration in the joint fluid, and other molecular markers of periprosthetic joint infection. Treatment options include irrigation and debridement with prosthesis retention, one-stage prosthesis exchange, two-stage prosthesis exchange with intervening placement of an antibiotic-loaded spacer, and salvage treatments such as joint arthrodesis and amputation. Treatment selection is dependent on multiple factors including the timing of the symptom onset, patient health, the infecting organism, and a history of infection in the joint. Although prosthesis retention has the theoretical advantages of decreased morbidity and improved return to function, two-stage exchange provides a lower rate of recurrent infection. As the burden of periprosthetic joint infection increases, the orthopaedic and medical community should become more familiar with the disease. It is hoped that the tools currently under investigation will aid clinicians in diagnosing periprosthetic joint infection in an

  13. [A child with iritis due to Chlamydia pneumoniae infection].

    PubMed

    Yamada, S; Tsumura, N; Nagai, K; Yamada, T; Sakata, Y; Tominaga, K; Kato, H; Motohiro, T; Masunaga, N; Mochizuki, M

    1994-12-01

    A case of uncommon iritis due to Chlamydia pneumoniae (C. pneumoniae) is reported. The patient was a 9-year-old boy who had suffered from cough, pharyngeal pain, and low grade fever. The symptoms persisted for more than 1 month in spite of an oral cephem antibiotic. Ophthalmalgia, congestion around the iris and cough had lasted with alleviation and exacerbation. A diagnosis of C. pneumoniae infection was made by specific polymerase chain reaction (PCR) method and microimmunofluorescence test (MIF). The symptoms subsided with administration of clarithromycin (CAM: 300 mg/day) for 2 weeks. Because of the simultaneous alleviation of iritis, C. pneumoniae infection was considered to introduce the iritis. Much remains to be clarified about this pathogenesis of iritis and more detailed evaluations are required.

  14. Bone and joint infections by Mucorales, Scedosporium, Fusarium and even rarer fungi.

    PubMed

    Koehler, Philipp; Tacke, Daniela; Cornely, Oliver A

    2016-01-01

    Mucorales, Scedosporium and Fusarium species are rarely considered as cause for bone and joint infections. However, these moulds are emerging as important fungal pathogens in immunocompromised and immunocompetent patients. Typical pre-disposing host conditions are immunosuppression and diabetes. Most common causative pathogens are Mucorales followed by Scedosporium and Fusarium. Acremonium and Phialemonium species are rare but some case reports exist. MRI is the gold standard imaging technique. Tissue specimens obtained as aspirates, imaging guided biopsy or open surgery need mycological and histopathological work-up for genus and species identification. Multimodal treatment strategies combine surgical debridement, drainage of joints or abscesses, removal of infected prosthetic joints and systemic antifungals. The treatment of mucormycosis is polyene based and may be combined with either posaconazole or - in rare cases - caspofungin. As Scedosporium species are intrinsically resistant to polyenes and azoles show absence of in vitro activity, voriconazole plus synergistic treatment regimens become the therapeutic standard. In fusariosis, fungal susceptibility is virtually impossible to predict, so that combination treatment of voriconazole and lipid-based amphotericin B should be the first-line strategy while susceptibility results are pending. In the absence of randomized controlled trials, infections due to the above moulds should be registered, e.g. in the registries of the European Confederation of Medical Mycology (ECMM).

  15. Operative treatment of cervicobrachialgia and vertigo due to uncovertebral joint arthritis.

    PubMed

    Del Sasso, L; Mondini, A; Brambilla, S; Pampuri, M; Martini, P

    1991-12-01

    In the field of cervical spondylosis, cervicobrachialgia caused by uncovertebral joint arthritis has been well defined and classified, as it is seen quite commonly in clinical practice. Non-operative treatment relieves the symptoms in most cases. Operative treatment is used when the neurovascular structures are involved and the patient does not respond to conservative treatment. The authors present the surgical technique they employed on 38 patients with neck and arm pain due to uncovertebral joint arthritis, and they report the long-term results.

  16. First Case Report of a Late Onset Knee Periprosthetic Joint Infection Caused by Lactococcus garvieae

    PubMed Central

    2016-01-01

    Lactococcus garvieae is known as a Gram-positive, catalase-negative, and facultatively anaerobic fish pathogen. The association between Lactococcus spp. and human infectious diseases is described as being mainly associated with lumbar osteomyelitis, hepatic abscess, and infective endocarditis. In the literature of orthopedic post-prosthetic infections, L. garvieae was associated with a case of hip prosthetic infection in a fishmonger woman. We present the case of a 79-year-old male patient with multiple comorbidities, who is admitted to our center with a 5-day history of pain, swelling, and motility disorder of the right knee by the presence of a bicondylar knee replacement surgery, which was performed due to gonarthrosis 17 years ago. The radiographies of the right knee revealed no signs of displacement or loosening of the prothesis. After multiple radical debridements including VAC therapy and targeted antibiotic therapy we have managed to defeat the infection without exchange arthroplasty. Although we could not demonstrate the source of infection, we can only presume that in our case the source of infection was represented by the ingestion of possibly contaminated food. The patient had a habit of eating Nile perch fish (Lates niloticus) every 4 weeks. We illustrated once more the possibility of a late onset L. garvieae related orthopedic periprosthetic joint infection by multiple comorbidities. PMID:27833769

  17. Assessment of morbidity due to Schistosoma japonicum infection in China

    PubMed Central

    2014-01-01

    This paper presents a historical assessment of morbidity due to the Schistosoma japonicum infection in China. Due to the socio-economic situation, which did not allow for a control program to be implemented until the early 1950s, morbidity was serious and mortality was high before this. Based on a few investigations and published papers, it can be said that the disease caused millions of deaths, and destroyed numerous families and villages. Since the 1950s, there has been a national control program, intensive control and prevention work has been carried out, and consequently the disease is being controlled. At present, both the prevalence and the morbidity of the disease have been decreasing substantially. The morbidity of the three phases of the disease is outlined in this paper. Comparatively higher morbidity is seen in the acute and advanced phases of the disease. The four major forms of advanced schistosomiasis i.e., ascites, megalosplenia, dwarfism, and colonic tumoroid proliferation, are outlined with their characteristic clinical presentations; their proportions are different during various periods of the national control program. Ectopic schistosomiasis and the relationship between the S. japonicum infection and colorectal cancer are also discussed. Post-transmission schistosomiasis is briefly discussed (which can happen even if the disease reaches the criteria of elimination, and the infection and transmission have stopped, but yet it still develops). The problem of mammalian reservoir hosts of S. japonicum makes the epidemiology and control of schistosomiasis in China even more complicated and arduous, and the control progress in animal reservoirs is briefly presented. PMID:24529186

  18. Unyvero i60 implant and tissue infection (ITI) multiplex PCR system in diagnosing periprosthetic joint infection.

    PubMed

    Hischebeth, Gunnar T R; Randau, Thomas M; Buhr, Johanna K; Wimmer, Matthias D; Hoerauf, Achim; Molitor, Ernst; Bekeredjian-Ding, Isabelle; Gravius, Sascha

    2016-02-01

    Periprosthetic joint infection (PJI) is one of the most challenging complications in orthopedic surgery. In cases of suspected periprosthetic joint infection several diagnostic methods are available. In this study we investigated the performance of the newly available Unyvero i60 implant and tissue infection (ITI) multiplex PCR System. 62 specimens from 31 patients with suspected PJI or aseptic loosening of a painful joint arthoplasty were included in this study. Besides the established diagnostic procedures we included a commercial multiplex PCR detection system for diagnosis of PJI. The PCR results obtained from analysis of sonication and synovial fluids (62 specimens) showed a sensitivity of 66.7%, a specificity of 100%, a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 68.4% when compared to cultural methods. Notably, cultures from sonication fluid displayed a sensitivity of 88.9%, a specificity of 61.5%, a PPV of 76.2% and a NPV of 80.0% when compared to tissue cultures. In conclusion, multiplex PCR is an additional - rapid - method for diagnosing PJI. Positive results with the PCR assay used in this study were always confirmed by subsequent matching culture positivity. However, apart from the time saved the nucleic acid amplification technique did not yield additional information than that obtained from microbiological cultures.

  19. Superantigens in Staphylococcus aureus isolated from prosthetic joint infection

    PubMed Central

    Kim, Choon K.; Karau, Melissa J.; Greenwood-Quaintance, Kerryl E.; Tilahun, Ashenafi Y.; David, Chella S.; Mandrekar, Jayawant N.; Patel, Robin; Rajagopalan, Govindarajan

    2014-01-01

    Staphylococcus aureus is a common cause of prosthetic joint infection (PJI). The prevalence of superantigens (SAgs) among PJI-associated S. aureus is unknown. Eighty-four S. aureus isolates associated with PJI isolated between 1999 and 2006 were studied. SAg genes, sea, seb, sec, sed, see, seg, seh, sei and tst, were assayed by PCR. Seventy-eight (92.9%) isolates carried at least one SAg gene studied, with 61 (72.6%) harboring more than one. seg was most commonly (70.2%) and seh was least frequently (4.8%) detected. tst-positive isolates were associated with early infection and increased ESR at diagnosis (P = 0.006 and P = 0.021, respectively). seg and sei were associated with methicillin resistance (P = 0.008 and 0.002, respectively). SAg genes are prevalent in S. aureus causing PJI; a majority of PJI-associated isolates produce biologically active SAgs in both planktonic and biofilm growth modes. PMID:25619753

  20. Rapid Molecular Microbiologic Diagnosis of Prosthetic Joint Infection

    PubMed Central

    Cazanave, Charles; Greenwood-Quaintance, Kerryl E.; Hanssen, Arlen D.; Karau, Melissa J.; Schmidt, Suzannah M.; Gomez Urena, Eric O.; Mandrekar, Jayawant N.; Osmon, Douglas R.; Lough, Lindsay E.; Pritt, Bobbi S.; Steckelberg, James M.

    2013-01-01

    We previously showed that culture of samples obtained by prosthesis vortexing and sonication was more sensitive than tissue culture for prosthetic joint infection (PJI) diagnosis. Despite improved sensitivity, culture-negative cases remained; furthermore, culture has a long turnaround time. We designed a genus-/group-specific rapid PCR assay panel targeting PJI bacteria and applied it to samples obtained by vortexing and sonicating explanted hip and knee prostheses, and we compared the results to those with sonicate fluid and periprosthetic tissue culture obtained at revision or resection arthroplasty. We studied 434 subjects with knee (n = 272) or hip (n = 162) prostheses; using a standardized definition, 144 had PJI. Sensitivities of tissue culture, of sonicate fluid culture, and of PCR were 70.1, 72.9, and 77.1%, respectively. Specificities were 97.9, 98.3, and 97.9%, respectively. Sonicate fluid PCR was more sensitive than tissue culture (P = 0.04). PCR of prosthesis sonication samples is more sensitive than tissue culture for the microbiologic diagnosis of prosthetic hip and knee infection and provides same-day PJI diagnosis with definition of microbiology. The high assay specificity suggests that typical PJI bacteria may not cause aseptic implant failure. PMID:23658273

  1. Infected abdominal aortic aneurysm due to Escherichia coli.

    PubMed

    Bouzas, Miguel; Tchana-Sato, Vincent; Lavigne, Jean Paul

    2016-10-19

    Early diagnosis of infected abdominal aortic aneurysm (IAAA) is still a medical challenge due to its diverse and non-specific symptoms and signs. The most common responsible pathogens are Salmonella, Staphylococcus, Campylobacter and Streptococcus species. The authors report the case of a 67-year-old man, admitted for high fever and finally diagnosed with Escherichia coli (E.coli)-related IAAA. The IAAA ruptured during the general anaesthesia induction, leading to an emergency surgery. The authors successfully proceeded to an open aneurysmectomy with extensive debridement and in situ graft replacement. This case emphasizes the potential for rapid IAAA expansion, its high-rupture risk and the importance of computed tomography as a diagnostic tool.

  2. Oral antibiotic treatment of staphylococcal bone and joint infections in adults.

    PubMed

    Kim, Baek-Nam; Kim, Eu Suk; Oh, Myoung-Don

    2014-02-01

    Bone and joint infections, especially implant-associated infections, are difficult to cure. Long-term antibiotic therapy, combined with appropriate surgery and the removal of prostheses, is required. The most common causative organisms in bone and joint infections are staphylococci. Oral agents are often used after an initial course of parenteral antibiotic treatment. However, it is unclear which oral regimens are most effective in staphylococcal bone and joint infections. We review various oral antibiotic regimens and discuss which regimens are effective for this indication.

  3. Patient-Related Risk Factors for Periprosthetic Joint Infection after Total Joint Arthroplasty: A Systematic Review and Meta-Analysis

    PubMed Central

    Kunutsor, Setor K.; Whitehouse, Michael R.; Blom, Ashley W.; Beswick, Andrew D.

    2016-01-01

    Background Periprosthetic joint infections (PJIs) are dreaded complications of total joint arthroplasties. The risk of developing PJIs is likely to be influenced by several patient factors such as sociodemographic characteristics, body mass index (BMI), and medical and surgical histories. However, the nature and magnitude of the long-term longitudinal associations between these patient-related factors and risk of developing PJIs are uncertain. Objective To conduct a systematic review and meta-analysis to assess the associations between several patient-related factors and PJI. Data Sources MEDLINE, EMBASE, Web of Science, Cochrane Library, and reference lists of relevant studies from inception to September 2015. Study Selection Longitudinal studies with at least one-year of follow-up for PJIs after total joint arthroplasty. Data Extraction and Synthesis Two investigators extracted data on study characteristics, methods, and outcomes. A consensus was reached with involvement of a third. The relative risk (RR) with 95% confidence intervals was used as the summary measure of association across studies. Study-specific RRs with 95% confidence intervals were meta-analysed using random effect models and were grouped by study-level characteristics. Results Sixty-six observational (23 prospective cohort and 43 retrospective cohort or case-control) studies with data on 512,508 participants were included. Comparing males to females and smokers to non-smokers, the pooled RRs for PJI were 1.36 (1.18–1.57) and 1.83 (1.24–2.70) respectively. There was no evidence of any significant associations of PJI with age and high alcohol intake. Comparing BMI ≥ 30 versus < 30 kg/m2; ≥ 35 versus < 35 kg/m2; and ≥ 40 versus < 40 kg/m2; the pooled RRs were 1.60 (1.29–1.99); 1.53 (1.22–1.92); and 3.68 (2.25–6.01) respectively. Histories of diabetes, rheumatoid arthritis, depression, steroid use, and previous joint surgery were also associated with increased risk of PJI. The

  4. Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study.

    PubMed

    Benito, N; Franco, M; Ribera, A; Soriano, A; Rodriguez-Pardo, D; Sorlí, L; Fresco, G; Fernández-Sampedro, M; Dolores Del Toro, M; Guío, L; Sánchez-Rivas, E; Bahamonde, A; Riera, M; Esteban, J; Baraia-Etxaburu, J M; Martínez-Alvarez, J; Jover-Sáenz, A; Dueñas, C; Ramos, A; Sobrino, B; Euba, G; Morata, L; Pigrau, C; Coll, P; Mur, I; Ariza, J

    2016-08-01

    It is important to know the spectrum of the microbial aetiology of prosthetic joint infections (PJIs) to guide empiric treatment and establish antimicrobial prophylaxis in joint replacements. There are no available data based on large contemporary patient cohorts. We sought to characterize the causative pathogens of PJIs and to evaluate trends in the microbial aetiology. We hypothesized that the frequency of antimicrobial-resistant organisms in PJIs has increased in the recent years. We performed a cohort study in 19 hospitals in Spain, from 2003 to 2012. For each 2-year period (2003-2004 to 2011-2012), the incidence of microorganisms causing PJIs and multidrug-resistant bacteria was assessed. Temporal trends over the study period were evaluated. We included 2524 consecutive adult patients with a diagnosis of PJI. A microbiological diagnosis was obtained for 2288 cases (90.6%). Staphylococci were the most common cause of infection (1492, 65.2%). However, a statistically significant rising linear trend was observed for the proportion of infections caused by Gram-negative bacilli, mainly due to the increase in the last 2-year period (25% in 2003-2004, 33.3% in 2011-2012; p 0.024 for trend). No particular species contributed disproportionally to this overall increase. The percentage of multidrug-resistant bacteria PJIs increased from 9.3% in 2003-2004 to 15.8% in 2011-2012 (p 0.008), mainly because of the significant rise in multidrug-resistant Gram-negative bacilli (from 5.3% in 2003-2004 to 8.2% in 2011-2012; p 0.032). The observed trends have important implications for the management of PJIs and prophylaxis in joint replacements.

  5. Measurement of rehabilitation in thumb MP joint subluxation due to rheumatoid arthritis.

    PubMed

    Kitano, Keisuke; Tsujiuchi, Nobutaka; Ito, Akihito; Tokunaga, Daisaku; Kubo, Toshikazu; Nakamura, Satoru

    2014-01-01

    As treatment for subluxation due to rheumatoid arthritis (RA), rehabilitation by hand therapy is one option, but the number of therapist is not sufficient. Therefore, a device for rehabilitation of thumb metacarpophalangeal (MP) joint subluxation has been developed. To improve the device, it is necessary to measure in close proximity to the actual rehabilitation. Therefore, the authors tried to measure two kinds of rehabilitation by using motion capture and a contact force sensor. To measure rehabilitation movements, three markers were attached to the metacarpal bone, six markers were attached to each side of the interphalangeal (IP) joint, MP joint and proximal phalanx of the right thumb of the subjects, and a finger model was created by these markers. Further, three markers were placed on the left index of the therapist, and force direction was calculated by these markers. Measurement was conducted on healthy subjects, Rehabilitation was performed by the person who is not a therapist, but received the guidance of the doctor who is coauthor. As a result, the authors could measure rehabilitation by hand therapy, force, point of action and displacement. The results suggest that rehabilitation with traction twice as efficient as that without traction. Furthermore, it was found that rehabilitation is possible with calculated force, and the force is reproducible by the actuator in the device.

  6. Lower Urinary Tract Infection and Periprosthetic Joint Infection after Elective Primary Total Hip Arthroplasty

    PubMed Central

    Park, Chan Ho; Lee, Young-Kyun

    2017-01-01

    Purpose Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is a grave complication. Urinary tract infection (UTI) as a source for PJI is controversial. Our purposes were, (1) to evaluate the incidence of PJI after elective primary THA and (2) to determine whether UTI was associated with a risk of PJI after elective primary THA. Materials and Methods We retrospectively reviewed the medical records of 527 patients who underwent elective primary THA by using universal aseptic technique from May 2003 to October 2007. UTI group (13 patients) was defined as patients who underwent THA in status of having an UTI, and the remaining patients were defined as control group (514 patients). We compared the incidence of PJI in both groups. Results During the study period, the incidence of PJI was 0%, regardless of existence (or presence) of UTI. Conclusion There was no significant association between UTI and PJI, when cautiously performed THA. PMID:28316960

  7. Good quality of life outcomes after treatment of prosthetic joint infection with debridement and prosthesis retention.

    PubMed

    Aboltins, Craig; Dowsey, Michelle; Peel, Trish; Lim, Wen K; Choong, Peter

    2016-05-01

    Patients treated for early prosthetic joint infection (PJI) with surgical debridement and prosthesis retention have a rate of successful infection eradication that is similar to patients treated with the traditional approach of prosthesis exchange. It is therefore important to consider other outcomes after prosthetic joint infection treatment that may influence management decisions, such as quality of life (QOL). Our aim was to describe infection cure rates and quality of life for patients with prosthetic joint infection treated with debridement and prosthesis retention and to determine if treatment with this approach was a risk factor for poor quality of life outcomes. Prospectively collected pre and post-arthroplasty data were available for 2,134 patients, of which PJI occurred in 41. For patients treated for prosthetic joint infection, the 2-year survival free of treatment failure was 87% (95%CI 84-89). Prosthetic joint infection cases treated with debridement and retention had a similar improvement from pre-arthroplasty to 12-months post-arthroplasty as patients without PJI in QOL according to the SF-12 survey. Prosthetic joint infection treated with debridement and retention was not a risk factor for poor quality of life on univariate or multivariate analysis. Prosthetic joint infection treated with debridement and prosthesis retention results in good cure rates and quality of life. Further studies are required that directly compare quality of life for different surgical approaches for prosthetic joint infection to better inform management decisions. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:898-902, 2016.

  8. Lymph drainage in patients with joint immobility due to chronic ulcerated lesions.

    PubMed

    Pereira de Godoy, J M; Braile, D M; de Fátima Guerreiro Godoy, M

    2008-01-01

    The fibrous process of chronic ulcerated lesions of lower limbs can impair the mobility of the affected limb. The aim of this work was to assess the benefits of lymph drainage in patients who suffer from this disease. Twenty female and five male patients with ages ranging from 53 to 69 years (mean age 60.6 years) were evaluated. All had a history of at least 10 years of varicose veins and/or ulcerated lesions of the lower limbs with initial dermatofibrosis, with the positive Godet sign during the physical examination of the limb. Patients with intermittent claudication, diabetes and trauma were excluded from the study, as well as patients with chronic dermatofibrosis, and in whom positive Godet sign was not seen. Patients with immobility or very limited movement of the ankle and with some limitation in the toe joints were selected. The patients were randomly divided into group A comprising 15 individuals, and group B 10. All the individual treatments were established before the start of the evaluation period. Lymph drainage was performed on the patients of group A four or five times per week. Group B was subjected to a type of massage for the same period and at the same frequency. The mobility of the ankle joints was evaluated using goniometry before the start and after 30 days of treatment. In all the patients who underwent lymph drainage, an improvement of the joint mobility was seen, whereas in the control, group B, there was no obvious change. In conclusion, lymph drainage gave an improvement in the mobility of the ankle joint after impairment due to initial dermatofibrosis in patients with chronic ulcerated lesions.

  9. Multidrug resistant Acinetobacter baumannii reaches a new frontier: prosthetic hip joint infection.

    PubMed

    Hischebeth, G T R; Wimmer, M D; Molitor, E; Seifert, H; Gravius, S; Bekeredjian-Ding, I

    2015-02-01

    Acinetobacter baumannii is an emerging nosocomial pathogen primarily in countries with a high prevalence of multidrug resistance. Here we report the detection of a bla OXA23 carbapenemase-producing A. baumannii strain in a German patient with prosthetic hip joint infection following several hip joint surgeries but no history of foreign travel.

  10. Septic arthritis in Iceland 1990–2002: increasing incidence due to iatrogenic infections

    PubMed Central

    Geirsson, Á J; Statkevicius, S; Víkingsson, A

    2008-01-01

    Objectives: To assess the impact of increased number of diagnostic and therapeutic joint procedures on the incidence and type of septic arthritis (SA). Methods: All cases of SA in Iceland from 1990–2002 were identified by thorough review of the available medical information. The results of synovial fluid cultures from every microbiology department in Iceland were checked and positive culture results reviewed, as well as patient charts with a discharge diagnosis of septic arthritis (International Statistical Classification of Diseases and Related Health Problems (ICD) code M009). Results: A total of 253 cases of SA (69 children and 184 adults) were diagnosed in Iceland in 1990–2002, giving an average incidence of 7.1 cases/100 000 inhabitants. The incidence of SA increased from 4.2 cases/100 000 in 1990 to 11.0 cases/100 000 in 2002. This rise in SA was primarily observed in adults where the incidence rose by 0.61 cases/100 000 per year (p<0.001). SA was iatrogenic in 41.8% of adults and the number of iatrogenic infections increased from 2.8 cases/year in 1990–1994 to 9.0 cases/year in 1998–2002 (p<0.01). The annual number of arthroscopies increased from 430 in 1990–1994 to 2303 in 1998–2002 (p<0.001) and there was a correlation between the total usage of intra-articular drugs in Iceland and the incidence of SA (p<0.01). The frequency of post-arthroscopy SA was 0.14% and post-arthrocentesis SA 0.037%. Conclusions: The incidence of SA has increased in recent years due to an increased number of arthroscopies and joint injections. Although the frequency of SA per procedure has not changed, these results emphasise the importance of sterile technique and firm indications for joint procedures. PMID:17901088

  11. Outbreak of Intestinal Infection Due to Rhizopus microsporus▿

    PubMed Central

    Cheng, Vincent C. C.; Chan, Jasper F. W.; Ngan, Antonio H. Y.; To, Kelvin K. W.; Leung, S. Y.; Tsoi, H. W.; Yam, W. C.; Tai, Josepha W. M.; Wong, Samson S. Y.; Tse, Herman; Li, Iris W. S.; Lau, Susanna K. P.; Woo, Patrick C. Y.; Leung, Anskar Y. H.; Lie, Albert K. W.; Liang, Raymond H. S.; Que, T. L.; Ho, P. L.; Yuen, K. Y.

    2009-01-01

    Sinopulmonary and rhinocerebral zygomycosis has been increasingly found in patients with hematological malignancies and bone marrow transplantation, but intestinal zygomycosis remains very rare in the literature. We investigated an outbreak of intestinal infection due to Rhizopus microsporus in 12 patients on treatment for hematological malignancies over a period of 6 months in a teaching hospital. The intake of allopurinol during hospitalization (P < 0.001) and that of commercially packaged ready-to-eat food items in the preceding 2 weeks (P < 0.001) were found to be independently significant risk factors for the development of intestinal zygomycosis. A total of 709 specimens, including 378 environmental and air samples, 181 food samples, and 150 drug samples, were taken for fungal culture. Among them, 16 samples of allopurinol tablets, 3 prepackaged ready-to-eat food items, and 1 pair of wooden chopsticks were positive for Rhizopus microsporus, which was confirmed by ITS1-5.8S-ITS2 rRNA gene cluster (internal transcribed spacer [ITS]) sequencing. The mean viable fungal counts of allopurinol obtained from wards and pharmacy were 4.22 × 103 CFU/g of tablet (range, 3.07 × 103 to 5.48 × 103) and 3.24 × 103 CFU/g of tablet (range, 2.68 × 103 to 3.72 × 103), respectively, which were much higher than the mean count of 2 × 102 CFU/g of food. Phylogenetic analysis by ITS sequencing showed multiple clones from isolates of contaminated allopurinol tablets and ready-to-eat food, of which some were identical to patients' isolates, and with one isolate in the cornstarch used as an excipient for manufacture of this drug. We attempted to type the isolates by random amplification of polymorphic DNA analysis, with limited evidence of clonal distribution. The primary source of the contaminating fungus was likely to be the cornstarch used in the manufacturing of allopurinol tablets or ready-to-eat food. Rhizopus microsporus is thermotolerant and can multiply even at 50

  12. [Disseminated infection due to Penicillium marneffei related to HIV infection: first observation in Argentina].

    PubMed

    Santiso, Gabriela; Chediak, Viviana; Maiolo, Elena; Mujica, María T; San Juan, Jorge; Arechavala, Alicia; Negroni, Ricardo

    2011-01-01

    The first case observed in Argentina of AIDS-related human penicillosis is herein presented. The patient was a six- teen year-old young man coming from a rural area of southern China. He was admitted at the F. J. Muñiz Hospital of Buenos Aires city with severe pneumonia and adult respiratory distress. Penicillium marneffei was isolated from bronchoalveolar lavage fuid and was microscopically observed in a skin cytodiagnosis. P. marneffei identification was confirmed by rRNA amplification and its phenotypic characteristics. The patient suffered an advanced HIV infection and also presented several AIDS-related diseases due to CMV, nosocomial bacterial infections and Pneumocystis jirovecii which led to a fatal outcome.

  13. Neisseria meningitidis Infecting a Prosthetic Knee Joint: A New Case of an Unusual Disease

    PubMed Central

    Becerril Carral, Berta; López Cárdenas, Salvador; Canueto Quintero, Jesús

    2017-01-01

    Primary meningococcal meningitis is an infrequent but known disease. However, the infection of a prosthetic joint with Neisseria meningitidis is rare. We hereby describe the second case of an arthroplasty infected with Neisseria meningitidis that responded favourably to prosthesis retention with surgical debridement, in combination with antibiotics treatment. PMID:28326209

  14. Clinical features of group B Streptococcus prosthetic joint infections and molecular characterization of isolates.

    PubMed

    Corvec, S; Illiaquer, M; Touchais, S; Boutoille, D; van der Mee-Marquet, N; Quentin, R; Reynaud, A; Lepelletier, D; Bémer, P

    2011-01-01

    Twelve group B Streptococcus (GBS) prosthetic joint infection (PJI) cases are reported. The mean patient age was 55 years. Eleven infections were caused by GBS alone. The associated isolates belonged to phylogenetic lineages different from those that cause neonatal meningitis. The clinical outcome was favorable for the eight patients for whom follow-up data were available.

  15. Clinical Features of Group B Streptococcus Prosthetic Joint Infections and Molecular Characterization of Isolates ▿

    PubMed Central

    Corvec, S.; Illiaquer, M.; Touchais, S.; Boutoille, D.; van der Mee-Marquet, N.; Quentin, R.; Reynaud, A.; Lepelletier, D.; Bémer, P.

    2011-01-01

    Twelve group B Streptococcus (GBS) prosthetic joint infection (PJI) cases are reported. The mean patient age was 55 years. Eleven infections were caused by GBS alone. The associated isolates belonged to phylogenetic lineages different from those that cause neonatal meningitis. The clinical outcome was favorable for the eight patients for whom follow-up data were available. PMID:21068273

  16. A Study of Plazomicin Compared With Colistin in Patients With Infection Due to Carbapenem-Resistant Enterobacteriaceae (CRE)

    ClinicalTrials.gov

    2016-10-03

    Bloodstream Infections (BSI) Due to CRE; Hospital-Acquired Bacterial Pneumonia (HABP) Due to CRE; Ventilator-Associated Bacterial Pneumonia (VABP) Due to CRE; Complicated Urinary Tract Infection (cUTI) Due to CRE; Acute Pyelonephritis (AP) Due to CRE

  17. [Infection due to Mycobacterium bovis in common variable immunodeficiency].

    PubMed

    Herrera-Sánchez, Diana Andrea; Castilla-Rodríguez, Jaisel Luz; Castrejón-Vázquez, María Isabel; Vargas-Camaño, María Eugenia; Medina-Torres, Edgar Alejandro; Blancas-Galicia, Lizbeth; Espinosa-Padilla, Sara Elva

    2015-01-01

    Common variable immunodeficiency (CVID) is an heterogeneous group of disorders characterized by impaired antibody production. It shows a wide spectrum of manifestations including severe and recurrent respiratory infections (Streptococcus pneumoniae, Haemophilus) and gastrointestinal (Campylobacter jejuni, rotavirus and Giardia lamblia). Viral infections caused by herpes zoster, cytomegalovirus (CMV) and hepatitis C are rare. The opportunistic agents such as CMV, Pneumocystis jirovecii, cryptococcus and atypical mycobacteria have been reported as isolated cases. This paper reports the case of a 38-year-old female patient, who began six years before with weight loss of 7 kg in six months, fatigue, weakness, sweating, fever and abdominal pain. Furthermore, patient had intestinal obstruction and abdominal CT showed mesenteric lymph growth. The mesenteric lymph node biopsy revealed positives Mycobacterium PCR, Ziehl-Neelsen staining and culture for M. bovis. In the laparotomy postoperative period was complicated with nosocomial pneumonia, requiring mechanical ventilation and tracheostomy. Two years later, she developed right renal abscess that required surgical drainage, once again with a positive culture for Mycobacterium bovis. She was referred to highly specialized hospital and we documented panhypogammaglobulinemia and lymphopenia. Secondary causes of hypogammaglobulinemia were ruled out and common variable immunodeficiency (CVID) was confirmed, we started IVIG replacement. Four years later she developed mixed cellularity Hodgkin's lymphoma. Until today she continues with IVIG and chemotherapy. This report of a patient with CVID and Mycobacterium bovis infection, a unusual association, shows the cellular immunity susceptibility in this immunodeficiency, additional to the humoral defect.

  18. Spondylodiscitis due to anaerobic bacteria about a case of Parvimonas micra infection.

    PubMed

    Pilmis, B; Israel, J; Le Monnier, A; Mizrahi, A

    2015-08-01

    Parvimonas micra is a rare isolate in clinical specimens. We report a case of spondylodiscitis caused by P. micra, a rarely reported Gram positive cocci. The case was an elderly patient with joint surgery and ischaemic heart disease history. Infection resolved after adequate antibiotic therapy.

  19. Saccharomyces boulardii and infection due to Giardia lamblia.

    PubMed

    Besirbellioglu, Bulent A; Ulcay, Asim; Can, Mehmet; Erdem, Hakan; Tanyuksel, Mehmet; Avci, Ismail Yasar; Araz, Engin; Pahsa, Alaaddin

    2006-01-01

    Therapy with metronidazole is the recommended option in giardiasis. However, some clinical trial reports suggest the appearance of drug resistance to explain therapeutic failure. Several investigations have been carried out on the effect of probiotic microorganisms for preventing or treating gastrointestinal diseases, but little is known about their efficacy against protozoal infections. The principal objective of our study was to evaluate the efficacy of Saccharomyces boulardii against Giardia lamblia infections. A double-blind, placebo-controlled study was carried out on adult patients with giardiasis. Group 1 (30 patients) included metronidazole 750 mg 3 times daily along with S. boulardii capsules (250 mg b.i.d. orally) for 10 d while group 2 (35 patients) was treated with metronidazole 750 mg 3 times daily and with empty capsules as placebo for 10 d. Patients were re-examined at 2 and 4 weeks after treatment, and stool examinations were performed. At week 2, G. lamblia cysts were detected in 6 cases (17.1%) of group 2 and none in group 1. At the end of the fourth week, presence of the cysts continued in the same 6 cases in group 2 (control group). These findings indicated that S. boulardii may be effective in treating giardiasis when combined with metronidazole therapy.

  20. [Neuropathic pain due to herpes zoster infection with atypical localization].

    PubMed

    Sağır, Özlem; Özaslan, Sabri; Meriç, Yücel; Arslan, İsmail; Köroğlu, Ahmet

    2013-01-01

    Acute herpes zoster infection appears in the situation of depression of immune system and reactivation of varicella zoster virus which causes small pox. Pain and maculopapular lesion accompany clinical symptoms. Various pharmacological and invasive methods can be used for treatment. Efficient therapy is important for prevention of postherpetic neuralgia and cure of acute pain and dermatological lesions. A 55 years old, 160 cm height and 65 kg weight female patient with complaints of severe pain, sensation of burning, tingling at the right hand and forearm was admitted to our pain department. The patient who was diagnosed as cervical hernia at an other medical center had a normal physical servical spine examination. Patient history and physical examination findings with acute herpes zoster infection was considered. Right stellate ganglion blockade for diagnosis and treatment was performed because of regressed and atypically located lesions and a visual analog scale score of 10. VAS score decreased 50% at 9th min after block, VAS score at 2nd hour was 2. Antiviral, gabapentin, and tricyclic antidepressant treatment was started after stellat ganglion blockade and patient was discharged. After 3 months complaints dissapeared and drug doses were discreased and stopped. In conclusion we think that stellate ganglion blockade can be useful in diagnosis, acute pain control, improving patient comfort and compatibility to drug therapy in atypically located herpes zoster.

  1. Designer vaccines to prevent infections due to group B Streptococcus.

    PubMed

    Kasper, D L

    1995-10-01

    Group B streptococci (GBS) are the major cause of serious infections in neonates and an important cause of infection in adults, particularly peripartum women and patients with diabetes mellitus and malignancy. Immunity to GBS in neonates is associated with naturally acquired maternal antibodies to the type-specific capsular polysaccharides of these organisms. IgG class antibodies directed to these polysaccharides are passed transplacentally and protect the child from invasive GBS disease. Phase I and II clinical trials showed that the purified polysaccharides had limited immunogenicity. However, vaccine responders passed functional IgG class antibodies to their children. A glycoconjugate vaccine has been designed so that the type-specific polysaccharides are covalently linked to a carrier protein. This secondary amine linkage is between aldehyde groups created on the eighth carbon of a selected number of periodate-oxidized sialic acid residues of the polysaccharide and epsilon-amino groups on lysine residues of tetanus toxoid. Careful epitope mapping studies had demonstrated that modification by controlled periodate oxidation could be accomplished and that an important conformational epitope on the polysaccharide would be preserved. Preclinical testing of the glycoconjugate vaccines in animal models of GBS disease demonstrated the immunogenicity and protective efficacy of the vaccine-induced antibodies. Phase I clinical testing of the glycoconjugate vaccine is in progress, and the early results appear promising.

  2. Prosthetic joint infections secondary to rapidly growing mycobacteria: Two case reports and a review of the literature.

    PubMed

    Henry, Michael W; Miller, Andy O; Kahn, Barbara; Windsor, Russel E; Brause, Barry D

    2016-01-01

    Rapidly growing mycobacteria (RGM) are a rare but treatable cause of prosthetic joint infections. This study reports on two patients comprising three prosthetic joint infections caused by RGM successfully treated at the institution. With removal of the infected prosthetic joint and judicious use of prolonged courses of antibiotics, patients with prosthetic joint infections secondary to RGM can both be cured and retain function of the affected joint. In addition, this study identified 40 additional cases reported during an extensive review of the literature and provide a summary of these cases. These infections can present within days of arthroplasty or can develop only decades after the index surgery. The clinical presentations often mimic those of more routine bacterial prosthetic joint infections.

  3. Meningomyelitis due to nematode infection in four cats.

    PubMed

    Gómez, M; Mieres, M; Moroni, M; Mora, A; Barrios, N; Simeone, C; Lindsay, D S

    2010-06-24

    Spinal cord parasitic migrations in cats are uncommon. This report describes four cases of chronic hindlimb paraparesis in cats associated with nematode infection. Complete neurologic, hematologic, serum chemistry and radiographic examination was performed on all animals. Computed tomographic (CT)-myelographic examination at the lumbar area in one cat showed a slight swelling of the spinal cord. Necropsy examination of the spinal cord revealed generalized edema and marked submeningeal hemorrhage at the thoracic region in three cats. On histopathologic examination, numerous sections of adult nematodes and eggs were present in histological sections of the affected spinal cord segments in all cats. The morphologic features of the nematode, location and appearance of the lesions suggest that the parasite responsible for the paralysis in these cats is Gurltia paralysans.

  4. Staphylococcal scalded skin syndrome due to burn wound infection.

    PubMed

    Farroha, A; Frew, Q; Jabir, S; Dziewulski, P

    2012-09-30

    Introduction. Le syndrome de la peau ébouillantée staphylococcique (sigle anglais conventionnel, SSSS) est une exfoliation aiguë de la peau causée par des toxines A et B. Bien que le Staphylococcus aureus soit une cause fréquente d’infection des brûlures, la SSSS suite à une infection brûlure est rare. Méthode. Les Auteurs ont effectué une revue rétrospective de tous les cas de patients atteints de SSSS hospitalises admis dans un service régional des brûlures entre janvier 2008 et janvier 2012. Résultats. Deux cas de SSSS ont été signalés au cours de cette période qui se sont produits suite à une brûlure. Le premier cas était un garçon de 17 mois qui avait été hospitalisé pour un traitement conservateur pour ébouillantement dans 6% de la surface corporelle totale de profondeur variable. Le quatrième jour, il a développé une exfoliation dans 85% de la surface corporelle. Quant au deuxième cas, il s’agissait d’un garçon de dix mois qui a subi une brûlure de 1% de la surface corporelle et qui a été traité en manière conservatrice dans la communauté par son médecin généraliste. Le cinquième jour, il a développé une exfoliation dans 80% de la surface corporelle. Le Staphylococcus aureus a été isolé qui provenait des brûlures dans les deux cas. Conclusion. Ces deux cas montrent qu’il est essentiel que les brûlologues et les spécialistes des soins intensifs soient au courant de la possibilité de la présence de SSSS chez des patients souffrant de brûlures, avec tous ses potentiels effets dévastateurs.

  5. Current Evidence for the Use of Laminar Flow in Reducing Infection Rates in Total Joint Arthroplasty

    PubMed Central

    James, M; Khan, W.S; Nannaparaju, M.R; Bhamra, J.S; Morgan-Jones, R

    2015-01-01

    Since the introduction of laminar air flow in orthopaedic theatres by Sir John Charnley, it has widely become accepted as the standard during orthopaedic procedures such as joint arthroplasty. We present a review of available current literature for the use of laminar flow operating theatre ventilation during total joint arthroplasty and examines the effectiveness of laminar flow ventilated operating theatres in preventing post-operative wound infection. Results of our findings suggest that while bacterial and air particulate is reduced by laminar air flow systems, there is no conclusive effect on the reduction of post-operative wound infections following total joint arthroplasty. We conclude that a combination of strict aseptic technique, prophylactic antibiotics and good anaesthetic control during surgery remains crucial to reduce post-operative surgical infections. PMID:26587068

  6. Abortion in cattle due to infection with Staphylococcus lugdunensis.

    PubMed

    Ardigò, Paolo; D'Incau, Mario; Pongolini, Stefano

    2014-11-01

    An aborted fetus of 7 months gestation, the associated placenta, and a single blood sample from the dam were submitted for diagnostic investigation to the diagnostic laboratory of the Lombardy and Emilia-Romagna Experimental Zooprophylactic Institute in Parma, Italy. The serum was negative for Neospora caninum, Coxiella burnetii, Chlamydophila abortus, Bovine herpesvirus 1 (BHV-1), Bovine viral diarrhea virus (BVDV), Brucella abortus, and Brucella melitensis. Fetal tissues and placental cotyledons were pooled and tested by polymerase chain reaction (PCR) for the presence of BHV-1, Bovine herpesvirus 4, BVDV, N. caninum, C. burnetii, Chlamydophila spp., Schmallemberg virus, and Leptospira interrogans. All PCR assays were negative. Bacteriological examinations performed on the fetal organs revealed a pure growth of Staphylococcus lugdunensis in all organs cultured. In human beings, S. lugdunensis is responsible for community-acquired and nosocomial infections, in both immunocompetent and immunocompromised patients. In veterinary medicine, the pathogenic potential of S. lugdunensis has not been fully investigated. The incidence of S. lugdunensis is regarded as being underreported because it could be easily misidentified as Staphylococcus aureus. The current report documents the ability of S. lugdunensis to cause abortion in cattle, indicating the need for accurate diagnostic procedures to identify this emerging and zoonotic pathogen whose incidence is likely underestimated in both human and veterinary medicine.

  7. Recent lessons for the management of bone and joint infections.

    PubMed

    Kaplan, Sheldon L

    2014-01-01

    The epidemiology and clinical manifestations of osteoarticular infections are changing primarily as a result of the emergence of community-acquired methicillin-resistant Staphylococcus aureus infections. Multifocal disease, venous thrombosis and pathologic fractures are manifestations of CA-MRSA osteomyelitis. MRI is the diagnostic imaging modality of choice for musculoskeletal infections. Nafcillin/oxacillin or cefazolin remains the antibiotic of choice for treating infections caused by MSSA. A β-lactam antibiotic is recommended for Kingella kingae. Vancomycin and clindamycin are the first line agents for treating osteomyelitis caused by CA-MRSA. A short course of parenteral antibiotics followed by appropriate oral antibiotics is equivalent to total course of parenteral antibiotics for most patients and avoids the risks associated with PICCs. Surgical drainage of subperiosteal abscesses and surrounding pyomyositis is common with S. aureus clones currently circulating. Collaboration with hematologists for managing patients with venous thromboses is recommended.

  8. Antibiotic susceptibility among Staphylococcus epidermidis isolated from prosthetic joint infections, with focus on doxycycline.

    PubMed

    Hamad, Tarza; Hellmark, Bengt; Nilsdotter-Augustinsson, Åsa; Söderquist, Bo

    2015-12-01

    In recent years, coagulase-negative staphylococci such as Staphylococcus epidermidis have gained importance as nosocomial pathogens, especially in immunocompromised patients and prosthetic joint infections (PJIs). These infections are often long lasting and difficult to treat due to the production of bacterial biofilm and the transformation of the bacteria into a stationary growth phase. Rifampicin is able to penetrate the biofilm, but to reduce the risk of development of rifampicin resistance it should be used in combination with an additional antibiotic. In this study we used Etest to investigate the antimicrobial susceptibility of 134 clinical isolates of S. epidermidis obtained from PJIs to six oral antibiotics: doxycycline, rifampicin, linezolid, fusidic acid, clindamycin, and ciprofloxacin. We also performed synergy testing on doxycycline in combination with each of the remaining antibiotics. Ninety-three (69%) of the 134 isolates were susceptible to doxycycline, 94/134 (70%) to rifampicin, 56/134 (42%) to clindamycin, 25/134 (19%) to ciprofloxacin, 81/134 (60%) to fusidic acid, and 100% to linezolid. Thirty-two (80%) of the 40 isolates not fully susceptible to rifampicin were susceptible to doxycycline. Doxycycline in combination with each of the other investigated antibiotics exerted an additive effect on nearly half of the isolates, with the exception of clindamycin, which displayed an even higher percentage of additive effect (69%). To conclude, as the majority of the S. epidermidis isolates were susceptible to doxycycline, this antimicrobial agent may provide a potential alternative for combination therapy together with rifampicin.

  9. Case report: first report of a prosthetic joint infection caused by Facklamia hominis.

    PubMed

    Corona, Pablo S; Haddad, Sleiman; Andrés, José; González-López, Juan José; Amat, Carles; Flores, Xavier

    2014-12-01

    Facklamia spp. are gram-positive cocci first described in 1997. They are α-hemolytic, facultative anaerobes, catalase-negative cocci, resembling viridians streptococci on 5% sheep blood agar. Facklamia hominis is, by far, the most common species of the 6 so far described, and it is thought that its natural habitat is the female genital tract. Four previous human infections with Facklamia spp. have been documented. We report the first case of a chronic prosthetic joint infection caused by F. hominis and its successful treatment by a 2-stage exchange procedure to eradicate the infection. This is also the first osteoarticular infection reported. The clinical implications are discussed.

  10. Long-term effects of neonatal bone and joint infection on adjacent growth plates.

    PubMed

    Peters, W; Irving, J; Letts, M

    1992-01-01

    Review of children with physeal damage from neonatal infection other than the hip at Winnipeg Children's Hospital showed that six patients had residual growth interference from adjacent infection in the bone or joint. Several of the infections involved multiple joints, with growth plate arrest occurring in the distal femoral growth plate in four, in the proximal humerus in four, in the proximal femur in two, in the distal radius in one, and in the distal humerus in one. Although the initial infection was frequently believed to be successfully treated in the neonate, the clinical effect of these infections on the growth plate was not fully appreciated in five of the infants until the children reached a mean age of 9 years. Because growth abnormalities in physeal bars may not be clinically evident for several years after the initial infection has been treated, we recommend that children with bone and joint infections occurring in the first month of life be followed to skeletal maturity, observing the adjacent physis for late tethering.

  11. Symptomatic Peripheral Mycotic Aneurysms Due to Infective Endocarditis

    PubMed Central

    González, Isabel; Sarriá, Cristina; López, Javier; Vilacosta, Isidre; San Román, Alberto; Olmos, Carmen; Sáez, Carmen; Revilla, Ana; Hernández, Miguel; Caniego, Jose Luis; Fernández, Cristina

    2014-01-01

    Abstract Peripheral mycotic aneurysms (PMAs) are a relatively rare but serious complication of infective endocarditis (IE). We conducted the current study to describe and compare the current epidemiologic, microbiologic, clinical, diagnostic, therapeutic, and prognostic characteristics of patients with symptomatic PMAs (SPMAs). A descriptive, comparative, retrospective observational study was performed in 3 tertiary hospitals, which are reference centers for cardiac surgery. From 922 definite IE episodes collected from 1996 to 2011, 18 patients (1.9%) had SPMAs. Because all SPMAs developed in left-sided IE, we performed a comparative study between 719 episodes of left-sided IE without SPMAs and 18 episodes with SPMAs. We found a higher frequency of intravenous drug abuse, native valve IE, intracranial bleeding, septic emboli, multiple embolisms, and IE diagnostic delay >30 days in patients with SPMAs than in patients without SPMAs. The causal microorganisms were gram-positive cocci (n =10), gram-negative bacilli (n = 2), gram-positive bacilli (n = 3), Bartonella henselae (n = 1), Candida albicans (n = 1), and negative culture (n = 1). The median IE diagnosis delay was 15 days (interquartile range [IQR], 13–33 d) in the case of high-virulence microorganisms versus 45 days (IQR, 30–240 d) in the case of low- to medium-virulence microorganisms. Twelve SPMAs were intracranial and 6 were extracranial. In 10 cases (8 intracranial and 2 extracranial), SPMAs were the initial presentation of IE; the remaining cases developed symptoms during or after finishing parenteral antibiotic treatment. The initial diagnosis of intracranial SPMAs was made by computed tomography (CT) or magnetic resonance imaging in 6 unruptured aneurysms and by angiography in 6 ruptured aneurysms. The initial test in extracranial SPMAs was Doppler ultrasonography in limbs, CT in liver, and coronary angiography in heart. Four (3 intracranial, 1 extracranial) of 7 (6 intracranial, 1 extracranial

  12. Bilateral Hip Joint Hylan G-F 20 Granulomatous Synovitis due to Viscosupplementation Injections.

    PubMed

    Weinrauch, Patrick; Trigger, Robert; Tsikleas, George

    2014-01-01

    We present the diagnosis of bilateral granulomatous inflammation of the hip joints associated with Hylan G-F 20 viscosupplementation injections. Clinicians recommending therapeutic Hylan injections for the management of hip arthritis should maintain clinical awareness regarding this potential complication.

  13. Bone and Joint Infections in Children: Acute Hematogenous Osteomyelitis.

    PubMed

    Agarwal, Anil; Aggarwal, Aditya N

    2016-08-01

    Acute hematogenous osteomyelitis (AHO) is one of the commonest bone infection in childhood. Staphylococcus aureus is the commonest organism causing AHO. With use of advanced diagnostic methods, fastidious Kingella kingae is increasingly becoming an important organism in etiology of osteoarticular infections in children under the age of 3 y. The diagnosis of AHO is primarily clinical. The main clinical symptom and sign in AHO is pain and tenderness over the affected bone especially in the metaphyseal region. However, in a neonate the clinical presentation may be subtle and misleading. Laboratory and radiological investigations supplement the clinical findings. The acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are frequently elevated. Ultrasonography and MRI are key imaging modalities for early detection of AHO. Determination of infecting organism in AHO is the key to the correct antibiotic choice, treatment duration and overall management and therefore, organism isolation using blood cultures and site aspiration should be attempted. Several effective antibiotics regimes are available for managing AHO in children. The choice of antibiotic and its duration and mode of delivery requires individualization depending upon severity of infection, causative organism, regional sensitivity patterns, time elapsed between onset of symptoms and child's presentation and the clinical and laboratory response to the treatment. If pus has been evidenced in the soft tissues or bone region, surgical decompression of abscess is mandatory.

  14. Voltages across assembly joints due to direct-strike lightning currents

    SciTech Connect

    Dinallo, M.S.; Fisher, R.J.

    1994-08-01

    An extensive set of direct-strike lightning tests has been carried out on a set of facsimile assembly joints of the kinds employed in the design of nuclear weapon cases. Taken as a whole, the test hardware included all the conceptual design elements that are embodied, either singly or in combination, in any specific assembly joint incorporated into any stockpiled weapon. During the present testing, the effects of all key design parameters on the voltages developed across the interior of the joints were investigated under a range of lightning stroke current parameter values. Design parameter variations included the types and number of joint fasteners, mechanical preload, surface finish tolerance and coatings, and the material from which the joint assembly was fabricated. Variations of the simulated lightning stroke current included amplitude (30-, 100-, and 200-kA peak), rise time, and decay time. The maximum voltage observed on any of the test joints that incorporated proper metal-to-metal surface contact was 65 V. Typical response values were more on the order of 20 V. In order to assess the effect of the presence of a dielectric coating (either intentional or as a result of corrosion) between the mating surfaces of a joint, a special configuration was tested in which the mating parts of the test assembly were coated with a 1-mil-thick dielectric anodizing layer. First strokes to these test assemblies resulted in very narrow voltage spikes of amplitudes up to 900 V. The durations of these spikes were less than 0.1 {mu}s. However, beyond these initial spikes, the voltages typically had amplitudes of up to 400 V for durations of 3 to 5 {mu}s.

  15. A Possible Novel Prosthetic Joint Infection Pathogen, Mycoplasma salivarium, Identified by Metagenomic Shotgun Sequencing.

    PubMed

    Thoendel, Matthew; Jeraldo, Patricio; Greenwood-Quaintance, Kerryl E; Chia, Nicholas; Abdel, Matthew P; Steckelberg, James M; Osmon, Douglas R; Patel, Robin

    2017-04-01

    Defining the microbial etiology of culture-negative prosthetic joint infection (PJI) can be challenging. Metagenomic shotgun sequencing is a new tool to identify organisms undetected by conventional methods. We present a case where metagenomics was used to identify Mycoplasma salivarium as a novel PJI pathogen in a hypogammaglobulinemic individual.

  16. Listeria monocytogenes infection in a prosthetic knee joint in rheumatoid arthritis.

    PubMed Central

    Booth, L V; Walters, M T; Tuck, A C; Luqmani, R A; Cawley, M I

    1990-01-01

    The prosthetic knee joint of a 64 year old woman with severe rheumatoid arthritis was found to be infected with Listeria monocytogenes. After treatment with intravenous antibiotics, symptoms gradually resolved. She subsequently received prolonged treatment with oral co-trimoxazole and 18 months later remained well. PMID:2310230

  17. Clinical Effectiveness of Negative Pressure Wound Therapy Following Surgical Resection of Sternoclavicular Joint Infection: A Case Report

    PubMed Central

    Moffatt-Bruce, Susan D; Merritt, Robert E; D'Souza, Desmond M

    2016-01-01

    Septic arthritis of the sternoclavicular joint (SCJ) is a rare condition accounting for 0.5% of bone and joint infections. The majority of cases require joint resection and advancement flaps to provide coverage to the resulting wound defect. However, in the setting of an infected wound space, surgeons are often inclined to allow wound healing by secondary intention. Negative pressure wound therapy (NPWT) can be an important adjunct to promote and shorten wound healing time following SCJ resection. PMID:27843733

  18. Performance limitations of joint variable-feedback controllers due to manipulator structural flexibility

    NASA Technical Reports Server (NTRS)

    Cetinkunt, Sabri; Book, Wayne J.

    1990-01-01

    The performance limitations of manipulators under joint variable-feedback control are studied as a function of the mechanical flexibility inherent in the manipulator structure. A finite-dimensional time-domain dynamic model of a two-link two-joint planar manipulator is used in the study. Emphasis is placed on determining the limitations of control algorithms that use only joint variable-feedback information in calculations of control decisions, since most motion control systems in practice are of this kind. Both fine and gross motion cases are studied. Results for fine motion agree well with previously reported results in the literature and are also helpful in explaining the performance limitations in fast gross motions.

  19. Human infections due to Salmonella Blockley, a rare serotype in South Africa: a case report

    PubMed Central

    2012-01-01

    Background Infections due to nontyphoidal Salmonella have increased worldwide over the last couple of decades. Salmonella enterica serotype Blockley (Salmonella Blockley) infections is associated with chickens and is a rarely isolated serotype in human infections in most countries. Case presentation We report a case of human infections due to Salmonella Blockley in KwaZulu-Natal, South Africa in 2011. Three African males (aged 4, 14 and 16) presented to a clinic with diarrhoea, stomach cramps and headache. They started experiencing signs of illness a day after they consumed a common meal, consisting of meat, rice and potatoes. Stool specimens from the patients cultured Salmonella Blockley. The strains showed an indistinguishable pulsed-field gel electrophoresis pattern. Conclusion This is the first recorded case of human infections due to Salmonella Blockley in South Africa. PMID:23050633

  20. A Case of Penicillin-Resistant Veillonella Prosthetic Joint Infection of the Knee

    PubMed Central

    Peterson, Joy H.; Brodersen, Mark P.; Huff, Tamara

    2016-01-01

    Veillonella sp. and V. dispar are emerging pathogens. This is the third case of a monomicrobial Veillonella sp. prosthetic joint infection (PJI) among knees and hips; this is the second prosthetic knee infection described. The infection was treated with a 2-stage procedural approach combined with 6 weeks of ceftriaxone with excellent clinical response. There was no relapse in 2 years of follow-up care. This case exemplifies the importance of incubating anaerobic cultures for at least 7 days to grow some anaerobic pathogens. PMID:28050296

  1. Meningitis and bacteremia due to Bacillus cereus. A case report and a review of Bacillus infections.

    PubMed

    Siegman-Igra, Y; Lavochkin, J; Schwartz, D; Konforti, N

    1983-06-01

    A patient with meningitis and bacteremia due to Bacillus cereus is described. The patient had transsphenoidal hypophysectomy for chromophobe adenoma, complicated by rhinorrhea, which was corrected by subarachnoid drainage. Three weeks after removal of the drain, the patient presented with meningitis and died the following day. The causative organism was identified as B. cereus. The literature on Bacillus infections is reviewed with special attention to severe infections. A modified classification is proposed, dividing infections into superficial, closed-space and systemic ones. Sixty-one previously reported cases of systemic Bacillus infections are reviewed according to type of infection (endocarditis, meningitis or pulmonary infection), and the underlying conditions, ways of acquiring the infection, clinical picture and mortality are discussed.

  2. Invasive infection in an acute myeloblastic leukemia patient due to triazole-resistant Candida tropicalis.

    PubMed

    de Carvalho Parahym, Ana Maria Rabelo; da Silva, Carolina Maria; Leão, Mariele Porto Carneiro; Macario, Michele Chianca; Filho, Gustavo Antônio da Trindade Meira Henriques; de Oliveira, Neiva Tinti; Neves, Rejane Pereira

    2011-11-01

    Non-albicans Candida species are being increasingly reported as causes of nosocomial fungal infections. For example, invasive candidiasis caused by C. tropicalis has been associated with hematologic malignancies. In this study, we report a fatal case of fungemia and a possible urinary and pulmonary infection in a leukemia patient that was due to a strain of C. tropicalis resistant to 2 triazole antifungals.

  3. Central nervous system infection due to Mycobacterium haemophilum in a patient with acquired immunodeficiency syndrome.

    PubMed

    Buppajarntham, Aubonphan; Apisarnthanarak, Anucha; Rutjanawech, Sasinuj; Khawcharoenporn, Thana

    2015-03-01

    Mycobacterium haemophilum is an environmental organism that rarely causes infections in humans. We report a patient with acquired immunodeficiency syndrome who had central nervous system infection due to M. haemophilum. The diagnosis required brain tissue procurement and molecular identification method while the treatment outcome was unfavourable.

  4. Two-stage Revision for Periprosthetic Hip and Knee Joint Infections

    PubMed Central

    Kini, Sunil Gurpur; Gabr, Ayman; Das, Rishi; Sukeik, Mohamed; Haddad, Fares Sami

    2016-01-01

    Background: Periprosthetic joint infection (PJI) continues to be one of the leading causes of failure following hip and knee surgery. The diagnostic workflow of PJI includes detailed clinical examination, serum markers, imaging and aspiration/biopsy of the affected joint. The goals of treatment are eradication of the infection, alleviation of pain, and restoration of joint function. Surgical management of PJI consists of debridement, antibiotics and implant retention (DAIR) and single or two-stage revision procedures. Two-stage revision remains the gold standard for treatment of PJIs. We aim to discuss the two stage procedure in this article and report the outcomes. Methods: The first stage of the two stages consists of removal of all components and associated cement with aggressive debridement and placement of an antibiotic-loaded cement spacer. Patients are then treated with variable periods of parenteral antibiotics, followed by an antibiotic free period to help ensure the infection has been eradicated. If the clinical evaluation and serum inflammatory markers suggest infection control, then the second stage can be undertaken and this involves removal of the cement spacer, repeat debridement, and placement of a new prosthesis. Results: Common themes around the two-stage revision procedure include timing of the second stage, antibiotics used in the interim period, length of the interim period before consideration of reimplantation and close liaising with microbiologists. Conclusion: Successful eradication of infection and good functional outcome using the two stage procedure is dependent on a multidisciplinary approach and having a standard reproducible startegy. PMID:28144371

  5. Bloodstream infection due to Brachyspira pilosicoli in a patient with multiorgan failure.

    PubMed

    Prim, Núria; Pericas, Roser; Español, Montse; Rivera, Alba; Mirelis, Beatriz; Coll, Pere

    2011-10-01

    Brachyspira pilosicoli is an etiological agent of human intestinal spirochetosis. Bloodstream infection due to this microorganism is rare. We report a case of B. pilosicoli bacteremia in a 70-year-old patient who presented with multiorgan failure.

  6. Improved detection methods for infected hip joint prostheses.

    PubMed

    Høgdall, Dan; Hvolris, Jørgen Jesper; Christensen, Lise

    2010-11-01

    Awareness of the role of bacterial biofilm in the pathogenesis of low-grade or chronic infections diagnosed in hip arthroplasty has been on the rise in recent years. The importance of bacterial biofilm for the development of prosthesis failure is probably underestimated, and terms like aseptic loosening, sterile pus and aseptic necrosis are up for revision. The diagnosis of biofilm has been, and still is, difficult, but new molecular biological techniques, alone or in combination with older established ones, have further helped us to uncover lesions, where biofilm is part of the pathology. This article based on a literature search and own observations is primarily focused on newer methods that help us identify the pathology behind infection-based prosthesis failure. We suggest that the fluorescence in situ hybridization technique on carefully selected biopsy material is used in the future to identify live as well as dead bacteria within their environment. The method is quick and sensitive and provides a reliable result with optimal detection rate.

  7. Bilateral Hip Joint Hylan G-F 20 Granulomatous Synovitis due to Viscosupplementation Injections

    PubMed Central

    Trigger, Robert; Tsikleas, George

    2014-01-01

    We present the diagnosis of bilateral granulomatous inflammation of the hip joints associated with Hylan G-F 20 viscosupplementation injections. Clinicians recommending therapeutic Hylan injections for the management of hip arthritis should maintain clinical awareness regarding this potential complication. PMID:25210640

  8. Bilateral prosthetic hip joint infections associated with a Psoas abscess. A Case Report

    PubMed Central

    Gunaratne, G D Rajitha; Khan, Riaz J K; Tan, Cynthia; Golledge, Clayton

    2016-01-01

    Introduction: Psoas abscess is a recognized but under-diagnosed complication of prosthetic hip joint infections. Case report: We report a case of a 68-year-old man with right and left hip arthroplasties performed 22 and 14 years ago, respectively, who presented with non-specific symptoms and was subsequently diagnosed with left psoas abscess on CT scan. Drainage of the psoas abscess was complicated by the formation of a discharging sinus connected to the left hip. He then developed an infected right thigh haematoma, which also formed a discharging sinus connecting to the right hip post-drainage. He was treated with bilateral two-stage revision total hip arthroplasties and multiple courses of prolonged antibacterial therapy. Both abscesses and hip joints cultured the same species of multi-sensitive Staphylococcus aureus. The causal link between the psoas abscess and the prosthetic hip infections is discussed, as well as the investigation and management. Conclusion: We recommend routine exploration of the iliopsoas bursa when revision of an infected total hip arthroplasty is performed to rule out intrapelvic spread of the infection [3]. There should be high index of suspicion of prosthetic hip infection in patients presenting with Psoas abscess and vice versa. A CT scan might be warranted to rule out concomitant infection in both these patients. PMID:28116254

  9. Diagnosis and management of the infected total joint arthroplasty

    SciTech Connect

    Cuckler, J.M.; Star, A.M.; Alavi, A.; Noto, R.B. )

    1991-07-01

    The preoperative diagnosis of the infected orthopedic implant is complicated by lack of a single precise test to forewarn patient and surgeon of the presence of microorganisms. Given the overall limitation of accuracy of preoperative diagnosis to approximately 80% when 111In scanning, preoperative aspiration, and ESR are considered, it would seem prudent to approach each revision surgery with the possibility in mind of subclinical sepsis as the cause for failure of the implant. The essentials of surgical technique including thorough debridement of the wound and removal of all existing foreign bodies, especially including PMMA bone cement, are critical to minimizing the risk for occurrence or persistence of sepsis. Although the use of antibiotic impregnated bone cement may enhance the treatment of orthopedic sepsis, the data available to date lead to the conclusion that two-stage revision surgery in the face of known sepsis remains the cornerstone of surgical therapy for the infected implant, along with aggressive and rational antibiotic treatment. The surgeon is offered the following guidelines in the management of the septic total hip arthroplasty. 1. Preoperative evaluation including ESR, 111In WBC scan, and aspiration for culture and sensitivity (fluoroscopically guided for the hip) will produce on average approximately 80% accuracy. 2. Intraoperative cultures at the time of revision surgery should be obtained prior to administration of systemic antibiotics; three tissue specimens (hip capsule, femoral membrane, acetabular membrane) should be submitted for culture and sensitivity determination. 3. Careful debridement of the surgical site of granulation tissue and all foreign bodies (e.g., PMMA) should be performed within the limits of patient safety to maximize the likelihood of success. 37 refs.

  10. Linezolid in late-chronic prosthetic joint infection caused by gram-positive bacteria.

    PubMed

    Cobo, Javier; Lora-Tamayo, Jaime; Euba, Gorane; Jover-Sáenz, Alfredo; Palomino, Julián; del Toro, Ma Dolores; Rodríguez-Pardo, Dolors; Riera, Melchor; Ariza, Javier

    2013-05-01

    Linezolid may be an interesting alternative for prosthetic joint infection (PJI) due to its bioavailability and its antimicrobial spectrum. However, experience in this setting is scarce. The aim of the study was to assess linezolid's clinical and microbiological efficacy, and also its tolerance. This was a prospective, multicenter, open-label, non-comparative study of 25 patients with late-chronic PJI caused by Gram-positive bacteria managed with a two-step exchange procedure plus 6 weeks of linezolid. Twenty-two (88%) patients tolerated linezolid without major adverse effects, although a global decrease in the platelet count was observed. Three patients were withdrawn because of major toxicity, which reversed after linezolid stoppage. Among patients who completed treatment, 19 (86%) demonstrated clinical and microbiological cure. Two patients presented with clinical and microbiological failure, and one showed clinical cure and microbiological failure. In conclusion, linezolid showed good results in chronic PJI managed with a two-step exchange procedure. Tolerance seems acceptable, though close surveillance is required.

  11. Myocarditis and myositis due to infection with Hepatozoon species in pine martens (Martes martes) in Scotland.

    PubMed

    Simpson, V R; Panciera, R J; Hargreaves, J; McGarry, J W; Scholes, S F E; Bown, K J; Birtles, R J

    2005-04-02

    Postmortem examinations of four pine martens which had died as a result of road accidents in Scotland revealed focal, granulomatous lesions in the heart and skeletal muscles of three of them. An immunoperoxidase staining technique showed that the lesions were due to infection with Hepatozoon species. A PCR-based assay was used to confirm the presence of Hepatozoon DNA in the infected tissues. The nucleotide base sequence of the PCR products suggested that the infecting organism was probably a new species of Hepatozoon, most closely related to, but distinct from, Hepatozoon canis. The pine martens were in good physical condition and there was no indication that the infection was causing ill health.

  12. Child sexual abuse and sexually transmitted infections: review of joint genitourinary medicine and paediatric examination practice.

    PubMed

    Kawsar, M; Long, S; Srivastava, O P

    2008-05-01

    Joint examination by doctors with complementary skills and screening for sexually transmitted infections (STIs) are recommended in children who may have been sexually abused or have been found to have an STI. Our study showed that criminal proceedings were more likely to be brought in cases with physical signs of sexual abuse. It could be difficult to prove whether sexual abuse had taken place or not with microbiological evidence alone, in the absence of other evidence. Significance of viral STIs in the context of sexual abuse should be evaluated carefully. The review of our practice re-enforced the importance of joint examination of children with suspected STIs.

  13. Detection of incoherent joint state due to inaccurate bone motion estimation.

    PubMed

    Schwartz, Cédric; Leboeuf, Fabien; Rémy-Néris, Olivier; Brochard, Sylvain; Lempereur, Mathieu; Burdin, Valérie

    2013-01-01

    In biomechanical modelling and motion analysis, the use of personalised data such as bone geometry would provide more accurate and reliable results. However, there are still a limited number of tools used to measure the evolution of articular interactions. This paper proposes a coherence index to describe the articular status of contact surfaces during motion. The index relies on a robust estimation of the evolution of surfacic interactions between the joint surfaces. The index is first compared to distance maps on simulated motions. It is then used to compare two motion capture protocols (two different localisations of the markers for scapula tracking). The results show that the index detects progressive modifications in the joint and allows distinguishing the two protocols, in accordance with the literature. In the future, the index could, among other things, be used to compare/improve biomechanical models and motion analysis protocols.

  14. [Minor bcr/abl positive acute lymphoblastic leukemia preceded by knee joint pain due to bone marrow necrosis].

    PubMed

    Sato, Kazuya; Mori, Masaki; Meguro, Akiko; Miyoshi, Takuji; Nagai, Tadashi; Muroi, Kazuo; Komatsu, Norio; Ozawa, Keiya

    2004-11-01

    A 16-year-old male was referred to our hospital in April 2003 due to severe knee joint pain from five months previously. Lymphoblasts were identified in his peripheral blood, resulting in a diagnosis of acute lymphoblastic leukemia (ALL). Bone marrow examination revealed massive necrosis with clusters of lymphoblasts and the bcr/abl fusion gene. Magnetic resonance imaging (MRI) of the knee joint showed low signal intensity on T1-weighted images, and peripheral rim enhancement on Gd-DTPA enhanced fat suppression images, which was compatible with bone marrow necrosis. After the patient achieved complete remission (CR), the knee joint pain has disappeared. He was treated with an allogeneic bone marrow transplantation (BMT) from an HLA-identical unrelated donor and has been in CR for 26 months after the diagnosis of ALL. In the knee joint, the replacement of fatty marrow after BMT has been confirmed with MRI. Hematological malignancies including ALL should be considered in the cases of bone marrow necrosis and adequate treatment may improve necrosis.

  15. Diagnosis of Periprosthetic Joint Infection: The Role of Nuclear Medicine May Be Overestimated.

    PubMed

    Diaz-Ledezma, Claudio; Lamberton, Courtney; Lichstein, Paul; Parvizi, Javad

    2015-06-01

    Although the International Consensus Meeting on Periprosthetic Joint Infection's definition of periprosthetic joint infection (PJI) does not include nuclear imaging as part of the diagnostic criteria, many contemporary nuclear imaging studies are reporting exceptional results in PJI diagnosis. We conducted a systematic review of studies published from 2004 to 2012 reporting the accuracy of nuclear imaging for diagnosis of PJI, utilizing a specially designed tool (QUADAS-2) for critical appraisal and investigation of bias. Our results revealed high risk of bias as well as high levels of concern regarding the clinical applicability of these tests in a majority of the studies. On the basis of our findings, we recommend that the use of nuclear imaging for diagnosis of PJI be limited to a few select cases.

  16. Patient-related medical risk factors for periprosthetic joint infection of the hip and knee

    PubMed Central

    Eka, Aleeson

    2015-01-01

    Despite advancements and improvements in methods for preventing infection, periprosthetic joint infection (PJI) is a significant complication following total joint arthroplasty (TJA). Prevention is the most important strategy to deal with this disabling complication, and prevention should begin with identifying patient-related risk factors. Medical risk factors, such as morbid obesity, malnutrition, hyperglycemia, uncontrolled diabetes mellitus, rheumatoid arthritis (RA), preoperative anemia, cardiovascular disorders, chronic renal failure, smoking, alcohol abuse and depression, should be evaluated and optimized prior to surgery. Treating patients to get laboratory values under a specified threshold or cessation of certain modifiable risk factors can decrease the risk of PJI. Although significant advances have been made in past decades to identify these risk factors, there remains some uncertainty regarding the risk factors predisposing TJA patients to PJI. Through a review of the current literature, this paper aims to comprehensively evaluate and provide a better understanding of known medical risk factors for PJI after TJA. PMID:26539450

  17. [Antibiotic therapy of bone and joint infections in children: recent changes].

    PubMed

    Lorrot, M; Doit, C; Ilharreborde, B; Vitoux, C; Le Henaff, L; Sebag, G; Pennecot, G; Grimprel, E; Bingen, É

    2011-09-01

    Management of bone and joint infections in children associates early appropriate antibiotic therapy against Staphylococcus aureus and Kingella kingae and, if necessary, surgical drainage of abscess or septic arthritis. In 2007, the Paediatric Infectious Diseases Group of the French Society of Paediatrics (GPIP) proposed guidelines for antibiotherapy in acute and non-complicated cases, with an intravenous therapy during 4 to 7 days followed by oral therapy during 3 weeks.

  18. Pharmacokinetic Variability of Daptomycin during Prolonged Therapy for Bone and Joint Infections

    PubMed Central

    Roux, Sandrine; Gagnieu, Marie-Claude; Valour, Florent; Lustig, Sébastien; Ader, Florence; Laurent, Frédéric; Chidiac, Christian; Ferry, Tristan

    2016-01-01

    The interindividual and intraindividual variabilities in daptomycin pharmacokinetics were investigated in 23 patients (69 pharmacokinetic profiles) who were treated for several months for bone and joint infections. Population daptomycin clearance was significantly influenced by renal function and was significantly higher in male than in female patients. We observed significant intraindividual changes in daptomycin clearance, which were uncorrelated with changes in renal function, suggesting that therapeutic drug monitoring is important in patients receiving prolonged daptomycin therapy. PMID:26902764

  19. Propionibacterium avidum as an Etiological Agent of Prosthetic Hip Joint Infection

    PubMed Central

    Brüggemann, Holger; Scholz, Christian F. P.; Leimbach, Andreas; Söderquist, Bo

    2016-01-01

    Propionibacterium acnes is well-established as a possible etiologic agent of prosthetic joint infections (PJIs). Other Propionibacterium spp. have occasionally been described as a cause of PJIs, but this has not previously been the case for P. avidum despite its capacity to form biofilm. We describe two patients with prosthetic hip joint infections caused by P. avidum. Both patients were primarily operated with an anteriorly curved skin incision close to the skin crease of the groin, and both were obese. Initial treatment was performed according to the DAIR procedure (debridement, antibiotics, and implant retention). In case 1, the outcome was successful, but in case 2, a loosening of the cup was present 18 months post debridement. The P. avidum isolate from case 1 and two isolates from case 2 (obtained 18 months apart) were selected for whole genome sequencing. The genome of P. avidum obtained from case 1 was approximately 60 kb larger than the genomes of the two isolates of case 2. These latter isolates were clonal with the exception of SNPs in the genome. All three strains possessed the gene cluster encoding exopolysaccharide synthesis. P. avidum has a pathogenic potential and the ability to cause clinically relevant infections, including abscess formation, in the presence of foreign bodies such as prosthetic joint components. Skin incision in close proximity to the groin or deep skin crease, such as the anteriorly curved skin incision approach, might pose a risk of PJIs by P. avidum, especially in obese patients. PMID:27355425

  20. Nursing care of the adult client with infection due to Pneumocystis carinii.

    PubMed

    Ungvarski, P J

    1991-01-01

    Since the beginning of the AIDS epidemic, Pneumocystis carinii pneumonia (PCP) has been the most prevalent opportunistic infection diagnosed in people with AIDS. After a decade of care and research, significant progress has been achieved not only in treating PCP but also in preventing it. Concomitantly, new problems have surfaced, for example, nosocomial spread of mycobacterium tuberculosis and occupational hazards, both related to treating people living with AIDS (PWAs) with PCP. The author provides a comprehensive overview of infection due to Pneumocystis carinii, as seen in adults with HIV infection, and the related nursing issues.

  1. Infective endocarditis due to Enterobacter cloacae resistant to third- and fourth-generation cephalosporins.

    PubMed

    Yoshino, Yusuke; Okugawa, Shu; Kimura, Satoshi; Makita, Eiko; Seo, Kazunori; Koga, Ichiro; Matsunaga, Naohisa; Kitazawa, Takatoshi; Ota, Yasuo

    2015-04-01

    We report the case of using a long-term combination of meropenem and amikacin to treat infective endocarditis caused by Enterobacter cloacae resistant to third- and fourth-generation cephalosporins. Multi-drug resistant Gram-negative bacilli, such as the E. cloacae in our study, may become possible pathogens of infective endocarditis. Our experience with this case indicates that long-term use of a combination of β-lactam and aminoglycosides might represent a suitable management option for future infective endocarditis cases due to non-Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella spp. (HACEK group) Gram-negative bacilli such as ours.

  2. Culture-negative infective endocarditis of the aortic valve due to Aerococcus urinae: a rare aetiology.

    PubMed

    Alozie, Anthony; Yerebakan, Can; Westphal, Bernd; Steinhoff, Gustav; Podbielski, Andreas

    2012-04-01

    Bacteria of the species Aerococcus urinae are Gram-positive, catalase-negative cocci that are arranged in pairs, tetrads, or clusters resembling enterococci or staphylococci. They are rare causative agents of infective endocarditis. Repetitive urinary tract infections based upon underlying genitourinary tract abnormalities could involve these bacteria. Due to their similarity to other Gram-positive cocci misinterpretation may occur along the line of microbiologic differentiation, which could potentially lead to a fatal outcome. We herein report on the clinical course of a 68 year-old male patient who in the setting of an embolic stroke was initially diagnosed with a culture-negative acute infective endocarditis of the aortic valve.

  3. Elastic discontinuity due to ectopic calcification in a human fibrous joint

    PubMed Central

    Lin, Jeremy D.; Aloni, Shaul; Altoe, Virginia; Webb, Samuel M.; Ryder, Mark I.; Ho, Sunita P.

    2012-01-01

    Disease can alter the natural ramp-like elastic gradients to steeper step-like profiles at soft-hard tissue interfaces. Prolonged function can further mediate mechanochemical events that alter biomechanical response within diseased organs. In this study a human bone-tooth fibrous joint was chosen as a model system, in which the effects of bacterial-induced disease, i.e. periodontitis, on natural elastic gradients were investigated. Specifically, the effects of ectopic biomineral, i.e. calculus, on innate chemical and elastic gradients within the diseased cementum-dentin complex in comparison to a healthy complex, both of which are fundamental parameters to load-bearing tissues, will be discussed. Complementary techniques for mapping changes in physicochemical properties as a result of disease, included micro-X-ray computed tomography, microprobe micro X-ray fluorescence imaging, transmission electron and atomic force microscopy (TEM, AFM) techniques, and AFM-based nanoindentation. Results demonstrated primary effects as derivatives of ectopic mineralization within the diseased fibrous joint. Ectopic mineralization with no cementum resorption, but altered cementum physicochemical properties with increasing X-ray attenuation, exhibited stratified concretion with increasing X-ray fluorescence counts of calcium and phosphorus elements in the extracellular matrix. These were correlated to decreased hygroscopicity, indenter displacement, and apparent strain relieving characteristics. Disease progression identified as concretion through the periodontal ligament (PDL)-cementum enthesis and sometimes the originally hygroscopic cementum-dentin junction, resulted in a significantly increased indentation elastic modulus (3.16±1.19 GPa) and a shift toward a discontinuous interface compared to healthy conditions (1.54±0.83 GPa) (Student’s t-test, p<0.05). The observed primary effects could result in secondary downstream effects, such as compromised mechanobiology at the

  4. Urinary tract infections due to Trichosporon spp. in severely ill patients in an intensive care unit

    PubMed Central

    Mattede, Maria das Graças Silva; Piras, Cláudio; Mattede, Kelly Dematte Silva; Ferrari, Aline Trugilho; Baldotto, Lorena Simões; Assbu, Michel Silvestre Zouain

    2015-01-01

    Objective To evaluate the incidence of urinary tract infections due to Trichosporon spp. in an intensive care unit. Methods This descriptive observational study was conducted in an intensive care unit between 2007 and 2009. All consecutive patients admitted to the intensive care unit with a confirmed diagnosis were evaluated. Results Twenty patients presented with urinary tract infections due to Trichosporon spp. The prevalence was higher among men (65%) and among individuals > 70 years of age (55%). The mortality rate was 20%. The average intensive care unit stay was 19.8 days. The onset of infection was associated with prior use of antibiotics and was more frequent in the fall and winter. Conclusion Infection due to Trichosporon spp. was more common in men and among those > 70 years of age and was associated with the use of an indwelling urinary catheter for more than 20 days and with the use of broadspectrum antibiotics for more than 14 days. In addition, patients with urinary infection due to Trichosporon spp. were most often hospitalized in intensive care units in the fall and winter periods. PMID:26465246

  5. Hip Joint Stresses Due to Cam-Type Femoroacetabular Impingement: A Systematic Review of Finite Element Simulations

    PubMed Central

    Ng, K. C. Geoffrey; Lamontagne, Mario; Labrosse, Michel R.; Beaulé, Paul E.

    2016-01-01

    Background The cam deformity causes the anterosuperior femoral head to obstruct with the acetabulum, resulting in femoroacetabular impingement (FAI) and elevated risks of early osteoarthritis. Several finite element models have simulated adverse loading conditions due to cam FAI, to better understand the relationship between mechanical stresses and cartilage degeneration. Our purpose was to conduct a systematic review and examine the previous finite element models and simulations that examined hip joint stresses due to cam FAI. Methods The systematic review was conducted to identify those finite element studies of cam-type FAI. The review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and studies that reported hip joint contact pressures or stresses were included in the quantitative synthesis. Results Nine articles studied FAI morphologies using finite element methods and were included in the qualitative synthesis. Four articles specifically examined contact pressures and stresses due to cam FAI and were included in the quantitative synthesis. The studies demonstrated that cam FAI resulted in substantially elevated contact pressures (median = 10.4 MPa, range = 8.5–12.2 MPa) and von Mises stresses (median 15.5 MPa, range = 15.0–16.0 MPa) at the acetabular cartilage; and elevated maximum-shear stress on the bone (median = 15.2 MPa, range = 14.3–16.0 MPa), in comparison with control hips, during large amplitudes of hip motions. Many studies implemented or adapted idealized, ball-and-cup, parametric models to predict stresses, along with homogeneous bone material properties and in vivo instrumented prostheses loading data. Conclusion The formulation of a robust subject-specific FE model, to delineate the pathomechanisms of FAI, remains an ongoing challenge. The available literature provides clear insight into the estimated stresses due to the cam deformity and provides an assessment of its risks leading to early

  6. Diabetes mellitus, hemoglobin A1C, and the incidence of total joint arthroplasty infection.

    PubMed

    Iorio, Richard; Williams, Kelly M; Marcantonio, Andrew J; Specht, Lawrence M; Tilzey, John F; Healy, William L

    2012-05-01

    Patients with diabetes have a higher incidence of infection after total joint arthroplasty (TJA) than patients without diabetes. Hemoglobin A1c (HbA1c) levels are a marker for blood glucose control in diabetic patients. A total of 3468 patients underwent 4241 primary or revision total hip arthroplasty or total knee arthroplasty at one institution. Hemoglobin A1c levels were examined to evaluate if there was a correlation between the control of HbA1c and infection after TJA. There were a total of 46 infections (28 deep and 18 superficial [9 cellulitis and 9 operative abscesses]). Twelve (3.43%) occurred in diabetic patients (n = 350; 8.3%) and 34 (0.87%) in nondiabetic patients (n = 3891; 91.7%) (P < .001). There were 9 deep (2.6%) infections in diabetic patients and 19 (0.49%) in nondiabetic patients. In noninfected, diabetic patients, HbA1c level ranged from 4.7% to 15.1% (mean, 6.92%). In infected diabetic patients, HbA1c level ranged from 5.1% to 11.7% (mean, 7.2%) (P < .445). The average HbA1c level in patients with diabetes was 6.93%. Diabetic patients have a significantly higher risk for infection after TJA. Hemoglobin A1c levels are not reliable for predicting the risk of infection after TJA.

  7. Hardware Removal Due to Infection after Open Reduction and Internal Fixation: Trends and Predictors

    PubMed Central

    Rasouli, Mohammad R.; Viola, Jessica; Maltenfort, Mitchell G.; Shahi, Alisina; Parvizi, Javad; Krieg, James C.

    2015-01-01

    Background: Little is known about trends and predictors of hardware related infection following open reduction and internal fixation (ORIF) of extremity fractures, one of the major causes of failure following ORIF. The present study was designed and conducted to determine trends and predictors of infection-related hardware removal following ORIF of extremities using a nationally representative database. Methods: We used Nationwide Inpatient Sample data from 2002 to 2011 to identify cases of ORIF following upper and lower extremity fractures, as well as cases that underwent infection-related hardware removal following ORIF. Multivariate analysis was performed to identify independent predictors of infection-related hardware removal, controlling for patient demographics and comorbidities, hospital characteristics, site of fracture, and year. Results: For all ORIF procedures, the highest rate of hardware removal related to infection was observed in tarsal fractures (5.56%), followed by tibial (3.65%) and carpal (3.37%) fractures. Hardware removal rates due to infection increased in all fractures except radial/ulnar fractures. Tarsal fractures(odds ratio (OR)=1.06, 95% confidence interval (CI): 1.04-1.09, P<0.001), tibial fractures (OR=1.04, 95% CI: 1.03-1.06, P<0.001) and those patients with diabetes mellitus (OR=2.64, 95% CI: 2.46-2.84, P<0.001), liver disease (OR=2.04, 95% CI: 1.84- 2.26, P<0.001), and rheumatoid arthritis (OR=2.06, 95% CI: 1.88-2.25 P<0.001) were the main predictors of infection-related removals; females were less likely to undergo removal due to infection (OR= 0.61, 95% CI: 0.59-0.63 P<0.001). Conclusions: Hardware removal rates due to infection increased in all fractures except radial/ulnar fractures. Diabetes, liver disease, and rheumatoid arthritis were important predictors of infection-related hardware removal. The study identified some risk factors for hardwarerelated infection following ORIF, such as diabetes, liver disease, and rheumatoid

  8. One-stage Exchange Arthroplasty for Periprosthetic Hip and Knee Joint Infections

    PubMed Central

    Nguyen, Manny; Sukeik, Mohamed; Zahar, Akos; Nizam, Ikram; Haddad, Fares Sami

    2016-01-01

    Background: Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. In an aging population of the developed world, the increasing numbers of hip and knee replacements will inevitably lead to increasing incidence of PJI, carrying with (it) significant patient morbidity and cost to the health care system. Two-stage exchange arthroplasty is currently the gold standard but it is associated with multiple operations, prolonged hospitalization and impaired functionality. One-stage exchange arthroplasty is similar to the two-stage procedure but the interval between removal of the prosthesis and reimplantation of a new one is only a few minutes. It has the theoretical benefits of a single anesthetic, shorter hospitalization, less cost and improved function. Methods: We reviewed the current literature regarding the outcomes of one-stage exchange arthroplasties focusing on re-infection rates and functional outcomes. Results: Current themes around the one-stage exchange procedure include the indications for the procedure, definition of re-infection, surgical techniques used to provide fixation and differences in approach for hip and knee replacements. Conclusion: The current literature on one-stage exchange procedure is promising, with comparable results to two-stage revisions for hips and knees in selected patients. However, there is a great need for a large multi-centred randomized control trial, focusing on re-infection rates and functional scores postoperatively, to provide concrete guidelines in managing this complex condition. PMID:28144374

  9. Skin Infection due to Trichophyton tonsurans Still Occurs in People in Korea but not as Outbreaks

    PubMed Central

    2016-01-01

    Since 1995, Trichophyton tonsurans has been one of the causative agents of dermatophytosis in Korea. Herein we evaluate 77 patients infected with T. tonsurans who visited an outpatient clinic between 2004 and 2014. Infections due to T. tonsurans were diagnosed by mycological examination, which included direct microscopic examination using 15% KOH and culture in potato dextrose agar complemented with 0.5% chloramphenicol. The annual prevalence of infection due to T. tonsurans was the highest in 2014 (15 cases) but remained constant in non-gladiators between 2004 and 2014. The ratio of male to female patients was 1:0.3. The spring season presented the highest incidence compared with other seasons, with 27 cases. The incidence of infections due to T. tonsurans among gladiators was highest in spring compared with the other seasons whereas the incidence in non-gladiators was the highest in the winter. The body site most commonly affected was the face. Tinea corporis was the most common subtype of dermatophytosis caused by T. tonsurans. Herein, we demonstrate that the prevalence of infection with T. tonsurans remain constant throughout the study period in Korea. PMID:26839486

  10. Skin Infection due to Trichophyton tonsurans Still Occurs in People in Korea but not as Outbreaks.

    PubMed

    Lee, Weon Ju; Sim, Hyun Bo; Jang, Yong Hyun; Lee, Seok-Jong; Kim, Do Won; Jun, Jae Bok; Bang, Yong Jun

    2016-02-01

    Since 1995, Trichophyton tonsurans has been one of the causative agents of dermatophytosis in Korea. Herein we evaluate 77 patients infected with T. tonsurans who visited an outpatient clinic between 2004 and 2014. Infections due to T. tonsurans were diagnosed by mycological examination, which included direct microscopic examination using 15% KOH and culture in potato dextrose agar complemented with 0.5% chloramphenicol. The annual prevalence of infection due to T. tonsurans was the highest in 2014 (15 cases) but remained constant in non-gladiators between 2004 and 2014. The ratio of male to female patients was 1:0.3. The spring season presented the highest incidence compared with other seasons, with 27 cases. The incidence of infections due to T. tonsurans among gladiators was highest in spring compared with the other seasons whereas the incidence in non-gladiators was the highest in the winter. The body site most commonly affected was the face. Tinea corporis was the most common subtype of dermatophytosis caused by T. tonsurans. Herein, we demonstrate that the prevalence of infection with T. tonsurans remain constant throughout the study period in Korea.

  11. [Infections of finger and toe nails due to fungi and bacteria].

    PubMed

    Nenoff, P; Paasch, U; Handrick, W

    2014-04-01

    Infections of the finger and the toe nails are most frequently caused by fungi, primarily dermatophytes. Causative agents of tinea unguium are mostly anthropophilic dermatophytes. Both in Germany, and worldwide, Trichophyton rubrum represents the main important causative agent of onychomycoses. Yeasts are isolated from fungal nail infections, both paronychia and onychomycosis far more often than generally expected. This can represent either saprophytic colonization as well as acute or chronic infection of the nail organ. The main yeasts causing nail infections are Candida parapsilosis, and Candida guilliermondii; Candida albicans is only in third place. Onychomycosis due to molds, or so called non-dermatophyte molds (NDM), are being increasingly detected. Molds as cause of an onychomycosis are considered as emerging pathogens. Fusarium species are the most common cause of NDM onychomycosis; however, rare molds like Onychocola canadensis may be found. Bacterial infections of the nails are caused by gram negative bacteria, usually Pseudomonas aeruginosa (recognizable because of green or black coloration of the nails) but also Klebsiella spp. and gram positive bacteria like Staphylococcus aureus. Treatment of onychomycosis includes application of topical antifungal agents (amorolfine, ciclopirox). If more than 50 % of the nail plate is affected or if more than three out of ten nails are affected by the fungal infection, oral treatment using terbinafine (in case of dermatophyte infection), fluconazole (for yeast infections), or alternatively itraconazole are recommended. Bacterial infections are treated topically with antiseptic agents (octenidine), and in some cases with topical antibiotics (nadifloxacin, gentamicin). Pseudomonas infections of the nail organ are treated by ciprofloxacin; other bacteria are treated according to the results of culture and sensitivity testing.

  12. Role of Infection Due to Campylobacter jejuni in the Initiation of Guillain-Barre Syndrome

    DTIC Science & Technology

    1993-01-01

    Initiation of Guillain - Barre Syndrome 90PP0820 Ban Mishu and Martin J. Blaser Veterans Administration Medical Center 93-26165 Research Service 1310 24th...Unlimited Best Available Copy 104 Role of Infection Due to Campylobacterjejuni in the Initiation of Guillain - Barre Syndrome Ban Mishu and Martin J. Blaser...may cause Guillain -Barrk syndrome (GBS) by triggering demyelination of peripheral nerves. GBS is preceded by an acute infectious illness (due to a

  13. Chronic joint disease caused by persistent Chikungunya virus infection is controlled by the adaptive immune response.

    PubMed

    Hawman, David W; Stoermer, Kristina A; Montgomery, Stephanie A; Pal, Pankaj; Oko, Lauren; Diamond, Michael S; Morrison, Thomas E

    2013-12-01

    Chikungunya virus (CHIKV) is a reemerging mosquito-borne pathogen that causes incapacitating disease in humans characterized by intense joint pain that can persist for weeks, months, or even years. Although there is some evidence of persistent CHIKV infection in humans suffering from chronic rheumatologic disease symptoms, little is known about chronic disease pathogenesis, and no specific therapies exist for acute or chronic CHIKV disease. To investigate mechanisms of chronic CHIKV-induced disease, we utilized a mouse model and defined the duration of CHIKV infection in tissues and the associated histopathological changes. Although CHIKV RNA was readily detectable in a variety of tissues very early after infection, CHIKV RNA persisted specifically in joint-associated tissues for at least 16 weeks. Inoculation of Rag1(-/-) mice, which lack T and B cells, resulted in higher viral levels in a variety of tissues, suggesting that adaptive immunity controls the tissue specificity and persistence of CHIKV infection. The presence of CHIKV RNA in tissues of wild-type and Rag1(-/-) mice was associated with histopathological evidence of synovitis, arthritis, and tendonitis; thus, CHIKV-induced persistent arthritis is not mediated primarily by adaptive immune responses. Finally, we show that prophylactic administration of CHIKV-specific monoclonal antibodies prevented the establishment of CHIKV persistence, whereas therapeutic administration had tissue-specific efficacy. These findings suggest that chronic musculoskeletal tissue pathology is caused by persistent CHIKV infection and controlled by adaptive immune responses. Our results have significant implications for the development of strategies to mitigate the disease burden associated with CHIKV infection in humans.

  14. Fulminating gas-forming psoas muscle abscess due to Klebsiella pneumoniae following a deep neck infection.

    PubMed

    Jang, T N; Juang, G D; Fung, C P

    1997-02-01

    Psoas muscle abscess due to Klebsiella pneumoniae infection is rare. We report a 55-year-old diabetic man who presented with progressive back pain of 1 month's duration. The patient had undergone surgical drainage for a deep neck infection with K. pneumoniae 43 days previously. On the present admission, physical examination revealed tenderness over the anterior upper aspect of both thighs, and computed tomography showed pneumoretroperitoneum dissecting the bilateral iliopsoas muscles. Parenteral administration of antibiotics was started immediately. Due to the patient's poor health status, we opted for repeated computed tomographic and sonographic-guided percutaneous drainage rather than surgical drainage. Blood and pus cultures revealed only K. pneumoniae. The patient recovered without significant sequelae. This report stresses the risk of metastatic infections caused by K. pneumoniae, especially in diabetic patients. Our experience suggests that repeated percutaneous drainage is feasible in cases of severe iliopsoas abscess, especially when risks associated with surgery are high.

  15. First case of human infection due to Pseudomonas fulva, an environmental bacterium isolated from cerebrospinal fluid.

    PubMed

    Almuzara, Marisa N; Vazquez, Miryam; Tanaka, Naoto; Turco, Marisa; Ramirez, Maria S; Lopez, Eduardo L; Pasteran, Fernando; Rapoport, Melina; Procopio, Adriana; Vay, Carlos A

    2010-02-01

    We report the first case of human infection due to Pseudomonas fulva. P. fulva caused acute meningitis following the placement of a drainage system in a 2-year-old female. Additionally, the isolate displayed a VIM-2 carbapenemase in a class 1 integron context.

  16. IgM binding to sialosyllactosaminylparagloboside in a patient with polyradiculoneuropathy due to Mycoplasma pneumoniae infection.

    PubMed

    Inuzuka, T; Miyatani, N; Baba, H; Tanaka, M; Tanaka, K; Sato, S; Nakamura, K; Miyatake, T

    1988-07-01

    IgM in serum without paraprotein in a patient with polyradiculoneuropathy due to a Mycoplasma pneumoniae infection reacted specifically with a ganglioside, sialosyllactosaminylparagroboside (SLPG), in a human peripheral nerve on a thin-layer chromatogram plate by an immunostaining technique. This finding suggests the possibility that anti-SLPG antibody in the patient's serum may play a role in the pathogenesis of neuropathy.

  17. Hand Hygiene Program Decreases School Absenteeism Due to Upper Respiratory Infections

    ERIC Educational Resources Information Center

    Azor-Martinez, Ernestina; Cobos-Carrascosa, Elena; Seijas-Vazquez, Maria Luisa; Fernández-Sánchez, Carmen; Strizzi, Jenna M.; Torres-Alegre, Pilar; Santisteban-Martínez, Joaquin; Gimenez-Sanchez, Francisco

    2016-01-01

    Background: We assessed the effectiveness of a handwashing program using hand sanitizer to prevent school absenteeism due to upper respiratory infections (URIs). Methods: This was a randomized, controlled, and open study on a sample of 1341 children 4-12 years old, attending 5 state schools in Almería (Spain), with an 8-month follow-up. The…

  18. Invasive infection due to Saprochaete capitata in a young patient with hematological malignancies

    PubMed Central

    Parahym, Ana Maria Rabelo de Carvalho; Rolim, Pedro José; da Silva, Carolina Maria; Domingos, Igor de Farias; Gonçalves, Sarah Santos; Leite, Edinalva Pereira; de Morais, Vera Lúcia Lins; Macêdo, Danielle Patrícia Cerqueira; de Lima, Reginaldo Gonçalves; Neves, Rejane Pereira

    2015-01-01

    We report a case of invasive infection due to Saprochaete capitata in a patient with hematological malignancies after chemotherapy treatment and empiric antifungal therapy with caspofungin. Although severely immunocompromised the patient survived been treated with amphotericin B lipid complex associated with voriconazole. PMID:26273269

  19. Wound infection caused by Lichtheimia ramosa due to a car accident

    PubMed Central

    Bibashi, Evangelia; de Hoog, G. Sybren; Pavlidis, Theodoros E.; Symeonidis, Nikolaos; Sakantamis, Athanasios; Walther, Grit

    2012-01-01

    A 32-year-old immunocompetent man sustained severe traumas contaminated with organic material due to a car accident. An infection caused by Lichtheimia ramosa at the site of contamination was early diagnosed and cured by multiple surgical debridement and daily cleansing with antiseptic solution only. PMID:24432204

  20. Urinary tract infection due to salmonella in an otherwise healthy child.

    PubMed

    Yousefichaijan, Parsa; Yosefi, Parsa; Dorreh, Fatemeh

    2014-03-01

    Salmonella species are a rare cause of urinary tract infection in children. They are associated with a high incidence of structural abnormalities or immunosuppressive status. We report the case of a healthy 7-year-old boy with pyelonephritis due to Salmonella group. He did not have a history of recent gastroenteritis.

  1. Aggressive Early Debridement in Treatment of Acute Periprosthetic Joint Infections After Hip and Knee Replacements

    PubMed Central

    Volpin, Andrea; Sukeik, Mohamed; Alazzawi, Sulaiman; Haddad, Fares Sami

    2016-01-01

    Background: Periprosthetic Joint Infection Remains a Dreaded Complication After Hip and Knee Replacement Surgery. Treatment Options for Acute Postoperative and Acute Hematogenous Infections Include Arthroscopic or Open Debridement With Retention or Exchange of the Prostheses. This Review Article Aims to Summarize the Evidence for Management of Acute Postoperative And Acute Hematogenous Infections. Methods: A Systematic Literature Search Was Performed Using a Computer-based Search Engine Covering Medline (OvidSP), PubMed Database (U.S. National Library of Medicine, National Institutes of Health), Embase, Web of Science, Cochrane and Google Scholar for Relevant Articles. Results: Common Themes Around Treatment of Acute Postoperative and Acute Hematogenous Infections Discussed in this Review Include the Timing of Intervention, Description of the Optimal Procedure and How we Perform it at our Institution, the Role of Arthroscopic Debridement, Most Commonly Isolated Micro-organisms and Prognostic Factors for Infection Control. Conclusion: Success in Treating Acute Postoperative and Acute Hematogenous Infections Depends on Early Diagnosis and Aggressive Surgical Debridement Combined With Effective Antibiotic Therapy. PMID:28144377

  2. Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections.

    PubMed

    Hauck, C; Cober, E; Richter, S S; Perez, F; Salata, R A; Kalayjian, R C; Watkins, R R; Scalera, N M; Doi, Y; Kaye, K S; Evans, S; Fowler, V G; Bonomo, R A; van Duin, D

    2016-06-01

    Patients infected or colonized with carbapenem-resistant Klebsiella pneumoniae (CRKp) are often chronically and acutely ill, which results in substantial mortality unrelated to infection. Therefore, estimating excess mortality due to CRKp infections is challenging. The Consortium on Resistance against Carbapenems in K. pneumoniae (CRACKLE) is a prospective multicenter study. Here, patients in CRACKLE were evaluated at the time of their first CRKp bloodstream infection (BSI), pneumonia or urinary tract infection (UTI). A control cohort of patients with CRKp urinary colonization without CRKp infection was constructed. Excess hospital mortality was defined as mortality in cases after subtracting mortality in controls. In addition, the adjusted hazard ratios (aHR) for time-to-hospital-mortality at 30 days associated with infection compared with colonization were calculated in Cox proportional hazard models. In the study period, 260 patients with CRKp infections were included in the BSI (90 patients), pneumonia (49 patients) and UTI (121 patients) groups, who were compared with 223 controls. All-cause hospital mortality in controls was 12%. Excess hospital mortality was 27% in both patients with BSI and those with pneumonia. Excess hospital mortality was not observed in patients with UTI. In multivariable analyses, BSI and pneumonia compared with controls were associated with aHR of 2.59 (95% CI 1.52-4.50, p <0.001) and 3.44 (95% CI 1.80-6.48, p <0.001), respectively. In conclusion, in patients with CRKp infection, pneumonia is associated with the highest excess hospital mortality. Patients with BSI have slightly lower excess hospital mortality rates, whereas excess hospital mortality was not observed in hospitalized patients with UTI.

  3. THA following deformities due to congenital dislocation of the hip joint.

    PubMed

    Macheras, George A; Koutsostathis, Stefanos D; Lepetsos, Panagiotis; Anastasopoulos, Panagiotis P; Galanakos, Spyridon; Papadakis, Stamatios A

    2014-10-02

    Total hip replacement is the treatment of choice for the patient suffering from end-stage hip osteoarthritis. Excellent long-term results have been published. In the presence of deformities due to congenital hip dislocation, total hip replacement is, in most of the cases, a difficult task, since the technique of performing such an operation is demanding and the results could vary. This paper presents our experience and preferred strategies focusing on challenges and surgical techniques associated with reconstructing the dysplastic hip.

  4. Capturing orthopaedic surgical site infection data and assessing dental recommendations with respect to total joint arthroplasty.

    PubMed

    Florschutz, Anthony V; Parsley, Brian S; Shapiro, Irving M

    2015-04-01

    Greater documentation of patient history and clinical course is crucial for identifying factors that can influence surgical outcomes. The Centers for Medicare and Medicaid Services have already begun public reporting of hospital data on readmission, complication, and infection rates and will soon launch a website to make physician-specific outcomes data public. The orthopaedic community has the opportunity to lead the way in ensuring that adequate and accurate data is collected to facilitate appropriate comparisons that are based on patients' true risk of complications and the complexity of treatment. Several studies have reported a link between oral pathogens and periprosthetic infection, although it remains unclear whether organisms unique to dental tissues are also present in osteoarthritic joints and tissues affected by periprosthetic joint infection. The American Academy of Orthopaedic Surgeons and the American Dental Association are aware of these concerns and have created guidelines for antibiotic prophylaxis in patients who have undergone total hip or knee arthroplasty and require high-risk dental procedures. Because these guidelines have received considerable criticism, recommendations that are based on scientific and case-controlled clinical studies and provide effective guidance on this important subject are needed.

  5. Global Forum: The Burden of Bone and Joint Infections: A Growing Demand for More Resources.

    PubMed

    Malizos, Konstantinos N

    2017-03-01

    The rate and severity of septic complications following joint replacement surgery and the incidence of posttraumatic infections are projected to increase at a faster pace because of a tendency to operate on high-risk patients, including older patients, patients with diabetes, and patients who are immunocompromised or have comorbidities. Musculoskeletal infections are devastating adverse events that may become life-threatening conditions. They create an additional burden on total health-care expenditures, and can lead to functional impairment, long-lasting disability, or even permanent handicap, with the inevitable social and economic burdens. The scientific community should take a more active role to draw public attention to the plight of hundreds of thousands of people across the globe who experience complications, become disabled, and, in some cases, die, and it should highlight what could be achieved if the global community takes decisive steps to improve access, early detection, and appropriate care. However, mitigating the adverse personal, clinical, and socioeconomic effects of these conditions requires increasing financial resources provided by both governments and funding organizations. Furthermore, a targeted action plan from the providers and the professional societies should be put in place so that the burden created by bone and joint infections is included in the agenda for global health-care priorities.

  6. Complicated Catheter-Associated Urinary Tract Infections Due to Escherichia coli and Proteus mirabilis

    PubMed Central

    Jacobsen, S. M.; Stickler, D. J.; Mobley, H. L. T.; Shirtliff, M. E.

    2008-01-01

    Catheter-associated urinary tract infections (CAUTIs) represent the most common type of nosocomial infection and are a major health concern due to the complications and frequent recurrence. These infections are often caused by Escherichia coli and Proteus mirabilis. Gram-negative bacterial species that cause CAUTIs express a number of virulence factors associated with adhesion, motility, biofilm formation, immunoavoidance, and nutrient acquisition as well as factors that cause damage to the host. These infections can be reduced by limiting catheter usage and ensuring that health care professionals correctly use closed-system Foley catheters. A number of novel approaches such as condom and suprapubic catheters, intermittent catheterization, new surfaces, catheters with antimicrobial agents, and probiotics have thus far met with limited success. While the diagnosis of symptomatic versus asymptomatic CAUTIs may be a contentious issue, it is generally agreed that once a catheterized patient is believed to have a symptomatic urinary tract infection, the catheter is removed if possible due to the high rate of relapse. Research focusing on the pathogenesis of CAUTIs will lead to a better understanding of the disease process and will subsequently lead to the development of new diagnosis, prevention, and treatment options. PMID:18202436

  7. How to minimize infection and thereby maximize patient outcomes in total joint arthroplasty: a multicenter approach: AAOS exhibit selection.

    PubMed

    Illingworth, Kenneth David; Mihalko, William M; Parvizi, Javad; Sculco, Thomas; McArthur, Benjamin; el Bitar, Youssef; Saleh, Khaled J

    2013-04-17

    Total joint arthroplasty is one of the most common and most successful orthopaedic procedures. Infection after total joint arthroplasty is a devastating problem that expends patient, surgeon, and hospital resources, and it substantially decreases the chances of a successful patient outcome. Postoperative infection affects approximately 1% to 7% of all total joint arthroplasties, at a cost of approximately $50,000 per infection. Decreasing postoperative periprosthetic joint infection is of the utmost importance for the total joint arthroplasty surgeon. Preoperative, perioperative, intraoperative, and postoperative measures to minimize infection and optimize patient outcomes in total joint arthroplasty are discussed. Preoperative measures include management of patients colonized by Staphylococcus aureus, nutritional optimization, and management of medical comorbidities. Perioperative measures include skin preparation and prophylactic antibiotics. Intraoperative measures include body exhaust suits, laminar flow, ultraviolet light, operating-room traffic control, surgical suite enclosures, anesthesia-related considerations, and antibiotic-loaded bone cement. Postoperative measures include continued antibiotic prophylaxis, blood transfusions, hematoma formation and wound drainage, duration of hospital stay, and antibiotic prophylaxis for future invasive procedures.

  8. Dynamics of bovine intramammary infections due to coagulase-negative staphylococci on four farms.

    PubMed

    Bexiga, Ricardo; Rato, Márcia G; Lemsaddek, Abdelhak; Semedo-Lemsaddek, Teresa; Carneiro, Carla; Pereira, Helena; Mellor, Dominic J; Ellis, Kathryn A; Vilela, Cristina L

    2014-05-01

    The objectives of this study were to compare the impact of different coagulase-negative species (CNS) on udder health measured in terms of individual quarter milk somatic cell count (SCC) and duration of intramammary infection, and to get some insight into most likely routes of infection for different CNS species. This longitudinal observational study was performed on four farms that were sampled at 4-week intervals for a total of 12 visits each. Quarters infected with CNS were followed through time with milk samples being submitted for bacteriological culture and SCC determination. PCR amplification of the internal transcribed spacer region and sequencing of the sodA and rpoB genes were used for species allocation. Pulsed-field gel electrophoresis (PFGE) was performed to assess strain identity. The percentage of quarters affected per farm varied between 6 and 35%, with the most frequently isolated CNS species being Staphylococcus epidermidis, followed by Staph. simulans, Staph. chromogenes and Staph. haemolyticus. It was possible to follow 111 intramammary infections due to CNS through time. Duration of infection had a mean of 188 d and was not significantly different between CNS species. Geometric mean quarter SCC overall was 132 000 cells/ml and was also not significantly different between CNS species. Despite the possibility of a different epidemiology of infection, the impact in terms of udder health seems to be similar for different CNS species.

  9. The burden of bone, native joint and soft tissue infections on orthopaedic emergency referrals in a city hospital.

    PubMed

    Howell, A; Parker, S; Tsitskaris, K; Oddy, M J

    2016-01-01

    Introduction Bone, native joint and soft tissue infections are frequently referred to orthopaedic units although their volume as a proportion of the total emergency workload has not been reported previously. Geographic and socioeconomic variation may influence their presentation. The aim of this study was to quantify the burden of such infections on the orthopaedic department in an inner city hospital, determine patient demographics and associated risk factors, and review our current utilisation of specialist services. Methods All cases involving bone, native joint and soft tissue infections admitted under or referred to the orthopaedic team throughout 2012 were reviewed retrospectively. Prosthetic joint infections were excluded. Results Almost 15% of emergency admissions and referrals were associated with bone, native joint or soft tissue infection or suspected infection. The cohort consisted of 169 patients with a mean age of 43 years (range: 1-91 years). The most common diagnosis was cellulitis/other soft tissue infection and the mean length of stay was 13 days. Two-thirds of patients (n=112, 66%) underwent an operation. Fifteen per cent of patients were carrying at least one blood borne virus, eleven per cent were alcohol dependent, fifteen per cent were using or had been using intravenous drugs and nine per cent were homeless or vulnerably housed. Conclusions This study has shown that a significant number of patients are admitted for orthopaedic care as a result of infection. These patients are relatively young, with multiple complex medical and social co-morbidities, and a long length of stay.

  10. Case report: cranioplasty infection due to Roseomonas gilardii at a university hospital in Turkey.

    PubMed

    Ece, Gulfem; Ruksen, Mete; Akay, Ali

    2013-01-01

    Roseomonas is a pink-pigmented, nonfermentative, oxidative, Gram-negative coccobacilli that has clinical importance as opportunistic pathogen which can lead to infections especially in immunosuppressed individuals. It is relatively less reported in many centers. These microorganisms are detected after several days growth in culture environment, and typical pink, mucoid colonies are detected. We are reported a case of cranioplasty infection that took place in a patient with with cranial abscess formation due to Roseomonas gilardii at Izmir University School of Medicine Medicalpark Hospital.

  11. Oral mucosa alterations in chronic hepatitis and cirrhosis due to HBV or HCV infection.

    PubMed

    Sulka, Agnieszka; Simon, Krzysztof; Piszko, Paweł; Kalecińska, Ewa; Dominiak, Marzena

    2006-03-01

    The aim of the study was to evaluate the character of lesions within oral mucosa in patients suffering from chronic hepatitis and cirrhosis of the liver due to either HBV or HCV infection. A total of 74 patients treated at the Clinic of Infectious Diseases in Wrocław for chronic hepatitis B (20 patients, group I) and for chronic hepatitis C (23 patients group III) and cirrhosis of the liver due to HBV (15 patients , group II) and HCV (16 patients, group IV) infection. The control group comprised 29 healthy subjects. Lesions within the oral mucosa found on clinical examinations were confirmed with a histopathological evaluation. Patients suffering from chronic hepatitis B revealed leukoplakia (1/20), melanoplakia (1/20), petechiae (1/20), 17 patients from this group did not show any changes. Patients suffering from chronic hepatitis C revealed leukoplakia (6/23), Delbanco's disease (2/23), melanoplakia (1/23), lichen planus (1/23), petechiae (1/23), 12 patients from this group did not show any changes. Patients suffering from cirrhosis of the liver due of HBV infection revealed leukoplakia (3/15) petechiae (2/15), Delbanco's disease (1/15), angular cheilitis (1/15), aphthae (1/15), 7 patients from this group did not reveal any changes. Patients suffering from cirrhosis of the liver due of HCV infection revealed petechiae (2/16), melanoplakia (1/16), candidosis (1/16), labial herpes (1/16), 11 patients from this group did not reveal any changes. In control group we observed leukoplakia (3/29), Delbanco's disease (1/29), labial herpes (1/29), petechiae (1/29), and 23 subjects did not present pathological lesions within the oral mucosa. Results indicate the lack of connection between chronic HBV and HCV infection as well as the stage of the disease with the incidence and character of oral lesions in oral mucosa.

  12. A Retrospective Case-Series of Children With Bone and Joint Infection From Northern Australia

    PubMed Central

    Brischetto, Anna; Leung, Grace; Marshall, Catherine S.; Bowen, Asha C.

    2016-01-01

    Abstract Our clinical workload as infectious diseases pediatricians in northern Australia is dominated by complicated bone and joint infections in indigenous children. We reviewed the clinical presentation, microbiology, management, and outcomes of children presenting to Royal Darwin Hospital with bone and joint infections between 2010 and 2013, and aimed to compare severity and incidence with other populations worldwide. A retrospective audit was performed on children aged 0 to 18 years who were admitted to Royal Darwin Hospital between 1 January 2010 and 31 December 2013 with a bone and joint infection. Seventy-nine patients were identified, of whom 57 (72%) had osteomyelitis ± associated septic arthritis and 22 (28%) had septic arthritis alone. Sixty (76%) were indigenous Australians. The incidence rate of osteomyelitis for indigenous children was 82 per 100,000 children. Staphylococcus aureus was the confirmed pathogen in 43/79 (54%), of which 17/43 (40%) were methicillin resistant. Median length of stay was 17 days (interquartile range: 10–31 days) and median length of IV antibiotics was 15 days (interquartile range: 6–24 days). Fifty-six (71%) required at least 1 surgical procedure. Relapse within 12 months was documented in 12 (15%) patients. We report 3 key findings: osteomyelitis incidence in indigenous children of northern Australia is amongst the highest reported in the world; methicillin-resistant S aureus accounts for 36% of osteomyelitis with a positive microbiological diagnosis; and the severity of disease requires extended antibiotic therapy. Despite this, 15% of the cohort relapsed within 12 months and required readmission. PMID:26937926

  13. The risk of biomaterial-associated infection after revision surgery due to an experimental primary implant infection.

    PubMed

    Engelsman, Anton F; Saldarriaga-Fernandez, Isabel C; Nejadnik, M Reza; van Dam, Gooitzen M; Francis, Kevin P; Ploeg, Rutger J; Busscher, Henk J; van der Mei, Henny C

    2010-10-01

    The fate of secondary biomaterial implants was determined by bio-optical imaging and plate counting, after antibiotic treatment of biomaterials-associated-infection (BAI) and surgical removal of an experimentally infected, primary implant. All primary implants and tissue samples from control mice showed bioluminescence and were culture-positive. In an antibiotic treated group, no bioluminescence was detected and only 20% of all primary implants and no tissue samples were culture-positive. After revision surgery, bioluminescence was detected in all control mice. All the implants and 80% of all tissue samples were culture-positive. In contrast, in the antibiotic treated group, 17% of all secondary implants and 33% of all tissue samples were culture-positive, despite antibiotic treatment. The study illustrates that due to the BAI of a primary implant, the infection risk of biomaterial implants is higher in revision surgery than in primary surgery, emphasizing the need for full clearance of the infection, as well as from surrounding tissues prior to implantation of a secondary implant.

  14. A Case of Infective Abdominal Aortic Aneurysm due to Haemophilus influenzae Type B

    PubMed Central

    Sato, Toshimitsu; Kobayashi, Masayoshi

    2012-01-01

    Infective abdominal aortic aneurysm (IAAA) is relatively rare, but a case which is caused by Haemophilus influenzae type B is very rare. We experienced one IAAA case due to H. influenzae type B. The patient was 69-year-old man presenting with severe abdominal and back pain and elevated C-reactive protein (CRP), as inflammatory marker. The patient was found to have saccular aneurysm infrarenal aorta on computed tomography scanning. First, we started to treat him with antibiotic agent and second, we operated him at day 8 after admission with expanded polytetrafluoroethylene graft. Revascularization was made in situ reconstruction. As the result of culture with aneurysm wall, we found that the cause of this aneurysm was the infection of H. influenzae type B. As far as we know, this bacterium is scarcely reported as the cause of infective aortic aneurysms. We reported this IAAA case with the review of the English literature. PMID:23997558

  15. A Case of Infective Abdominal Aortic Aneurysm due to Haemophilus influenzae Type B.

    PubMed

    Sato, Toshimitsu; Kobayashi, Masayoshi

    2012-09-01

    Infective abdominal aortic aneurysm (IAAA) is relatively rare, but a case which is caused by Haemophilus influenzae type B is very rare. We experienced one IAAA case due to H. influenzae type B. The patient was 69-year-old man presenting with severe abdominal and back pain and elevated C-reactive protein (CRP), as inflammatory marker. The patient was found to have saccular aneurysm infrarenal aorta on computed tomography scanning. First, we started to treat him with antibiotic agent and second, we operated him at day 8 after admission with expanded polytetrafluoroethylene graft. Revascularization was made in situ reconstruction. As the result of culture with aneurysm wall, we found that the cause of this aneurysm was the infection of H. influenzae type B. As far as we know, this bacterium is scarcely reported as the cause of infective aortic aneurysms. We reported this IAAA case with the review of the English literature.

  16. [Ciprofloxacin and therapy of urinary tract infections, including those due to Staphylococcus saprophyticus].

    PubMed

    Ivanov, D V; Budanov, S V

    2006-01-01

    Staphylococcus saprophyticus is one of the main pathogens of cystitis in young women. The human biotopes are contaminated by the staphylococcus on direct contacts with domestic animals or after using not properly cooked food of animal origin. Young women are more susceptible to colonization of the urinary tract by S. saprophyticus vs. the other contingents. Sexual intercourse is conducive to the colonization and infection. Shifts in the urinary tract microflora due to the use of spermicide, as well as candidiasis promote colonization of the urinary tract by S. saprophyticus. At present fluoroquinolones are considered as a significant independent group of chemotherapeutics within the class of quinolones, inhibitors of DNA gyrase, characterized by high clinical efficacy in the treatment of urinary tract infections. Especially significant clinical experience with ciprofloxacin in the therapy of urinary tract infections is available.

  17. Prosthetic joint-associated infections treated with DAIR (debridement, antibiotics, irrigation, and retention)

    PubMed Central

    Vos, Stan J (CJ); Saouti, Rachid; Vergroesen, Diederik A; Graat, Harm C A; Debets-Ossenkopp, Yvette J; Peters, Edgar J G; Nolte, Peter A

    2013-01-01

    Background and purpose For prosthetic joint-associated infection (PJI), a regimen of debridement, antibiotics, irrigation, and retention of the prosthesis (DAIR) is generally accepted for acute infections. Various risk factors associated with treatment success have been described. The use of local antibiotic carriers (beads and sponges) is relatively unknown. We retrospectively analyzed risk factors in a cohort of patients from 3 hospitals, treated with DAIR for PJI. Patients and methods 91 patients treated with DAIR for hip or knee PJI in 3 Dutch centers between 2004 and 2009 were retrospectively evaluated. The mean follow-up was 3 years. Treatment success was defined as absence of infection after 2 years, with retention of the prosthesis and without the use of suppressive antibiotics. Results 60 patients (66%) were free of infection at follow-up. Factors associated with treatment failure were: a history of rheumatoid arthritis, late infection (> 2 years after arthroplasty), ESR at presentation above 60 mm/h, and infection caused by coagulase-negative Staphylococcus. Symptom duration of less than 1 week was associated with treatment success. The use of gentamicin sponges was statistically significantly higher in the success group, and the use of beads was higher in the failure group in the univariate analysis, but these differences did not reach significance in the logistic regression analysis. Less surgical procedures were performed in the group treated with sponges than in the group treated with beads. Interpretation In the presence of rheumatoid arthritis, duration of symptoms of more than 1 week, ESR above 60 mm/h, late infection (> 2 years after arthroplasty), and coagulase-negative Staphylococcus PJI, the chances of successful DAIR treatment decrease, and other treatment methods should be considered. PMID:23848215

  18. Genotypic and phenotypic characterization of Staphylococcus epidermidis causing chronic relapsing prosthetic joint infections.

    PubMed

    Henry, Benoît; Corvec, Stéphane; Crémet, Lise; Guillouzouic, Aurélie; Marraillac, Julie; Juvin, Marie-Emmanuelle; Touchais, Sophie; Asseray, Nathalie; Boutoille, David; Reynaud, Alain; Bémer, Pascale

    2012-08-01

    Twenty-one isolates of Staphylococcus epidermidis from 9 patients with persistent prosthetic joint infections were analysed by pulsed-field gel electrophoresis and antibiotic susceptibility assays. In 7 of these cases, the S. epidermidis isolate was different from that of the initial episode. In 1 further case, the superinfection was polyclonal. Recurrence, i.e., renewed isolation of a clone identical to that of an initial episode, occurred in 3 cases, 1 of which was in the absence of superinfection. A high degree of antibiotic resistance was demonstrated, including methicillin in 17 of 21 strains. In conclusion, a frequent occurrence of superinfection and a high degree of resistance make management of these infections complex.

  19. Salvage Procedures for Management of Prosthetic Joint Infection After Hip and Knee Replacements

    PubMed Central

    Mahmoud, Samer S.S.; Sukeik, Mohamed; Alazzawi, Sulaiman; Shaath, Mohammed; Sabri, Omar

    2016-01-01

    Background: The increasing load placed by joint replacement surgery on health care systems makes infection, even with the lowest rates, a serious concern that needs to be thoroughly studied and addressed using all possible measures. Methods: A comprehensive review of the current literature on salvage procedures for recurrent PJIs using PubMed, EMBASE and CINAHL has been conducted. Results: Prolonged suppressive antibiotic therapy (PSAT), resection arthroplasty and arthrodesis were the most common procedures performed. Suppressive antibiotic therapy is based on the use of well tolerated long term antibiotics in controlling sensitive organisms. Resection arthroplasty which should be reserved as a last resort provided more predictable outcomes in the hip whereas arthrodesis was associated with better outcomes in the knee. Various methods for arthrodesis including internal and external fixation have been described. Conclusion: Despite good union and infection control rates, all methods were associated with complications occasionally requiring further surgical interventions. PMID:28144373

  20. Finite element modelling predicts changes in joint shape and cell behaviour due to loss of muscle strain in jaw development

    PubMed Central

    Brunt, Lucy H.; Norton, Joanna L.; Bright, Jen A.; Rayfield, Emily J.; Hammond, Chrissy L.

    2015-01-01

    Abnormal joint morphogenesis is linked to clinical conditions such as Developmental Dysplasia of the Hip (DDH) and to osteoarthritis (OA). Muscle activity is known to be important during the developmental process of joint morphogenesis. However, less is known about how this mechanical stimulus affects the behaviour of joint cells to generate altered morphology. Using zebrafish, in which we can image all joint musculoskeletal tissues at high resolution, we show that removal of muscle activity through anaesthetisation or genetic manipulation causes a change to the shape of the joint between the Meckel's cartilage and Palatoquadrate (the jaw joint), such that the joint develops asymmetrically leading to an overlap of the cartilage elements on the medial side which inhibits normal joint function. We identify the time during which muscle activity is critical to produce a normal joint. Using Finite Element Analysis (FEA), to model the strains exerted by muscle on the skeletal elements, we identify that minimum principal strains are located at the medial region of the joint and interzone during mouth opening. Then, by studying the cells immediately proximal to the joint, we demonstrate that biomechanical strain regulates cell orientation within the developing joint, such that when muscle-induced strain is removed, cells on the medial side of the joint notably change their orientation. Together, these data show that biomechanical forces are required to establish symmetry in the joint during development. PMID:26253758

  1. NKT cells prevent chronic joint inflammation after infection with Borrelia burgdorferi.

    PubMed

    Tupin, Emmanuel; Benhnia, Mohammed Rafii-El-Idrissi; Kinjo, Yuki; Patsey, Rebeca; Lena, Christopher J; Haller, Matthew C; Caimano, Melissa J; Imamura, Masakazu; Wong, Chi-Huey; Crotty, Shane; Radolf, Justin D; Sellati, Timothy J; Kronenberg, Mitchell

    2008-12-16

    Borrelia burgdorferi is the etiologic agent of Lyme disease, a multisystem inflammatory disorder that principally targets the skin, joints, heart, and nervous system. The role of T lymphocytes in the development of chronic inflammation resulting from B. burgdorferi infection has been controversial. We previously showed that natural killer T (NKT) cells with an invariant (i) TCR alpha chain (iNKT cells) recognize glycolipids from B. burgdorferi, but did not establish an in vivo role for iNKT cells in Lyme disease pathogenesis. Here, we evaluate the importance of iNKT cells for host defense against these pathogenic spirochetes by using Valpha14i NKT cell-deficient (Jalpha18(-/-)) BALB/c mice. On tick inoculation with B. burgdorferi, Jalpha18(-/-) mice exhibited more severe and prolonged arthritis as well as a reduced ability to clear spirochetes from infected tissues. Valpha14i NKT cell deficiency also resulted in increased production of antibodies directed against both B. burgdorferi protein antigens and borrelial diacylglycerols; the latter finding demonstrates that anti-glycolipid antibody production does not require cognate help from Valpha14i NKT cells. Valpha14i NKT cells in infected wild-type mice expressed surface activation markers and produced IFNgamma in vivo after infection, suggesting a participatory role for this unique population in cellular immunity. Our data are consistent with the hypothesis that the antigen-specific activation of Valpha14i NKT cells is important for the prevention of persistent joint inflammation and spirochete clearance, and they counter the long-standing notion that humoral rather than cellular immunity is sufficient to facilitate Lyme disease resolution.

  2. A case of orbital apex syndrome due to Pseudomonas aeruginosa infection.

    PubMed

    Kusunoki, Takeshi; Kase, Kaori; Ikeda, Katsuhisa

    2011-09-28

    Orbital apex syndrome is commonly been thought to have a poor prognosis. Many cases of this syndrome have been reported to be caused by paranasal sinus mycosis. We encountered a very rare case (60-year-old woman) of sinusitis with orbital apex syndrome due to Pseudomonas aeruginosa infection. She had received insulin and dialysis for diabtes and diabetic nephropathy, moreover anticoagulants after heart by-pass surgery. She underwent endoscopic sinus operation and was treated with antibiotics, but her loss of left vision did not improve. Recently, sinusitis cases due to Pseudomonas aeruginosa were reported to be a increasing. Therefore, we should consider the possibility of Pseudomonas aeruginosa as well as mycosis as infections of the sinus, especially inpatients who are immunocompromised body.

  3. A case of orbital apex syndrome due to Pseudomonas aeruginosa infection

    PubMed Central

    Kusunoki, Takeshi; Kase, Kaori; Ikeda, Katsuhisa

    2011-01-01

    Orbital apex syndrome is commonly been thought to have a poor prognosis. Many cases of this syndrome have been reported to be caused by paranasal sinus mycosis. We encountered a very rare case (60-year-old woman) of sinusitis with orbital apex syndrome due to Pseudomonas aeruginosa infection. She had received insulin and dialysis for diabtes and diabetic nephropathy, moreover anticoagulants after heart by-pass surgery. She underwent endoscopic sinus operation and was treated with antibiotics, but her loss of left vision did not improve. Recently, sinusitis cases due to Pseudomonas aeruginosa were reported to be a increasing. Therefore, we should consider the possibility of Pseudomonas aeruginosa as well as mycosis as infections of the sinus, especially inpatients who are immunocompromised body. PMID:24765368

  4. Premature delivery due to intrauterine Candida infection that caused neonatal congenital cutaneous candidiasis: a case report.

    PubMed

    Ito, Fumitake; Okubo, Tomoharu; Yasuo, Tadahiro; Mori, Taisuke; Iwasa, Koichi; Iwasaku, Kazuhiro; Kitawaki, Jo

    2013-01-01

    Congenital cutaneous candidiasis is a very rare disease with less than 100 cases published in the medical literature. Neonates having this disease present with systemic skin lesions caused by intrauterine Candida infections. We present a case of threatened premature delivery due to Candida chorioamnionitis, which caused both maternal postpartum endometritis and neonatal congenital cutaneous candidiasis. A 34-year-old woman who was admitted for fetal membrane bulging at 20 weeks of gestation underwent McDonald cervical cerclage. We diagnosed threatened premature delivery due to intrauterine infection; therefore, we terminated the gestation by cesarean section at 24 weeks of gestation. Fungi-like yeast was detected in infantile gastric juice. Histopathological findings of the placenta revealed that Candida albicans mycelium invaded the placenta, chorioamniotic membrane and umbilical cord.

  5. Characterization of a New Animal Model for Evaluation and Treatment of Back Pain Due to Lumbar Facet Joint Osteoarthritis

    PubMed Central

    Kim, Jae-Sung; Kroin, Jeffrey S.; Buvanendran, Asokumar; Li, Xin; van Wijnen, Andre J.; Tuman, Kenneth J.; Im, Hee-Jeong

    2011-01-01

    Degeneration of lumbar facet joints (FJs) has been implicated in lower back pain. To verify the biological links between cellular and structural alterations within FJ components and development of symptomatic chronic back pain, we generated an animal model for FJ degeneration by intra-articular injection of monosodium iodoacetate (MIA) in FJs (L3/L4, L4/L5, L5/L6) of Sprague Dawley rats followed by behavioral pain tests. The degree of primary hyperalgesia was assessed by measuring pain sensation due to pressure using an algometer, which mimics a mechanical stimulus for FJ injury. Biochemical assessments and µCT imaging revealed severely damaged FJ cartilage, proteoglycan loss and alterations of subchondral bone structure by MIA injection. The µCT analyses further suggested that the behavioral hyperalgesia from FJ degeneration is not associated with foramina stenosis. These biological and structural changes in FJs are closely related to sustained and robust chronic pain. Therapeutic modulation of chronic pain using pharmaceutical drugs was investigated in the facet joint osteoarthritis animal model. Morphine and pregabalin markedly alleviate pressure hyperalgesia while celecoxib (selective inhibitor of COX-2) and ketorolac (inhibitor of COX-1 and -2) demonstrate moderate to negligible anti-hyperalgesic effects, respectively. PMID:21953085

  6. Pulmonary mucormycosis due to Lichtheimia ramosa in a patient with HIV infection.

    PubMed

    Kutlu, Murat; Ergin, Cağrı; Bir, Ferda; Hilmioğlu-Polat, Süleyha; Gümral, Ramazan; Necan, Ceyda; Koçyiğit, Ali; Sayın-Kutlu, Selda

    2014-08-01

    Mucormycosis is increasingly common in patients with risk factors such as diabetes mellitus, neutropenia, and corticosteroid therapy. However, mucormycosis seems to be less common in patients with human immunodeficiency virus (HIV) infection compared to patients with other risk factors. Despite their lower virulence, Lichtheimia species should be regarded as emerging pathogens among Mucoralean fungi. We report a fatal case of pulmonary mucormycosis due to Lichtheimia ramosa in a 52-year-old man with an end-stage HIV infection. He had a cachectic appearance and his CD4 count was 8 cells/mm(3). The fungal infection was diagnosed based on a positive sputum culture with histopathologic confirmation. The fungus was resistant to caspofungin, anidulafungin, and voriconazole [minimum inhibitory concentration (MCI) >32 µg/ml], whereas the E test MIC values of itraconazole, posaconazole, and amphotericin B were 0.38, 0.38, and 0.5 µg/ml, respectively. Although intravenous drug use is the main risk factor for the development of mucormycosis in HIV-infected patients, it may also develop in patients with low CD4 count, opportunistic infections and/or additional diseases, such as Kaposi's sarcoma or severe immunodeficiency, as in our case.

  7. Diagnosis and management of catheter-related bloodstream infections due to Staphylococcus aureus.

    PubMed

    Gosbell, I B

    2005-12-01

    Intravenous catheters are essential to modern medical care but frequently cause complications, the most important of which is infection, commonly due to Staphylococcus aureus. It is estimated at least 3000 episodes of catheter-related bloodstream infection occur annually in Australia, and 9% to 25% of patients with such infections die. Infection rates vary depending on the type of device, with the lowest rates associated with peripherally inserted central catheters and highest rates with haemodialysis catheters. In febrile patients, the presence of an intravenous catheter should always prompt consideration of whether the line is the source, even if there is no exit site inflammation. If catheter-related infection appears likely, the line should be removed if possible. Either peripheral and line tip cultures, or timed cultures of blood drawn peripherally and through the line, should be taken. Empirical antibiotics should be aimed at S. aureus and aerobic Gram-negative organisms, and blood cultures should be repeated at 72 h. If S. aureus is grown, cure requires removal of the catheter, at least 14 days of parenteral therapy, and consideration of echocardiography (preferably transoesophageal). If the patient remains febrile for >72 h, blood cultures at 72 h grow S. aureus, or there is a prosthetic heart valve, the risk of endocarditis is high and 6 weeks of parenteral therapy should be given. Prevention requires an organized system of surveillance, with a strict policy on insertion of central lines in controlled conditions and regimented catheter care. The role of impregnated catheters in prevention remains controversial.

  8. Leukocyte Esterase as a Biomarker in the Diagnosis of Periprosthetic Joint Infection

    PubMed Central

    Wang, Chi; Li, Rui; Wang, Qi; Duan, Jinyan; Wang, Chengbin

    2017-01-01

    Background Total joint arthroplasty (TJA) has been one of the most rewarding interventions for treating patients suffering from joint disorders. However, periprosthetic joint infection (PJI) is a serious complication that frequently accompanies TJA. Our study aimed to investigate the application of the leukocyte esterase (LE) strip in the diagnosis of PJI. Material/Methods From October 2014 to July 2015, 72 patients who had undergone joint puncture after arthroplasty in our hospital were enrolled in this trial. One drop of synovial fluid from each available patient was applied to the LE strip, and the results were observed after 1–3 min. If the color turned to dark purple, we recognized this as a positive result, while other colors were regarded as negative results. Centrifugation was used when the synovial fluid was mixed with blood. The Musculoskeletal Infection Society (MSIS) definition was used as the standard reference to identify whether PJI was found in patients or not. The results of diagnosis and LE strips test were compared, and indicators reflecting diagnostic value were calculated. Correlation of the LE data with erythrocyte sedimentation rate (ESR), elevated C-reactive protein (CRP), synovial white blood cell (WBC) counts, and polymorphonuclear neutrophil (PMN) percentage was calculated. Results By MSIS criteria, 38 patients were diagnosed with PJI and 34 patients were not infected. Two types of LE strip presented the same results with sensitivity of 84.21% (95% confidence interval [CI]: 68.75~93.98%), specificity of 97.06% (95% CI: 84.67~99.93%), positive predictive value (PPV) of 96.97% (95% CI: 84.24~99.92%), and negative predictive value (NPV) of 84.62% (95% CI: 69.47~94.14%). There were one false-positive case and six false-negative cases in this trial. There is a strong correlation between LE strip and synovial fluid PMN percentage. Conclusions The sensitivity and specificity of the LE strip in the diagnosis of PJI are quite high, which means

  9. Current concepts in the management of infections in bones and joints.

    PubMed

    Dickie, A S

    1986-11-01

    Significant changes have taken place in the epidemiology, microbiology and antibiotic therapy of bone and joint infections. Gram-negative bacilli have become an increasingly common cause, particularly in immunocompromised patients; anaerobes have been implicated in osteomyelitis associated with metallic foreign bodies; and there is increasing use of oral antibiotic regimens following an initial period of parenteral treatment. Gram-negative bacilli and anaerobes are found in polymicrobial non-haematogenous osteomyelitis (e.g. post-traumatic, post-surgical), but Staphylococcus aureus remains the most common cause of acute haematogenous osteomyelitis, with streptococci and Haemophilus influenzae responsible for most of the remainder. A precise microbiological diagnosis is essential. Diagnosis is based on Gram stain and culture of bone biopsies or aspirated pus, or on blood cultures. Specimens should be obtained before starting therapy. Any suspected primary foci of infection should be cultured. Parenteral antibiotics are given as soon as specimens are obtained, and continued for at least 3 weeks. The common causative organisms in septic arthritis are the same as in osteomyelitis, with the addition of Neisseria gonorrhoeae in young, sexually active adults. As in osteomyelitis, a precise microbiological diagnosis is of paramount importance, ideally by joint aspiration for cell count, Gram stain, biochemical analysis and culture, or by blood cultures. Optimum therapy is with antibiotics, repeated therapeutic aspirations, and resting the joint. Parenteral antibiotics should be started as soon as specimens are obtained and continued for 4 to 6 weeks. Gonococcal arthritis, however, can be treated successfully with 1 week of antibiotics. When treatment of either osteomyelitis or septic arthritis is continued with oral antibiotics, serum antibiotic concentrations or serum bactericidal levels are mandatory to ensure adequate absorption.

  10. Ten-Year Experience of Cutaneous and/or Subcutaneous Infections Due to Coelomycetes in France

    PubMed Central

    Guégan, Sarah; Garcia-Hermoso, Dea; Sitbon, Karine; Ahmed, Sarah; Moguelet, Philippe; Dromer, Françoise; Lortholary, Olivier

    2016-01-01

    Background. Coelomycetes are rarely but increasingly reported in association with human infections involving mostly skin and subcutaneous tissues, both in immunocompetent and immunocompromised patients. Coelomycetes constitute a heterogeneous group of filamentous fungi with distinct morphological characteristics in culture, namely an ability to produce asexual spores within fruit bodies. Methods. We included all cases of proven primary cutaneous and/or subcutaneous infections due to coelomycetes received for identification at the French National Reference Center for Invasive Mycoses and Antifungals between 2005 and 2014. Eumycetoma, chromoblastomycosis, and disseminated infections were excluded. Results. Eighteen cases were analyzed. The median age was 60.5 years. In all cases, patients originated from tropical or subtropical areas. An underlying immunodepression was present in 89% of cases. Cutaneous and/or subcutaneous lesions, mainly nodules, abscesses, or infiltrated plaques, were observed in distal body areas. Isolates of different genera of coelomycetes were identified: Medicopsis (6), Paraconiothyrium (3), Gloniopsis (3), Diaporthe (3), Peyronellaea (2), Lasiodiplodia (1). Lesion treatment consisted of complete (10) or partial (2) surgical excision and/or the use of systemic antifungal therapy, namely voriconazole (5) and posaconazole (4). Literature review yielded 48 additional cases of cutaneous and/or subcutaneous infections due to coelomycetes. Conclusions. Infectious diseases physicians should suspect coelomycetes when observing cutaneous and/or subcutaneous infections in immunocompromised hosts from tropical areas; a sequence-based approach is crucial for strains identification but must be supported by consistent phenotypic features; surgical treatment should be favored for solitary, well limited lesions; new triazoles may be used in case of extensive lesions, especially in immunocompromised patients. PMID:27419178

  11. A novel modified acrylic bone cement matrix. A step forward on antibiotic delivery against multiresistant bacteria responsible for prosthetic joint infections.

    PubMed

    Matos, Ana C; Gonçalves, Lídia M; Rijo, Patrícia; Vaz, Mário A; Almeida, António J; Bettencourt, Ana F

    2014-05-01

    Currently the safe and responsible use of antibiotics is a world-wide concern as it promotes prevention of the increasing emergence of multiresistant bacterial strains. Considering that there is a noticeable decline of the available antibiotic pipeline able to combat emerging resistance in serious infection a major concern grows around the prosthetic joint infections once the available commercial antibiotic loaded polymethylmethacrylate bone cements (BC) are inadequate for local antibiotic treatment, especially against MRSA, the most commonly isolated and antibiotic-resistant pathogen in bone infections. In this paper a novel modified BC matrix loaded with minocycline is proposed. A renewed interest in this tetracycline arises due to its broad-spectrum of activity against the main organisms responsible for prosthetic joint infections, especially against MRSA. The modified BC matrices were evaluated concerning minocycline release profile, biomechanical properties, solid-state characterization, antimicrobial stability and biocompatibility under in vitro conditions. BC matrix loaded with 2.5% (w/wBC) of minocycline and 10.0% (w/wBC) of lactose presented the best properties since it completely released the loaded minocycline, maintained the mechanical properties and the antimicrobial activity against representative strains of orthopedic infections. In vitro biocompatibility was assessed for the elected matrix and neither minocycline nor lactose loading enhanced BC cytotoxicity.

  12. Six-Month Multicenter Study on Invasive Infections Due to Group B Streptococci in Argentina

    PubMed Central

    Lopardo, Horacio A.; Vidal, Patricia; Jeric, Paola; Centron, Daniela; Paganini, Hugo; Facklam, Richard R.; Elliott, John

    2003-01-01

    There is little information about invasive infections by group B streptococci (GBS) and their antimicrobial susceptibilities in Latin America. We performed a prospective multicenter study to determine the serotype distribution and the antimicrobial susceptibility of GBS in Argentina. We identified 58 cases, but only 44 had sufficient data to be evaluated. Eight early-, four late-, and one fatal late, late-onset neonatal infections due to GBS were found. A total of 31 patients were adults with bacteremia, skin and soft tissue infections, osteomyelitis, arthritis, meningitis, abdominal infections, and renal abscess. Serotype III was prevalent in late-onset neonatal disease, and several serotypes (Ia/c, III, Ia, and II) were involved in early-onset neonatal infections. Serotypes II, Ia/c, III, and IV were commonly found in adults, with serotype II prevalent in younger adults (18 to 69 years old) and serotype Ia/c prevalent in elderly adults (>70 years old). The mortality rate attributable to GBS infections was 10.8%. All GBS were susceptible to penicillin and ceftriaxone. Resistance to clindamycin (1.7%), erythromycin (5.2%), azithromycin (5.2%), minocycline (69%), and tetracycline (72.4%), to high levels of kanamycin and amikacin (1.7%), and to intermediately high levels of gentamicin (1.7%) was observed. The bifunctional enzyme AAC6′-APH2" was detected in the isolate resistant to aminoglycosides, and other genetic determinants were identified in other resistant isolates: tetM and tetO in tetracycline-resistant streptococci and mefA and ermTR for efflux-mediated and inducible macrolide-lincosamide-streptogramin B-resistant streptococci, respectively. For clinical purposes and rapid and easy detection of high-level aminoglycoside-resistant GBS, a screening method that used 1,000-μg kanamycin disks is proposed. PMID:14532204

  13. Detection of bacteria with molecular methods in prosthetic joint infection: sonication fluid better than periprosthetic tissue

    PubMed Central

    Rak, Mitja; KavčIč, Martina; Trebše, Rihard; CőR, Andrej

    2016-01-01

    Background and purpose The correct diagnosis of prosthetic joint infection (PJI) can be difficult because bacteria form a biofilm on the surface of the implant. The sensitivity of culture from sonication fluid is better than that from periprosthetic tissue, but no comparison studies using molecular methods on a large scale have been performed. We assessed whether periprosthetic tissue or sonication fluid should be used for molecular analysis. Patients and methods Implant and tissue samples were retrieved from 87 patients who underwent revision operation of total knee or total hip arthroplasty. Both sample types were analyzed using broad-range (BR-) PCR targeting the 16S rRNA gene. The results were evaluated based on the definition of periprosthetic joint infection from the Workgroup of the Musculoskeletal Infection Society. Results PJI was diagnosed in 29 patients, whereas aseptic failure was diagnosed in 58 patients. Analysis of sonication fluid using BR-PCR detected bacteria in 27 patients, whereas analysis of periprosthetic tissue by BR-PCR detected bacteria in 22 patients. In 6 of 7 patients in whom BR-PCR analysis of periprosthetic tissue was negative, low-virulence bacteria were present. The sensitivity and specificity values for periprosthetic tissue were 76% and 93%, respectively, and the sensitivity and specificity values for sonication fluid were 95% and 97%. Interpretation Our results suggest that sonication fluid may be a more appropriate sample than periprosthetic tissue for BR-PCR analysis in patients with PJI. However, further investigation is required to improve detection of bacteria in patients with so-called aseptic failure. PMID:27123818

  14. Improved Diagnosis of Prosthetic Joint Infection by Culturing Periprosthetic Tissue Specimens in Blood Culture Bottles

    PubMed Central

    Peel, Trisha N.; Dylla, Brenda L.; Hughes, John G.; Lynch, David T.; Greenwood-Quaintance, Kerryl E.; Cheng, Allen C.; Mandrekar, Jayawant N.

    2016-01-01

    ABSTRACT Despite known low sensitivity, culture of periprosthetic tissue specimens on agars and in broths is routine. Culture of periprosthetic tissue samples in blood culture bottles (BCBs) is potentially more convenient, but it has been evaluated in a limited way and has not been widely adopted. The aim of this study was to compare the sensitivity and specificity of inoculation of periprosthetic tissue specimens into blood culture bottles with standard agar and thioglycolate broth culture, applying Bayesian latent class modeling (LCM) in addition to applying the Infectious Diseases Society of America (IDSA) criteria for prosthetic joint infection. This prospective cohort study was conducted over a 9-month period (August 2013 to April 2014) at the Mayo Clinic, Rochester, MN, and included all consecutive patients undergoing revision arthroplasty. Overall, 369 subjects were studied; 117 (32%) met IDSA criteria for prosthetic joint infection, and 82% had late chronic infection. Applying LCM, inoculation of tissues into BCBs was associated with a 47% improvement in sensitivity compared to the sensitivity of conventional agar and broth cultures (92.1 versus 62.6%, respectively); this magnitude of change was similar when IDSA criteria were applied (60.7 versus 44.4%, respectively; P = 0.003). The time to microorganism detection was shorter with BCBs than with standard media (P < 0.0001), with aerobic and anaerobic BCBs yielding positive results within a median of 21 and 23 h, respectively. Results of our study demonstrate that the semiautomated method of periprosthetic tissue culture in blood culture bottles is more sensitive than and as specific as agar and thioglycolate broth cultures and yields results faster. PMID:26733067

  15. First Report of a Hip Prosthetic and Joint Infection Caused by Lactococcus garvieae in a Woman Fishmonger▿

    PubMed Central

    Aubin, G. G.; Bémer, P.; Guillouzouic, A.; Crémet, L.; Touchais, S.; Fraquet, N.; Boutoille, D.; Reynaud, A.; Lepelletier, D.; Corvec, S.

    2011-01-01

    We describe the first case of hip prosthetic infection due to Lactococcus garvieae. The patient, a 71-year-old woman fishmonger, developed a hip infection 7 years after total hip arthroplasty. The origin of infection was possibly due to the manipulation or intake of seafood or fish contaminated with Lactococcus garvieae. PMID:21367987

  16. First report of a hip prosthetic and joint infection caused by Lactococcus garvieae in a woman fishmonger.

    PubMed

    Aubin, G G; Bémer, P; Guillouzouic, A; Crémet, L; Touchais, S; Fraquet, N; Boutoille, D; Reynaud, A; Lepelletier, D; Corvec, S

    2011-05-01

    We describe the first case of hip prosthetic infection due to Lactococcus garvieae. The patient, a 71-year-old woman fishmonger, developed a hip infection 7 years after total hip arthroplasty. The origin of infection was possibly due to the manipulation or intake of seafood or fish contaminated with Lactococcus garvieae.

  17. Variation in biogenic volatile organic compound emission pattern of Fagus sylvatica L. due to aphid infection

    NASA Astrophysics Data System (ADS)

    Joó, É.; Van Langenhove, H.; Šimpraga, M.; Steppe, K.; Amelynck, C.; Schoon, N.; Müller, J.-F.; Dewulf, J.

    2010-01-01

    Volatile organic compounds (VOCs) have been the focus of interest to understand atmospheric processes and their consequences in formation of ozone or aerosol particles; therefore, VOCs contribute to climate change. In this study, biogenic VOCs (BVOCs) emitted from Fagus sylvatica L. trees were measured in a dynamic enclosure system. In total 18 compounds were identified: 11 monoterpenes (MT), an oxygenated MT, a homoterpene (C 14H 18), 3 sesquiterpenes (SQT), isoprene and methyl salicylate. The frequency distribution of the compounds was tested to determine a relation with the presence of the aphid Phyllaphis fagi L. It was found that linalool, (E)-β-ocimene, α-farnesene and a homoterpene identified as (E)-4,8-dimethyl-1,3,7-nonatriene (DMNT), were present in significantly more samples when infection was present on the trees. The observed emission spectrum from F. sylvatica L. shifted from MT to linalool, α-farnesene, (E)-β-ocimene and DMNT due to the aphid infection. Sabinene was quantitatively the most prevalent compound in both, non-infected and infected samples. In the presence of aphids α-farnesene and linalool became the second and third most important BVOC emitted. According to our investigation, the emission fingerprint is expected to be more complex than commonly presumed.

  18. Altered joint tribology in osteoarthritis: Reduced lubricin synthesis due to the inflammatory process. New horizons for therapeutic approaches.

    PubMed

    Szychlinska, M A; Leonardi, R; Al-Qahtani, M; Mobasheri, A; Musumeci, G

    2016-06-01

    Osteoarthritis (OA) is the most common form of joint disease. This review aimed to consolidate the current evidence that implicates the inflammatory process in the attenuation of synovial lubrication and joint tissue homeostasis in OA. Moreover, with these findings, we propose some evidence for novel therapeutic strategies for preventing and/or treating this complex disorder. The studies reviewed support that inflammatory mediators participate in the onset and progression of OA after joint injury. The flow of pro-inflammatory cytokines following an acute injury seems to be directly associated with altered lubricating ability in the joint tissue. The latter is associated with reduced level of lubricin, one of the major joint lubricants. Future research should focus on the development of new therapies that attenuate the inflammatory process and restore lubricin synthesis and function. This approach could support joint tribology and synovial lubrication leading to improved joint function and pain relief.

  19. Multiplex Antibody Detection for Noninvasive Genus-Level Diagnosis of Prosthetic Joint Infection

    PubMed Central

    Marmor, Simon; Bauer, Thomas; Desplaces, Nicole; Heym, Beate; Roux, Anne-Laure; Sol, Olivier; Rogé, Julie; Mahé, Florence; Désiré, Laurent; Aegerter, Philippe; Ghout, Idir; Ropers, Jacques; Gaillard, Jean-Louis

    2016-01-01

    We developed and evaluated a multiplex antibody detection-based immunoassay for the diagnosis of prosthetic joint infections (PJIs). Sixteen protein antigens from three Staphylococcus species (Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus lugdunensis) (8 antigens), Streptococcus agalactiae (4 antigens), and Propionibacterium acnes (4 antigens) were selected by comparative immunoproteomics using serum samples from PJI cases versus controls. A bead-based multiplex immunoassay that measured serum IgG against purified, recombinant forms of each of the 16 antigens was developed. We conducted a prospective study to evaluate the performance of the assay. A PJI was defined by the presence of a sinus tract and/or positive intraoperative sample cultures (at least one sample yielding a virulent organism or at least two samples yielding the same organism). A total of 455 consecutive patients undergoing revision or resection arthroplasty (hip, 66.3%; knee, 29.7%; shoulder, 4%) at two French reference centers for the management of PJI were included: 176 patients (38.7%) were infected and 279 (61.3%) were not. About 60% of the infections involved at least one of the species targeted by the assay. The sensitivity/specificity values were 72.3%/80.7% for targeted staphylococci, 75%/92.6% for S. agalactiae, and 38.5%/84.8% for P. acnes. The assay was more sensitive for infections occurring >3 months after arthroplasty and for patients with an elevated C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR). However, it detected 64.3% and 58.3% of targeted staphylococcal infections associated with normal CRP and ESR values, respectively. This new multiplex immunoassay approach is a novel noninvasive tool to evaluate patients suspected of having PJIs and provides information complementary to that from inflammatory marker values. PMID:26865683

  20. Severe Diarrhea Due To Cystoisospora belli Infection in an HTLV-1 Woman

    PubMed Central

    SHAFIEI, Reza; NAJJARI, Mohsen; KARGAR KHEIRABAD, Ali; HATAM, Golamreza

    2016-01-01

    Cystoisospora belli, formerly Isospora belli, as an opportunistic infection agent, is seen in immunocompromised patients like HTLV-1. We describe here cystoisosporiasis in an HTLV1 Iranian female in Mashhad, northwestern Iran in 2012 who presented with a debilitating diarrheal illness and great weight loss. C. belli was detected in her stool by modified acid-fast staining and then by molecular detection. Serologic testing was negative for HIV but she showed positivity for HTLV-1 infection. Treatment with TMP/SMX led to improvement of her diarrhea but she died after one year due to malabsorption syndrome. Adequate detection of C. belli diarrhea in immunocompromise patients of HTLV1 in endemic area can be cured by TMP/SMX. PMID:27095979

  1. Severe Diarrhea Due To Cystoisospora belli Infection in an HTLV-1 Woman.

    PubMed

    Shafiei, Reza; Najjari, Mohsen; Kargar Kheirabad, Ali; Hatam, Golamreza

    2016-01-01

    Cystoisospora belli, formerly Isospora belli, as an opportunistic infection agent, is seen in immunocompromised patients like HTLV-1. We describe here cystoisosporiasis in an HTLV1 Iranian female in Mashhad, northwestern Iran in 2012 who presented with a debilitating diarrheal illness and great weight loss. C. belli was detected in her stool by modified acid-fast staining and then by molecular detection. Serologic testing was negative for HIV but she showed positivity for HTLV-1 infection. Treatment with TMP/SMX led to improvement of her diarrhea but she died after one year due to malabsorption syndrome. Adequate detection of C. belli diarrhea in immunocompromise patients of HTLV1 in endemic area can be cured by TMP/SMX.

  2. The epidemiology of infections due to Neisseria meningitidis and Neisseria lactamica in a northern Nigerian community.

    PubMed

    Blakebrough, I S; Greenwood, B M; Whittle, H C; Bradley, A K; Gilles, H M

    1982-11-01

    The epidemiology of infection due to Neisseria meningitidis and Neisseria lactamica was studied in a northern Nigerian community. A low meningococcal carriage rate was observed throughout the two-year survey. Initially, most meningococci isolated from nasopharyngeal carriers belonged to serogroup C or to serogroup Y. Following an outbreak of group A meningococcal disease, more group A meningococcal carriers were detected. Antibody studies indicated that infection with group A meningococci had been more widespread in the community than was suggested by regular carrier surveys. Carriage of meningococci was detected most frequently in children one to nine years of age. Children were identified as the first carriers in households more frequently than adults. The half-life of carriage was three months. The meningococcal carriage rate did not increase during the hot dry season when epidemics of meningococcal disease occur most frequently in Nigeria. Neisseria lactamica was isolated from the nasopharynx of children more frequently than were meningococci.

  3. Scintigraphic detection of bone and joint infections with indium-111-labeled nonspecific polyclonal human immunoglobulin G

    SciTech Connect

    Oyen, W.J.; Claessens, R.A.; van Horn, J.R.; van der Meer, J.W.; Corstens, F.H. )

    1990-04-01

    The utility of indium-111-({sup 111}In) labeled immunoglobulin G (IgG) to detect infection of bone and adjacent tissues was investigated. Proof of infection was obtained by cultures taken at surgery. All 32 patients showed focally increased uptake on the technetium-99m- (99mTc) methylene diphosphonate (MDP) skeletal scintigraphies. Labeled immunoglobulin correctly identified presence, location, extent and soft-tissue involvement of the suspected inflammatory site. In these patients, focally increasing accumulation was noted over 48 hr. Discrimination between infection and sterile inflammatory lesions was not possible. Two fractures, 6-mo-old, and an aseptic loosening of a total-hip prosthesis were not visualized. Side effects after the immunoglobulin administration were not observed. Radiolabeled immunoglobulin is a new and safe radiopharmaceutical for the investigation of infectious bone and joint disease. The sensitivity of this agent appears at least as high as that of labeled leukocytes. However, labeled immunoglobulin can easily be prepared in every nuclear medicine department.

  4. Human isolates of Staphylococcus caprae: association with bone and joint infections.

    PubMed Central

    Shuttleworth, R; Behme, R J; McNabb, A; Colby, W D

    1997-01-01

    Staphylococcus caprae is a coagulase-negative, DNase-positive member of the genus Staphylococcus usually associated with goats, but since 1991 a few laboratories have reported isolating the organism from human clinical specimens. We report on the isolation of 14 strains from human specimens and note that 10 strains were obtained from patients with bone and joint infections. Nine of the 10 infections started with traumatic fractures, and the other was a case of mastoiditis. Seven of these 10 infections were in patients with orthopedic prostheses, which appears to be a risk factor. Three of the 14 strains were from transplant patients. For three of the patients, S. caprae was the only organism isolated. S. caprae may be misidentified because it is not represented in the current MicroScan or Vitek identification systems which are in use in many laboratories, but the organism can be differentiated by a few biochemical tests. S. caprae produces positive results for DNase, pyrrolidonyl aminopeptidase, and acid production from mannitol and maltose; it produces negative results for ornithine decarboxylase and tube coagulase. PMID:9316903

  5. Skin and Soft Tissue Infections due to Shewanella algae – An Emerging Pathogen

    PubMed Central

    Pillai, Meera; Vinod, Vivek; Dinesh, R. Kavitha

    2015-01-01

    Introduction: Shewanella spp. are emerging human pathogens, the predominant species being Shewanella algae. Shewanella skin and soft tissue infections are more commonly seen in immunocompromised patients with a pre-existing cutaneous ulcer and most often associated with exposure to marine environments. Aim: The study was conducted to investigate the epidemiological and clinical characteristics of Shewanella skin and soft tissue infections (SSTIs) for a period of five years. Materials and Methods: All Gram-negative non-fermenting motile isolates which produced pigmented colonies and positive for oxidase and H2S were further identified with Vitek 2 system. Results: A total of 16 patients with SSTIs due to Shewanella species were identified during the period from 2010 to 2014. Majority of patients were urban, elderly and fisher men. Shewanella algae (n=12, 75%) was the predominant isolate. Skin or mucosal portal of entry was found in all patients and seawater contact was recorded in 56.25% of the patients. 81% of infections were polymicrobial, common concomitant pathogens being gut and marine flora. Peripheral vascular diseases were the predominant risk factors with comorbidities like diabetes, hypertension and hepatobiliary diseases. Third generation cephalosporins, meropenem and gentamicin were the most effective antibiotics while two of the isolates were multidrug resistant. 75% of the infected patients recovered completely and three patients died of complications. Conclusion: Shewanella algae should be considered as an emerging pathogen of SSTIs mainly in patients with chronic ulcers and at times be multidrug resistant. These infections have a good clinical outcome if prompt medical, surgical and supportive treatment is offered. PMID:25859455

  6. Technetium-99m-labeled annexin V imaging for detecting prosthetic joint infection in a rabbit model.

    PubMed

    Tang, Cheng; Wang, Feng; Hou, Yanjie; Lu, Shanshan; Tian, Wei; Xu, Yan; Jin, Chengzhe; Wang, Liming

    2015-05-01

    Accurate and timely diagnosis of prosthetic joint infection is essential to initiate early treatment and achieve a favorable outcome. In this study, we used a rabbit model to assess the feasibility of technetium-99m-labeled annexin V for detecting prosthetic joint infection. Right knee arthroplasty was performed on 24 New Zealand rabbits. After surgery, methicillin-susceptible Staphylococcus aureus was intra-articularly injected to create a model of prosthetic joint infection (the infected group, n = 12). Rabbits in the control group were injected with sterile saline (n = 12). Seven and 21 days after surgery, technetium-99m-labeled annexin V imaging was performed in 6 rabbits of each group. Images were acquired 1 and 4 hours after injection of technetium-99m-labeled annexin V (150 MBq). The operated-to-normal-knee activity ratios were calculated for quantitative analysis. Seven days after surgery, increased technetium-99m-labeled annexin V uptake was observed in all cases. However, at 21 days a notable decrease was found in the control group, but not in the infected group. The operated-to-normal-knee activity ratios of the infected group were 1.84 ± 0.29 in the early phase and 2.19 ± 0.34 in the delay phase, both of which were significantly higher than those of the control group (P = 0.03 and P = 0.02). The receiver operator characteristic curve analysis showed that the operated-to-normal-knee activity ratios of the delay phase at 21 days was the best indicator, with an accuracy of 80%. In conclusion, technetium-99m-labeled annexin V imaging could effectively distinguish an infected prosthetic joint from an uninfected prosthetic joint in a rabbit model.

  7. Risk factors and outcomes for patients with bloodstream infection due to Acinetobacter baumannii-calcoaceticus complex.

    PubMed

    Chopra, Teena; Marchaim, Dror; Johnson, Paul C; Awali, Reda A; Doshi, Hardik; Chalana, Indu; Davis, Naomi; Zhao, Jing J; Pogue, Jason M; Parmar, Sapna; Kaye, Keith S

    2014-08-01

    Identifying patients at risk for bloodstream infection (BSI) due to Acinetobacter baumannii-Acinetobacter calcoaceticus complex (ABC) and providing early appropriate therapy are critical for improving patient outcomes. A retrospective matched case-control study was conducted to investigate the risk factors for BSI due to ABC in patients admitted to the Detroit Medical Center (DMC) between January 2006 and April 2009. The cases were patients with BSI due to ABC; the controls were patients not infected with ABC. Potential risk factors were collected 30 days prior to the ABC-positive culture date for the cases and 30 days prior to admission for the controls. A total of 245 case patients were matched with 245 control patients. Independent risk factors associated with BSI due to ABC included a Charlson's comorbidity score of ≥ 3 (odds ratio [OR], 2.34; P = 0.001), a direct admission from another health care facility (OR, 4.63; P < 0.0001), a prior hospitalization (OR, 3.11; P < 0.0001), the presence of an indwelling central venous line (OR, 2.75; P = 0.011), the receipt of total parenteral nutrition (OR, 21.2; P < 0.0001), the prior receipt of β-lactams (OR, 3.58; P < 0.0001), the prior receipt of carbapenems (OR, 3.18; P = 0.006), and the prior receipt of chemotherapy (OR, 15.42; P < 0.0001). The median time from the ABC-positive culture date to the initiation of the appropriate antimicrobial therapy was 2 days (interquartile range [IQR], 1 to 3 days). The in-hospital mortality rate was significantly higher among case patients than among control patients (OR, 3.40; P < 0.0001). BSIs due to ABC are more common among critically ill and debilitated institutionalized patients, who are heavily exposed to health care settings and invasive devices.

  8. Yersiniosis due to infection by Yersinia pseudotuberculosis 4b in captive meerkats (Suricata suricatta) in Japan.

    PubMed

    Nakamura, Shin-Ichi; Hayashidani, Hideki; Yonezawa, Aya; Suzuki, Isao; Une, Yumi

    2015-09-01

    Two meerkats (Suricata suricatta) housed in the same zoological garden in Japan died due to Yersinia pseudotuberculosis serotype 4b infection. Gross and microscopic lesions included necrotizing enteritis and enlargement of the spleen and liver with multifocal necrosis. Inflammatory cells, primarily neutrophils, and nuclear debris were associated with clusters of Gram-negative bacilli. Additionally, there were aberrant organism forms that were larger than bacilli and appeared as basophilic globular bodies. Immunohistochemical examination showed that the bacilli and globular bodies were strongly positive for Y. pseudotuberculosis O4 antigen. The globular bodies were considered a shape-changed form of Y. pseudotuberculosis, and these morphologically abnormal bacteria could present a diagnostic challenge.

  9. Tolerability and Plasma Drug Level Monitoring of Prolonged Subcutaneous Teicoplanin Treatment for Bone and Joint Infections

    PubMed Central

    Bennis, Youssef; Diouf, Momar; Saroufim, Carlo; Brunschweiler, Benoit; Rousseau, Florence; Joseph, Cédric; Hamdad, Farida; Ait Amer Meziane, Mohamed; Routier, Simon; Schmit, Jean-Luc

    2016-01-01

    Teicoplanin is a key drug for the treatment of multiresistant staphylococcal bone and joint infections (BJI), yet can only be administered via a parenteral route. The objective of this study was to evaluate the safety and tolerability of subcutaneous (s.c.) teicoplanin for that indication over 42 days. Thirty patients with Gram-positive cocci BJI were included. Once the target of 25 to 40 mg/liter trough serum concentration was achieved, treatment was switched from an intravenous to an s.c. route. No discontinuation of teicoplanin related to injection site reaction and no severe local adverse event were observed. On multivariate analysis, better tolerability was observed at the beginning of treatment, in patients over 70 years old, and for dosages less than 600 mg. In conclusion, we recommend s.c. administration of teicoplanin when needed. PMID:27458228

  10. Simplifying the treatment of acute bacterial bone and joint infections in children.

    PubMed

    Pääkkönen, Markus; Peltola, Heikki

    2011-12-01

    The treatment of acute hematogenous bone and joint infections of children - osteomyelitis (OM), septic arthritis (SA) and OM-SA combination (OM+SA) - has simplified over the past years. The old approach included months-long antibiotic treatment, started intravenously for at least a week, followed by oral completion of the course. Recent prospective randomized trials show that most cases heal with a total course of 3 weeks (OM, OM+SA) or 2 weeks (SA) of an appropriate antibiotic, provided the clinical response is good and C-reactive protein level has normalized. If the prevalence of methicillin-resistant Staphylococcus aureus and Kingella kingae is low, clindamycin and a first-generation cephalosporin are safe, inexpensive and effective alternatives. They should be administered in large doses and four times a day. Clindamycin, vancomycin and expensive linezolid are options against methicillin-resistant Staphylococcus aureus. Extensive surgery beyond a diagnostic sample by aspiration is rarely needed in uncomplicated cases.

  11. Advancements in Diagnosing Periprosthetic Joint Infections after Total Hip and Knee Arthroplasty

    PubMed Central

    Patel, Ripal; Alijanipour, Pouya; Parvizi, Javad

    2016-01-01

    Periprosthetic joint infection (PJI) is a complication of total joint arthroplasty that is challenging to diagnose. Currently, there is no “gold standard” for definite diagnosis of PJI. A multi-criteria definition has been described for PJI based on microbiology cultures, serum markers, such as erythrocyte sedimentation rate and C-reactive protein (CRP), synovial fluid biomarkers, such as leukocyte esterase and histopathology assessment of the periprosthetic tissue. The conventional serum markers are generally nonspecific and can be elevated in inflammatory conditions. Therefore, they cannot be relied on for definite diagnosis of PJI. Hence, with the use of proteomics, synovial fluid biomarkers such as α-defensin, IL-6, and CRP have been proposed as more accurate biomarkers for PJI. Current methods to culture micro-organisms have several limitations, and can be false-negative and false-positive in a considerable number of cases. In an attempt to improve culture sensitivity, diagnostic methods to target biofilms have recently been studied. The understanding of the concept of biofilms has also allowed for the development of novel techniques for PJI diagnosis, such as visualizing biofilms with fluorescent in-situ hybridization and detection of bacteria via DNA microarray. Lastly, the use of amplification-based molecular techniques has provided methods to identify specific species of bacteria that cause culture-negative PJI. While diagnosing PJI is difficult, these advances could be valuable tools for clinicians. PMID:28144375

  12. Prosthetic Joint Infection in Patients with Rheumatoid Arthritis: An Outcome Analysis Compared with Controls

    PubMed Central

    Shih, Hsin-Nung

    2013-01-01

    Background Patients with rheumatoid arthritis (RA) have been shown to have an increased susceptibility to the development of prosthetic joint infection (PJI) after hip or knee replacement. However, little information is available on the demographic data, outcome of treatment and prognostic factors in RA patients when compared to those in non-RA patients. Methods/Principal Findings We performed a retrospective cohort analysis of all cases of PJI that were treated at our institution between 2002 and 2008. Of 346 episodes of PJI during the study period, 46 (13.3%) occurred in patients with RA. Compared to the non-RA cohort, RA patients with PJI were female predominant (74% vs 27%, p<0.001), younger (median age, 51 vs 63 years, p<0.001) and developed infection earlier (median joint age, 72 vs 128 days, p<0.001). The 2-year survival rate free of treatment failure was lower in RA patients with PJI episodes either treated with débridement (22% vs 52%, p = 0.002) or two-stage exchange (78% vs 95%, p = 0.004). A longer duration of symptoms before débridement surgery (median, 11 vs 5 days, p = 0.015), and absence of antibiotics in bone cement for two-stage exchange (relative risk, 8.0; p = 0.02) were associated with treatment failure in patients with RA. Discussion The outcome of PJI in RA patients was generally worse than that in non-RA patients. Risk of treatment failure increased in the setting of delayed débridement and two-stage exchange without the use of antibiotic-impregnated bone cement. These findings highlight the importance of vigilant monitoring and aggressive treatment for PJI in RA patients. PMID:23990969

  13. Therapeutic options for acute cough due to upper respiratory infections in children.

    PubMed

    Paul, Ian M

    2012-02-01

    Cough due to upper respiratory tract infections (URIs) is one of the most frequent complaints encountered by pediatric health-care providers, and one of the most disruptive symptoms for children and families. Despite the frequency of URIs, there is limited evidence to support the few therapeutic agents currently available in the United States (US) to treat acute cough due to URI. Published, well-designed, contemporary research supporting the efficacy of narcotics (codeine, hydrocodone) and US Food and Drug Administration (FDA)-approved over-the-counter (OTC) oral antitussives and expectorants (dextromethorphan, diphenhydramine, chlophedianol, and guaifenesin) is absent for URI-associated pediatric cough. Alternatively, honey and topically applied vapor rubs may be effective antitussives.

  14. Reversible Cortical Blindness as a Prominent Manifestation of Cerebral Embolism due to Infective Endocarditis.

    PubMed

    Kranidiotis, Georgios P; Gougoutsi, Alexandra N; Retsas, Theodoros A; Anastasiou-Nana, Maria I

    2010-01-01

    Introduction. Infective endocarditis in the left heart may be complicated by stroke, due to embolisation from infectious valvular vegetations. Infarction of both occipital lobes, which are supplied by the posterior cerebral arteries, is infrequent, and is the cause of cortical blindness from lesion of the visual cortex. Cortical blindness is characterized by intact pupillary reflexes, a normal fundoscopy, and, rarely, denial of visual loss. Case Presentation. We report the case of a 58-year-old woman, recipient of a mechanical aortic valve, who presented with fever, multiple organ dysfunction, and cortical blindness. Transesophageal echocardiography and blood cultures confirmed the diagnosis of infective endocarditis caused by methicillin-sensitive Staphylococcus aureus. Computed tomography of the brain without contrast revealed the presence of infarctions in both occipital lobes. It is noteworthy that the visual loss resolved after treatment of endocarditis. Conclusions. A stroke occurring in a patient presenting with fever and a history of valvular heart disease strongly suggests the presence of infective endocarditis. Bilateral thromboembolic infarcts of the occipital lobes cause cortical blindness, that can resolve after treatment of endocarditis.

  15. Neonatal infections due to multi-resistant strains: Epidemiology, current treatment, emerging therapeutic approaches and prevention.

    PubMed

    Tzialla, Chryssoula; Borghesi, Alessandro; Pozzi, Margherita; Stronati, Mauro

    2015-12-07

    Severe infections represent the main cause of neonatal mortality accounting for more than one million neonatal deaths worldwide every year. Antibiotics are the most commonly prescribed medications in neonatal intensive care units. The benefits of antibiotic therapy when indicated are clearly enormous, but the continued and widespread use of antibiotics has generated over the years a strong selective pressure on microorganisms, favoring the emergence of resistant strains. Health agencies worldwide are galvanizing attention toward antibiotic resistance in gram-positive and gram-negative bacteria. Infections in neonatal units due to multidrug and extensively multidrug resistant bacteria are rising and are already seriously challenging antibiotic treatment options. While there is a growing choice of agents against multi-resistant gram-positive bacteria, new options for multi-resistant gram-negative bacteria in the clinical practice have decreased significantly in the last 20 years making the treatment of infections caused by multidrug-resistant pathogens challenging mostly in neonates. Treatment options are currently limited and will be some years before any new treatment for neonates become available for clinical use, if ever. The aim of the review is to highlight the current knowledge on antibiotic resistance in the neonatal population, the possible therapeutic choices, and the prevention strategies to adopt in order to reduce the emergency and spread of resistant strains.

  16. Biological Activities of Uric Acid in Infection Due to Enteropathogenic and Shiga-Toxigenic Escherichia coli

    PubMed Central

    Broome, Jacqueline E.; Lis, Agnieszka

    2016-01-01

    In previous work, we identified xanthine oxidase (XO) as an important enzyme in the interaction between the host and enteropathogenic Escherichia coli (EPEC) and Shiga-toxigenic E. coli (STEC). Many of the biological effects of XO were due to the hydrogen peroxide produced by the enzyme. We wondered, however, if uric acid generated by XO also had biological effects in the gastrointestinal tract. Uric acid triggered inflammatory responses in the gut, including increased submucosal edema and release of extracellular DNA from host cells. While uric acid alone was unable to trigger a chloride secretory response in intestinal monolayers, it did potentiate the secretory response to cyclic AMP agonists. Uric acid crystals were formed in vivo in the lumen of the gut in response to EPEC and STEC infections. While trying to visualize uric acid crystals formed during EPEC and STEC infections, we noticed that uric acid crystals became enmeshed in the neutrophilic extracellular traps (NETs) produced from host cells in response to bacteria in cultured cell systems and in the intestine in vivo. Uric acid levels in the gut lumen increased in response to exogenous DNA, and these increases were enhanced by the actions of DNase I. Interestingly, addition of DNase I reduced the numbers of EPEC bacteria recovered after a 20-h infection and protected against EPEC-induced histologic damage. PMID:26787720

  17. Papular dermatitis due to Leishmania infantum infection in seventeen dogs: diagnostic features, extent of the infection and treatment outcome

    PubMed Central

    2014-01-01

    Background This study describes immunological responses, diagnostic features, follow up and treatment outcomes from seventeen dogs with papular dermatitis due to Leishmania infection diagnosed by cytology or real time-PCR. Methods Specific Leishmania humoral and cellular immune responses were evaluated by means of an immunofluorescence antibody test in all cases and a delayed-type hypersensitivity (DTH) reaction to leishmanin in eight cases. The extent of infection was studied in several tissues including blood, lymph node, conjunctival and oral swabs, by means of PCR, at the time of diagnosis and during follow-up. Culture was performed on nine dogs from cutaneous lesions and lymph node aspirates and molecular typing was carried out on isolates based on ITS-1, ITS-2 and Haspb gene sequencing analysis. Results Cytological and molecular results from fine needle aspirates of papules were diagnostic in 8 out of 13 (61.5%) cases and in 14 out of 15 dogs (93.3%), respectively. In all dogs, specific anti-Leishmania antibody levels were low or absent. Blood and lymph node PCRs and lymph node culture were negative in all dogs. Three out of the nine dogs (33%) were positive by culture from cutaneous lesions. The three isolates were identified as ITS type A, however, polymorphism was observed in the Haspb gene (PCR products of 626 bp, 962 bp and 371 bp). DTH response was positive in all tested dogs at the time of diagnosis. The majority of dogs were successfully treated with only N-methylglucamine antimoniate, after which cutaneous lesions disappeared or were reduced to depigmented, flattened scars. All dogs remained seronegative and the majority of dogs were negative by PCR in several tissues during follow-up. Conclusions This study points out that papular dermatitis due to L. infantum is probably an underestimated benign cutaneous problem, associated with a parasite specific cell mediated immunity and a poor humoral immune response. Papular dermatitis is seen in young dogs

  18. Cervical Facet Joint Infection and Associated Epidural Abscess with Streptococcus intermedius from a Dental Infection Origin A Case Report and Review.

    PubMed

    Kaye, Ian David; Protopsaltis, Themistocles S

    2016-09-01

    Pyogenic cervical facet joint infections are rare and such infections from a dental origin are even less common. Of these few cases, none have described infection with Streptococcus intermedius as the pathogen. A 65-year-old orthopaedic surgeon complained of fevers, right-sided radiating neck pain, stiffness, swelling, erythema, and right upper extremity weakness one month after he had broken a crown over his right mandibular premolar, a continued source of pain. Imaging of the cervical spine showed a right C4-C5 facet inflammatory arthropathy and a small epidural abscess that was cultured and initially treated with intravenous antibiotics. The oral maxillofacial surgery team performed an extraction of the infected, symptomatic tooth. For continued right upper extremity weakness, the patient underwent C4-C5 laminoforaminotomy and irrigation and debridement of the right C4-C5 facet joint. After 6 weeks of intravenous antibiotics, the patient's infectious and inflammatory markers had normalized. By 4 months, he had regained full strength at his upper extremity and a painless and full range of motion of his cervical spine.Pyogenic cervical facet joint infection is very rare and potentially dangerous. A high clinical suspicion and appropriate imaging, including magnetic resonance imaging, are important for correct diagnosis. Prompt medical and surgical treatment may avert complications, and although the patient presented made a complete recovery, patients may be left with neurological compromise.

  19. A resorbable antibiotic eluting bone void filler for periprosthetic joint infection prevention.

    PubMed

    Jones, Zachary; Brooks, Amanda E; Ferrell, Zachary; Grainger, David W; Sinclair, Kristofer D

    2016-11-01

    Periprosthetic joint infection (PJI) following total knee arthroplasty is a globally increasing procedural complication. These infections are difficult to treat and typically require revision surgery. Antibiotic-loaded bone cement is frequently utilized to deliver antibiotics to the site of infection; however, bone cement is a nondegrading foreign body and known to leach its antibiotic load, after an initial burst release, at subtherapeutic concentrations for months. This work characterized a resorbable, antibiotic-eluting bone void filler designed to restore bone volume and prevent PJI. Three device formulations were fabricated, consisting of different combinations of synthetic inorganic bone graft material, degradable polymer matrices, salt porogens, and antibiotic tobramycin. These formulations were examined to determine the antibiotic's elution kinetics and bactericidal potential, the device's degradation in vitro, as well as osteoconductivity and device resorption in vivo using a pilot rabbit bone implant model. Kirby-Bauer antibiotic susceptibility tests assessed bactericidal activity. Liquid chromatography with tandem mass spectrometry measured antibiotic elution kinetics, and scanning electron microscopy was used to qualitatively assess degradation. Results indicated sustained antibiotic release from all three formulations above the Staphylococcus aureus minimum inhibitory concentration for a period of 5 to 8 weeks. Extensive degradation was observed with the Group 3 formulation after 90 days in phosphate-buffered saline, with a lesser degree of degradation observed in the other two formulations. Results from the pilot rabbit study showed the Group 3 device to be biocompatible, with minimal inflammatory response and no fibrous encapsulation in bone. The device was also highly osteoconductive-exhibiting an accelerated mineral apposition rate. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1632-1642, 2016.

  20. Bacterial Findings in Infected Hip Joint Replacements in Patients with Rheumatoid Arthritis and Osteoarthritis: A Study of 318 Revisions for Infection Reported to the Norwegian Arthroplasty Register

    PubMed Central

    Schrama, J. C.; Lutro, O.; Langvatn, H.; Hallan, G.; Espehaug, B.; Sjursen, H.; Engesaeter, L. B.; Fevang, B.-T.

    2012-01-01

    High rates of Staphylococcus aureus are reported in prosthetic joint infection (PJI) in rheumatoid arthritis (RA). RA patients are considered to have a high risk of infection with bacteria of potentially oral or dental origin. One thousand four hundred forty-three revisions for infection were reported to the Norwegian Arthroplasty Register (NAR) from 1987 to 2007. For this study 269 infection episodes in 255 OA patients served as control group. In the NAR we identified 49 infection episodes in 37 RA patients from 1987 to 2009. The RA patients were, on average, 10 years younger than the OA patients and there were more females (70% versus 54%). We found no differences in the bacterial findings in RA and OA. A tendency towards a higher frequency of Staphylococcus aureus (18% versus 11%) causing PJI was found in the RA patients compared to OA. There were no bacteria of potential odontogenic origin found in the RA patients, while we found 4% in OA. The bacteria identified in revisions for infection in THRs in patients with RA did not significantly differ from those in OA. Bacteria of oral or dental origin were not found in infected hip joint replacements in RA. PMID:24977078

  1. Sudden psychotic episode probably due to meningoencephalitis and Chlamydia pneumoniae acute infection

    PubMed Central

    2005-01-01

    Background Since 9% to 20% of all cases of acute psychosis presenting to an Emergency Department (ED) are due to a general medical condition, cautious medical workup should be mandatory in such patients. Differential diagnosis must consider conditions as diverse as renal failure or CNS infection. Acute Chlamydia pneumoniae infection usually causes a self-limited respiratory syndrome. Rarely, acute neurological complications occur, with acute meningoencephalitis most frequently reported. Diagnosis requires a high level of suspicion and is difficult to confirm. Case report We describe a 22 year-old female Caucasian who, three days after a mild pharingitis, developed an acute psychosis with exuberant symptoms interspersed with periods of lucidity, in a background of normal consciousness and orientation. Initial medical and imagiological workup were inconclusive. After 20 days of unsuccessful treatment with antipsychotics she developed a high fever and was re-evaluated medically. Lumbar puncture revealed an inflammatory cerebrospinal fluid. MRI showed irregular thickening and nodularity of the lateral ventricles' lining. An anti-Chlamydia pneumoniae IgM antibody titter of 85 IU/ml was detected. All symptoms cleared after treatment with antibiotics and corticosteroids. Conclusion This is, to our knowledge, the first reported case of acute CP-associated meningoencephalitis manifesting as an acute psychotic episode. It illustrates the principle that non-organic psychiatric syndromes must remain a diagnosis of exclusion in first-time acute psychosis. PMID:16164756

  2. Mycobacteriosis in ostriches (Struthio camelus) due to infection with Mycobacterium bovis and Mycobacterium avium complex.

    PubMed

    Kelly, Pamela; Jahns, Hanne; Power, Eugene; Bainbridge, John; Kenny, Kevin; Corpa, Juan M; Cassidy, Joseph P; Callanan, John J

    2013-12-01

    Avian tuberculosis rarely affects ratites compared to other bird species and is typically caused by Mycobacterium avium species. This study describes the pathological and microbiological findings in three adult ostriches with mycobacteriosis, in one of which Mycobacterium bovis was isolated from the lesions. Post mortem examinations on ostriches from two different zoological collections in Ireland revealed multifocal caseous granulomas affecting the spleen and liver in all cases, with additional involvement of intestines in two cases. In one case, granulomas were present within the pharynx, at the thoracic inlet and multifocally on the pleural surface. Acid-fast bacilli were observed in all lesions. Mycobacterium sp. of the M. avium complex was isolated from the intestinal lesions in the two cases with intestinal involvement, and M. bovis sp. oligotype SB0140 was cultured from the liver of the third ostrich. This represents the first reported case of M. bovis infection in an ostrich. Avian tuberculosis due to M. bovis is rare and to date has been reported in only parrots and experimentally inoculated birds. Mycobacterium bovis needs to be considered as a possible cause of tuberculosis in ostriches because the lesions are similar to those observed with M. avium complex infection.

  3. A two-dimensional simulation of plasma leakage due to dengue infection

    NASA Astrophysics Data System (ADS)

    Nuraini, N.; Windarto, Jayanti, Swarna; Soewono, Edy

    2014-03-01

    Dengue Hemorrhagic Fever (DHF) is a disease caused by Dengue virus infection. One major characteristic in a patient with DHF is the occurrence of plasma leakage. Plasma leakage is a consequence of the immune system mechanism which activates cytokine. As a result, permeability of vascular will increase. Another characteristic in a DHF patient is hypoalbuminea (decreasing of albumin concentration). Plasma leakage can be modelled by constructing mathematical model of albumin concentration in plasma blood due to increasing of cytokine. In this paper, decreasing of albumin concentration in blood plasma is modelled using diffusion equation. In addition, two-dimensional numerical simulations of albumin concentration are also presented. From the simulation, it is found that the greater leakage rate or the wider leakage area, the greater decreasing albumin concentration will be. Furthermore, when time t increases, the albumin concentration decreases to zero.

  4. Unexpected death due to right-sided infective endocarditis in a methamphetamine abuser.

    PubMed

    Takasaki, Tomoya; Nishida, Naoki; Esaki, Rie; Ikeda, Noriaki

    2003-03-01

    A case of unexpected death due to right-sided infective endocarditis (IE) in a 44-year-old female methamphethamine abuser is presented. The woman was taken to a hospital by ambulance with a high fever having almost lost consciousness. She died about 6 h after admission. Autopsy revealed IE of the tricuspid valve. Septic thrombi from the lung were seen in other organs, and accordingly she was considered to have already been in a septic state on admission. Right-sided IE is relatively rare among the overall cases of IE, and is considered to result in good prognosis. It is also considered that right-sided IE occurs commonly among addictive drug abusers. We should therefore bear in mind that the presence of right-sided IE may be a predicting factor of drug abuse even if the injection site is not clearly visible, and for this reason, a toxicological analysis of the addictive drugs should be carried out.

  5. Rare case of bilateral perforated corneal ulcer due to gonococcal infection, managed with temporary periosteal graft.

    PubMed

    Samira, Nuriadara; Bani, Anna Puspitasari; Susiyanti, Made

    2016-02-23

    A 17-year-old female patient was referred to Kirana Ophthalmology Unit, Cipto Mangunkusumo Hospital, with a 10-day history of redness and swelling of the eyes, and inability to open them. Other symptoms included pain, blurred vision and excessive yellowish-white discharge from both eyes. There was a history of multiple sexual partners. The patient was assessed with bilateral perforated corneal ulcer due to gonococcal infection, based on the findings of intracellular and extracellular Gram-negative diplococci found on the Gram staining examination. The cornea in both eyes showed perforation with iris prolapse inferiorly. The perforations were treated with temporary periosteal grafts. The grafts remained in place after the surgery. Final uncorrected visual acuity was 6/20 in the right eye and 6/24 in the left eye, a few months after surgery.

  6. The effect of depth of centrifuged synovial fluid on leukocyte esterase test for periprosthetic joint infection.

    PubMed

    Ruangsomboon, Pakpoom; Chinprasertsuk, Sriprapa; Khejonnit, Varanya; Chareancholvanich, Keerati

    2017-03-17

    Centrifugation of aspirated synovial fluid before leukocytes esterase (LE) testing for diagnosing periprosthetic joint infection (PJI) may make blood tinged specimens interpretable. We aimed to establish the proper sampling depth of centrifuged specimens for LE testing as one diagnostic criterion and also AS-D chloroacetate esterase (CAE) staining testing as an adjunctive tool. A definite PJI knee joint group and an aseptic primary total knee arthroplasty control group were studied quasi-experimentally (N = 46). At 2000 g for 15 minutes, 3 ml of synovial fluid was centrifuged. LE strip testing and median synovial WBC count were performed at 2, 4, and 6 mm depths. CAE staining test characterized LE particles. ROC curve, area under the curve, and significant differences were determined. The proper predictive depth to diagnose PJI was sought by forward stepwise logistic regression. All fresh blood-tinged specimens had uncertain interpretations. Centrifugation increased interpretability (55% to 100%). ROC curve and area under the curve at 2, 4, and 6 mm depths were 0.822, 0.804, and 0.786, respectively. The cut point of ++ to diagnose PJI was statistically significant (p < 0.05) at all depths. P-values of forward stepwise logistic regression at 2, 4, and 6 mm were 0.001, 0.752, and 0.756, respectively. CAE staining confirmed extracellular LE release by polymorphonuclear neutrophils (PMN). A specimen at < 2 mm from the surface of centrifuged synovial fluid at a grading of ++ or more for PJI diagnosis is proper for LE testing. CAE staining testing adjunctively characterizes LE particles and cell morphology. This article is protected by copyright. All rights reserved.

  7. Levofloxacin at the usual dosage to treat bone and joint infections: a cohort analysis.

    PubMed

    Asseray, N; Bourigault, C; Boutoille, D; Happi, L; Touchais, S; Corvec, S; Bemer, P; Navas, D

    2016-06-01

    Fluoroquinolones are recommended for the treatment of bone and joint infections (BJIs), and levofloxacin is commonly used in this setting. However, no pre-marketing clinical study has supported its use, especially its dosage, for treating BJIs. This study aimed to assess the benefit-risk ratio of levofloxacin administered orally at a standard dosage of 500 mg once daily (OD) in a cohort of patients with BJIs. The medical records of patients admitted to a large French teaching hospital for BJI over a 1-year period and managed by a multidisciplinary team were reviewed. Patient data were recorded on a standardised form and the outcome was assessed at the end of antibiotic treatment and after 1-year of follow-up. A total of 230 patients were included, of whom 79 were treated with an antibiotic regimen including levofloxacin (34%). Most BJIs (97%) were surgically treated by wound debridement and/or removal or replacement of the infected device. Adverse drug reactions to levofloxacin leading to treatment discontinuation occurred in three patients (4%). The antibiotic treatment duration was significantly longer in patients treated with levofloxacin compared with other antibiotic regimens (median, 13 weeks vs. 6 weeks). Post-treatment outcomes were considered favourable (total or partial recovery, including orthopaedics aftermath) in 89-93% of patients, with no significant difference between treatment groups. In conclusion, oral levofloxacin at 500 mg OD is a well-tolerated and efficacious antibiotic treatment for BJIs. Our approach of following-up all treated patients is a useful way to validate specific clinical practices.

  8. Soft tissue infection due to Mycobacterium fortuitum following acupuncture: a case report and review of the literature.

    PubMed

    Guevara-Patiño, Armando; Sandoval de Mora, Marisol; Farreras, Aileen; Rivera-Olivero, Ismar; Fermin, Danibeth; de Waard, Jacobus H

    2010-09-03

    We report the first case of a post-acupuncture soft tissue infection due to Mycobacterium fortuitum. Two months after finishing an acupuncture treatment session, an immunocompetent 23-year-old woman developed cellulitis at the side of the needle insertions and the acid-fast bacillus was isolated from a closed abscess. The patient was successfully treated with a proper drug combination. We review the literature concerning the infection source and the risks for skin and soft tissue infection due to mycobacteria after acupuncture. The infection source in most cases is unknown but is probably associated with the inadequate sterilization of the needles or the puncture site. We show that these infections are not rare but difficult to diagnose. To avoid delays in the definitive diagnosis, infection with mycobacteria should be considered for skin and soft tissue infections, in particular late-onset infections, which are negative for routine bacterial cultures and without a clinical response to antibiotics used for acute pyogenic infections. Bacterial cultures from this lesion should be maintained for at least six weeks before discharged as negative.

  9. Annual disease burden due to human papillomavirus 16 and 18 infections in Finland.

    PubMed

    Syrjänen, Kari J

    2009-01-01

    Apart from cancers of the lower female genital tract, human papillomaviruses (HPV) are associated with a large number of benign, premalignant and malignant lesions at different anatomic sites in both genders. Malignant tumours and their precursors are usually attributed to the oncogenic (high-risk, HR) HPV types, whereas benign lesions (mostly papillomas) are ascribed to the low-risk (LR) HPV types, most notably HPV6 and HPV11. To date, the main interest has been focused on HR-HPV types and their associated pathology, and much less attention has been paid to the lesions caused by the LR-HPV types. The recent licensing of an effective prophylactic vaccine against the 2 most important LR-HPV types (HPV6 and HPV11) has resulted in considerably increased interest in these LR-HPV types as well. This author recently conducted a systematic survey of the annual disease burden due to HPV6/11 infections in Finland. As a rational continuation, the present survey was conducted to estimate the annual disease burden due to HPV16 and HPV18 infections in our country. Together, these 2 documents form the foundation for calculations of the annual costs needed to treat the diseases caused by these 2 most common LR and HR HPV types. Similar to HPV6/11, accurate estimates of disease burden are also mandatory for all modelling of the cost-effectiveness of prophylactic HPV16/18 vaccines. In the first step, the published HPV literature was used to create a list of benign, premalignant and malignant lesions associated with this virus at different anatomic sites. The GLOBOCAN 2004 (IARC; International Agency for Research on Cancer) database was used to derive the global numbers of incident cases for each of these malignancies in 2002, and the Finnish Cancer Registry (FCR) website was used to obtain these numbers for Finland (y 2005). The evidence linking HPV to each individual tumour category was classified as: (1) established, (2) emerging, and (3) controversial. All published evidence was

  10. Ulnar-sided wrist pain due to isolated disk tear of triangular fibrocartilage complex within the distal radioulnar joint: two case reports.

    PubMed

    Abe, Yukio; Tominaga, Yasuhiro

    2011-01-01

    Wrist arthroscopy has been successfully used with many modifications and improvements. However, distal radioulnar joint (DRUJ) arthroscopy is still uncommon. We experienced 2 cases of ulnar-sided wrist pain due to isolated triangular fibrocartilage complex (TFCC) disk tear within the DRUJ. DRUJ arthroscopy in these cases showed horizontal tear and fibrillation of TFCC disk without TFCC tear at the radiocarpal joint. Foveal attachment was intact in both cases. These were treated with debridement, which relieved pain after surgery and achieved good functional recovery. Although DRUJ arthroscopy is technically difficult, it is mandatory for making a diagnosis and treating ulnar-sided wrist pain.

  11. Fungal periprosthetic joint infection in total knee arthroplasty: a systematic review.

    PubMed

    Jakobs, Oliver; Schoof, Benjamin; Klatte, Till Orla; Schmidl, Stefan; Fensky, Florian; Guenther, Daniel; Frommelt, Lars; Gehrke, Thorsten; Gebauer, Matthias

    2015-03-03

    Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). A standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. In this systematic review, we collected data from 36 studies with a total of 45 reported cases of a TKA complicated by a fungal PJI. Subsequently, an analysis focusing on diagnostic, medicaments and surgical procedures in the pre-, intra- and postoperative period was performed. Candida spp. accounts for about 80% (36 out of 45 cases) of fungal PJIs and is therefore the most frequently reported pathogen. A systemic antifungal therapy was administered in all but one patient whereas a local antifungal therapy, e.g. the use of an impregnated spacer, is of inferior relevance. Resection arthroplasty with delayed re-implantation (two-stage revision) was the surgical treatment of choice. However, in 50% of all reported cases the surgical therapy was heterogeneous. The outcome under a combined therapy was moderate with recurrent fungal PJI in 11 patients and subsequent bacterial PJI as a main complication in 5 patients. In summary, this systematic review integrates data from up to date 45 reported cases of a fungal PJI of a TKA. On the basis of the current literature strategies for the treatment of this devastating complication after TKA are discussed.

  12. Amplification-Based DNA Analysis in the Diagnosis of Prosthetic Joint Infection

    PubMed Central

    Vandercam, Bernard; Jeumont, Sabine; Cornu, Olivier; Yombi, Jean-Cyr; Lecouvet, Frédéric; Lefèvre, Philippe; Irenge, Léonid M.; Gala, Jean-Luc

    2008-01-01

    Microbiological cultures are moderately sensitive for diagnosing prosthetic joint infection (PJI). This study was conducted to determine whether amplification-based DNA methods applied on intraoperative samples could enhance PJI diagnosis compared with culture alone in routine surgical practice. Revision arthroplasty was performed for suspected PJI (n = 41) and osteoarthrosis control (n = 28) patients, and a diagnosis of PJI was confirmed in 34 patients. Amplification by polymerase chain reaction was performed on both 16S ribosomal DNA universal target genes and femA Staphylococcus-specific target genes. Species identification was achieved through amplicon sequencing. Amplification of the femA gene led to subsequent testing for methicillin resistance by amplification of the mecA gene. Microbiological and molecular assays identified a causative organism in 22 of 34 patients (64.7%) and in 31 of 34 patients (91.2%), respectively. In 18 of the 22 culture-positive patients, molecular and microbiological results were concordant for bacterial genus, species, and/or methicillin resistance. Bacterial agents were identified only by molecular methods in nine PJI patients, including seven who were receiving antibiotics at the time of surgery and one with recent but not concomitant antibiotherapy. DNA-based methods were found to effectively complement microbiological methods, without interfering with existing procedures for sample collection, for the identification of causative pathogens from intraoperative PJI samples, especially in patients with recent or concomitant antibiotherapy. PMID:18832459

  13. High dose tigecycline in critically ill patients with severe infections due to multidrug-resistant bacteria

    PubMed Central

    2014-01-01

    Introduction The high incidence of multidrug-resistant (MDR) bacteria among patients admitted to ICUs has determined an increase of tigecycline (TGC) use for the treatment of severe infections. Many concerns have been raised about the efficacy of this molecule and increased dosages have been proposed. Our purpose is to investigate TGC safety and efficacy at higher than standard doses. Methods We conducted a retrospective study of prospectively collected data in the ICU of a teaching hospital in Rome. Data from all patients treated with TGC for a microbiologically confirmed infection were analyzed. The safety profile and efficacy of high dosing regimen use were investigated. Results Over the study period, 54 patients (pts) received TGC at a standard dose (SD group: 50 mg every 12 hours) and 46 at a high dose (HD group: 100 mg every 12 hours). Carbapenem-resistant Acinetobacter.baumannii (blaOXA-58 and blaOXA-23 genes) and Klebsiella pneumoniae (blaKPC-3 gene) were the main isolated pathogens (n = 79). There were no patients requiring TGC discontinuation or dose reduction because of adverse events. In the ventilation-associated pneumonia population (VAP) subgroup (63 patients: 30 received SD and 33 HD), the only independent predictor of clinical cure was the use of high tigecycline dose (odds ratio (OR) 6.25; 95% confidence interval (CI) 1.59 to 24.57; P = 0.009) whilst initial inadequate antimicrobial treatment (IIAT) (OR 0.18; 95% CI 0.05 to 0.68; P = 0.01) and higher Sequential Organ Failure Assessment (SOFA) score (OR 0.66; 95% CI 0.51 to 0.87; P = 0.003) were independently associated with clinical failure. Conclusions TGC was well tolerated at a higher than standard dose in a cohort of critically ill patients with severe infections. In the VAP subgroup the high-dose regimen was associated with better outcomes than conventional administration due to Gram-negative MDR bacteria. PMID:24887101

  14. Sequence types of Staphylococcus epidermidis associated with prosthetic joint infections are not present in the laminar airflow during prosthetic joint surgery.

    PubMed

    Månsson, Emeli; Hellmark, Bengt; Sundqvist, Martin; Söderquist, Bo

    2015-07-01

    Molecular characterization of Staphylococcus epidermidis isolates from prosthetic joint infections (PJIs) has demonstrated a predominance of healthcare-associated multi-drug resistant sequence types (ST2 and ST215). How, and when, patients acquire these nosocomial STs is not known. The aim was to investigate if sequence types of S. epidermidis associated with PJIs are found in the air during prosthetic joint surgery. Air sampling was undertaken during 17 hip/knee arthroplasties performed in operating theaters equipped with mobile laminar airflow units in a 500-bed hospital in central Sweden. Species identification was performed using MALDI-TOF MS and 16S rRNA gene analysis. Isolates identified as S. epidermidis were further characterized by MLST and antibiotic susceptibility testing. Seven hundred and thirty-five isolates were available for species identification. Micrococcus spp. (n = 303) and coagulase-negative staphylococci (n = 217) constituted the majority of the isolates. Thirty-two isolates of S. epidermidis were found. S. epidermidis isolates demonstrated a high level of allelic diversity with 18 different sequence types, but neither ST2 nor ST215 was found. Commensals with low pathogenic potential dominated among the airborne microorganisms in the operating field during prosthetic joint surgery. Nosocomial sequence types of S. epidermidis associated with PJIs were not found, and other routes of inoculation are therefore of interest in future studies.

  15. Screening for Staphylococcus epidermidis markers discriminating between skin-flora strains and those responsible for infections of joint prostheses.

    PubMed

    Galdbart, J O; Allignet, J; Tung, H S; Rydèn, C; El Solh, N

    2000-07-01

    Fifty-four Staphylococcus epidermidis strains responsible for infections of joint prostheses and 23 strains isolated from skin flora were studied for markers of virulence, to discriminate invasive strains from normal flora. They were screened for binding to polystyrene and matrix proteins and for the presence of staphylococcal genes involved in adhesion. The ica operon involved in biofilm formation was the only marker discriminating between these 2 categories of strains.

  16. [Primary-care morbidity and true morbidity due to acute respiratory infections].

    PubMed

    Pérez Rodríguez, A E; González Ochoa, E; Bravo González, J R; Carlos Silva, L; Linton, T

    1992-01-01

    The present work presents the study of morbidity due to acute respiratory infections (ARI) in areas of the town of Lisa in Ciudad Habana, and Isla Juventud (Cuba), to characterize different aspects of morbidity measured by health care attendance and to measure true morbidity. About 90% of consultations for ARI were first-time consultations, while their ratio to further consultations was 5.3. True morbidity rates (TMR), obtained trough active research, ranged from 110.4 to 163.4 cases per 1000 inhabitants, considerably higher than morbidity rates measured by primary care consultations (MRPCC) in the same time period. The true morbidity index (TMI), as measured by the ratio of the two previous rates, ranged from 5 to 15. A high proportion (47.6%) of cases reported no medical care attendance. These results provide approximate estimates of true morbidity in the study area, and allow the establishment of a new control program, also improving epidemiologic surveillance within primary care activities.

  17. Abattoir condemnation due to parasitic infections and its economic implications in the region of Trikala, Greece.

    PubMed

    Theodoropoulos, G; Theodoropoulou, E; Petrakos, G; Kantzoura, V; Kostopoulos, J

    2002-08-01

    The prevalence of parasitic infections responsible for the condemnation of carcasses and viscera during meat inspection, and their economic implication, was estimated in a year long abattoir survey of 10 277 slaughtered farm animals in the region of Trikala, Greece. The organs examined for the presence of parasitic lesions during meat inspection were: liver and lungs of all animals, rumen of cattle, small intestine of lambs and kids, and muscles of cattle and swine. The parasitic lesions observed in the lungs of cattle, sheep and goats were caused only by hydatid cysts. No hydatid cysts were observed in the lungs of swine. The parasitic lesions observed in the liver of cattle, sheep and goats were as a result of hydatid cysts and flukes of Fasciola hepatica and Dicrocoelium dendriticum, while those of swine were due to milk spots only. Moniezia sp. proglottids were found in the small intestine of lambs only. The prevalence of parasites responsible for the condemnation of marketable organs was low (0.26%). Parasites were responsible for 22% of the total of condemned organs, and their annual cost was 99, 00 GDR (approximately 292 Euros). The parasites most contributing to marketable organ condemnation were hydatid cysts (26%) and D. dendriticum flukes (26%).

  18. Pathogenic potential of novel Chlamydiae and diagnostic approaches to infections due to these obligate intracellular bacteria.

    PubMed

    Corsaro, Daniele; Greub, Gilbert

    2006-04-01

    Novel chlamydiae are newly recognized members of the phylum Chlamydiales that are only distantly related to the classic Chlamydiaceae, i.e., Chlamydia and Chlamydophila species. They also exhibit an obligate biphasic intracellular life cycle within eukaryote host cells. Some of these new chlamydiae are currently considered potential emerging human and/or animal pathogens. Parachlamydia acanthamoebae and Simkania negevensis are both emerging respiratory human pathogens, Waddlia chondrophila could be a novel abortigenic bovine agent, and Piscichlamydia salmonis has recently been identified as an agent of the gill epitheliocystis in the Atlantic salmon. Fritschea spp. and Rhabdochlamydia spp. seem to be confined to arthropods, but some evidence for human exposure exists. In this review, we first summarize the data supporting a pathogenic potential of the novel chlamydiae for humans and other vertebrates and the interactions that most of these chlamydiae have with free-living amoebae. We then review the diagnostic approaches to infections potentially due to the novel chlamydiae, especially focusing on the currently available PCR-based protocols, mammalian cell culture, the amoebal coculture system, and serology.

  19. Fulminant Necrotizing Fasciitis of the Thigh, Following an Infection of the Sacro-iliac Joint in an Immunosuppressed, Young Woman.

    PubMed

    Gothner, Martin; Dudda, Marcel; Kruppa, Christiane; Schildhauer, Thomas A; Swol, Justyna

    2015-09-28

    Necrotizing soft tissue infection of an extremity is a rare but life-threatening disease. The disease is an infection that involves the soft tissue layer and is characterized by rapidly spreading inflammation (especially of the fascial planes and the surrounding tissues) with a high mortality. Early diagnosis is essential for the outcome of the patients. Radical surgical debridement is the treatment of choice. The predisposing factors are immunosuppression, diabetes mellitus and drug abuse. This report presents a case of necrotizing fasciitis in the thigh, following an abscess of the sacro-iliac joint, as a rare complication in a young, immunosuppressed woman. The patient's history revealed intravenous drug abuse and hepatitis C. After immediate diagnosis by magnetic resonance imaging, radical surgical debridement was required and performed. Prior to soft tissue coverage with a split skin graft, five additional sequential debridements were necessary. During her hospital stay, the patient experienced further cerebral and pulmonary septic embolisms and an infection of the elbow. Six months after admission, the patient was discharged in good condition to a rehabilitation center. Necrotizing fasciitis is a life-threatening complication following an abscess of the sacro-iliac joint. Physicians must be vigilant to inflammatory signs and pain in immunosuppressed patients. An abscess of the sacro-iliac joint is rare, but complications of an untreated abscess can be fatal in these patients.

  20. Prevalence of the ica operon and insertion sequence IS256 among Staphylococcus epidermidis prosthetic joint infection isolates.

    PubMed

    Koskela, A; Nilsdotter-Augustinsson, A; Persson, L; Söderquist, B

    2009-06-01

    Joint replacement surgery has improved the quality of life for hundreds of thousands of patients. However, the infection of a joint implant is an important and serious complication, though the prevalence is low. Staphylococcus epidermidis is the most important pathogen involved in foreign-body infections. S. epidermidis is also a commensal that comprises a substantial part of the normal skin flora of humans. The possibility to demonstrate potential specific virulence markers may facilitate the interpretation of the bacteriological findings, as well as the clinical decision. The prevalence of the ica locus and insertion sequence IS256 by using polymerase chain reaction (PCR) among 32 clinical S. epidermidis isolates from prosthetic joint infections (PJIs) and 24 commensal isolates from nares and skin was investigated. Sixteen (50%) of the 32 PJI isolates harbored the ica operon compared with one-third of the commensal isolates obtained from the samples of the skin and nares of healthy individuals. The IS256 was demonstrated in 26 (81%) out of 32 PJI isolates. By contrast, IS256 was found in one of 24 commensal isolates. In conclusion, IS256 may be superior to the ica operon as a marker of the invasive capacity of S. epidermidis, since it was found in most of the PJI isolates, but rarely among commensals.

  1. [Tropical and travel-related dermatomycoses : Part 2: cutaneous infections due to yeasts, moulds, and dimorphic fungi].

    PubMed

    Nenoff, P; Reinel, D; Krüger, C; Grob, H; Mugisha, P; Süß, A; Mayser, P

    2015-07-01

    Besides dermatophytoses, a broad range of cutaneous infections due to yeasts and moulds may occur in subtropical and tropical countries where they can affect travellers. Not to be forgotten are endemic occurring dimorphic or biphasic fungi in countries with hot climate, which cause systemic and secondary cutaneous infections in immunosuppressed and immunocompetent people. In the tropics, the prevalence of pityriasis versicolor, caused by the lipophilic yeast Malassezia spp., is about 30-40 %, in distinct areas even 50 %. Increased hyperhidrosis under tropical conditions and simultaneously humidity congestion have to be considered as significant disposing factors for pityriasis versicolor. In tropical countries, therefore, an exacerbation of a preexisting pityriasis versicolor in travellers is not rare. Today, mostly genital yeast infections due to the new species Candida africana can be found worldwide. Due to migration from Africa this yeast pathogen has reached Germany and Europe. Eumycetomas due to mould fungi are rarely diagnosed in Europe. These deep cutaneous mould infections are only found in immigrants from African countries. The therapy of eumycetoma is protracted and often not successful. Cutaneous cryptococcoses due to the yeast species Cryptococcus neoformans and Cryptococcus gattii occur worldwide; however, they are found more frequently in the tropics. Immunosuppressed patients, especially those with HIV/AIDS, are affected by cryptococcoses. Furthermore, Cryptococcus gattii also causes infections in immunocompetent hosts in Central Africa, Australia, California, and Central America.Rarely found are infections due to dimorphic fungi after travel to countries where these fungal pathogens are endemic. In individual cases, cutaneous or lymphogenic transferred sporotrichosis due to Sporothrix schenkii can occur. Furthermore, scarcely known is secondary cutaneous coccidioidomycosis due to Coccidioides immitis after travelling to desert-like endemic

  2. Risk factors for hospitalization due to respiratory syncytial virus infection among infants in the Basque Country, Spain.

    PubMed

    Cilla, G; Sarasua, A; Montes, M; Arostegui, N; Vicente, D; Pérez-Yarza, E; Pérez-Trallero, E

    2006-06-01

    This study analysed the role of several risk factors for hospitalization due to community-acquired, respiratory syncytial virus (RSV) infection. The risk factors detected in infants hospitalized for RSV infection in the first 24 months of life were compared with those in the general infant population in our region. There were 361 episodes of hospitalization in 357 infants. Eighty per cent of the infants did not present underlying conditions for severe RSV infection and only 10 (3%) were candidates for palivizumab prophylaxis. In multivariate analysis, birthweight of <2500 g was independently associated with hospitalization for RSV infection and was the most commonly detected medical risk factor. Other risk factors were maternal age at delivery <25 years, birth in the second half of the year, prematurity, suburban residence and congenital heart disease. In conclusion, together with well-known risk factors, we found that low birthweight was an independent factor for severe RSV infection.

  3. Fatal respiratory distress syndrome due to coronavirus infection in a child with severe combined immunodeficiency.

    PubMed

    Szczawinska-Poplonyk, Aleksandra; Jonczyk-Potoczna, Katarzyna; Breborowicz, Anna; Bartkowska-Sniatkowska, Alicja; Figlerowicz, Magdalena

    2013-09-01

    Coronaviruses have been demonstrated to contribute substantially to respiratory tract infections among the child population. Though infected children commonly present mild upper airway symptoms, in high-risk patients with underlying conditions, particularly in immunocompromised children these pathogens may lead to severe lung infection and extrapulmonary disorders. In this paper, we provide the first report of the case of a 15-month-old child with severe combined immunodeficiency and coronavirus HKU1-related pneumonia with fatal respiratory distress syndrome.

  4. Conservative Surgical Treatment of Infected Ulceration of the First Metatarsophalangeal Joint With Osteomyelitis in Diabetic Patients.

    PubMed

    Dalla Paola, Luca; Carone, Anna; Morisi, Claudio; Cardillo, Sara; Pattavina, Marco

    2015-01-01

    Ulceration of the plantar aspect of the first metatarsophalangeal joint is a common localization in the diabetic foot. Conservative treatment of this lesion is a challenging problem, performed through the soft tissues and osseous debridement. The present study included a cohort of 28 patients affected by diabetes mellitus and a first ray lesion penetrating the bone. After surgical debridement with removal of the infected bone, we positioned antibiotic-loaded bone cement and stabilized the treated area with an external fixator. All patients with critical limb ischemia had their vascular disease treated before the procedure. The mean follow-up was 12.2 ± 6.9 months. Four patients developed a relapse of the ulceration after the procedure. In the postoperative period, 1 patient (3.57%) developed dehiscence of the surgical site and underwent a second procedure. In the follow-up period, 2 patients (7.14%) experienced bone cement dislocation. In 1 of these patients, a new ulceration was observed dorsally to the surgical site. The approach was surgical revision with bone cement replacement and stabilization with a new external fixator. In the other patient, given the absence of ulcerations, the cement was removed, and arthrodesis with internal stabilization using 2 cannulated screws was performed. One patient (3.57%), who had developed a relapse of ulceration after recurrent critical ischemia, underwent a percutaneous revascularization procedure and transmetatarsal amputation. During the follow-up period, no ulceration recurrences, transfer ulcerations, shoe fit problems, or gait abnormalities were detected in the other 24 patients. Our study presents the results of a technique requiring a 1-stage surgical approach to a relatively common problem, which is often difficult to solve.

  5. Risk Factors for Postoperative Urinary Tract Infections in Patients Undergoing Total Joint Arthroplasty.

    PubMed

    Alvarez, Andrew P; Demzik, Alysen L; Alvi, Hasham M; Hardt, Kevin D; Manning, David W

    2016-01-01

    Background. Urinary tract infections (UTIs) are the most common minor complication following total joint arthroplasty (TJA) with incidence as high as 3.26%. Bladder catheterization is routinely used during TJA and the Centers for Medicare and Medicaid Services (CMS) has recently identified hospital-acquired catheter associated UTI as a target for quality improvement. This investigation seeks to identify specific risk factors for UTI in TJA patients. Methods. We retrospectively studied patients undergoing TJA for osteoarthritis between 2006 and 2013 in the American College of Surgeon's National Surgical Improvement Program Database (ACS-NSQIP). A univariate analysis screen followed by multivariate logistic regression identified specific patient demographics, comorbidities, preoperative laboratory values, and operative characteristics independently associated with postoperative UTI. Results. 1,239 (1.1%) of 115,630 TJA patients we identified experienced a postoperative UTI. The following characteristics are independently associated with postoperative UTI: female sex (OR 2.1, 95% CI 1.6-2.7), chronic steroid use (OR 2.0, 95% CI 1.2-3.2), ages 60-69 (OR 1.5, 95% CI 1.0-2.1), 70-79 (OR 2.0, 95% CI 1.4-2.9), and ≥80 (OR 2.3, 95% CI 1.5-3.6), ASA Classes 3-5 (OR 1.5, 95% CI 1.2-1.9), preoperative creatinine >1.35 (OR 1.8, 95% CI 1.3-2.6), and operation time greater than 130 minutes (OR 1.8, 95% CI 1.3-2.4). Conclusions. In this large database query, postoperative UTI occurs in 1.1% of patients following TJA and several variables including female sex, age greater than 60, and chronic steroid use are independent risk factors for occurrence. Practitioners should be aware of populations at greater risk to support efforts to comply with CMS initiated quality improvement.

  6. Urinary free light chains may help to identify infection in patients with elevated systemic inflammation due to rheumatic disease.

    PubMed

    Bramlage, Carsten P; Froelich, Britta; Wallbach, Manuel; Minguet, Joan; Grupp, Clemens; Deutsch, Cornelia; Bramlage, Peter; Müller, Gerhard A; Koziolek, Michael

    2017-04-01

    The risk of infection in patients with rheumatic diseases is elevated, but a clear marker to differentiate the cause of the systemic inflammation is missing. We assessed the ability urinary immunoglobulin free light chains (FLCs) to indicate the presence of infection in patients with rheumatic disease. We performed a retrospective analysis of patients with rheumatic disease attending the Georg-August University Hospital in Goettingen, Germany, from January 2011 to December 2013. Subjects were included if they had urine levels of κ and λ FLCs available. A reference group of patients without autoimmune disease, but with documented infection, was constructed. A total of 1500 patients had their urinary FLCs quantified during the study period. Of the 382 patients with rheumatic disease, 172 (45%) displayed no systemic inflammation, 162 (42%) had inflammation due to the underlying disease activity, and 48 (13%) had inflammation due to a confirmed infection. Urinary FLC concentrations were much higher in patients with rheumatic diseases and infection (κ 68.8 ± 81.8 mg/L, λ 31.4 ± 53.5 mg/L) compared to those with inflammation due to rheumatic disease activity (κ 22.7 ± 26.3 mg/L, λ 8.1 ± 9.1 mg/L, κ p < 0.001, λ p = 0.004). Urinary κ FLCs demonstrated good ability to predict infection, with a sensitivity of 63% and specificity of 84%. Urinary λ FLCs gave similar values, with a sensitivity of 65% and specificity of 81%. FLCs may be useful for distinguishing inflammation due to rheumatic disease activity from that due to the additional presence of infection. The ability to quantify these proteins in urine provides a simple alternative to the use of blood.

  7. Change in spectrum of Brownian fluctuations of optically trapped red blood cells due to malarial infection

    NASA Astrophysics Data System (ADS)

    Saraogi, Vishal; Padmapriya, P.; Paul, Apurba; Tatu, Utpal S.; Natarajan, Vasant

    2010-05-01

    We study the properties of single red blood cells (RBCs) held in an optical-tweezers trap. We observe a change in the spectrum of Brownian fluctuations between RBCs from normal and malaria-infected samples. The change, caused by infection-induced structural changes in the cell, appears as a statistical increase in the mean (by 25%) and standard deviation (by 200%) of the corner frequency measured over ~100 cells. The increase is observed even though the ensemble of cells being measured consists mostly of cells that do not actually host the parasite, but are from an infected pool. This bystander effect appears to vindicate other observations that infected cells can affect the biomechanical properties of uninfected cells. The change is also observed to be independent of the stage of infection and its duration, highlighting its potential for disease detection.

  8. Inflammatory damage on respiratory and nervous systems due to hRSV infection.

    PubMed

    Bohmwald, Karen; Espinoza, Janyra A; Becerra, Daniela; Rivera, Katherine; Lay, Margarita K; Bueno, Susan M; Riedel, Claudia A; Kalergis, Alexis M

    2015-10-01

    The exacerbated inflammatory response elicited by human Respiratory Syncytial Virus (hRSV) in the lungs of infected patients causes a major health burden in the pediatric and elderly population. Since the discovery of hRSV, the exacerbated host immune-inflammatory response triggered by this virus has been extensively studied. In this article, we review the effects on the airways caused by immune cells and cytokines/chemokines secreted during hRSV infection. While molecules such as interferons contribute at controlling viral infection, IL-17 and others produce damage to the hRSV-infected lung. In addition to affecting the airways, hRSV infection can cause significant neurologic abnormalities in the host, such as seizures and encephalopathy. Although the origin of these symptoms remains unclear, studies from patients suffering neurological alteration suggest an involvement of the inflammatory response against hRSV.

  9. Risk factors and the clinical and surgical features of fungal prosthetic joint infections: A retrospective analysis of eight cases

    PubMed Central

    Geng, Lei; Xu, Meng; Yu, Ligang; Li, Jie; Zhou, Yonggang; Wang, Yan; Chen, Jiying

    2016-01-01

    Fungal prosthetic joint infections (PJI) and reports of their clinical investigation are rare. In addition, there has been little evidence regarding the outcome of the two-stage exchange protocol for the treatment of fungal PJI. In order to investigate the risk factors and clinical, microbiological and pathological features of fungal PJIs, as well as the effects of the two-stage exchange protocol on their outcome, the present study analyzed eight retrospective fungal PJI cases, involving four cases affecting the hips and four affecting the knees, between May 2000 and March 2012. In all cases, a cemented spacer saturated with antimicrobials was used during the two-stage exchange protocol, and systematic antifungal agents were administrated during the interim period. The average follow-up duration was 4.4 years. Of the eight cases, six had undergone additional surgery on the infected joint prior to infection with the fungus. Following histological analyses, it was determined that the average number of polymorphonuclear cells in the three patients infected with a fungus was only <5/high power field (HPF; magnification, ×400), and that of the five patients with a hybrid infection was >5/HPF. The average Harris Hip scores or Hospital for Special Surgery knee scores were 43.6 preoperatively and 86 at the last follow-up. The two-stage exchange protocol was performed eight times in seven cases, with a failure rate of 12.5%. The remaining case was successfully treated by resection arthroplasty. The average duration of antifungal agent administration during the interim period in five of the eight cases was 1.5 months. For three of the patients, the duration of antifungal agent administration was prolonged until the c-reactive protein levels were decreased to normal. The average duration of spacer implantation into the joint was 4.3 months. The results of the present study suggested that undergoing surgery on a prosthetic joint may be a potential risk factor for the

  10. Regional distribution of nosocomial infections due to ESBL-positive Enterobacteriaceae in Germany: data from the German National Reference Center for the Surveillance of Nosocomial Infections (KISS).

    PubMed

    Leistner, R; Schröder, C; Geffers, C; Breier, A-C; Gastmeier, P; Behnke, M

    2015-03-01

    Surveillance systems for hospital infections are reporting increasing rates of extended-spectrum β-lactamase (ESBL)-positive Enterobacteriaceae in Europe. We aimed to perform a national survey on this trend and on the regional distribution of nosocomial infections due to ESBL-positive Enterobacteriaceae in German hospitals. Data from 2007 to 2012 from two components of the German national nosocomial infection surveillance system were used for this analysis. The data derive from intensive care units and surgical departments. Independent factors determining the proportion of ESBL-positive Enterobacteriaceae among nosocomial infections due to Enterobacteriaceae and changes in its regional distribution (broken down into German federal states) were calculated by regression analysis. From 2007 to 2012, the data showed a significantly increasing proportion of ESBL-positive Enterobacteriaceae in surgical site infections (from 11.46 to 15.38, 134%, p 0.003), urinary tract infections (9.36 to 16.56, 177%, p <0.001) and lower respiratory tract infections (11.91 to 14.70, 123%, p <0.001) due to Enterobacteriaceae. Factors independently associated with a growing proportion were: Thuringia (p 0.009; odds ratio (OR) 1.53), North Rhine-Westphalia (p <0.001; OR 1.41) and general surgery ward (p 0.002; OR 1.47). The proportion of ESBL-positive Enterobacteriaceae in nosocomial infections has significantly increased in Germany over the last 6 years. Hospitals in Central Germany and surgical departments in all of Germany are especially affected by this development.

  11. Temporomandibular Joint Septic Arthritis and Mandibular Osteomyelitis Arising From an Odontogenic Infection: A Case Report and Review of the Literature.

    PubMed

    Gams, Kevin; Freeman, Phillip

    2016-04-01

    Septic arthritis of the temporomandibular joint (TMJ) has been infrequently reported in the literature. Some investigators believe that this condition is under-reported because it is underdiagnosed. Misdiagnosis or late diagnosis of this condition can lead to serious morbidity, including fistula formation, intracranial abscess, fibrous or bony ankylosis, temporal bone or condylar osteomyelitis, growth alteration, and several others. This report describes a case of septic TMJ arthritis arising from direct spread of an odontogenic infection with subsequent development of mandibular osteomyelitis. The purpose of this case report is to 1) increase awareness of an underdiagnosed condition, 2) establish the seriousness of this infection, 3) for the first time report on a case of TMJ septic arthritis caused by Bacteroides infection, and 4) provide a review of the relevant literature.

  12. Posttraumatic severe infection of the ankle joint - long term results of the treatment with resection arthrodesis in 133 cases.

    PubMed

    Kienast, Benjamin; Kiene, J; Gille, J; Thietje, R; Gerlach, U; Schulz, A P

    2010-02-26

    Although there is a clear trend toward internal fixation for ankle arthrodesis, there is general consensus that external fixation is required for cases of posttraumatic infection. We retrospectively evaluated the technique and clinical long term results of external fixation in a triangular frame for cases of posttraumatic infection of the ankle. From 1993 to 2006 a consecutive series of 155 patients with an infection of the ankle was included in our study. 133 cases of the advanced "Gächter" stage III and IV were treated with arthrodesis. We treated the patients with a two step treatment plan. After radical debridement and sequestrectomy the malleoli and the joint surfaces were resected. An AO fixator was applied with two Steinmann-nails inserted in the tibia and in the calcaneus and the gap was temporary filled with gentamicin beads as the first step. In the second step we performed an autologous bone graft after a period of four weeks. The case notes were evaluated regarding trauma history, medical complaints, further injuries and illnesses, walking and pain status and occupational issues. Mean age at the index procedure was 49.7 years (18-82), 104 patients were male (67.1%). Follow up examination after mean 4.5 years included a standardised questionnaire and a clinical examination including the criteria of the AOFAS-Score and radiographs. 92.7% of the cases lead to a stable arthrodesis. In 5 patients the arthrodesis was found partly-stable. In six patients (4,5%) the infection was not controllable during the treatment process. These patients had to be treated with a below knee amputation. The mean AOFAS score at follow up was 63.7 (53-92). Overall there is a high degree of remaining disability. The complication rate and the reduced patient comfort reserve this method mainly for infection. Joint salvage is possible in the majority of cases with an earlier stage I and II infection.

  13. Spontaneous splenic rupture due to Babesia microti infection: Case report and review of the literature.

    PubMed

    Usatii, Natalia; Khachatrian, Aelita; Stratidis, John

    2014-01-01

    This article describes the case of spontaneous splenic rupture as a rare complication of infection with Babesia species. We will discuss the symptomatology that this disease could present along with both surgical and non-surgical management approaches. Babesia infection often presents with mild to moderate symptoms, but can rapidly progress to significant injury including splenic rupture. The first case reported in a medical journal was in 2007. Treatment usually involves a two-drug regimen; clindamycin plus quinine, or atovaquone plus azithromycin (as in our patient). If hemodynamic stability is present, a primary non-surgical treatment may be especially beneficial since splenectomy may worsen optimal immunologic function and the infection itself.

  14. Long-term environmental radioactive contamination of Europe due to the Chernobyl accident - Results of the Joint Danube Survey 2013.

    PubMed

    Maringer, Franz Josef; Ackerl, Claudia; Baumgartner, Andreas; Burger-Scheidlin, Christopher; Kocadag, Maria; Sterba, Johannes H; Stietka, Michael; Welch, Jan Matthew

    2017-02-27

    In the course of the Joint Danube Survey 3 (JDS3), coordinated by the International Commission for the Protection of the Danube River (ICPDR), laboratory ships travelled 2375km down the Danube River engaging in sampling, processing and on-board analyses during the summer of 2013. The results of the radiometric analysis of (90)Sr, (137)Cs and natural radionuclides in recent riverbed sediment are presented. The activity concentrations of (90)Sr and (137)Cs in Danube sediments have been found below 100Bq/kg.

  15. The preoperative prediction of success following irrigation and debridement with polyethylene exchange for hip and knee prosthetic joint infections.

    PubMed

    Buller, Leonard T; Sabry, Fady Youssef; Easton, Robert W; Klika, Alison K; Barsoum, Wael K

    2012-06-01

    Although the criterion standard for the treatment of prosthetic joint infections (PJIs) is 2-stage revision with interim placement of an antibiotic-loaded spacer, irrigation and debridement with polyethylene exchange offer advantages such as fewer surgeries, reduced potential for intraoperative complications, and lower direct costs. The purpose of this study was to develop a tool to preoperatively predict the probability of successful infection eradication following irrigation and debridement with polyethylene exchange for hip or knee PJIs. A total of 10,411 surgical cases were retrospectively reviewed, and data were collected from 309 charts. Overall, 149 (48.2%) cases failed to eradicate the infection following irrigation and debridement with polyethylene exchange. Univariate analysis identified multiple variables independently associated with reinfection including duration of symptoms, preoperative inflammatory markers, and infecting organism. Logistic regression was used to generate a model (bootstrap-corrected concordance index of 0.645) to predict successful eradication of the infection, which was the basis for a nomogram. Using commonly obtained preoperative variables, the nomogram can be used to predict the probability of infection-free survival at 1, 2, 3, 4, and 5 years. Preoperative knowledge of the probability that a treatment strategy will eradicate a patient's PJI may improve risk assessment.

  16. [Prevalence of infection due to HTLV-1 in remnant quilombos in Central Brazil].

    PubMed

    Nascimento, Laura Branquinho do; Carneiro, Megmar Aparecida Dos Santos; Teles, Sheila Araújo; Lopes, Carmen Luci Rodrigues; Reis, Nádia Rúbia da Silva; Silva, Agabo Macedo da Costa E; Motta-Castro, Ana Rita Coimbra; Otsuki, Koko; Vicente, Ana Carolina Paulo; Martins, Regina Maria Bringel

    2009-01-01

    This study aimed to determine the prevalence of HTLV-1 infection among remnant black quilombo communities in Central Brazil. A total of 1,837 individuals were evaluated, among whom nine were HTLV-1/2 seropositive according to ELISA. All of them were positive for HTLV-1 by means of Western blot and/or PCR, thus resulting in a prevalence of 0.5% (95% CI: 0.2-1.0). The HTLV-1 infected individuals ranged in age from 11 to 82 years. The majority of them were females. Regarding risk characteristics, histories of breastfeeding, blood transfusion, multiple sexual partners and sexually transmitted diseases were reported by these individuals. The findings from this study indicate the importance of identifying HTLV-1 infected individuals, as a strategy for infection control and prevention in these remnant quilombos.

  17. A case of infant botulism infection due to consumption of untreated well-water.

    PubMed

    Kobayashi, Tomoko; Haginoya, Kazuhiro; Morimoto, Tetsuji; Hatakeyama, Takashi; Tsuchiya, Shigeru

    2014-04-01

    A 7-week-old boy with flaccid paralysis was diagnosed with infant botulism caused by Clostridium botulinum toxin type A. In this case of infant botulism, untreated well-water was identified as a potential source of this infection.

  18. Pathogenesis of respiratory infections due to influenza virus: Implications for developing countries

    SciTech Connect

    Leigh, M.W.; Carson, J.L.; Denny, F.W. Jr. )

    1991-05-01

    The influenza viruses have an important and distinctive place among respiratory viruses: they change antigenic character at irregular intervals, infect individuals of all ages, cause illnesses characterized by constitutional symptoms and tracheobronchitis, produce yearly epidemics associated frequently with excess morbidity and mortality, and predispose the host to bacterial superinfections. Much is known about influenza viruses, but their role in respiratory infections among children in developing countries is poorly understood, and the risk factors that lead to the excess morbidity and mortality have not been identified clearly. Among the many risk factors that may be important are alterations in host immunity, malnutrition, prior or coincident infections with other microorganisms, inhaled pollutants, and lack of access to medical care. There is a great need for research that can establish more precisely the role these and other unidentified factors play in the pathogenesis of influenza infections in children in the developing world. 37 references.

  19. Risk Factors for Postoperative Urinary Tract Infections in Patients Undergoing Total Joint Arthroplasty

    PubMed Central

    Demzik, Alysen L.; Alvi, Hasham M.; Hardt, Kevin D.; Manning, David W.

    2016-01-01

    Background. Urinary tract infections (UTIs) are the most common minor complication following total joint arthroplasty (TJA) with incidence as high as 3.26%. Bladder catheterization is routinely used during TJA and the Centers for Medicare and Medicaid Services (CMS) has recently identified hospital-acquired catheter associated UTI as a target for quality improvement. This investigation seeks to identify specific risk factors for UTI in TJA patients. Methods. We retrospectively studied patients undergoing TJA for osteoarthritis between 2006 and 2013 in the American College of Surgeon's National Surgical Improvement Program Database (ACS-NSQIP). A univariate analysis screen followed by multivariate logistic regression identified specific patient demographics, comorbidities, preoperative laboratory values, and operative characteristics independently associated with postoperative UTI. Results. 1,239 (1.1%) of 115,630 TJA patients we identified experienced a postoperative UTI. The following characteristics are independently associated with postoperative UTI: female sex (OR 2.1, 95% CI 1.6–2.7), chronic steroid use (OR 2.0, 95% CI 1.2–3.2), ages 60–69 (OR 1.5, 95% CI 1.0–2.1), 70–79 (OR 2.0, 95% CI 1.4–2.9), and ≥80 (OR 2.3, 95% CI 1.5–3.6), ASA Classes 3–5 (OR 1.5, 95% CI 1.2–1.9), preoperative creatinine >1.35 (OR 1.8, 95% CI 1.3–2.6), and operation time greater than 130 minutes (OR 1.8, 95% CI 1.3–2.4). Conclusions. In this large database query, postoperative UTI occurs in 1.1% of patients following TJA and several variables including female sex, age greater than 60, and chronic steroid use are independent risk factors for occurrence. Practitioners should be aware of populations at greater risk to support efforts to comply with CMS initiated quality improvement. PMID:28018678

  20. Nutritional status as a predictive marker for surgical site infection in total joint arthroplasty

    PubMed Central

    Alfargieny, Randa; Bodalal, Zuhir; Bendardaf, Riyad; El-Fadli, Mustafa; Langhi, Salem

    2015-01-01

    Background: Surgical site infection (SSI) is considered one of the most serious complications in total joint arthroplasty (TJA). This study seeks to analyze the predictive value of preoperative and postoperative nutritional biomarkers for SSI in elective TJA. Methodology: Nutritional markers were gathered retrospectively utilizing patient's records from the orthopedics department at Benghazi Medical Center (BMC). The sample spanned cases admitted during the 20-month period between January 2012 and August 2013 and had undergone either elective total hip replacement or total knee replacement. The collected lab results included a complete blood count, total lymphocyte count (TLC), and serum albumin (S. alb.) levels. The patients were then divided into two groups based on the occurrence of an SSI. Results: A total of 135 total knee (81.5%, n = 110/135) and total hip (18.5%, n = 25/135) replacements were performed at BMC during the study period. Among these cases, 57% (n = 78/135) had patient records suitable for statistical analysis. The average preoperative TLC was 2.422 ×103 cells/mm3 (range = 0.8–4.7 ×103 cells/mm3) whereas that number dropped after the surgery to 1.694 ×103 cells/mm3 (range = 0.6–3.8 ×103 cells/mm3). S. alb. levels showed a mean of 3.973 g/dl (range = 2.9–4.7 g/dl) preoperatively and 3.145 g/dl (range = 1.0–4.1 g/dl) postoperatively. The majority of TJA patients did not suffer any complication (67.4%, n = 91/135) while eight cases (5.9%) suffered from a superficial SSI. Conclusion: Preoperative S. alb. was identified as the only significant predictor for SSI (P = 0.011). Being a preventable cause of postoperative morbidity, it is recommended that the nutritional status (especially preoperative S. alb.) of TJA patients be used as a screening agent and appropriate measures be taken to avoid SSI. PMID:26629466

  1. First Case of Human Infection Due to Pseudomonas fulva, an Environmental Bacterium Isolated from Cerebrospinal Fluid ▿

    PubMed Central

    Almuzara, Marisa N.; Vazquez, Miryam; Tanaka, Naoto; Turco, Marisa; Ramirez, Maria S.; Lopez, Eduardo L.; Pasteran, Fernando; Rapoport, Melina; Procopio, Adriana; Vay, Carlos A.

    2010-01-01

    We report the first case of human infection due to Pseudomonas fulva. P. fulva caused acute meningitis following the placement of a drainage system in a 2-year-old female. Additionally, the isolate displayed a VIM-2 carbapenemase in a class 1 integron context. PMID:20032258

  2. CT-Guided Percutaneous Drainage of Infected Collections Due to Gastric Leak After Sleeve Gastrectomy for Morbid Obesity: Initial Experience

    SciTech Connect

    Kelogrigoris, M. Sotiropoulou, E.; Stathopoulos, K.; Georgiadou, V.; Philippousis, P.; Thanos, L.

    2011-06-15

    This study was designed to evaluate the efficacy and safety of computed tomography (CT)-guided drainage in treating infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity. From January 2007 to June 2009, 21 patients (9 men and 12 women; mean age, 39.2 (range, 26-52) years) with infected collections due to gastric leak after laparoscopic sleeve gastrectomy for morbid obesity underwent image-guided percutaneous drainage. All procedures were performed using CT guidance and 8- to 12-Fr pigtail drainage catheters. Immediate technical success was achieved in all 21 infected collections. In 18 of 21 collections, we obtained progressive shrinkage of the collection with consequent clinical success (success rate 86%). In three cases, the abdominal fluid collection was not resolved, and the patients were reoperated. Among the 18 patients who avoided surgery, 2 needed replacement of the catheter due to obstruction. No major complications occurred during the procedure. The results of our study support that CT-guided percutaneous drainage is an effective and safe method to treat infected abdominal fluid collections due to gastric leak in patients who had previously underwent laparoscopic sleeve gastrectomy for morbid obesity. It may be considered both as a preparatory step for surgery and a valuable alternative to open surgery. Failure of the procedure does not, however, preclude a subsequent surgical operation.

  3. Is Xpert MRSA/SA SSTI real-time PCR a reliable tool for fast detection of methicillin-resistant coagulase-negative staphylococci in periprosthetic joint infections?

    PubMed

    Lourtet-Hascoëtt, J; Bicart-See, A; Félicé, M P; Giordano, G; Bonnet, E

    2015-09-01

    Periprosthetic joint infections (PJIs) are frequently caused by methicillin-resistant coagulase-negative staphylococci (CoNS). Cultures remain the gold standard but often require a few days. Thus, a rapid test could be interesting to guide antibiotic strategy earlier. The purpose of this study was to evaluate the performances of RT-PCR Xpert® MRSA/SA technique for the detection of methicillin-resistant CoNS (MRCoNS) from deep samples in patients with PJIs. RT-PCR was tested on 72 samples. Sensitivity, specificity, positive predictive value, and negative predictive value of RT-PCR method were 0.36, 0.98, 0.90, and 0.74, respectively. Although RT-PCR may allow early microbial diagnosis of PJI due to Staphylococcus aureus (MSSA and MRSA), the low sensitivity and the high cost of this method to detect MRCoNS could limit its use in this field.

  4. Infections due to gentamicin-resistant Staphylococcus aureus strain in a nursery for neonatal infants.

    PubMed Central

    Vogel, L; Nathan, C; Sweeney, H M; Kabins, S A; Cohen, S

    1978-01-01

    An apparently homogeneous strain of Staphylococcus aureus resistant to gentamicin (Gmr), kanamycin, tobramycin, and sisomicin, but susceptible to amikacin and netilmicin, caused multiple infections in neonatal infants in a special care nursery. Nasal cultures revealed a high rate of carriage of the Gmr staphylococcus in infants without clinical infection. Segregating patients according to a modified cohort system and use of careful aseptic techniques led to apparent elimination of the Gmr strain. The resistance to aminoglycosides in this strain was mediated by an aminoglycoside 6'-N-acetyltransferase and a gentamicin phosphotransferase. Genetic determinants for these enzymes were borne on a circular covalently closed plasmid of approximately 11 megadaltons. These resistance determinants closely resemble those found in isolates of S. aureus that have caused nosocomial infections in patients in Europe. PMID:263886

  5. [Advances in the research of an animal model of wound due to Mycobacterium tuberculosis infection].

    PubMed

    Chen, Ling; Jia, Chiyu

    2015-12-01

    Tuberculosis ranks as the second deadly infectious disease worldwide. The incidence of tuberculosis is high in China. Refractory wound caused by Mycobacterium tuberculosis infection ranks high in misdiagnosis, and it is accompanied by a protracted course, and its pathogenic mechanism is still not so clear. In order to study its pathogenic mechanism, it is necessary to reproduce an appropriate animal model. Up to now the study of the refractory wound caused by Mycobacterium tuberculosis infection is just beginning, and there is still no unimpeachable model for study. This review describes two models which may reproduce a wound similar to the wound caused by Mycobacterium tuberculosis infection, so that they could be used to study the pathogenesis and characteristics of a tuberculosis wound in an animal.

  6. Spontaneous splenic rupture due to Babesia microti infection: Case report and review of the literature

    PubMed Central

    Usatii, Natalia; Khachatrian, Aelita; Stratidis, John

    2014-01-01

    This article describes the case of spontaneous splenic rupture as a rare complication of infection with Babesia species. We will discuss the symptomatology that this disease could present along with both surgical and non-surgical management approaches. Babesia infection often presents with mild to moderate symptoms, but can rapidly progress to significant injury including splenic rupture. The first case reported in a medical journal was in 2007. Treatment usually involves a two-drug regimen; clindamycin plus quinine, or atovaquone plus azithromycin (as in our patient). If hemodynamic stability is present, a primary non-surgical treatment may be especially beneficial since splenectomy may worsen optimal immunologic function and the infection itself. PMID:26839774

  7. Fatal Pulmonary Infection Due to Multidrug-Resistant Mycobacterium abscessus in a Patient with Cystic Fibrosis

    PubMed Central

    Sanguinetti, Maurizio; Ardito, Fausta; Fiscarelli, Ersilia; La Sorda, Marilena; D'Argenio, Patrizia; Ricciotti, Gabriella; Fadda, Giovanni

    2001-01-01

    We report a case of fatal pulmonary infection caused by Mycobacterium abscessus in a young patient with cystic fibrosis, who underwent bipulmonary transplantation after a 1-year history of severe lung disease. Fifteen days after surgery he developed septic fever with progressive deterioration in lung function. M. abscessus, initially isolated from a pleural fluid specimen, was then recovered from repeated blood samples, suggesting a disseminated nature of the mycobacterial disease. Drug susceptibility testing assay, performed on two sequential isolates of the microorganism, showed a pattern of multidrug resistance. Despite aggressive therapy with several antimycobacterial drugs, including clarithromycin, the infection persisted, and the patient died. PMID:11158161

  8. Reduction of Mycobacterium tuberculosis infection in Bacillus Calmette Guerin immunized people is due to training of innate immunity.

    PubMed

    Eisenhut, Michael

    2015-03-01

    The currently used vaccine for prevention of tuberculosis is Bacillus Calmette Guerin, which has been associated with a protective effect of 51% against tuberculosis. New vaccination strategies based on an enhancement of adaptive T-cell based immunity have been unsuccessful in increasing the efficiency of BCG immunisation. The proposed hypothesis is that a reduction of Mycobacterium (M.) tuberculosis infection in Bacillus Calmette Guerin immunized people is due to training of innate immunity. Evidence to support the hypothesis is a systematic review, which showed that BCG protects against M. tuberculosis infection as evident from negative interferon gamma release assay results in BCG immunised exposed people. BCG has been shown to enhance innate immunity in monocytes via nucleotide binding oligomerisation domain 2 receptor activation by muramyldipeptide. An alternative hypothesis may be that T-suppressor cells induced by BCG immunisation may be the reason for the absence of an interferon gamma response mimicking absence of infection in immunized people. In order to test the primary hypothesis an ultra-low dose mouse model of M. tuberculosis infection could be used. Innate immunity could be enhanced by administration of murabutide and groups with and without murabutide enhanced BCG immunisation and with and without elimination of T-suppressor cells compared. The contribution of training of innate immunity in reduction of infection could hereby be demonstrated by treatment of mice prior to immunisation with an inhibitor of epigenetic programming. Confirmation of the hypothesis could provide the foundation of a new approach to an improved vaccine against M. tuberculosis infection.

  9. Respiratory Failure due to Possible Donor-Derived Sporothrix schenckii Infection in a Lung Transplant Recipient

    PubMed Central

    Bahr, Nathan C.; Janssen, Katherine; Billings, Joanne; Loor, Gabriel; Green, Jaime S.

    2015-01-01

    Background. De novo and donor-derived invasive fungal infections (IFIs) contribute to morbidity and mortality in solid organ transplant (SOT) recipients. Reporting of donor-derived IFIs (DDIFIs) to the Organ Procurement Transplant Network has been mandated since 2005. Prior to that time no systematic monitoring of DDIFIs occurred in the United States. Case Presentation. We report a case of primary graft dysfunction in a 49-year-old male lung transplant recipient with diffuse patchy bilateral infiltrates likely related to pulmonary Sporothrix schenckii infection. The organism was isolated from a bronchoalveolar lavage on the second day after transplantation. Clinical and radiographic responses occurred after initiation of amphotericin B lipid formulation. Conclusion. We believe that this was likely a donor-derived infection given the early timing of the Sporothrix isolation after transplant in a bilateral single lung transplant recipient. This is the first case report of sporotrichosis in a lung transplant recipient. Our patient responded well to amphotericin induction therapy followed by maintenance therapy with itraconazole. The implications of donor-derived fungal infections and Sporothrix in transplant recipients are reviewed. Early recognition and management of these fungi are essential in improving outcomes. PMID:26697244

  10. Improved resistance to Eimeria acervulina infection in chickens due to dietary supplementation with garlic metabolites

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The effects of a compound including secondary metabolites of garlic, propyl thiosulfinate (PTS) and propyl thiosulfinatate oxide (PTSO), on in vitro and in vivo parameters of chicken gut immunity during experimental Eimeria acervulina infection were evaluated. In in vitro assays, the compound of P...

  11. Unusual Presentation of Gianotti-Crosti Syndrome due to Epstein-Barr Virus Infection.

    PubMed

    Al Dhaheri, Hind Saif; Al Kaabi, Amani; Kara Hamo, Yasmin; Al Kaabi, Aysha; Al Kaabi, Salwa; Al Tatari, Hossam

    2016-01-01

    Gianotti-Crosti syndrome (GCS) is viral exanthema of childhood. It typically presents with a symmetric erythematous papular and papulovesicular eruption. It has been classically associated with hepatitis B virus, as well as rarely with Epstein-Barr virus (EBV). We report a case of GCS related to EBV infection without the classical systemic symptoms in a five-year-old male patient.

  12. Implantable Cardiac Defibrillator Pocket Infection Due to a Previously Undescribed Cupriavidus Species▿

    PubMed Central

    Christensen, Joshua B.; Vitko, Nicholas P.; Voskuil, Martin I.; Castillo-Mancilla, Jose R.

    2010-01-01

    The genus Cupriavidus consists of Gram-negative, nonfermenting bacteria most of which are environmental organisms, though some species have been associated with human disease. We report the recovery and identification of an isolate that represents a previously undescribed species of Cupriavidus from an implantable cardiac defibrillator pocket infection. PMID:20427695

  13. Diabetes mellitus, hyperglycemia, hemoglobin A1C and the risk of prosthetic joint infections in total hip and knee arthroplasty.

    PubMed

    Maradit Kremers, Hilal; Lewallen, Laura W; Mabry, Tad M; Berry, Daniel J; Berbari, Elie F; Osmon, Douglas R

    2015-03-01

    Diabetes mellitus is an established risk factor for infections but evidence is conflicting to what extent perioperative hyperglycemia, glycemic control and treatment around the time of surgery modify the risk of prosthetic joint infections (PJIs). In a cohort of 20,171 total hip and knee arthroplasty procedures, we observed a significantly higher risk of PJIs among patients with a diagnosis of diabetes mellitus (hazard ratio [HR] 1.55, 95% CI 1.11, 2.16), patients using diabetes medications (HR 1.56, 95% CI 1.08, 2.25) and patients with perioperative hyperglycemia (HR 1.59, 95% CI 1.07, 2.35), but the effects were attenuated after adjusting for body mass index, type of surgery, ASA score and operative time. Although data were limited, there was no association between hemoglobin A1c values and PJIs.

  14. Pneumococcal Infections

    MedlinePlus

    ... the bloodstream (bacteremia) Joint infection (arthritis) Ear infection (otitis media) Infection of the sinus membranes (sinusitis) Eye infection ( ... breathing; for bacteremia, fever and less energy; for ear infections, fever and ear pain; and for sinustitis, fever ...

  15. The Zeitgeist of Challenging the Evidence. A Perspective on the International Consensus Meeting on Periprosthetic Joint Infection

    PubMed Central

    Fayaz, Hangama C.; Jupiter, Jesse B.

    2017-01-01

    Background: The economic burden of the treatment of periprosthetic joint infection (PJI) is high and the treatment of PJI has a high degree of international controversy. Several papers have declared the International Consensus Meeting on Periprosthetic Joint Infection (ICMPJI) to be the “flawless pledge of international academics” to overcome the challenges of musculoskeletal infections. The purpose of this paper is to highlight for the first time some essential insights into the key dilemmas that are associated with this international consensus process. Methods: The proceedings of the ICMPJI was reviewed, and the critical consensus agreements that were reached were communicated via e-mail to 48 leading orthopaedic surgeons, microbiologists and statisticians around the world. Of these, 30 responded, 8 did not, and 10 of respondents were not aware of the ICMPJI. Results: A thorough review of the ICMPJI proceedings identified a clear need to resolve some of the dilemmas that we highlight in this paper. The Delphi procedure has been described as a survey technique that enables a group dynamic-based practice. Although there have been several published reports on this procedure, its scientific merit is still being debated. Several challenges and questions have been raised regarding the application of the Delphi technique, but there is no doubt that it is a vital approach for achieving consensus on subjects where none currently exists. Conclusion: Performing prospective clinical studies in this area is currently the best and only option to overcome this challenge. In the long term, this approach will not only incorporate the standard of clinical evidence but also adopt regional mores for treating infection, which include patient values, cultural differences and local financial resources. PMID:28271085

  16. Organism profile in periprosthetic joint infection: pathogens differ at two arthroplasty infection referral centers in Europe and in the United States.

    PubMed

    Aggarwal, Vinay K; Bakhshi, Hooman; Ecker, Niklas Unter; Parvizi, Javad; Gehrke, Thorsten; Kendoff, Daniel

    2014-10-01

    Infecting microorganism is a strong predictor of treatment success for periprosthetic joint infection (PJI). The purpose of this study was to compare the infecting pathogens causing PJI at two large infection referral centers in the United States and in Europe. In this study, 898 consecutive cases of PJI were identified at the HELIOS ENDO-Klinik Hamburg in Europe and 772 cases were identified at the Rothman Institute in the United States. The incidence of organisms at the HELIOS ENDO-Klinik Hamburg versus the Rothman Institute was: coagulase-negative Staphylococcus (39.3 vs. 20.2%), S. aureus (13.0 vs. 31.0%), Streptococcus (6.5 vs. 5.8%), Enterococcus (7.0 vs. 3.9%), anaerobic (9.0 vs. 0.9%), fungal (0.3 vs. 2.3%), mycobacterial (0 vs. 0.6%), polymicrobial (3.4 vs. 7.4%), culture negative (16.1 vs. 15.8%), and other organisms (0.9 vs. 5.4%). The percentage of methicillin-resistant S. aureus was significantly higher at the American center than at the European center (48.1 vs. 12.8%; p < 0.0001). Our findings show higher virulence and resistance organisms are more prevalent at a referral center in the United States compared with one in Europe.

  17. Acute Abdomen Due to Penicillium marneffei: An Indicator of HIV Infection in Manipur State.

    PubMed

    Ghalige, Hemanth Sureshwara; Sahoo, Biswajeet; Sharma, Sanjeeb; Devi, Khuraijam Ranjana; Singh Th, Sudhir Chandra

    2014-09-01

    Opportunistic infection in HIV disease often present to clinicians in an atypical manner testing clinical acumen. Here, we report a case of Penicilliosis marneffei (PM) infection presenting to surgical emergency as acute abdomen with undiagnosed HIV status in advanced AIDS, chief complaints being prolonged fever and diffuse abdominal pain. Radiologic imaging showed non-specific mesenteric and retroperitoneal lymphadenopathy. Fine needle aspiration cytology (FNAC) of the lymph node was done and subjected to direct microscopy, gram staining and culture on Sabouraud's dextrose agar (SDA) which showed Penicillium marneffei. He was then treated with intravenous amphotericin. This case is reported for its rarity and unusual presentation to sensitise clinicians and microbiologists to consider PM as an aetiology in acute abdomen in high risk individuals, more so, in patients from north-east India.

  18. Repeat corneal graft failure due to graft-to-host herpetic infection

    PubMed Central

    2013-01-01

    Background Herein, we present the case of a young female patient with keratoconus, who was subjected twice to repeat keratoplasty, and each time, she experienced a corneal graft failure. Findings Under the suspicion of herpetic eye disease, we administered topical and systemic anti-herpetic treatment after the second repeat keratoplasty. The postoperative course was uneventful, and the corneal graft is clear, until recently. Immunohistochemistry and DNA-polymerase chain reaction were negative for herpes simplex virus-1 (HSV-1) in the host cornea, but they detected HSV-1 in both transplanted corneal grafts, thereby supporting our clinical hypothesis that graft-to-host HSV-1 infection elicited this chain reaction of complications in our patient. Conclusion This clinical report illustrates in a unique way the dramatic impact an unsuspected herpetic infection in the corneal graft in cases of keratoplasty may have and underscores the necessity of suspecting and adequately treating these distinct cases. PMID:23514192

  19. Prevention of infection due to Pneumocystis spp. in human immunodeficiency virus-negative immunocompromised patients.

    PubMed

    Rodriguez, Martin; Fishman, Jay A

    2004-10-01

    Pneumocystis infection in humans was originally described in 1942. The organism was initially thought to be a protozoan, but more recent data suggest that it is more closely related to the fungi. Patients with cellular immune deficiencies are at risk for the development of symptomatic Pneumocystis infection. Populations at risk also include patients with hematologic and nonhematologic malignancies, hematopoietic stem cell transplant recipients, solid-organ recipients, and patients receiving immunosuppressive therapies for connective tissue disorders and vasculitides. Trimethoprim-sulfamethoxazole is the agent of choice for prophylaxis against Pneumocystis unless a clear contraindication is identified. Other options include pentamidine, dapsone, dapsone-pyrimethamine, and atovaquone. The risk for PCP varies based on individual immune defects, regional differences, and immunosuppressive regimens. Prophylactic strategies must be linked to an ongoing assessment of the patient's risk for disease.

  20. Posttraumatic Skin and Soft-Tissue Infection due to Pseudomonas fulva.

    PubMed

    Cobo, Fernando; Jiménez, Gemma; Rodríguez-Granger, Javier; Sampedro, Antonio

    2016-01-01

    We report a case of posttraumatic skin and soft-tissue infection in a patient with a left thigh wound after a traffic accident. Pseudomonas fulva was isolated from a wound aspirate and was identified to the species level by Maldi-tof. The patient responded to drainage, debridement of wound, and two weeks of intravenous antibiotic therapy. Follow-up after 3 weeks was satisfactory with healthy cover of the injured area.

  1. Posttraumatic Skin and Soft-Tissue Infection due to Pseudomonas fulva

    PubMed Central

    Jiménez, Gemma; Rodríguez-Granger, Javier; Sampedro, Antonio

    2016-01-01

    We report a case of posttraumatic skin and soft-tissue infection in a patient with a left thigh wound after a traffic accident. Pseudomonas fulva was isolated from a wound aspirate and was identified to the species level by Maldi-tof. The patient responded to drainage, debridement of wound, and two weeks of intravenous antibiotic therapy. Follow-up after 3 weeks was satisfactory with healthy cover of the injured area. PMID:27752373

  2. Adiaspiromycosis Causing Respiratory Failure and a Review of Human Infections Due to Emmonsia and Chrysosporium spp.

    PubMed Central

    Sutton, Deanna A.; Graybill, John R.

    2012-01-01

    We report a case of a 27-year-old male who presented with respiratory distress that required mechanical ventilation. Transbronchial biopsy revealed adiaspores of the fungus Emmonsia crescens within granulomata, a condition known as adiaspiromycosis. The patient received amphotericin products and corticosteroids, followed by itraconazole, and made a full recovery. Emmonsia crescens is a saprobe with a wide distribution that is primarily a rodent pathogen. The clinical characteristics of the 20 cases of human pulmonary adiaspiromycosis reported since the last comprehensive case review in 1993 are described here, as well as other infections recently reported for the genus Emmonsia. Pulmonary adiaspiromycosis has been reported primarily in persons without underlying host factors and has a mild to severe course. It remains uncertain if the optimal management of severe pulmonary adiaspiromycosis is supportive or if should consist of antifungal treatment, corticosteroids, or a combination of the latter two. The classification of fungi currently in the genus Emmonsia has undergone considerable revision since their original description, including being grouped with the genus Chrysosporium at one time. Molecular genetics has clearly differentiated the genus Emmonsia from the Chrysosporium species. Nevertheless, there has been a persistent confusion in the literature regarding the clinical presentation of infection with fungi of these two genera; to clarify this matter, the reported cases of invasive Chrysosporium infections were reviewed. Invasive Chrysosporium infections typically occur in impaired hosts and can have a fatal course. Based on limited in vitro susceptibility data for Chrysosporium zonatum, amphotericin B is the most active drug, itraconazole susceptibility is strain-dependent, and fluconazole and 5-fluorocytosine are not active. PMID:22259200

  3. Decreased Risk of Ventilator-Associated Pneumonia in Sepsis Due to Intra-Abdominal Infection

    PubMed Central

    Philippart, François; Bouroche, Gaëlle; Timsit, Jean-François; Garrouste-Orgeas, Maité; Azoulay, Elie; Darmon, Michael; Adrie, Christophe; Allaouchiche, Bernard; Ara-Somohano, Claire; Ruckly, Stéphane; Dumenil, Anne-Sylvie; Souweine, Bertrand; Goldgran-Toledano, Dany; Bouadma, Lila; Misset, Benoît

    2015-01-01

    Rationale Experimental studies suggest that intra-abdominal infection (IAI) induces biological alterations that may affect the risk of lung infection. Objectives To investigate the potential effect of IAI at ICU admission on the subsequent occurrence of ventilator-associated pneumonia (VAP). Methods We used data entered into the French prospective multicenter Outcomerea database in 1997–2011. Consecutive patients who had severe sepsis and/or septic shock at ICU admission and required mechanical ventilation for more than 3 days were included. Patients with acute pancreatitis were not included. Measurements and Main Results Of 2623 database patients meeting the inclusion criteria, 290 (11.1%) had IAI and 2333 (88.9%) had other infections. The IAI group had fewer patients with VAP (56 [19.3%] vs. 806 [34.5%], P<0.01) and longer time to VAP (5.0 vs.10.5 days; P<0.01). After adjustment on independent risk factors for VAP and previous antimicrobial use, IAI was associated with a decreased risk of VAP (hazard ratio, 0.62; 95% confidence interval, 0.46–0.83; P<0.0017). The pathogens responsible for VAP were not different between the groups with and without IAI (Pseudomonas aeruginosa, 345 [42.8%] and 24 [42.8%]; Enterobacteriaceae, 264 [32.8%] and 19 [34.0%]; and Staphylococcus aureus, 215 [26.7%] and 17 [30.4%], respectively). Crude ICU mortality was not different between the groups with and without IAI (81 [27.9%] and 747 [32.0%], P = 0.16). Conclusions In our observational study of mechanically ventilated ICU patients with severe sepsis and/or septic shock, VAP occurred less often and later in the group with IAIs compared to the group with infections at other sites. PMID:26339904

  4. Unusual Presentation of Gianotti-Crosti Syndrome due to Epstein-Barr Virus Infection

    PubMed Central

    Al Dhaheri, Hind Saif; Al Kaabi, Amani; Kara Hamo, Yasmin

    2016-01-01

    Gianotti-Crosti syndrome (GCS) is viral exanthema of childhood. It typically presents with a symmetric erythematous papular and papulovesicular eruption. It has been classically associated with hepatitis B virus, as well as rarely with Epstein-Barr virus (EBV). We report a case of GCS related to EBV infection without the classical systemic symptoms in a five-year-old male patient. PMID:28050291

  5. First Probable Case of Subcutaneous Infection Due to Truncatella angustata: a New Fungal Pathogen of Humans?

    PubMed Central

    Żak, Iwona; Tyrak, Jerzy; Bryk, Agata

    2015-01-01

    Truncatella angustata is a coelomycetous fungus, typically associated with vascular plants as either an endophyte or a pathogen. This organism has not previously been implicated in human disease. This report describes a case of T. angustata subcutaneous infection in an immunocompetent patient. A conclusive diagnosis was achieved through partial sequencing of ribosomal DNA (rDNA) cluster. The patient was successfully treated with voriconazole followed by itraconazole. PMID:25809973

  6. Respiratory failure due to blastomycosis infection in a patient with hypertension, cirrhosis and chronic pancreatitis.

    PubMed

    Alhaji, Mohammad; Sadikot, Ruxana T

    2013-12-01

    Blastomycosis is an endemic fungal infection in North America. It usually causes acute and occasionally chronic pneumonias with disseminated infection, particularly skin lesion, as an extrapulmonary manifestation. Many cases are asymptomatic; however, a few patients progress to develop severe pulmonary infection leading to acute respiratory distress syndrome, which carries a high mortality rate. Disseminated blastomycosis involving the heart is exceptionally rare and can be potentially life threatening. To our knowledge, there are only four reported cases of cardiac blastomycosis in the literature. Here, we report a case of cardiac blastomycosis who initially presented with respiratory failure. In our patient, it was practically impossible to establish a diagnosis of cardiac blastomycosis antemortem because of his previous cardiac history related to alcoholic cardiomyopathy, which confounded the cardiac findings. This case raises an important issue of clinically considering involvement of the heart in cases of disseminated blastomycosis. Perhaps if the patient did not have a prior cardiac history, a new onset heart failure may have suggested cardiac involvement.

  7. Abortion due to infection with Chlamydia psittaci in a sheep farmer's wife.

    PubMed Central

    Johnson, F W; Matheson, B A; Williams, H; Laing, A G; Jandial, V; Davidson-Lamb, R; Halliday, G J; Hobson, D; Wong, S Y; Hadley, K M

    1985-01-01

    A farmer's wife who had helped with lambing aborted spontaneously in March after a short febrile illness in the 28th week of her pregnancy. She developed disseminated intravascular coagulation post partum with acute renal failure and pulmonary oedema. Recovery was complete after two weeks of hospital care. A strain of Chlamydia psittaci, probably of ovine origin, was isolated from the placenta and fetus. The patient's serum showed rising titres of antibody against chlamydia group antigen; the placental and fetal isolates; and a known ovine abortion, but not a known avian, strain of C psittaci. IgG against both ovine abortion and enteric strains of C psittaci was detected, but IgM against only an abortion strain was detected. Histological examination showed pronounced intervillus placentitis with chlamydial inclusions in the trophoblast but no evidence of fetal infection or amnionitis. Laboratory evidence of chlamydial infection was found in an aborting ewe on the farm in January and in remaining sheep and lambs in July. Doctors should recognise the possible risk to pregnant women in rural areas where chlamydial infections in farm animals are widespread. Images FIG 1 FIG 2 PMID:3918685

  8. Molecular and serological detection of Babesia bovis- and Babesia bigemina-infection in bovines and water buffaloes raised jointly in an endemic field.

    PubMed

    Romero-Salas, Dora; Mira, Anabela; Mosqueda, Juan; García-Vázquez, Zeferino; Hidalgo-Ruiz, Mario; Vela, Noot Aditya Ortiz; de León, Adalberto Angel Perez; Florin-Christensen, Monica; Schnittger, Leonhard

    2016-02-15

    to tick control than when reared jointly with bovines subjected to tick control (B. bovis 31.6% vs. 9.5%, p<0.01; B. bigemina 42.1% vs. 9.5%, p<0.01, for water buffaloes reared with untreated vs. treated bovines) and/or when reared without bovines (B. bovis 31.6% vs. 11.6%, p<0.01; B. bigemina 42.1% vs. 20%, p<0.01). An accumulation of seropositivity and a decline of infection rates were observed in older animals, while differences observed with regard to gender may warrant further investigation. In summary, our findings suggest that water buffaloes are much more capable to limit or eliminate Babesia infection, possibly due to a more capable immune defense. Furthermore, an increased Babesia spp. parasite reservoir of bovines seems to increase the infection rate of water buffaloes when both are reared on the same pasture.

  9. Six-Month Multicenter Study on Invasive Infections Due to Streptococcus pyogenes and Streptococcus dysgalactiae subsp. equisimilis in Argentina

    PubMed Central

    Lopardo, Horacio A.; Vidal, Patricia; Sparo, Monica; Jeric, Paola; Centron, Daniela; Facklam, Richard R.; Paganini, Hugo; Pagniez, N. Gaston; Lovgren, Marguerite; Beall, Bernard

    2005-01-01

    During a 6-month period, 95 invasive infections due to Streptococcus pyogenes and group C or group G Streptococcus dysgalactiae subsp. equisimilis were recorded from 40 centers of 16 cities in Argentina. We describe here epidemiologic data available for 55 and 19 patients, respectively, associated with invasive infections due to S. pyogenes and S. dysgalactiae subsp. equisimilis. The associated isolates and 58 additional pharyngeal isolates were genotyped and subjected to serologic and/or antibiotic susceptibility testing. Group A streptococcal emm type distribution and strain association with toxic shock appeared to differ somewhat from results found within the United States; however, serologic characterization and sof sequence typing suggested that emm types found in both countries are reflective of shared clonal types. PMID:15695683

  10. Successful management of gastropulmonary fistula due to invasive fungal infection after chemotherapy and autologous stem cell transplantation: a case report

    PubMed Central

    Ričardas, Janilionis; Lina, Lukoševičiūtė; Virgilijus, Beiša; Valdemaras, Jotautas; Roberta, Petrauskaitė; Valdas, Pečeliūnas; Renata, Jucaitienė

    2016-01-01

    Background. Invasive fungal infections (IFI) contribute significantly to mortality and morbidity in patients receiving myelosuppressive chemotherapy for hematologic malignancies. Acquired gastropulmonary fistula is a rare complication of IFI. Material and methods. We present a case history of a patient with malignant myeloma. She was treated with autologous stem cell transplantation and chemotherapy for three years. She had been treated with antifungal agents as well. Following a specific treatment, she developed an invasive fungal infection (IFI) of the left lung which had been complicated with left gastropulmonary fistula. The patient’s general condition was deteriorating, so it was decided to perform a surgical intervention. At the first procedure, open-window thoracostomy was created in order to facilitate treatment by daily packing of the cavity. Four weeks after the thoracostomy, a thoracomyoplasty was performed to repair a gastropleural fistula. During the laparotomy, the gastric fundus was freed from adjacent tissues and repaired. Intrathoracic transposition of the latissimus dorsi and anterior serratus muscle flaps was performed simultaneously to create a new diaphragm. The open-window thoracostomy was left open due to some small bronchial fistulas. The thoracostomy opening healed spontaneously during the following six months. Conclusion. We report what is, to the best of our knowledge, the first case of an invasive fungal infection (Geotrichum capitatum) successfully treated with intravenous amphotericin B, voriconazole, and surgery on infected soft tissues (organs) for a patient with multiple myeloma in prolonged neutropenia. The efficacy and safety of the surgery for infected soft tissues requires further evaluation. PMID:28356805

  11. Successful Treatment of Bloodstream Infection Due to Metallo-β-Lactamase-Producing Stenotrophomonas maltophilia in a Renal Transplant Patient

    PubMed Central

    Mojica, Maria F.; Ouellette, Christopher P.; Leber, Amy; Becknell, M. Brian; Ardura, Monica I.; Perez, Federico; Aitken, Samuel L.

    2016-01-01

    Stenotrophomonas maltophilia is an emerging multidrug-resistant (MDR) opportunistic pathogen for which new antibiotic options are urgently needed. We report our clinical experience treating a 19-year-old renal transplant recipient who developed prolonged bacteremia due to metallo-β-lactamase-producing S. maltophilia refractory to conventional treatment. The infection recurred despite a prolonged course of colistimethate sodium (colistin) but resolved with the use of a novel drug combination with clinical efficacy against the patient's S. maltophilia isolate. PMID:27551008

  12. Early in situ changes in chondrocyte biomechanical responses due to a partial meniscectomy in the lateral compartment of the mature rabbit knee joint.

    PubMed

    Fick, J M; P Ronkainen, A; Madden, R; Sawatsky, A; Tiitu, V; Herzog, W; Korhonen, R K

    2016-12-08

    We determined the biomechanical responses of chondrocytes to indentation at specific locations within the superficial zone of cartilage (i.e. patellar, femoral groove, femoral condylar and tibial plateau sites) taken from female New Zealand white rabbits three days after a partial meniscectomy in the lateral compartment of a knee joint. Confocal laser scanning microscopy combined with a custom indentation system was utilized to image chondrocyte responses at sites taken from ten contralateral and experimental knee joints. Cell volume, height, width and depth changes, global, local axial and transverse strains and Young׳s moduli were determined. Histological assessment was performed and proteoglycan content from the superficial zone of each site was determined. Relative to contralateral group cells, patellar, femoral groove and lateral femoral condyle cells in the experimental group underwent greater volume decreases (p < 0.05), due to smaller lateral expansions (with greater decreases in cell height only for the lateral femoral condyle cells; p < 0.05) whereas medial femoral and medial tibial plateau cells underwent smaller volume decreases (p < 0.05), due to less deformation in cell height (p < 0.05). Proteoglycan content was reduced in the patellar (p > 0.05), femoral groove, medial femoral condyle and medial tibial plateau experimental sites (p < 0.05). The findings suggest: (i) cell biomechanical responses to cartilage loading in the rabbit knee joint can become altered as early as 3 days after a partial meniscectomy, (ii) are site-specific, and (iii) occur before alterations in tissue mechanics or changes detectable with histology.

  13. [A case of liver abscess due to Streptococcus anginosus infection secondary to a dental extraction].

    PubMed

    Iwashita, Hideyuki; Matsui, Noriaki; Tsukamoto, Shinji; Funakoshi, Sadahiro; Yamaguchi, Masashi; Kabemura, Teppei; Sohda, Tetsuro; Sakisaka, Shotaro

    2015-08-01

    A 74-year-old man was referred to our hospital because of a high fever. He had undergone a dental extraction about 1 month prior to admission because of apical periodontitis. Imaging study revealed liver abscess lesions. Infection with Streptococcus anginosus was confirmed using both stab and blood culture. An adequate selection of antibiotics was administered, and a good outcome was obtained. There have been no case reports of liver abscess caused by intraoral commensal flora related to dental extraction in healthy adults. This case shows that liver abscesses can occur secondary to dental extractions, even in healthy adults.

  14. Splenic abscess due to fungal infection after kidney transplantation; a case report

    PubMed Central

    Malakoutian, Tahereh; Yarmohamadi, Maliheh; Mohammadi, Ronak; Asgari, Mojgan; Mahmoodian, Reyhaneh

    2016-01-01

    Splenic abscess is one of the rare and potentially life-threatening complications after kidney transplantation. Splenic abscess generally occurs in patients who have immunodeficiency state. It becomes more important with the increased use of immunosuppressed drugs and organ transplantation. The clinical presentation of splenic abscess is insidious, often with constitutional symptoms. Left upper quadrant tenderness is an uncommon sign. Therefore, its diagnosis is difficult and requires a high degree of clinical suspicion. We report a case under renal transplantation with recurrent fungal infection in different organs with two episodes of fungemia who died after splenectomy. PMID:27689116

  15. [Atrial chaotic tachycardia during a respiratory tract infection due to NL63 coronavirus].

    PubMed

    Chantreuil, J; Favrais, G; Soule, N; Maakaroun-Vermesse, Z; Chaillon, A; Chantepie, A; Saliba, E

    2013-03-01

    We report the case of a 3-month-old boy hospitalized with acute bronchiolitis. Respiratory distress was associated with cardiogenic shock caused by chaotic atrial tachycardia. The cause of bronchiolitis was a coronavirus NL63 viral infection, confirmed in nasopharyngeal aspirations. The patient required intensive care including diuretics (furosemide), anti-arrhythmic drugs (amiodarone and digoxin), and inotropic drugs (milrinone and levosimendan) associated with mechanical ventilation. The outcome was favorable in 10 days and the sinusal cardiac rhythm was completely restored at discharge.

  16. Arsenophonus nasoniae and Rickettsiae Infection of Ixodes ricinus Due to Parasitic Wasp Ixodiphagus hookeri

    PubMed Central

    Bohacsova, Monika; Mediannikov, Oleg; Kazimirova, Maria; Raoult, Didier; Sekeyova, Zuzana

    2016-01-01

    Arsenophonus nasoniae, a male-killing endosymbiont of chalcid wasps, was recently detected in several hard tick species. Following the hypothesis that its presence in ticks may not be linked to the direct occurrence of bacteria in tick's organs, we identified A. nasoniae in wasps emerging from parasitised nymphs. We confirmed that 28.1% of Ixodiphagus hookeri wasps parasitizing Ixodes ricinus ticks were infected by A. nasoniae. Moreover, in examined I. ricinus nymphs, A. nasoniae was detected only in those, which were parasitized by the wasp. However, in part of the adult wasps as well as in some ticks that contained wasp's DNA, we did not confirm A. nasoniae. We also found, that in spite of reported male-killing, some newly emerged adult wasp males were also infected by A. nasoniae. Additionally, we amplified the DNA of Rickettsia helvetica and Rickettsia monacensis (known to be Ixodes ricinus-associated bacteria) in adult parasitoid wasps. This may be related either with the digested bacterial DNA in wasp body lumen or with a role of wasps in circulation of rickettsiae among tick vectors. PMID:26901622

  17. Arsenophonus nasoniae and Rickettsiae Infection of Ixodes ricinus Due to Parasitic Wasp Ixodiphagus hookeri.

    PubMed

    Bohacsova, Monika; Mediannikov, Oleg; Kazimirova, Maria; Raoult, Didier; Sekeyova, Zuzana

    2016-01-01

    Arsenophonus nasoniae, a male-killing endosymbiont of chalcid wasps, was recently detected in several hard tick species. Following the hypothesis that its presence in ticks may not be linked to the direct occurrence of bacteria in tick's organs, we identified A. nasoniae in wasps emerging from parasitised nymphs. We confirmed that 28.1% of Ixodiphagus hookeri wasps parasitizing Ixodes ricinus ticks were infected by A. nasoniae. Moreover, in examined I. ricinus nymphs, A. nasoniae was detected only in those, which were parasitized by the wasp. However, in part of the adult wasps as well as in some ticks that contained wasp's DNA, we did not confirm A. nasoniae. We also found, that in spite of reported male-killing, some newly emerged adult wasp males were also infected by A. nasoniae. Additionally, we amplified the DNA of Rickettsia helvetica and Rickettsia monacensis (known to be Ixodes ricinus-associated bacteria) in adult parasitoid wasps. This may be related either with the digested bacterial DNA in wasp body lumen or with a role of wasps in circulation of rickettsiae among tick vectors.

  18. DRESS syndrome due to antibiotic therapy of osteoarticular infections in children: two case reports.

    PubMed

    Ramírez, A; Abril, J C; Cano, J

    2015-01-01

    Osteoarticular infection in children frequently occurs before 10 years of age. Surgical drainage is sometimes required, whereas acute osteomyelitis can be treated with antibiotic therapy alone. The duration of antibiotic therapy varies, 2 weeks is sufficient for septic arthritis, whereas 6 weeks is often required for complicated cases. Some of these antibiotic drugs present direct complications with low clinical impact in certain individuals. Hypersensitivity to these drugs causes different reactions in children. DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe and potentially life-threatening drug reaction. It is characterised by high fever, malaise, lymphadenopathy and skin rash. From a clinical perspective, these symptoms can lead to an exacerbation of the initial infectious process for which treatment was commenced. The liver is the organ most often affected in DRESS syndrome associated with haematological changes, potentially similar to sepsis. We present two cases of children with osteoarticular infections who developed DRESS syndrome after antibiotic therapy. Both patients made a complete recovery after cessation of the antibiotic drugs used.

  19. Risk of human toxocarosis in Poland due to Toxocara infection of dogs and cats.

    PubMed

    Gawor, Jakub; Borecka, Anna; Marczyńska, Magdalena; Dobosz, Sabina; Żarnowska-Prymek, Hanna

    2014-03-01

    The purpose of this paper was to present the current data on the risk of toxocarosis in humans in Poland and to give an overview of the clinical and diagnostic aspects of the disease. The number of reported clinical cases of Toxocara infection in children in Poland in medical literature has increased recently. The results of field surveys aimed to evaluate the soil contamination with geohelminth eggs conducted during the last few years showed that Toxocara is the most common zoonotic agent in urban public sites and in rural settlements. The questionnaire revealed rural inhabitants' low awareness of zoonotic parasite threats to humans. In particular parents should be advised as to what proper preventive measures to undertake to eliminate the toxocarosis risk factors for children in rural environment. Prevention of initial environment contamination with Toxocara canis and T. cati eggs, which includes proper treatment regimes to eliminate patent infections in dogs and cats and preventing pets from defecating in public areas and private households is vital. To provide the public with suitably presented information as well as pet owners with uniform recommendations, a close collaboration between veterinary and public health professionals is crucial.

  20. Role of host xanthine oxidase in infection due to enteropathogenic and Shiga-toxigenic Escherichia coli

    PubMed Central

    Crane, John K

    2013-01-01

    Xanthine oxidase (XO) has been recognized as an important host defense enzyme for decades. In our recent study in Infection and Immunity, we found that enteropathogenic and Shiga-toxigenic E. coli (EPEC and STEC) were far more resistant to killing by the XO pathway than laboratory E. coli strains used in the past. Although XO plus hypoxanthine substrate rarely generated enough H2O2 to kill EPEC and STEC, the pathogens were able to sense the H2O2 and react to it with an increase in expression of virulence factors, most notably Shiga toxin (Stx). H2O2 produced by XO also triggered a chloride secretory response in T84 cell monolayers studied in the Ussing chamber. Adding exogenous XO plus its substrate in vivo did not decrease the number of STEC bacteria recovered from ligated intestinal loops, but instead appeared to worsen the infection and increased the amount of Stx2 toxin produced. XO plus hypoxanthine also increases the ability of Stx2 to translocate across intestinal monolayers. With regard to EPEC and STEC, the role of XO appears more complex and subtle than what has been reported in the past, since XO also plays a role in host-pathogen signaling, in regulating virulence in pathogens, in Stx production and in toxin translocation. Uric acid produced by XO may also be in itself an immune modulator in the intestinal tract. PMID:23811846

  1. Role of host xanthine oxidase in infection due to enteropathogenic and Shiga-toxigenic Escherichia coli.

    PubMed

    Crane, John K

    2013-01-01

    Xanthine oxidase (XO) has been recognized as an important host defense enzyme for decades. In our recent study in Infection and Immunity, we found that enteropathogenic and Shiga-toxigenic E. coli (EPEC and STEC) were far more resistant to killing by the XO pathway than laboratory E. coli strains used in the past. Although XO plus hypoxanthine substrate rarely generated enough H 2O 2 to kill EPEC and STEC, the pathogens were able to sense the H2O2 and react to it with an increase in expression of virulence factors, most notably Shiga toxin (Stx). H 2O 2 produced by XO also triggered a chloride secretory response in T84 cell monolayers studied in the Ussing chamber. Adding exogenous XO plus its substrate in vivo did not decrease the number of STEC bacteria recovered from ligated intestinal loops, but instead appeared to worsen the infection and increased the amount of Stx2 toxin produced. XO plus hypoxanthine also increases the ability of Stx2 to translocate across intestinal monolayers. With regard to EPEC and STEC, the role of XO appears more complex and subtle than what has been reported in the past, since XO also plays a role in host-pathogen signaling, in regulating virulence in pathogens, in Stx production and in toxin translocation. Uric acid produced by XO may also be in itself an immune modulator in the intestinal tract.

  2. Surveillance of prosthetic joint infections: international overview and new insights for hospital databases.

    PubMed

    Grammatico-Guillon, L; Rusch, E; Astagneau, P

    2015-02-01

    Since the US National Nosocomial Infections Surveillance System was implemented in the 1970s, several countries have developed their own surveillance systems, all including surgical site infection (SSI) as a major target. However, the performance of such systems needs to be evaluated further in terms of data quality and cost-effectiveness. The current article presents a literature overview of the main strategies used for SSI surveillance worldwide, focusing on hip and knee arthroplasty infections, and discusses new issues for further development of surveillance databases.

  3. Excessive pediatric fasciitis necrotisans due to Pseudomonas aeruginosa infection successfully treated with negative pressure wound therapy.

    PubMed

    Szabó, Levente; Szegedi, István; Kiss, Csongor; Szikszay, Edit; Remenyik, Éva; Csízy, István; Juhász, István

    2015-01-01

    The case of a 10-year old female child is described with a history of myeloproliferative disorder having skin, bone and visceral involvement. Bone marrow biopsy revealed histiocytosis X. During chemotherapy necrotizing fasciitis of the lower abdominal wall was diagnosed. Multiple microbiological cultures taken from the wound base revealed Pseudomonas aeruginosa infection. Surgical necrectomy and application of negative pressure wound therapy (NPWT) was started together with intensive care treatment for sepsis. As both wound and general condition of the patient improved, autologous split thickness skin grafting was carried out in two sitting under continuing NPWT application. The applied skin grafts showed excellent take, the perilesional subcutaneous recesses resolved and complete healing was achieved after 28 days of NPWT treatment. Proper dermatological diagnosis and immediate escharectomy complemented with application of NPWT can be life-saving in the treatment of necrotizing fasciitis.

  4. A Rare Case of Primary Supraclavicular Lymphadenitis due to Cryptococcus Neoformans in an HIV Infected Patient

    PubMed Central

    Sood, Anuradha; Chandel, Lata R; Chauhan, Smriti; Thakur, Kamlesh; Jaryal, S.C

    2014-01-01

    Cryptococcosis caused by encapsulated yeast Cryptococcus neoformans most commonly presents as disease of the central nervous system. Cryptococcus is a non–mycelial budding yeast found in soil, pigeon droppings and their nesting places. The three ‘classic’ virulence factors of cryptococci are: polysaccharide capsule, melanin production and growth at 37°C. Here, we present a rare case of cryptococcosis affecting left supraclavicular lymph node in a Human Immunodeficiency virus (HIV) infected individual. Culture of fine needle aspirate of the lymph node yielded Cryptococcus neoformans which was identified by standard microbiological techniques. Meyer’s mucicarmine stain imparted a typical rose burgundy colour to the capsule. Unusual characteristics of the isolate included poorly developed capsule and the presence of yeast in chains resembling pseudo-hyphae. This case highlights the importance of microbiological techniques for diagnosis and prompt treatment of cryptococcosis. PMID:24701506

  5. [Outbreak of nosocomial urinary tract infections due to a multidrug resistant Pseudomonas aeruginosa].

    PubMed

    Boutiba-Ben Boubaker, I; Boukadida, J; Triki, O; Hannachi, N; Ben Redjeb, S

    2003-04-01

    An outbreak of a multidrug resistant Pseudomonas aeruginosa including imipenem resistance occurred in the urology intensive care unit at Charles Nicolle Hospital (Tunis). All isolates presented the same antibiotic resistance pattern and were only susceptible to colistin. The epidemic strain was detected in different sites of this unit. Pulsed-field gel electrophoresis after enzymatic restriction using XbaI was performed in order to establish an epidemiologic link between these infections. Genotypic analysis showed two different patterns and the environmental source was identified in both cases. Although the same antibiotype was harbored by all the isolates, two outbreaks occurring in the same period were identified. The strengthening of hygiene measures allowed to stop the outbreak spreading. Since the hospital environment is the major source of Pseudomonas aeruginosa contamination, a continuous surveillance of the patients and the environmental sources is required for the implementation efficient control measures.

  6. Health burden in the Netherlands due to infection with thermophilic Campylobacter spp.

    PubMed Central

    Havelaar, A. H.; de Wit, M. A.; van Koningsveld, R.; van Kempen, E.

    2000-01-01

    Infection with thermophilic Campylobacter spp. usually leads to an episode of acute gastroenteritis. Occasionally, more severe diseases may be induced, notably Guillain Barré syndrome and reactive arthritis. For some, the disease may be fatal. We have integrated available data in one public health measure, the Disability Adjusted Life Year (DALY). DALYs are the sum of Years of Life Lost by premature mortality and Years Lived with Disability, weighted with a factor between 0 and 1 for the severity of illness. The mean health burden of campylobacter-associated illness in the Dutch population in the period 1990-5 is estimated as 1400 (90% CI 900-2000) DALY per year. The main determinants of health burden are acute gastroenteritis (440 DALY), gastroenteritis related mortality (310 DALY) and residual symptoms of Guillain-Barré syndrome (340 DALY). Sensitivity analysis demonstrated that alternative model assumptions produced results in the above-mentioned range. PMID:11218201

  7. [Case report: respiratory infection due to Alcaligenes xylosoxidans in a patient with Mounier-Kuhn syndrome].

    PubMed

    Arroyo-Cózar, Marta; Ruiz-García, Montserrat; Merlos, Eva M; Vielba, David; Macías, Enrique

    2012-10-01

    Mounier-Kuhn syndrome is a rare entity characterized by abnormal dilatation of the trachea and main bronchi (tracheobronchomegaly). Alcaligenes xylosoxidans is a non fermenting gram-negative pathogen common in extra-and intra-hospital environment, which may be related to immunosuppression states. We describe the case of a 75 years old male, ex-smoker with moderate functional obstruction, chronic respiratory failure and chronic colonization by Pseudomonas aeuriginosa. He had an infectious exacerbation of his disease, reason that previously required several hospital admissions. The patient was treated with antibiotics and his evolution was favourable with negativization in cultures of the pathogen. This is the first description of the isolation of Alcaligenes xylosoxidans as a cause of respiratory infection in a patient with Mounier-Kuhn syndrome.

  8. Potential risk of norovirus infection due to the consumption of "ready to eat" food.

    PubMed

    Serracca, Laura; Rossini, Irene; Battistini, Roberta; Goria, Maria; Sant, Serena; De Montis, Gabriella; Ercolini, Carlo

    2012-09-01

    In this study, we investigated the presence of enteric viruses such as norovirus (NoV), hepatitis A virus (HAV), hepatitis E virus (HEV), and adenovirus (HAdV), in vegetables available on the Italian markets. For this aim, 110 national and international "ready to eat" samples were collected and analyzed by biomolecular tests and positive samples were confirmed by sequencing. All samples (100 %) were negative for HAV, HEV, and HAdV, while 13.6 % (15/110) were positive for NoV. Actually there is not a formal surveillance system for NoV infections in Italy but we clearly demonstrated a potential risk associated with the consumption of "ready to eat" vegetables. This study confirmed for the first time in Italy the presence of norovirus in semi-dried tomatoes by PCR technique.

  9. Perceptions and behaviours of infectious diseases physicians when managing urinary tract infections due to MDR organisms

    PubMed Central

    Trevino, Sergio E.; Babcock, Hilary M.; Henderson, Jeffrey P.; Lane, Michael A.; Beekmann, Susan E.; Polgreen, Philip M.; Marschall, Jonas

    2015-01-01

    Objectives The objective of this study was to attain a better understanding of infectious diseases (ID) physicians' experience with MDR organism (MDRO) urinary tract infections (UTIs) by means of a survey on disease perception, diagnostic management and treatment preferences. Methods A nine-question survey was developed and distributed to members of the North American Emerging Infections Network (EIN) in September 2013. Results Seven hundred and fourteen out of 1461 EIN members responded to the survey (49%). The responses of 603 responders were studied. Most providers perceived an increase in the incidence of MDRO UTIs over the past 3 years (75% of adult ID responders and 63% of paediatric ID responders). One hundred and thirty-four (22%) responders prefer intravenous over oral administration of antimicrobials when both are available, 171 (28%) prefer longer durations of therapy when comparing an MDRO with a susceptible isolate of the same species and 142 (24%) order a repeat urine culture as ‘proof of cure’ after treating an MDRO UTI. Nevertheless, 530 (88%) responders perceived MDRO UTIs to be of similar severity as non-MDRO UTIs. Fifty-five percent of providers prescribed fosfomycin for MDRO UTI at least once; the most common prescribing pattern (among a wide spectrum of approaches) was a single dose (16%). Conclusions Future studies on MDRO UTIs should clarify the role of resistance in patient outcomes and the comparative efficacy of different antimicrobials. Of particular interest is fosfomycin, which is unrelated to other antibiotic classes and may take a more prominent role in treating MDRO cystitis. PMID:26349519

  10. Salmonellosis outbreak due to chicken contact leading to a foodborne outbreak associated with infected delicatessen workers.

    PubMed

    Hedican, Erin; Miller, Ben; Ziemer, Brian; LeMaster, Pam; Jawahir, Selina; Leano, Fe; Smith, Kirk

    2010-08-01

    Salmonella is the most common bacterial cause of foodborne outbreaks in the United States. Starting in June 2007, investigation of a cluster of Salmonella Montevideo cases with indistinguishable pulsed-field gel electrophoresis (PFGE) patterns resulted in the identification of an outbreak associated with contact with chickens purchased from a single hatchery. Nine Minnesota cases from May through August 2007 were part of this outbreak. Cases with the outbreak PFGE pattern of Salmonella Montevideo continued to occur in Minnesota after August, but none of these cases reported chicken contact. The majority of these cases resided in the same town in rural Minnesota. Routine interviews revealed that all cases from these counties purchased groceries from the same local grocery store, with two specifically reporting consuming items from the grocery store delicatessen in the week before illness. As a result, an investigation into the delicatessen was initiated. Illness histories and stool samples were collected from all delicatessen employees, and food and environmental samples were collected. None of the employees reported experiencing recent gastrointestinal symptoms, but the outbreak PFGE subtype of Salmonella Montevideo was identified from stool from two food workers. Food and environmental samples collected tested negative for Salmonella. One of the positive employees reported having chickens at home, but the animals did not test positive for Salmonella. The positive food workers were excluded from work until they had two consecutive negative stool cultures for Salmonella. There was no evidence of ongoing transmission thereafter. This was an outbreak of Salmonella Montevideo infections that began as an animal-contact-associated outbreak which subsequently resulted in a foodborne outbreak associated with infected food workers. These outbreaks illustrate the complex epidemiology of salmonellosis.

  11. High resolution melt analysis to track infections due to ribotype 027 Clostridium difficile.

    PubMed

    Grando, Danilla; Said, Mohamed M; Mayall, Barrie C; Gurtler, Volker

    2012-05-01

    The increased prevalence of hypervirulent ribotype 027 Clostridium difficile requires rapid identification of isolates in order to implement timely infection control strategies. High resolution melt (HRM) analysis of PCR products can identify strain variation amongst genera of bacteria. The intergenic (16S-23S rDNA) spacer region contains sequence regions conserved within genera and other sequence region variables between species within genera. We wished to investigate whether HRM analysis of PCR ribotyping products could identify ribotype 027 C. difficile. Ribotyping was performed on 93 clinical isolates and five control strains and band patterns were analysed using GelCompar II (Applied Maths, USA). Real-time PCR using ribotyping primers was performed and normalised melt curves were generated. The HRM data was then imported into ScreenClust software (QIAGEN) to generate principal component analysis graphs depicting clustered relationships of strains. Ribotyping produced clear PCR bands for 88/98 isolates tested. Dendrograms generated by GelCompar showed a diversity of ribotype patterns amongst these 88 isolates with 18 groups identified with 70% homology. One clinical isolate showed 100% homology with the control 027 strains. ScreenClust analysis of the same 88 HRM results showed clustering of isolates, with 027 strains identifiable as a unique cluster. HRM analysis correctly identified the control 027 stains and the clinical isolate shown to be 027. HRM combined with ScreenClust analysis of real-time PCR products of the 16S-23S rDNA spacer region successfully identified ribotype 027 strains. For infection control purposes this was achieved within 2-3 h of colony isolation.

  12. Knowledge, Attitudes and Practices Regarding Risk to Human Infection due to Mycobacterium bovis among Cattle Farming Communities in Western Uganda.

    PubMed

    Kazoora, H B; Majalija, S; Kiwanuka, N; Kaneene, J B

    2016-12-01

    A cross-sectional study involving multistage cluster sampling was undertaken in Kashari county, Mbarara district, western Uganda, in which quantitative and qualitative approaches were utilized to determine the knowledge, attitudes and practices regarding risk of human infection with zoonotic tuberculosis due to Mycobacterium bovis among cattle farmers. Of 496 respondents, 50% were farm owners and 50% herdsmen. Males were 70.9% of all the study participants. Among these, 37.5% had good knowledge, 41.4% had positive attitudes and 75.2% good practices regarding zoonotic tuberculosis. In the multivariable model, good knowledge was associated with having ever received health education, spending more than 5 years keeping cattle, having heard of cattle condemned at the abattoir due to tuberculosis and marital status. Positive attitudes were associated with having ever received health education, having heard of cattle condemned at the abattoir due to tuberculosis and being a farm owner versus being a herdsman. Good practices were associated with health education and good knowledge of the disease. Overall, knowledge and attitudes towards zoonotic tuberculosis due to M. bovis in humans was found to be low. While the majority of the respondents reported good practices, there were some still consuming raw milk and its products, which may predispose them to infection and indicates the need for greater outreach for zoonotic tuberculosis education.

  13. Pathophysiological Mechanisms of Staphylococcus Non-aureus Bone and Joint Infection: Interspecies Homogeneity and Specific Behavior of S. pseudintermedius

    PubMed Central

    Maali, Yousef; Martins-Simões, Patrícia; Valour, Florent; Bouvard, Daniel; Rasigade, Jean-Philippe; Bes, Michele; Haenni, Marisa; Ferry, Tristan; Laurent, Frédéric; Trouillet-Assant, Sophie

    2016-01-01

    Implicated in more than 60% of bone and joint infections (BJIs), Staphylococci have a particular tropism for osteoarticular tissue and lead to difficult-to-treat clinical infections. To date, Staphylococcus aureus internalization in non-professional phagocytic cells (NPPCs) is a well-explored virulence mechanism involved in BJI chronicity. Conversely, the pathophysiological pathways associated with Staphylococcus non-aureus (SNA) BJIs have scarcely been studied despite their high prevalence. In this study, 15 reference strains from 15 different SNA species were compared in terms of (i) adhesion to human fibronectin based on adhesion microplate assays and (ii) internalization ability, intracellular persistence and cytotoxicity based on an in vitro infection model using human osteoblasts. Compared to S. aureus, S. pseudintermedius was the only species that significantly adhered to human fibronectin. This species was also associated with high (even superior to S. aureus) internalization ability, intracellular persistence and cytotoxicity. These findings were confirmed using a panel of 17 different S. pseudintermedius isolates. Additionally, S. pseudintermedius internalization by osteoblasts was completely abolished in β1 integrin-deficient murine osteoblasts. These results suggest the involvement of β1 integrin in the invasion process, although this mechanism was previously restricted to S. aureus. In summary, our results suggest that internalization into NPPCs is not a classical pathophysiologic mechanism of SNA BJIs. S. pseudintermedius appears to be an exception, and its ability to invade and subsequently induce cytotoxicity in NPPCs could explain its severe and necrotic forms of infection, notably in dogs, which exhibit a high prevalence of S. pseudintermedius infection. PMID:27462303

  14. Pathophysiological Mechanisms of Staphylococcus Non-aureus Bone and Joint Infection: Interspecies Homogeneity and Specific Behavior of S. pseudintermedius.

    PubMed

    Maali, Yousef; Martins-Simões, Patrícia; Valour, Florent; Bouvard, Daniel; Rasigade, Jean-Philippe; Bes, Michele; Haenni, Marisa; Ferry, Tristan; Laurent, Frédéric; Trouillet-Assant, Sophie

    2016-01-01

    Implicated in more than 60% of bone and joint infections (BJIs), Staphylococci have a particular tropism for osteoarticular tissue and lead to difficult-to-treat clinical infections. To date, Staphylococcus aureus internalization in non-professional phagocytic cells (NPPCs) is a well-explored virulence mechanism involved in BJI chronicity. Conversely, the pathophysiological pathways associated with Staphylococcus non-aureus (SNA) BJIs have scarcely been studied despite their high prevalence. In this study, 15 reference strains from 15 different SNA species were compared in terms of (i) adhesion to human fibronectin based on adhesion microplate assays and (ii) internalization ability, intracellular persistence and cytotoxicity based on an in vitro infection model using human osteoblasts. Compared to S. aureus, S. pseudintermedius was the only species that significantly adhered to human fibronectin. This species was also associated with high (even superior to S. aureus) internalization ability, intracellular persistence and cytotoxicity. These findings were confirmed using a panel of 17 different S. pseudintermedius isolates. Additionally, S. pseudintermedius internalization by osteoblasts was completely abolished in β1 integrin-deficient murine osteoblasts. These results suggest the involvement of β1 integrin in the invasion process, although this mechanism was previously restricted to S. aureus. In summary, our results suggest that internalization into NPPCs is not a classical pathophysiologic mechanism of SNA BJIs. S. pseudintermedius appears to be an exception, and its ability to invade and subsequently induce cytotoxicity in NPPCs could explain its severe and necrotic forms of infection, notably in dogs, which exhibit a high prevalence of S. pseudintermedius infection.

  15. Incidence and economic burden of prosthetic joint infections in a university hospital: A report from a middle-income country.

    PubMed

    Alp, Emine; Cevahir, Fatma; Ersoy, Safiye; Guney, Ahmet

    2016-01-01

    In this study, we aimed to evaluate the incidence and economic burden of prosthetic joint infections (PJIs) in a university hospital in a middle-income country. Surveillance data between April 2011 and April 2013 in the Orthopedic Surgery Department was evaluated. Patients (>16 years old) who had primary arthroplasty in Erciyes University were included in the study, and patients with preoperative infection were excluded. Patients were followed up during their stay in the hospital and during readmission to the hospital for PJI by a trained Infection Control Nurse. During the study period, 670 patients were followed up. There were 420 patients (62.7%) with total hip arthroplasty (THA), 241 (36.0%) with total knee arthroplasty (TKA) and 9 (1.3%) with shoulder arthroplasty (SA). The median age was 64, and 70.6% were female. The incidence of PJI was 1.2% (5/420) in THA, 4.6% (11/241) in TKA and 0% (0/9) in SA. PJI was significantly more prevalent in TKA (p=0.029). All of the PJIs showed early infection, and the median time for the development of PJI was 23.5 days (range 7-120 days). The median total length of the hospital stay was seven times higher in PJI patients than patients without PJI (49 vs. 7 days, p=0.001, retrospectively). All hospital costs were 2- to 24-fold higher in patients with PJI than in those without PJI (p=0.001). In conclusion, the incidence and economic burden of PJI was high. Implementing a national surveillance system and infection control protocols in hospitals is essential for the prevention of PJI and a cost-effective solution for the healthcare system in low-middle-income countries.

  16. Molecular Pathogenesis, Epidemiology, and Clinical Manifestations of Respiratory Infections Due to Bordetella pertussis and Other Bordetella Subspecies

    PubMed Central

    Mattoo, Seema; Cherry, James D.

    2005-01-01

    Bordetella respiratory infections are common in people (B. pertussis) and in animals (B. bronchiseptica). During the last two decades, much has been learned about the virulence determinants, pathogenesis, and immunity of Bordetella. Clinically, the full spectrum of disease due to B. pertussis infection is now understood, and infections in adolescents and adults are recognized as the reservoir for cyclic outbreaks of disease. DTaP vaccines, which are less reactogenic than DTP vaccines, are now in general use in many developed countries, and it is expected that the expansion of their use to adolescents and adults will have a significant impact on reducing pertussis and perhaps decrease the circulation of B. pertussis. Future studies should seek to determine the cause of the unique cough which is associated with Bordetella respiratory infections. It is also hoped that data gathered from molecular Bordetella research will lead to a new generation of DTaP vaccines which provide greater efficacy than is provided by today's vaccines. PMID:15831828

  17. Prolongation of length of stay and Clostridium difficile infection: a review of the methods used to examine length of stay due to healthcare associated infections

    PubMed Central

    2012-01-01

    Background It is believed that Clostridium difficile infection (CDI) contributes to a prolongation of length of stay (LOS). Recent literature suggests that models previously used to determine LOS due to infection have overestimated LOS, compared to newer statistical models. The purpose of this review is to understand the impact that CDI has on LOS and in doing so, describe the methodological approaches used. Aim First, to investigate and describe the reported prolongation of LOS in hospitalised patients with CDI. Second, to describe the methodologies used for determining excess LOS. Methods An integrative review method was used. Papers were reviewed and analysed individually and themes were combined using integrative methods. Results Findings from all studies suggested that CDI contributes to a longer LOS in hospital. In studies that compared persons with and without CDI, the difference in the LOS between the two groups ranged from 2.8days to 16.1days. Potential limitations with data analysis were identified, given that no study fully addressed the issue of a time-dependent bias when examining the LOS. Recent literature suggests that a multi-state model should be used to manage the issue of time-dependent bias. Conclusion Studies examining LOS attributed to CDI varied considerably in design and data collected. Future studies examining LOS related to CDI and other healthcare associated infections should consider capturing the timing of infection in order to be able to employ a multi-state model for data analysis. PMID:22958238

  18. Gross margin losses due to Salmonella Dublin infection in Danish dairy cattle herds estimated by simulation modelling.

    PubMed

    Nielsen, T D; Kudahl, A B; Østergaard, S; Nielsen, L R

    2013-08-01

    assumptions about milk yield losses for cows in the resistant or carrier stages had the greatest influence on the estimated GM losses. This was more influential in the poorer management scenarios due to increased number of infected cows. The results can be used to inform dairy farmers of the benefits of preventing introduction and controlling spread of S. Dublin. Furthermore, they can be used in cost-benefit analyses of control actions for S. Dublin both at herd and sector level.

  19. Infective endocarditis due to Bacillus cereus in a pregnant female: A case report and literature review.

    PubMed

    Shah, Mahek; Patnaik, Soumya; Wongrakpanich, Supakanya; Alhamshari, Yaser; Alnabelsi, Talal

    2015-01-01

    Incidence of infective endocarditis during pregnancy is around 0.006% with high maternal and fetal mortality. Bacillus cereus is an extremely rare cause for endocarditis in intravenous drug abusers (IVDA) or those with valvular disease or devices such as pacemakers. We report a case of B. cereus endocarditis, which, to the best of our knowledge, has never been reported in pregnancy. A 30-year-old, 25-week pregnant female presented with right shoulder pain, swelling and erythema on the lateral aspect of deltoid muscle from large abscess over her deltoid muscle. She was found to have a vegetation on the native tricuspid valve. Cultures from abscess fluid and blood cultures grew B. cereus, she was appropriately treated with antimicrobials and had favorable outcomes. There are <20 cases of B. cereus endocarditis reported but none during pregnancy. When cultures grow unusual organisms the case must be thoroughly investigated. This case illustrates a rare situation (endocarditis in pregnancy) with an unusual outcome (B. cereus) on an uncommon valve (tricuspid valve).

  20. Lactoferrin: Balancing Ups and Downs of Inflammation Due to Microbial Infections.

    PubMed

    Drago-Serrano, Maria Elisa; Campos-Rodríguez, Rafael; Carrero, Julio César; de la Garza, Mireya

    2017-03-01

    Lactoferrin (Lf) is a glycoprotein of the primary innate immune-defense system of mammals present in milk and other mucosal secretions. This protein of the transferrin family has broad antimicrobial properties by depriving pathogens from iron, or disrupting their plasma membranes through its highly cationic charge. Noteworthy, Lf also exhibits immunomodulatory activities performing up- and down-regulation of innate and adaptive immune cells, contributing to the homeostasis in mucosal surfaces exposed to myriad of microbial agents, such as the gastrointestinal and respiratory tracts. Although the inflammatory process is essential for the control of invasive infectious agents, the development of an exacerbated or chronic inflammation results in tissue damage with life-threatening consequences. In this review, we highlight recent findings in in vitro and in vivo models of the gut, lung, oral cavity, mammary gland, and liver infections that provide experimental evidence supporting the therapeutic role of human and bovine Lf in promoting some parameters of inflammation and protecting against the deleterious effects of bacterial, viral, fungal and protozoan-associated inflammation. Thus, this new knowledge of Lf immunomodulation paves the way to more effective design of treatments that include native or synthetic Lf derivatives, which may be useful to reduce immune-mediated tissue damage in infectious diseases.

  1. Lactoferrin: Balancing Ups and Downs of Inflammation Due to Microbial Infections

    PubMed Central

    Drago-Serrano, Maria Elisa; Campos-Rodríguez, Rafael; Carrero, Julio César; de la Garza, Mireya

    2017-01-01

    Lactoferrin (Lf) is a glycoprotein of the primary innate immune-defense system of mammals present in milk and other mucosal secretions. This protein of the transferrin family has broad antimicrobial properties by depriving pathogens from iron, or disrupting their plasma membranes through its highly cationic charge. Noteworthy, Lf also exhibits immunomodulatory activities performing up- and down-regulation of innate and adaptive immune cells, contributing to the homeostasis in mucosal surfaces exposed to myriad of microbial agents, such as the gastrointestinal and respiratory tracts. Although the inflammatory process is essential for the control of invasive infectious agents, the development of an exacerbated or chronic inflammation results in tissue damage with life-threatening consequences. In this review, we highlight recent findings in in vitro and in vivo models of the gut, lung, oral cavity, mammary gland, and liver infections that provide experimental evidence supporting the therapeutic role of human and bovine Lf in promoting some parameters of inflammation and protecting against the deleterious effects of bacterial, viral, fungal and protozoan-associated inflammation. Thus, this new knowledge of Lf immunomodulation paves the way to more effective design of treatments that include native or synthetic Lf derivatives, which may be useful to reduce immune-mediated tissue damage in infectious diseases. PMID:28257033

  2. Review: emerging developments in the use of bioactive glasses for treating infected prosthetic joints.

    PubMed

    Rahaman, Mohamed N; Bal, B Sonny; Huang, Wenhai

    2014-08-01

    Bacterial contamination of implanted orthopedic prostheses is a serious complication that requires prolonged systemic antibiotic therapy, major surgery to remove infected implants, bone reconstruction, and considerable morbidity. Local delivery of high doses of antibiotics using poly(methyl methacrylate) (PMMA) cement as the carrier, along with systemic antibiotics, is the standard treatment. However, PMMA is not biodegradable, and it can present a surface on which secondary bacterial infection can occur. PMMA spacers used to treat deep implant infections must be removed after resolution of the infection. Alternative carrier materials for antibiotics that could also restore deficient bone are therefore of interest. In this article, the development of bioactive glass-based materials as a delivery system for antibiotics is reviewed. Bioactive glass is osteoconductive, converts to hydroxyapatite, and heals to hard and soft tissues in vivo. Consequently, bioactive glass-based carriers can provide the combined functions of controlled local antibiotic delivery and bone restoration. Recently-developed borate bioactive glasses are of particular interest since they have controllable degradation rates coupled with desirable properties related to osteogenesis and angiogenesis. Such glasses have the potential for providing a new class of biomaterials, as substitutes for PMMA, in the treatment of deep bone infections.

  3. Levodopa-responsive infantile parkinsonism due to a novel mutation in the tyrosine hydroxylase gene and exacerbation by viral infections.

    PubMed

    Diepold, Katharina; Schütz, Barbara; Rostasy, Kevin; Wilken, Bernd; Hougaard, Pia; Güttler, Flemming; Romstad, Anne; Birk Møller, Lisbeth

    2005-06-01

    Autosomal recessive forms of infantile dystonia due to mutations in the tyrosine hydroxylase (TH) gene have been described recently. The main clinical manifestations are Segawa's disease, or infantile hypokinetic rigid Parkinsonism. Here, we report on a patient with hyperrigidity, psychomotor developmental delay, and dystonic posturing of the hands, symptoms that appeared after a viral infection at the age of 14 months. Low homovanillic acid/5-hydroxyindolacetic acid (HVA/5HIAA) ratio in cerebrospinal fluid suggested a TH deficiency. Molecular analysis revealed a novel (H246Y) and a known (D498G) compound heterozygote mutation in the TH gene. The patient showed a remarkable response to treatment with levodopa. The new mutation and the association of viral infections with the onset and worsening of symptoms are discussed.

  4. Active infective endocarditis due to Erysipelothrix rhusiopathiae: zoonosis caused by vancomycin-resistant gram-positive rod.

    PubMed

    Miura, Takashi; Hashizume, Koji; Ariyoshi, Tsuneo; Miwa, Takashi; Furumoto, Akitsugu; Izumida, Mai; Yanagihara, Katsunori; Eishi, Kiyoyuki

    2013-02-01

    A 42-year-old female who was a voluntary worker in a school for handicapped children was referred to us for surgery for active infective endocarditis. Trans-esophageal echocardiography showed 2 large mobile vegetations on the aortic valve and severe aortic regurgitation. Aortic valve replacement was performed to prevent septic embolism and deterioration of congestive heart failure. The empiric therapy with vancomycin, ampicillin, and gentamycin was initiated because a pathogen was not identified. But Erysipelothrix rhusiopathiae (gram-positive rod) was isolated on the 4th day after surgery. The target therapy with penicillin G and clindamycin was started and continued for 4 weeks after surgery. The inflammatory parameters improved steadily and the patient was discharged on the 36th day after surgery. Infective endocarditis due to gram-positive rods can be easily mistaken for streptococci or dismissed as a skin contamination. But, E. rhusiopathiae endocarditis should be considered in the differential diagnosis.

  5. [Sudden death of a child due to aspiration of the gastric content during an infection with Norwalk-like virus].

    PubMed

    Thiele, Karlheinz; Müller, Lutz; Uerlings, Harald; Schmidt, Uwe

    2005-01-01

    The death of a 1.5-year-old child due to bronchoaspiration of the gastric content in the development of a letal infection caused by Norwalk-like virus was reported. The viral gastrointestinal diseases are common but they rarely produce a severe disease. Recent investigations show that Norwall-like virus (Noro-Virus) is the most frequent gastrointestinal pathogen in Central Europe. The etiological diagnosis of the gastrointestinal disease, starting from autopsy material, was only possible by polymerase chain reaction. The introduction of this technique allowed to reduce the number of cases of gastrointestinal diseases without etiological diagnosis and, at the same time, to increase the demonstration of the occurrence of infection caused by Norwalk-like virus.

  6. [Maternal chorioamnionitis and neonatal conjunctive infection due to an infrequent pathogen].

    PubMed

    García-Agudo, Lidia; Segovia-de la Cruz, Raquel; Palomo-León, Ana Belén; Martino-Castañar, Victoria; Heredero-Gálvez, Eva

    2013-09-01

    Chorioamnionitis generates significant neonatal mortality and morbidity. Its incidence in premature birth can reach 30% and up to 30-40% of cases of premature rupture of membranes is due to this entity. We describe a case of chorioamnionitis by a commensal of the oral flora (Eikenella corrodens) in a pregnant woman with premature rupture of membranes and preterm delivery, which caused conjunctivitis in the newborn. On occasion of this case, we review the issue, delving into the diagnosis and clinical significance of this pathogen.

  7. [Intestinal obstruction due to Ascaris lumbricoides infection in a geriatric patient].

    PubMed

    Chiappe, Alfredo; Arteaga, Kovy; Resurrección, Cristhian; Ñavincopa, Marcos; Ticona, Eduardo

    2016-10-01

    Ascaris lumbricoides is considered the largest intestinal nematode with a higher incidence in the childhood, representing a truly medical and public health problem, principally in undeveloped countries. We present the case of an 83 year old man, born and coming from the amazon region, without any relevant previous history of disease, admitted in the emergency department of our hospital for presenting intestinal obstruction and also presumptive biliary obstruction due to multiple balls of parasites, requiring immediate surgical intervention. We emphasize the need of consider this etiologic possibility in the differential diagnosis, that in this particular case, wasn't suspected in the first place.

  8. Streptococcus gordonii—a rare cause of prosthetic joint infection in a total hip replacement

    PubMed Central

    Fenelon, Christopher; Galbraith, John G.; Dalton, David M.; Masterson, Eric

    2017-01-01

    A 69-year-old female with a history of bilateral total hip replacements presented with rigors, fever and sudden onset left groin pain. A pelvic X-ray showed well-fixed implants. Blood results revealed a leucocytosis (white cell count 22.3 × 109 l–1) and elevated C-reactive protein (211 mg/l). Ultrasound-guided aspiration of her left hip grew Streptococcus gordonii. No source infection could be identified apart from a new chronic sinus infection in a left upper incisor. Following a discussion with the patient a 6-week course of intravenous ceftriaxone was started and was successful in normalizing her inflammatory markers. She was placed on long-term suppressive amoxicillin following this. Her suppressive antibiotic therapy was complicated by the development of a clostridium difficile infection and her antibiotics were changed to doxycycline. At 1-year follow-up, she was asymptomatic with no further episodes of groin pain or fever. PMID:28096320

  9. Increased Costs Associated with Bloodstream Infections Caused by Multidrug-Resistant Gram-Negative Bacteria Are Due Primarily to Patients with Hospital-Acquired Infections.

    PubMed

    Thaden, Joshua T; Li, Yanhong; Ruffin, Felicia; Maskarinec, Stacey A; Hill-Rorie, Jonathan M; Wanda, Lisa C; Reed, Shelby D; Fowler, Vance G

    2017-03-01

    The clinical and economic impacts of bloodstream infections (BSI) due to multidrug-resistant (MDR) Gram-negative bacteria are incompletely understood. From 2009 to 2015, all adult inpatients with Gram-negative BSI at our institution were prospectively enrolled. MDR status was defined as resistance to ≥3 antibiotic classes. Clinical outcomes and inpatient costs associated with the MDR phenotype were identified. Among 891 unique patients with Gram-negative BSI, 292 (33%) were infected with MDR bacteria. In an adjusted analysis, only history of Gram-negative infection was associated with MDR BSI versus non-MDR BSI (odds ratio, 1.60; 95% confidence interval [CI], 1.19 to 2.16; P = 0.002). Patients with MDR BSI had increased BSI recurrence (1.7% [5/292] versus 0.2% [1/599]; P = 0.02) and longer hospital stay (median, 10.0 versus 8.0 days; P = 0.0005). Unadjusted rates of in-hospital mortality did not significantly differ between MDR (26.4% [77/292]) and non-MDR (21.7% [130/599]) groups (P = 0.12). Unadjusted mean costs were 1.62 times higher in MDR than in non-MDR BSI ($59,266 versus $36,452; P = 0.003). This finding persisted after adjustment for patient factors and appropriate empirical antibiotic therapy (means ratio, 1.18; 95% CI, 1.03 to 1.36; P = 0.01). Adjusted analysis of patient subpopulations revealed that the increased cost of MDR BSI occurred primarily among patients with hospital-acquired infections (MDR means ratio, 1.41; 95% CI, 1.10 to 1.82; P = 0.008). MDR Gram-negative BSI are associated with recurrent BSI, longer hospital stays, and increased mean inpatient costs. MDR BSI in patients with hospital-acquired infections primarily account for the increased cost.

  10. Meta-Analysis of Sonication Fluid Samples from Prosthetic Components for Diagnosis of Infection after Total Joint Arthroplasty

    PubMed Central

    Zhai, Zanjing; Li, Haowei; Qin, An; Liu, Guangwang; Liu, Xuqiang; Wu, Chuanlong; Li, Huiwu; Zhu, Zhenan

    2014-01-01

    This meta-analysis included 12 studies that evaluated sonication fluid cultures (SFC) for the diagnosis of prosthetic joint infection (PJI). The pooled sensitivity and specificity were 0.80 (95% confidence interval [CI], 0.74 to 0.84) and 0.95 (CI, 0.90 to 0.98), respectively. Subgroup analyses showed that a 14-day anaerobic culture may improve sensitivity, the use of centrifugation or vortexing may improve specificity, and the use of 400 to 500 ml of Ringer's solution for containers may improve sensitivity and specificity. The best SFC cutoff was ≥5 CFU. In conclusion, SFC has high sensitivity and very high specificity for diagnosing PJI. PMID:24574298

  11. Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study.

    PubMed

    Rodríguez-Pardo, D; Pigrau, C; Lora-Tamayo, J; Soriano, A; del Toro, M D; Cobo, J; Palomino, J; Euba, G; Riera, M; Sánchez-Somolinos, M; Benito, N; Fernández-Sampedro, M; Sorli, L; Guio, L; Iribarren, J A; Baraia-Etxaburu, J M; Ramos, A; Bahamonde, A; Flores-Sánchez, X; Corona, P S; Ariza, J

    2014-11-01

    We aim to evaluate the epidemiology and outcome of gram-negative prosthetic joint infection (GN-PJI) treated with debridement, antibiotics and implant retention (DAIR), identify factors predictive of failure, and determine the impact of ciprofloxacin use on prognosis. We performed a retrospective, multicentre, observational study of GN-PJI diagnosed from 2003 through to 2010 in 16 Spanish hospitals. We define failure as persistence or reappearance of the inflammatory joint signs during follow-up, leading to unplanned surgery or repeat debridement>30 days from the index surgery related death, or suppressive antimicrobial therapy. Parameters predicting failure were analysed with a Cox regression model. A total of 242 patients (33% men; median age 76 years, interquartile range (IQR) 68-81) with 242 episodes of GN-PJI were studied. The implants included 150 (62%) hip, 85 (35%) knee, five (2%) shoulder and two (1%) elbow prostheses. There were 189 (78%) acute infections. Causative microorganisms were Enterobacteriaceae in 78%, Pseudomonas spp. in 20%, and other gram-negative bacilli in 2%. Overall, 19% of isolates were ciprofloxacin resistant. DAIR was used in 174 (72%) cases, with an overall success rate of 68%, which increased to 79% after a median of 25 months' follow-up in ciprofloxacin-susceptible GN-PJIs treated with ciprofloxacin. Ciprofloxacin treatment exhibited an independent protective effect (adjusted hazard ratio (aHR) 0.23; 95% CI, 0.13-0.40; p<0.001), whereas chronic renal impairment predicted failure (aHR, 2.56; 95% CI, 1.14-5.77; p 0.0232). Our results confirm a 79% success rate in ciprofloxacin-susceptible GN-PJI treated with debridement, ciprofloxacin and implant retention. New therapeutic strategies are needed for ciprofloxacin-resistant PJI.

  12. Clinical manifestations of Eosinophilic meningitis due to infection with Angiostrongylus cantonensis in children.

    PubMed

    Sawanyawisuth, Kittisak; Chindaprasirt, Jarin; Senthong, Vichai; Limpawattana, Panita; Auvichayapat, Narong; Tassniyom, Sompon; Chotmongkol, Verajit; Maleewong, Wanchai; Intapan, Pewpan M

    2013-12-01

    Eosinophilic meningitis, caused by the nematode Angiostrongylus cantonensis, is prevalent in northeastern Thailand, most commonly in adults. Data regarding clinical manifestations of this condition in children is limited and may be different those in adults. A chart review was done on 19 eosinophilic meningitis patients aged less than 15 years in Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. Clinical manifestations and outcomes were reported using descriptive statistics. All patients had presented with severe headache. Most patients were males, had fever, nausea or vomiting, stiffness of the neck, and a history of snail ingestion. Six patients had papilledema or cranial nerve palsies. It was shown that the clinical manifestations of eosinophilic meningitis due to A. cantonensis in children are different from those in adult patients. Fever, nausea, vomiting, hepatomegaly, neck stiffness, and cranial nerve palsies were all more common in children than in adults.

  13. Iliopsoas Abscess Possibly due to Klebsiella pneumoniae Infection after Chemoradiotherapy for Hypopharyngeal Cancer

    PubMed Central

    Hyo, Yukiyoshi; Fujisaki, Tomoya; Hyo, Rui; Tanaka, Hiroki; Harada, Tamotsu

    2016-01-01

    Iliopsoas abscess was once an uncommon condition but now occurs somewhat more frequently due to the increasing number of immunocompromised patients, such as those with diabetes. We encountered a case of iliopsoas abscess following chemoradiotherapy for hypopharyngeal cancer. A 60-year-old man was admitted for a sore throat and left neck swelling. Hypopharyngeal cancer was diagnosed, but the patient refused surgery. After two rounds of chemotherapy, febrile neutropenia developed and chest computed tomography (CT) revealed an iliopsoas abscess. The platelet count was low but recovered after administration of antibiotics and could not be explained by puncture of the abscess. CT-guided drainage eventually improved his symptoms. Even for disorders of the head and neck region, iliopsoas abscess should be suspected in immunocompromised patients who develop a fever. CT and magnetic resonance imaging should be performed at an early stage as it is important to determine whether surgical drainage is indicated. PMID:26989543

  14. Continuous Regional Arterial Infusion Therapy for Acute Necrotizing Pancreatitis Due to Mycoplasma pneumoniae Infection in a Child

    SciTech Connect

    Nakagawa, Motoo Ogino, Hiroyuki; Shimohira, Masashi; Hara, Masaki; Shibamoto, Yuta

    2009-05-15

    A case of acute necrotizing pancreatitis due to Mycoplasma pneumoniae infection was treated in an 8-year-old girl. She experienced acute pancreatitis during treatment for M. pneumoniae. Contrast-enhanced computed tomographic scan revealed necrotizing pancreatitis. The computed tomographic severity index was 8 points (grade E). A protease inhibitor, ulinastatin, was provided via intravenous infusion but was ineffective. Continuous regional arterial infusion therapy was provided with gabexate mesilate (FOY-007, a protease inhibitor) and meropenem trihydrate, and the pancreatitis improved. This case suggests that infusion therapy is safe and useful in treating necrotizing pancreatitis in children.

  15. Acute post-infectious cerebellar ataxia due to co-infection of human herpesvirus-6 and adenovirus mimicking myositis.

    PubMed

    Naselli, Aldo; Pala, Giovanna; Cresta, Federico; Finetti, Martina; Biancheri, Roberta; Renna, Salvatore

    2014-11-26

    Acute cerebellar ataxia (ACA) is a relatively common neurological disease in children. Most common types of ACA are acute post-infectious (APCA) and acute disseminated encephalomyelitis (ADEM). Less common but important causes include opsoclonus-myoclonus syndrome (OMS) and acute cerebellitis. Cerebellar neoplasms and acute hydrocephalus are additional causes of paediatric ataxia. APCA is the most common cause of ACA in children, comprising about 30-50% of total cases. This is a report about an immunocompetent 4-yrs-old male affected by APCA, due to co-infection by human herpesvirus-6 (HHV-6) and adenovirus, with symptoms mimicking myositis.

  16. Clinical efficacy of β-lactam/β-lactamase inhibitor combinations for the treatment of bloodstream infection due to extended-spectrum β-lactamase-producing Enterobacteriaceae in haematological patients with neutropaenia: a study protocol for a retrospective observational study (BICAR)

    PubMed Central

    Gudiol, C; Royo-Cebrecos, C; Tebe, C; Abdala, E; Akova, M; Álvarez, R; Maestro-de la Calle, G; Cano, A; Cervera, C; Clemente, W T; Martín-Dávila, P; Freifeld, A; Gómez, L; Gottlieb, T; Gurguí, M; Herrera, F; Manzur, A; Maschmeyer, G; Meije, Y; Montejo, M; Peghin, M; Rodríguez-Baño, J; Ruiz-Camps, I; Sukiennik, T C; Carratalà, J

    2017-01-01

    Introduction Bloodstream infection (BSI) due to extended-spectrum β-lactamase-producing Gram-negative bacilli (ESBL-GNB) is increasing at an alarming pace worldwide. Although β-lactam/β-lactamase inhibitor (BLBLI) combinations have been suggested as an alternative to carbapenems for the treatment of BSI due to these resistant organisms in the general population, their usefulness for the treatment of BSI due to ESBL-GNB in haematological patients with neutropaenia is yet to be elucidated. The aim of the BICAR study is to compare the efficacy of BLBLI combinations with that of carbapenems for the treatment of BSI due to an ESBL-GNB in this population. Methods and analysis A multinational, multicentre, observational retrospective study. Episodes of BSI due to ESBL-GNB occurring in haematological patients and haematopoietic stem cell transplant recipients with neutropaenia from 1 January 2006 to 31 March 2015 will be analysed. The primary end point will be case-fatality rate within 30 days of onset of BSI. The secondary end points will be 7-day and 14-day case-fatality rates, microbiological failure, colonisation/infection by resistant bacteria, superinfection, intensive care unit admission and development of adverse events. Sample size The number of expected episodes of BSI due to ESBL-GNB in the participant centres will be 260 with a ratio of control to experimental participants of 2. Ethics and dissemination The protocol of the study was approved at the first site by the Research Ethics Committee (REC) of Hospital Universitari de Bellvitge. Approval will be also sought from all relevant RECs. Any formal presentation or publication of data from this study will be considered as a joint publication by the participating investigators and will follow the recommendations of the International Committee of Medical Journal Editors (ICMJE). The study has been endorsed by the European Study Group for Bloodstream Infection and Sepsis (ESGBIS) and the European Study Group

  17. Can hierarchical modeling improve our understanding of bovine abortion due to Neospora caninum infection?

    PubMed

    Martinez, Brayan Alexander Fonseca; Leotti, Vanessa Bielefeldt; Borba, Mauro Riegert; Silva, Gustavo de Sousa E; Corbellini, Luís Gustavo

    2017-04-15

    The purpose of this study was to use mixed logistic regression to evaluate the association between Neospora caninum serostatus and abortion, accounting for the effects of farms. The main objective was to explore the interpretation of this model and discuss the contribution of this analysis to our understanding of the disease's epidemiology. A mixed-effects logistic model using farms as a random effect and the serostatus for N. caninum, age of cattle and farm location as fixed effects was performed. The data from 1256 cows over 15 months of age from 60 farms were used, and the abortion information was obtained from farm records. A significant association between N. caninum serostatus and abortion was found (p<0.0001). Seropositive cows had 6.63 times greater odds of having a history of previous abortion (95% CI: 4.35-13.37). There was remarkable variability across farms in the probability of a cow having a history of an abortion. Including the effects of the farms in the regression, it was possible to estimate an intraclass correlation coefficient (ICC) of 16%. That means that 16% of the variation in abortion occurrence that was not explained by the fixed effects was due to farms. In practical terms, this variation means that while there are farms with several seropositive cows and no/few abortion cases, the opposite is also true, with a high number of abortions in farms with low/medium seroprevalence. The remaining variability (84%) was not explained by the effect of N. caninum, age, region, and the effect of farms, i.e., it is due to unknown factors that are causing abortions. The results of this study reinforce the importance of N. caninum as a cause of abortions and demonstrate the significant heterogeneity in the probability of a cow having a history of an abortion that cannot be explained completely by N. caninum serostatus, age or location. Including the hierarchical structure of the population along with correct interpretation of the model estimates helps us

  18. Pneumonia and Pleural Empyema due to a Mixed Lactobacillus spp. Infection as a Possible Early Esophageal Carcinoma Signature

    PubMed Central

    Chaini, Eleftheria; Chainis, Nikolaos D.; Ioannidis, Anastasios; Magana, Maria; Nikolaou, Chryssoula; Papaparaskevas, Joseph; Liakata, Melina-Vassiliki; Katopodis, Panagiotis; Papastavrou, Leonidas; Tegos, George P.; Chatzipanagiotou, Stylianos

    2016-01-01

    Lactobacilli are human commensals found in the gastrointestinal and genitourinary tract. Although generally conceived as non-pathogenic microorganisms, the existence of several reports implicating them in certain severe pathological entities renders this species as opportunistic pathogens. The case of a 58-year-old woman with mixed Lactobacillus infection is described. The patient was admitted in an outpatient clinic with community acquired pneumonia, and on the third day of hospitalization she presented rapid pneumonia deterioration. Subsequent imaging techniques revealed increased pleural empyema in alignment with the general deterioration of her clinical condition. Pleural fluid culture revealed the presence of Lactobacillus delbrueckii and Lactobacillus gasseri and the infection was successfully treated with clindamycin. Five months after hospital discharge and an overall good condition, the patient developed signs of dysphagia and upon re-admission an inoperable esophageal carcinoma was diagnosed. The patient succumbed to the cancer 11 months later. Herein, we report for the first time a mixed respiratory infection due to lactobacilli, possibly associated with a formerly unveiled esophageal malignancy. PMID:27734016

  19. Pacemaker pocket infection due to environmental mycobacteria: Successful management of an outbreak and steps for prevention in future

    PubMed Central

    Bharat, Vijaya; Hittinahalli, Vivek; Mishra, Meenakshi; Pradhan, Sridhar

    2016-01-01

    Background An outbreak of surgical site infection (SSI) due to environmental mycobacteria (EMB) occurred in a hospital in Eastern India. Method A quality improvement project (QIP) was undertaken to analyze the causes and prevent further outbreak. Step (1) Proof of the need: Four patients who had undergone pacemaker implantation consecutively during a 10-day period developed SSI. Step (2) Diagnostic journey: Since all patients developed SSI within 2 months of implantation, a common source of infection was likely. Atypical mycobacteria (AMB) were grown from surgical sites as well as from the surface of operation table, image intensifier, and lead aprons. It was a rapid growing variety that lacked pigment, a characteristic of EMB with pathogenic potential. The EMB was finally traced to its source, the overhead water tank. Step (3) Remedial journey: By thorough cleaning of the water tank and enriching its chlorine content, the EMB was eliminated from its source. Step (4) Holding the gains: Protocol for cleaning the water tank once in 3 months was made. A checklist was prepared to ensure compliance to asepsis protocol in the operation theater. In the ensuing 5 years, the infection did not recur. Result The bacteria that caused SSI were identified as EMB that grew in the water tank and contaminated the operation room. It could be eliminated by appropriate measures. Interpretation Water is a potential reservoir for EMB. Use of the term ‘environmental mycobacteria’ instead of ‘atypical mycobacteria’ will generate awareness about contamination as the cause of SSI. PMID:26896269

  20. Epidemiology and Clinical Characteristics of Respiratory Infections Due to Adenovirus in Children Living in Milan, Italy, during 2013 and 2014

    PubMed Central

    Esposito, Susanna; Zampiero, Alberto; Bianchini, Sonia; Mori, Alessandro; Scala, Alessia; Tagliabue, Claudia; Sciarrabba, Calogero Sathya; Fossali, Emilio; Piralla, Antonio; Principi, Nicola

    2016-01-01

    To evaluate the predominant human adenovirus (HAdV) species and types associated with pediatric respiratory infections, nasopharyngeal swabs were collected from otherwise healthy children attending an emergency room in Milan, Italy, due to a respiratory tract infection from January 1 to February 28 of two subsequent years, 2013 and 2014. The HAdVs were detected using a respiratory virus panel fast assay (xTAG RVP FAST v2) and with a HAdV-specific real-time polymerase chain reaction; their nucleotides were sequenced, and they were tested for positive selection. Among 307 nasopharyngeal samples, 61 (19.9%) tested positive for HAdV. HAdV was the only virus detected in 31/61 (50.8%) cases, whereas it was found in association with one other virus in 25 (41.0%) cases and with two or more viruses in 5 (8.2%) cases. Human Enterovirus/human rhinovirus and respiratory syncytial virus were the most common co-infecting viral agents and were found in 12 (19.7%) and 7 (11.5%) samples, respectively. Overall, the HAdV strain sequences analyzed were highly conserved. In comparison to HAdV-negative children, those infected with HAdV had a reduced frequency of lower respiratory tract involvement (36.1% vs 55.2%; p = 0.007), wheezing (0.0% vs 12.5%; p = 0.004), and hospitalization (27.9% vs 56.1%; p<0.001). Antibiotic therapy and white blood cell counts were more frequently prescribed (91.9% vs 57.1%; p = 0.04) and higher (17,244 ± 7,737 vs 9,565 ± 3,211 cells/μL; p = 0.04), respectively, in children infected by HAdV-C than among those infected by HAdV-B. On the contrary, those infected by HAdV-B had more frequently lower respiratory tract involvement (57.1% vs 29.7%) but difference did not reach statistical significant (p = 0.21). Children with high viral load were absent from child care attendance for a longer period of time (14.5 ± 7.5 vs 5.5 ± 3.2 days; p = 0.002) and had higher C reactive protein levels (41.3 ± 78.5 vs 5.4 ± 9.6 μg/dL; p = 0.03). This study has shown that

  1. The Epidemiology of Pediatric Bone and Joint Infections in Cambodia, 2007–11

    PubMed Central

    Pocock, Joanna; Moore, Catrin E.; Soeng, Sona; Hor, PutChhat; Sar, Poda; Limmathurotsakul, Direk; Day, Nicholas; Kumar, Varun; Khan, Sophy; Sar, Vuthy; Parry, Christopher M.

    2013-01-01

    There are limited data on osteoarticular infections from resource-limited settings in Asia. A retrospective study of patients presenting to the Angkor Hospital for Children, Cambodia, January 2007–July 2011, identified 81 cases (28% monoarticular septic arthritis, 51% single-limb osteomyelitis and 15% multisite infections). The incidence was 13.8/100 000 hospital attendances. The median age was 7.3 years, with a male/female ratio of 1.9:1; 35% presented within 5 days of symptom onset (median 7 days). Staphylococcus aureus was cultured in 29 (36%) cases (52% of culture-positive cases); one isolate was methicillin-resistant (MRSA). Median duration of antimicrobial treatment was 29 days (interquartile range 21–43); rates of surgical intervention were 96%, and 46% of children had sequelae, with one fatality. In this setting osteoarticular infections are relatively common with high rates of surgical intervention and sequelae. Staphylococcus aureus is the commonest culturable cause, but methicillin-resistant S. aureus is not a major problem, unlike in other Asian centers. PMID:22977206

  2. Borrelia burgdorferi migrates into joint capsules and causes an up-regulation of interleukin-8 in synovial membranes of dogs experimentally infected with ticks.

    PubMed Central

    Straubinger, R K; Straubinger, A F; Härter, L; Jacobson, R H; Chang, Y F; Summers, B A; Erb, H N; Appel, M J

    1997-01-01

    Twenty 6-week-old specific-pathogen-free beagles were infected with Borrelia burgdorferi by tick challenge, and five uninfected dogs served as controls. During the study, all dogs were monitored for infection, clinical signs, and antibody response against B. burgdorferi. During episodes of lameness or postmortem, synovial fluids from each dog were examined for volume, cell number, polymorphonuclear leukocyte (PMN) content, cell viability, and chemotactic activity. Twenty-five tissues collected postmortem from each dog were tested for interleukin-8 (IL-8) mRNA, tumor necrosis factor alpha (TNF-alpha) mRNA, presence of live spirochetes, and histopathological changes. Thirteen infected dogs (group A), which seroconverted rapidly (maximum titers within 50 to 90 days), developed acute and severe mono- or oligoarthritis almost exclusively in the limb closest to the tick bite (median incubation period, 66 days). Synovial fluids of the arthritic joints collected during episodes of lameness had significantly elevated volume, cell count, PMN proportion, cell viability, and chemotactic activity for PMNs. The remaining joints of the same animals contained synovial fluids with elevated chemotactic activity and cell viability. Twelve dogs tested positive for IL-8 mRNA in multiple tissues (synovia, pericardium, and peritoneum), and 10 dogs expressed TNF-alpha mRNA, but only in the tributary lymph nodes of the inflamed joints. Histological examinations revealed severe poly- or oligoarthritis and moderate to severe cortical hyperplasia in draining lymph nodes of the inflamed joints in all 13 dogs. Seven infected dogs with mild or no clinical signs (group B) seroconverted slowly (peak titers after 90 days), and only some joint fluids showed chemotactic activity, which on average was lower than that in inflamed and noninflamed joints from dogs in group A. Four dogs expressed IL-8 mRNA (in the synovia and pericardium), and three dogs had TNF-alpha mRNA in tributary lymph nodes

  3. Increase in Bloodstream Infection Due to Vancomycin-Susceptible Enterococcus faecium in Cancer Patients: Risk Factors, Molecular Epidemiology and Outcomes

    PubMed Central

    Gudiol, Carlota; Ayats, Josefina; Camoez, Mariana; Domínguez, M. Ángeles; García-Vidal, Carolina; Bodro, Marta; Ardanuy, Carmen; Obed, Mora; Arnan, Montserrat; Antonio, Maite; Carratalà, Jordi

    2013-01-01

    We conducted a prospective study to assess the risk factors, molecular epidemiology and outcome of bloodstream infection (BSI) due to Enterococcus faecium in hospitalized cancer patients. Between 2006 and 2012, a significant increase in vancomycin-susceptible E. faecium BSI was observed among cancer patients. Comparison of 54 episodes of BSI due to E. faecium with 38 episodes of BSI due to E. faecalis showed that previous use of carbapenems was the only independent risk factor for E. faecium acquisition (OR 10.24; 95% CI, 1.35-77.66). All E. faecium isolates were susceptible to glycopeptides, whereas 97% showed high-level resistance to ampicillin and ciprofloxacin. All 30 isolates available for genotyping belonged to the hospital-associated E. faecium lineages 17, 18 and 78. After 2009, most of the isolates belonged to ST117 (lineage 78). Patients with E. faecium BSI were more likely to receive inadequate initial empirical antibiotic therapy than patients with E. faecalis BSI, and time to adequate empirical antibiotic therapy was also longer in the former group. No significant differences were found between the two groups regarding early and overall case-fatality rates. Independent risk factors for overall case-fatality were current corticosteroids (OR 4.18; 95% CI, 1.34-13.01) and intensive care unit admission (OR 9.97; 95% CI, 1.96-50.63). The emergence of E. faecium among cancer patients is a concern since there are limited treatment options and it may presage the emergence of vancomycin-resistant enterococci. A rationale approach that combines infection control with antimicrobial stewardship. PMID:24069339

  4. Recombinational joints in a simian virus 40 variant generated in a persistent infection.

    PubMed

    Norkin, L C; Piatak, M

    1982-12-01

    SP1, a viable simian virus 40 (SV40) variant isolated from a persistent infection of rhesus monkey kidney cells, contains sequence rearrangements in the untranslated region of the SV40 genome which are transcribed into late mRNA leader sequences and in the region which encodes the large T antigen. Nucleotide sequences about the recombinational junctions in SP1 were determined. The sequence data show that in most instances there was not extensive homology between recombining sequences. The recombinant sequences are discussed with respect to the mechanisms by which they might have been generated.

  5. Human Herpesvirus 6 DNA Levels in Cerebrospinal Fluid Due to Primary Infection Differ from Those Due to Chromosomal Viral Integration and Have Implications for Diagnosis of Encephalitis▿

    PubMed Central

    Ward, Katherine N.; Leong, Hoe Nam; Thiruchelvam, Anton D.; Atkinson, Claire E.; Clark, Duncan A.

    2007-01-01

    The prevalence and concentration of human herpesvirus 6 (HHV-6) DNA in the cerebrospinal fluid (CSF) of the immunocompetent in primary infection was compared with that in viral chromosomal integration. Samples from 510 individuals with suspected encephalitis, 200 young children and 310 older children and/or adults, and 12 other patients were tested. HHV-6 DNA concentration (log10 copies/ml) was measured in CSF, serum, and whole blood using PCR. Serum HHV-6 immunoglobulin G antibody was measured by indirect immunofluorescence. Primary infection was defined by antibody seroconversion and/or a low concentration of HHV-6 DNA (<3.0 log10 copies/ml) in a seronegative serum. Chromosomal integration was defined by a high concentration of viral DNA in serum (≥3.5 log10 copies/ml) or whole blood (≥6.0 log10 copies/ml). The prevalences of CSF HHV-6 DNA in primary infection and chromosomal integration were 2.5% and 2.0%, respectively, in the young children (<2 years) and 0% and 1.3%, respectively, in the older children and/or adults. The mean concentration of CSF HHV-6 DNA in 9 children with primary infection (2.4 log10 copies/ml) was significantly lower than that of 21 patients with viral chromosomal integration (4.0 log10 copies/ml). Only HHV-6B DNA was found in primary infection, whereas in viral integration, 4 patients had HHV-6A and 17 patients HHV-6B. Apart from primary infection, chromosomal integration is the most likely cause of HHV-6 DNA in the CSF of the immunocompetent. Our results show that any diagnosis of HHV-6 encephalitis or other type of active central nervous system infection should not be made without first excluding chromosomal HHV-6 integration by measuring DNA load in CSF, serum, and/or whole blood. PMID:17229866

  6. Deep prosthetic joint infection: a qualitative study of the impact on patients and their experiences of revision surgery

    PubMed Central

    Blom, Ashley W; Whitehouse, Michael R; Gooberman-Hill, Rachael

    2015-01-01

    Objectives Around 1% of patients who have a hip replacement have deep prosthetic joint infection (PJI) afterwards. PJI is often treated with antibiotics plus a single revision operation (1-stage revision), or antibiotics plus a 2-stage revision process involving more than 1 operation. This study aimed to characterise the impact and experience of PJI and treatment on patients, including comparison of 1-stage with 2-stage revision treatment. Design Qualitative semistructured interviews with patients who had undergone surgical revision treatment for PJI. Patients were interviewed between 2 weeks and 12 months postdischarge. Data were audio-recorded, transcribed, anonymised and analysed using a thematic approach, with 20% of transcripts double-coded. Setting Patients from 5 National Health Service (NHS) orthopaedic departments treating PJI in England and Wales were interviewed in their homes (n=18) or at hospital (n=1). Participants 19 patients participated (12 men, 7 women, age range 56–88 years, mean age 73.2 years). Results Participants reported receiving between 1 and 15 revision operations after their primary joint replacement. Analysis indicated that participants made sense of their experience through reference to 3 key phases: the period of symptom onset, the treatment period and protracted recovery after treatment. By conceptualising their experience in this way, and through themes that emerged in these periods, they conveyed the ordeal that PJI represented. Finally, in light of the challenges of PJI, they described the need for support in all of these phases. 2-stage revision had greater impact on participants’ mobility, and further burdens associated with additional complications. Conclusions Deep PJI impacted on all aspects of patients’ lives. 2-stage revision had greater impact than 1-stage revision on participants’ well-being because the time in between revision procedures meant long periods of immobility and related psychological distress

  7. Renal trematode infection due to Paratanaisia bragai in zoo housed Columbiformes and a red bird-of-paradise (Paradisaea rubra).

    PubMed

    Unwin, Steve; Chantrey, Julian; Chatterton, James; Aldhoun, Jitka A; Littlewood, D Timothy J

    2013-12-01

    Trematode infections affect a diverse range of avian species and the organs that are parasitised are also very varied. The family Eucotylidae contains seven genera of renal flukes that parasitise various birds. In birds, mild to severe lesions have been reported for species of the genus Paratanaisia, which was originally described from columbiform and galliform specimens collected in South America and has been identified in a number of wild avian species. This paper investigates eight cases of renal trematode infection at Chester Zoo in the UK due to Paratanaisia bragai in five previously unreported species: red bird-of-paradise, Socorro dove, Mindanao bleeding heart dove, laughing dove and emerald dove. Pathological changes, which varied between species, are discussed. A known intermediate snail host Allopeas clavulinum was present in the enclosures but there was no direct evidence of trematode infection. The size of the snails, possible low prevalence and the difficulty of visualising sporocysts contributed to this. Thus the development and application of further molecular diagnostic markers that can be applied to snail tissues is warranted. Parasite identification was confirmed utilizing DNA amplification from formalin-fixed paraffin-embedded tissues using PCR and trematode specific primers. Sequencing full ssrDNA and D1-D3 lsrDNA confirmed the identity in all cases as P. bragai. However, the short 310 bp fragment used provides insufficient variation or sequence length for wider application. The epidemiology, pathology and consequences for the management of these endangered species are discussed. Preliminary work on developing an effective ante mortem diagnostic PCR test kit is also highlighted.

  8. Ascitic fluid due to type II herpes simplex virus infection: report of a case with immunocytochemical confirmation.

    PubMed

    Yoshida, Keiko; Miyahira, Yoshimitsu; Ishida, Mitsuaki; Iwai, Muneo; Kagotani, Akiko; Arita, Namie; Iwamoto, Nozomi; Takikita, Mikiko; Kojima, Fumiyoshi; Okabe, Hidetoshi

    2013-04-01

    Herpes simplex virus (HSV) infection is usually observed in the oral cavity and external genitals, and HSV peritonitis is extremely rare. Herein, we report a case of type II HSV peritonitis successfully diagnosed by ascitic cytology. A 66-year-old Japanese man, who had been treated with steroid inhalation for 5 years due to chronic obstructive pulmonary disease, was suspected to have acute cholecystitis. Laparoscopic cholecystectomy and intraoperative cytological examination of ascitic fluid were performed. Cytological study of ascitic fluid revealed that abundant granular cell debris, degenerative cells and apoptotic bodies were present, as well as some single or multinucleated cells with ground glass nuclei. However, vivid mesothelial cells were rarely seen. Immunocytochemical staining for type II HSV was positive in single or multinucleated cells with ground glass nuclei. Therefore, a diagnosis of type II HSV peritonitis was made. This is the first reported case of type II HSV peritonitis successfully diagnosed by ascitic cytology. This report highlights that the presence of abundant cell debris, degenerative cells and apoptotic bodies, and the absence of vivid mesothelial cells are the key cytological findings to suspect HSV peritonitis, and the diagnosis can be confirmed by careful surveillance for characteristic nuclear findings of single or multinucleated cells. The frequency of opportunistic infection is increased because of the increased numbers of iatrogenic immunocompromised patients as seen in this case, therefore, cytological examination is a useful method for early detection of the causative agent of peritonitis including HSV.

  9. Implantation of mitral, aortic, and tricuspid bioprostheses due to infective endocarditis with necessary reimplantation of the bioprosthetic aortic valve.

    PubMed

    Danielecki, Cezary; Bugajski, Paweł; Olszewski, Roman; Greberski, Krzysztof; Kalawski, Ryszard

    2016-09-01

    The patient was admitted to the Department of Cardiac Surgery of the J. Struś City Hospital in Poznan due to infective endocarditis involving the aortic, mitral, and tricuspid valves. Implantation of three biological valve prostheses proceeded without complications. Starting on day 23, the patient's general condition deteriorated, with high fever. Despite postoperative antibiotic therapy, transesophageal echocardiography revealed the presence of vegetation on the bioprosthetic aortic valve. On the 46(th) day after the initial surgery, the patient required replacement of the aortic bioprosthesis, which exhibited the presence of numerous vegetations. The bioprosthetic mitral and tricuspid valves were not affected by the degenerative process. On the 12(th) day after the reimplantation of the bioprosthetic aortic valve, the patient was discharged from the hospital in good general condition.

  10. Implantation of mitral, aortic, and tricuspid bioprostheses due to infective endocarditis with necessary reimplantation of the bioprosthetic aortic valve

    PubMed Central

    Bugajski, Paweł; Olszewski, Roman; Greberski, Krzysztof; Kalawski, Ryszard

    2016-01-01

    The patient was admitted to the Department of Cardiac Surgery of the J. Struś City Hospital in Poznan due to infective endocarditis involving the aortic, mitral, and tricuspid valves. Implantation of three biological valve prostheses proceeded without complications. Starting on day 23, the patient's general condition deteriorated, with high fever. Despite postoperative antibiotic therapy, transesophageal echocardiography revealed the presence of vegetation on the bioprosthetic aortic valve. On the 46th day after the initial surgery, the patient required replacement of the aortic bioprosthesis, which exhibited the presence of numerous vegetations. The bioprosthetic mitral and tricuspid valves were not affected by the degenerative process. On the 12th day after the reimplantation of the bioprosthetic aortic valve, the patient was discharged from the hospital in good general condition. PMID:27785140

  11. Endocarditis due to a co-infection of Candida albicans and Candida tropicalis in a drug abuser.

    PubMed

    Fesharaki, Shirinsadat Hashemi; Haghani, Iman; Mousavi, Bita; Kargar, Melika Laal; Boroumand, Mohammadali; Anvari, Maryam Sotoudeh; Abbasi, Kyomars; Meis, Jacques F; Badali, Hamid

    2013-11-01

    In recent decades the incidence of Candida endocarditis has increased dramatically. Despite the application of surgery and antifungal therapy, Candida endocarditis remains a life-threatening infection with significant morbidity and mortality. We report a 37-year-old male drug abuser presenting with high fever, chest pain, loss of appetite and cardiac failure. His echocardiography revealed mobile large tricuspid valve vegetations. Fungal endocarditis was confirmed by culturing of the resected vegetation showing mixed growth of Candida albicans and Candida tropicalis, although three consecutive blood cultures were negative for Candida species. Phenotypic identification was reconfirmed by sequencing of the internal transcribed spacer (ITS rDNA) region. The patient was initially treated with intravenous fluconazole (6 mg kg(-1) per day), followed by 2 weeks of intravenous amphotericin B deoxycholate (1 mg kg(-1) per day). Although MICs were low for both drugs, the patient's antifungal therapy combined with valve replacement failed, and he died due to respiratory failure.

  12. Mechanism of Radial Redistribution of Energetic Trapped Ions Due to m=2/n=1 Internal Reconnection in Joint European Torus Shear Optimized Plasmas

    SciTech Connect

    N.N. Gorelenkov; A. Gondhalekar; A.A. Korotkov; S.E. Sharapov; D. Testa; and Contributors to the EFDA-JET Workprogramme

    2002-01-18

    Internal radial redistribution of MeV energy ICRF-driven hydrogen minority ions was inferred from neutral particle analyzer measurements during large amplitude MHD activity leading to internal reconnection in Shear Optimized plasmas in the Joint European Torus (JET). A theory is developed for energetic ion redistribution during a reconnection driven by an m=2/n=1 internal kink mode. Plasma motion during reconnection generates an electric field which can change the energy and radial position of the energetic ions. The magnitude of ion energy change depends on the value of the safety factor at the plasma core from which the energetic ions are redistributed. A relation is found for corresponding change in canonical momentum. P(subscript phi), which leads to radial displacement of the ions. The model yields distinctive new features of energetic ion redistribution under such conditions. Predicted characteristics of ion redistribution are compared with the NPA measurements, and good correlation is found. Sometimes fast ions were transported to the plasma edge due to interaction with a long-lived magnetic island which developed after the reconnection and had chirping frequency in the laboratory frame. Convection of resonant ions trapped in a radially moving phase-space island is modeled to understand the physics of such events.

  13. Rheumatoid arthritis patients are not at increased risk for 30-day cardiovascular events, infections, or mortality after total joint arthroplasty

    PubMed Central

    2013-01-01

    Introduction Serious infection, cardiovascular disease, and mortality are increased in rheumatoid arthritis (RA). Whether RA affects the risk for these complications after total joint arthroplasty (TJA) is unknown, we hypothesize that it does. We compared the occurrence of 30-day postoperative complications and mortality in a large cohort of RA and osteoarthritis (OA) patients undergoing hip or knee TJA. Methods Analyses included 7-year data from the Veterans Affairs Surgical Quality Improvement Program. The 30-day complications were compared by diagnosis by using logistic regression, and long-term mortality was examined by using Cox proportional hazards regression. All analyses were adjusted for age, sex, and clustering by surgical site. Additional covariates included sociodemographics, comorbidities, health behaviors, and operative risk factors. Results The 34,524 patients (839 RA, 33,685 OA) underwent knee (65.9%) or hip TJA. Patients were 95.7% men with a mean (SD) age of 64.4 (10.7) years and had 3,764 deaths over a mean follow-up of 3.7 (2.3) years. Compared with OA patients, those with RA were significantly more likely to require a return to the operating room (odds ratio (OR), 1.45 (95% CI, 1.08 to 1.94), but had similar rates of 30-day postoperative infection, OR 1.02 (0.72 to 1.47), cardiovascular events, OR 0.69 (0.37 to 1.28), and mortality, OR 0.94 (0.38 to 2.33). RA was associated with a significantly higher long-term mortality; hazard ratio (HR), 1.22 (1.00 to 1.49). Conclusion In this study of US veterans, RA patients were not at an increased risk for short-term mortality or other major complications after TJA, although they returned to the operating room more often and had increased long-term mortality. PMID:24252350

  14. Characterization of Staphylococcus caprae Clinical Isolates Involved in Human Bone and Joint Infections, Compared with Goat Mastitis Isolates.

    PubMed

    d'Ersu, J; Aubin, G G; Mercier, P; Nicollet, P; Bémer, P; Corvec, S

    2016-01-01

    Staphylococcus caprae is an emerging microorganism in human bone and joint infections (BJI). The aim of this study is to describe the features of S. caprae isolates involved in BJI (H for human) compared with those of isolates recovered in goat mastitis (A for animal). Fourteen isolates of each origin were included. Identifications were performed using a Vitek 2 GP ID card, tuf gene sequencing, and matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) Vitek MS. Molecular typing was carried out using pulsed-field gel electrophoresis (PFGE) and DiversiLab technology. The crystal violet method was used to determine biofilm-forming ability. Virulence factors were searched by PCR. Vitek MS technology provides an accurate identification for the two types of isolates compared to that of gold-standard sequencing (sensitivity, 96.4%), whereas the Vitek 2 GP ID card was more effective for H isolates. Molecular typing methods revealed two distinct lineages corresponding to the origin despite few overlaps: H and A. In our experimental conditions, no significant difference was observed in biofilm production ability between H and A isolates. Nine isolates (5 H isolates and 4 A isolates) behaved as weak producers while one A isolate was a strong producer. Concerning virulence factors, the autolysin atlC and the serine aspartate adhesin (sdrZ) genes were detected in 24 isolates (86%), whereas the lipase gene was always detected, except in one H isolate (96%). The ica operon was present in 23 isolates (82%). Fibrinogen-binding (fbe) or collagen-binding (cna) genes were not detected by using primers designed for Staphylococcus aureus or Staphylococcus epidermidis, even in low stringency conditions. Although S. caprae probably remains underestimated in human infections, further studies are needed to better understand the evolution and the adaptation of this species to its host.

  15. Characterization of Staphylococcus caprae Clinical Isolates Involved in Human Bone and Joint Infections, Compared with Goat Mastitis Isolates

    PubMed Central

    d'Ersu, J.; Aubin, G. G.; Mercier, P.; Nicollet, P.; Bémer, P.

    2015-01-01

    Staphylococcus caprae is an emerging microorganism in human bone and joint infections (BJI). The aim of this study is to describe the features of S. caprae isolates involved in BJI (H for human) compared with those of isolates recovered in goat mastitis (A for animal). Fourteen isolates of each origin were included. Identifications were performed using a Vitek 2 GP ID card, tuf gene sequencing, and matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) Vitek MS. Molecular typing was carried out using pulsed-field gel electrophoresis (PFGE) and DiversiLab technology. The crystal violet method was used to determine biofilm-forming ability. Virulence factors were searched by PCR. Vitek MS technology provides an accurate identification for the two types of isolates compared to that of gold-standard sequencing (sensitivity, 96.4%), whereas the Vitek 2 GP ID card was more effective for H isolates. Molecular typing methods revealed two distinct lineages corresponding to the origin despite few overlaps: H and A. In our experimental conditions, no significant difference was observed in biofilm production ability between H and A isolates. Nine isolates (5 H isolates and 4 A isolates) behaved as weak producers while one A isolate was a strong producer. Concerning virulence factors, the autolysin atlC and the serine aspartate adhesin (sdrZ) genes were detected in 24 isolates (86%), whereas the lipase gene was always detected, except in one H isolate (96%). The ica operon was present in 23 isolates (82%). Fibrinogen-binding (fbe) or collagen-binding (cna) genes were not detected by using primers designed for Staphylococcus aureus or Staphylococcus epidermidis, even in low stringency conditions. Although S. caprae probably remains underestimated in human infections, further studies are needed to better understand the evolution and the adaptation of this species to its host. PMID:26511738

  16. Edge profile analysis of Joint European Torus (JET) Thomson scattering data: Quantifying the systematic error due to edge localised mode synchronisation.

    PubMed

    Leyland, M J; Beurskens, M N A; Flanagan, J C; Frassinetti, L; Gibson, K J; Kempenaars, M; Maslov, M; Scannell, R

    2016-01-01

    The Joint European Torus (JET) high resolution Thomson scattering (HRTS) system measures radial electron temperature and density profiles. One of the key capabilities of this diagnostic is measuring the steep pressure gradient, termed the pedestal, at the edge of JET plasmas. The pedestal is susceptible to limiting instabilities, such as Edge Localised Modes (ELMs), characterised by a periodic collapse of the steep gradient region. A common method to extract the pedestal width, gradient, and height, used on numerous machines, is by performing a modified hyperbolic tangent (mtanh) fit to overlaid profiles selected from the same region of the ELM cycle. This process of overlaying profiles, termed ELM synchronisation, maximises the number of data points defining the pedestal region for a given phase of the ELM cycle. When fitting to HRTS profiles, it is necessary to incorporate the diagnostic radial instrument function, particularly important when considering the pedestal width. A deconvolved fit is determined by a forward convolution method requiring knowledge of only the instrument function and profiles. The systematic error due to the deconvolution technique incorporated into the JET pedestal fitting tool has been documented by Frassinetti et al. [Rev. Sci. Instrum. 83, 013506 (2012)]. This paper seeks to understand and quantify the systematic error introduced to the pedestal width due to ELM synchronisation. Synthetic profiles, generated with error bars and point-to-point variation characteristic of real HRTS profiles, are used to evaluate the deviation from the underlying pedestal width. We find on JET that the ELM synchronisation systematic error is negligible in comparison to the statistical error when assuming ten overlaid profiles (typical for a pre-ELM fit to HRTS profiles). This confirms that fitting a mtanh to ELM synchronised profiles is a robust and practical technique for extracting the pedestal structure.

  17. Prosthetic Joint Infection Diagnosis Using Broad-Range PCR of Biofilms Dislodged from Knee and Hip Arthroplasty Surfaces Using Sonication

    PubMed Central

    Gomez, Eric; Cazanave, Charles; Cunningham, Scott A.; Greenwood-Quaintance, Kerryl E.; Steckelberg, James M.; Uhl, James R.; Hanssen, Arlen D.; Karau, Melissa J.; Schmidt, Suzannah M.; Osmon, Douglas R.; Berbari, Elie F.; Mandrekar, Jayawant

    2012-01-01

    Periprosthetic tissue and/or synovial fluid PCR has been previously studied for prosthetic joint infection (PJI) diagnosis; however, few studies have assessed the utility of PCR on biofilms dislodged from the surface of explanted arthroplasties using vortexing and sonication (i.e., sonicate fluid PCR). We compared sonicate fluid 16S rRNA gene real-time PCR and sequencing to culture of synovial fluid, tissue, and sonicate fluid for the microbiologic diagnosis of PJI. PCR sequences generating mixed chromatograms were decatenated using RipSeq Mixed. We studied sonicate fluids from 135 and 231 subjects with PJI and aseptic failure, respectively. Synovial fluid, tissue, and sonicate fluid culture and sonicate fluid PCR had similar sensitivities (64.7, 70.4, 72.6, and 70.4%, respectively; P > 0.05) and specificities (96.9, 98.7, 98.3, and 97.8%, respectively; P > 0.05). Combining sonicate fluid culture and PCR, the sensitivity was higher (78.5%, P < 0.05) than those of individual tests, with similar specificity (97.0%). Thirteen subjects had positive sonicate fluid culture but negative PCR, and 11 had negative sonicate fluid culture but positive PCR (among which 7 had prior use of antimicrobials). Broad-range PCR and culture of sonicate fluid have equivalent performance for PJI diagnosis. PMID:22895042

  18. Ceftaroline-Fosamil Efficacy against Methicillin-Resistant Staphylococcus aureus in a Rabbit Prosthetic Joint Infection Model

    PubMed Central

    Gatin, Laure; Saleh-Mghir, Azzam; Tasse, Jason; Ghout, Idir; Laurent, Frédéric

    2014-01-01

    Ceftaroline (CPT), the active metabolite of the prodrug ceftaroline-fosamil (CPT-F), demonstrates in vitro bactericidal activity against methicillin-resistant Staphylococcus aureus (MRSA) and is effective in rabbit models of difficult-to-treat MRSA endocarditis and acute osteomyelitis. However, its in vivo efficacy in a prosthetic joint infection (PJI) model is unknown. Using a MRSA-infected knee PJI model in rabbits, the efficacies of CPT-F or vancomycin (VAN) alone and combined with rifampin (RIF) were compared. After each partial knee replacement with a silicone implant that fit into the tibial intramedullary canal was performed, 5 × 107 MRSA CFU (MICs of 0.38, 0.006, and 1 mg/liter for CPT, RIF, and VAN, respectively) was injected into the knee. Infected animals were randomly assigned to receive no treatment (controls) or CPT-F (60 mg/kg of body weight intramuscularly [i.m.]), VAN (60 mg/kg i.m.), CPT-F plus RIF (10 mg/kg i.m.), or VAN plus RIF starting 7 days postinoculation and lasting for 7 days. Surviving bacteria in crushed tibias were counted 3 days after ending treatment. Although the in vivo mean log10 CFU/g of CPT-treated (3.0 ± 0.9, n = 12) and VAN-treated (3.5 ± 1.1, n = 12) crushed bones was significantly lower than those of controls (5.6 ± 1.1, n = 14) (P < 0.001), neither treatment fully sterilized the bones (3/12 were sterile with each treatment). The mean log10 CFU/g values for the antibiotics in combination with RIF were 1.9 ± 0.5 (12/14 were sterile) for CPT-F and 1.9 ± 0.5 (12/14 were sterile) for VAN. In this MRSA PJI model, the efficacies of CPT-F and VAN did not differ; thus, CPT appears to be a promising antimicrobial agent for the treatment of MRSA PJIs. PMID:25136014

  19. Ceftaroline-Fosamil efficacy against methicillin-resistant Staphylococcus aureus in a rabbit prosthetic joint infection model.

    PubMed

    Gatin, Laure; Saleh-Mghir, Azzam; Tasse, Jason; Ghout, Idir; Laurent, Frédéric; Crémieux, Anne-Claude

    2014-11-01

    Ceftaroline (CPT), the active metabolite of the prodrug ceftaroline-fosamil (CPT-F), demonstrates in vitro bactericidal activity against methicillin-resistant Staphylococcus aureus (MRSA) and is effective in rabbit models of difficult-to-treat MRSA endocarditis and acute osteomyelitis. However, its in vivo efficacy in a prosthetic joint infection (PJI) model is unknown. Using a MRSA-infected knee PJI model in rabbits, the efficacies of CPT-F or vancomycin (VAN) alone and combined with rifampin (RIF) were compared. After each partial knee replacement with a silicone implant that fit into the tibial intramedullary canal was performed, 5 × 10(7) MRSA CFU (MICs of 0.38, 0.006, and 1 mg/liter for CPT, RIF, and VAN, respectively) was injected into the knee. Infected animals were randomly assigned to receive no treatment (controls) or CPT-F (60 mg/kg of body weight intramuscularly [i.m.]), VAN (60 mg/kg i.m.), CPT-F plus RIF (10 mg/kg i.m.), or VAN plus RIF starting 7 days postinoculation and lasting for 7 days. Surviving bacteria in crushed tibias were counted 3 days after ending treatment. Although the in vivo mean log10 CFU/g of CPT-treated (3.0 ± 0.9, n = 12) and VAN-treated (3.5 ± 1.1, n = 12) crushed bones was significantly lower than those of controls (5.6 ± 1.1, n = 14) (P < 0.001), neither treatment fully sterilized the bones (3/12 were sterile with each treatment). The mean log10 CFU/g values for the antibiotics in combination with RIF were 1.9 ± 0.5 (12/14 were sterile) for CPT-F and 1.9 ± 0.5 (12/14 were sterile) for VAN. In this MRSA PJI model, the efficacies of CPT-F and VAN did not differ; thus, CPT appears to be a promising antimicrobial agent for the treatment of MRSA PJIs.

  20. Pasteurella multocida non-native joint infection after a dog lick: A case report describing a complicated two-stage revision and a comprehensive review of the literature.

    PubMed

    Lam, Philip W; Page, Andrea V

    2015-01-01

    Prosthetic joint infections (PJIs) are commonly caused by pathogens such as Staphylococcus aureus and coagulase-negative staphylococci; however, other microbial etiologies and specific risk factors are increasingly recognized. Pasteurella multocida is a Gram-negative coccobacillus that is part of the normal oral flora in many animals, and is particularly common in dogs and cats. PJIs caused by P multocida have been reported only rarely in the literature and typically occur in the context of an animal bite or scratch. The present article describes a P multocida joint infection that occurred after a dog lick and complicated a two-stage revision arthroplasty. A comprehensive review of the literature regarding P multocida PJIs follows.

  1. Pasteurella multocida non-native joint infection after a dog lick: A case report describing a complicated two-stage revision and a comprehensive review of the literature

    PubMed Central

    Philip W, Lam; Page, Andrea V

    2015-01-01

    Prosthetic joint infections (PJIs) are commonly caused by pathogens such as Staphylococcus aureus and coagulase-negative staphylococci; however, other microbial etiologies and specific risk factors are increasingly recognized. Pasteurella multocida is a Gram-negative coccobacillus that is part of the normal oral flora in many animals, and is particularly common in dogs and cats. PJIs caused by P multocida have been reported only rarely in the literature and typically occur in the context of an animal bite or scratch. The present article describes a P multocida joint infection that occurred after a dog lick and complicated a two-stage revision arthroplasty. A comprehensive review of the literature regarding P multocida PJIs follows. PMID:26361490

  2. Oral antibody to interleukin-10 reduces growth rate depression due to Eimeria spp. infection in broiler chickens.

    PubMed

    Sand, Jordan M; Arendt, Maria K; Repasy, Alec; Deniz, Gűlay; Cook, Mark E

    2016-02-01

    Eimeria spp. must be controlled in floor-reared poultry to prevent the onset of coccidiosis. Here we use an oral antibody to chicken IL-10 to prevent growth depression due to Eimeria spp. infection. Egg antibody directed against an antigenic peptide of IL-10 was produced in laying hens and measured using an ELISA. In the first experiment, egg yolk powder containing antibody to chicken IL-10 (vlpramqt conjugate) (anti-IL-10 yolk powder) was fed at 3.4 g/kg feed to determine growth response following mixed Eimeria spp. challenge. Chicks were fed either anti-IL-10 antibodies or control antibodies and challenged (d3) with either sterile saline or a 10× attenuated Eimeria spp. vaccine. Control-fed and Eimeria-challenged chicks grew 8.8% slower than those challenged with saline (P < 0.04), whereas anti-IL-10-fed Eimeria challenged chicks were not different from untreated controls. In the second trial a dose response was performed with doses of either 0 (control antibody), 0.34-, or 3.4-g anti-IL-10 yolk powder/kg feed. Control-fed, Eimeria-challenged chicks grew 10.6% slower than control saline-challenged chicks (P < 0.05); however, anti-IL-10-fed chicks fed either dose of anti-IL-10 were not different from saline-challenged chicks. Finally, the effect of anti-IL-10 on acquired immunity was investigated. Chicks were fed control or anti-IL-10 yolk powder and vaccinated with a 1× dose of Eimeria vaccine at d 3. After 14 d, antibody was removed from the diet. Chicks were either saline or 10× Eimeria challenged at d 17. We found that the anti-IL-10-fed chickens did not show a reduction in growth due to challenge; hence anti-IL-10 does not appear to affect adaptive immunity during the primary immunization. Overall, use of an antibody to IL-10 is a novel method in preventing adverse effects of Eimeria spp. infection in poultry.

  3. Analysis of 525 Samples To Determine the Usefulness of PCR Amplification and Sequencing of the 16S rRNA Gene for Diagnosis of Bone and Joint Infections

    PubMed Central

    Fenollar, Florence; Roux, Véronique; Stein, Andréas; Drancourt, Michel; Raoult, Didier

    2006-01-01

    The 16S rRNA gene PCR in the diagnosis of bone and joint infections has not been systematically tested. Five hundred twenty-five bone and joint samples collected from 525 patients were cultured and submitted to 16S rRNA gene PCR detection of bacteria in parallel. The amplicons with mixed sequences were also cloned. When discordant results were observed, culture and PCR were performed once again. Bacteria were detected in 139 of 525 samples. Culture and 16S rRNA gene PCR yielded identical documentation in 475 samples. Discrepancies were linked to 13 false-positive culture results, 5 false-positive PCR results, 9 false-negative PCR results, 16 false-negative culture results, and 7 mixed infections. Cloning and sequencing of 16S rRNA gene amplicons in 6 of 8 patients with mixed infections identified 2 to 8 bacteria per sample. Rarely described human pathogens such as Alcaligenes faecalis, Comamonas terrigena, and 21 anaerobes were characterized. We also detected, by 16S rRNA gene PCR, four previously identified bacteria never reported in human infection, Alkanindiges illinoisensis, dehydroabietic acid-degrading bacterium DhA-73, unidentified Hailaer soda lake bacterium, and uncultured bacterium clone HuCa4. Seven organisms representing new potential species were also detected. PCR followed by cloning and sequencing may help to identify new pathogens involved in mixed bone infection. PMID:16517890

  4. Rubella-associated arthritis. I. Comparative study of joint manifestations associated with natural rubella infection and RA 27/3 rubella immunisation.

    PubMed Central

    Tingle, A J; Allen, M; Petty, R E; Kettyls, G D; Chantler, J K

    1986-01-01

    Joint manifestations observed during the course of a prospective RA 27/3 rubella immunisation trial were compared with those observed during an intercurrent wild rubella epidemic in an outlying community. Among 44 rubella haemagglutination inhibition (HAI) negative females ranging in age from 17 to 33 years who received rubella vaccine, six (13.6%) developed acute polyarticular arthritis within two to four weeks postvaccine and two (4.5%) had continuing or recurrent arthropathy lasting longer than 18 months. In contrast, among 23 females ranging in age from 11 to 39 years undergoing wild rubella infection, 12 (52.2%) developed acute polyarticular arthritis and seven (30.4%) had recurrent arthropathy 18 months postinfection. Among 23 males ranging in age from 13 to 54 years undergoing wild rubella infection, only two (8.7%) developed acute arthritis and both individuals had continuing joint manifestations 18 months postinfection. Wild rubella infection in adult populations is associated with a higher incidence, increased severity, and more prolonged duration of joint manifestations than is seen after RA 27/3 rubella immunisation. PMID:3947141

  5. Changes in lymphocyte and macrophage subsets due to morphine and ethanol treatment during a retrovirus infection causing murine AIDS

    SciTech Connect

    Watson, R.R.; Prabhala, R.H.; Darban, H.R.; Yahya, M.D.; Smith, T.L.

    1988-01-01

    The number of lymphocytes of various subsets were not significantly changed by the ethanol exposure except those showing activation markers which were reduced. The percentage of peripheral blood cells showing markers for macrophage functions and their activation were significantly reduced after binge use of ethanol. Ethanol retarded suppression of cells by retroviral infection. However by 25 weeks of infection there was a 8.6% survival in the ethanol fed mice infected with retrovirus which was much less than virally infected controls. Morphine treatment also increased the percentage of cells with markers for macrophages and activated macrophages in virally infected mice, while suppressing them in uninfected mice. The second and third morphine injection series suppressed lymphocyte T-helper and T-suppressor cells, but not total T cells. However, suppression by morphine was significantly less during retroviral disease than suppression caused by the virus only. At 25 weeks of infection 44.8% of morphine treated, infected mice survived.

  6. BRAIN ABSCESS DUE TO Staphylococcus aureus OF CRYPTOGENIC SOURCE IN AN HIV-1 INFECTED PATIENT IN USE OF ANTIRETROVIRAL THERAPY

    PubMed Central

    de OLIVEIRA, Anna Paula Romero; PAPPALARDO, Mara Cristina; DANTAS, Daniel; LINS, Diogo; VIDAL, José Ernesto

    2016-01-01

    The spectrum of neurological complications associated with human immunodeficiency virus type 1 (HIV-1) infection is broad. The most frequent etiologies include primary diseases (caused by HIV itself) or secondary diseases (opportunistic infections or neoplasms). Despite these conditions, HIV-infected patients are susceptible to other infections observed in patients without HIV infection. Here we report a rare case of a brain abscess caused by Staphylococcus aureus in an HIV-infected patient. After drainage of the abscess and treatment with oxacilin, the patient had a favorable outcome. This case reinforces the importance of a timely neurosurgical procedure that supported adequate management of an unusual cause of expansive brain lesions in HIV-1 infected patients. PMID:27074328

  7. Outbreak of tinea corporis gladiatorum, a fungal skin infection due to Trichophyton tonsurans, in a French high level judo team.

    PubMed

    Poisson, D M; Rousseau, D; Defo, Defo; Estève, E

    2005-09-01

    An outbreak of 49 cases of tinea corporis gladiatorum due to Trichophyton tonsurans infection occurred in a high level judo team of 131 members in Orleans, central France, between October 2004 and April 2005. The team was divided into 5 groups: cadet-junior boys (n=44), cadet-junior girls (n=33), male university students (n= 15), female university students (n=21), and a group called 'pole technique' made up of high level judokas who have finished academic study (n=18). The outbreak involved 86% of the cadet-junior boys, but only 6 men in the 'pole technique' (33%) and only 5 of the 69 other team members (7%) (cadet-junior girls and university students). We describe the outbreak and the results of a survey that found a known risk factor for the 'pole technique': sharing an electric hair shaver. Personal hygiene practices were found to be very good among the cadet-junior boys. The high attack rate in this group may be linked to the poor shower facilities in the gymnasium where they practiced that led them to have their showers several hours after the end of daily practice.

  8. Potential Role of Fibroblast-Like Synoviocytes in Joint Damage Induced by Brucella abortus Infection through Production and Induction of Matrix Metalloproteinases ▿

    PubMed Central

    Scian, Romina; Barrionuevo, Paula; Giambartolomei, Guillermo H.; De Simone, Emilio A.; Vanzulli, Silvia I.; Fossati, Carlos A.; Baldi, Pablo C.; Delpino, M. Victoria

    2011-01-01

    Arthritis is one of the most common complications of human brucellosis, but its pathogenic mechanisms have not been elucidated. Fibroblast-like synoviocytes (FLS) are known to be central mediators of joint damage in inflammatory arthritides through the production of matrix metalloproteinases (MMPs) that degrade collagen and of cytokines and chemokines that mediate the recruitment and activation of leukocytes. In this study we show that Brucella abortus infects and replicates in human FLS (SW982 cell line) in vitro and that infection results in the production of MMP-2 and proinflammatory mediators (interleukin-6 [IL-6], IL-8, monocyte chemotactic protein 1 [MCP-1], and granulocyte-macrophage colony-stimulating factor [GM-CSF]). Culture supernatants from Brucella-infected FLS induced the migration of monocytes and neutrophils in vitro and also induced these cells to secrete MMP-9 in a GM-CSF- and IL-6-dependent fashion, respectively. Reciprocally, culture supernatants from Brucella-infected monocytes and neutrophils induced FLS to produce MMP-2 in a tumor necrosis factor alpha (TNF-α)-dependent fashion. The secretion of proinflammatory mediators and MMP-2 by FLS did not depend on bacterial viability, since it was also induced by heat-killed B. abortus (HKBA) and by a model Brucella lipoprotein (L-Omp19). These responses were mediated by the recognition of B. abortus antigens through Toll-like receptor 2. The intra-articular injection of HKBA or L-Omp19 into the knee joint of mice resulted in the local induction of the proinflammatory mediators MMP-2 and MMP-9 and in the generation of a mixed inflammatory infiltrate. These results suggest that FLS, and phagocytes recruited by them to the infection focus, may be involved in joint damage during brucellar arthritis through the production of MMPs and proinflammatory mediators. PMID:21730088

  9. KLIC-score for predicting early failure in prosthetic joint infections treated with debridement, implant retention and antibiotics.

    PubMed

    Tornero, E; Morata, L; Martínez-Pastor, J C; Bori, G; Climent, C; García-Velez, D M; García-Ramiro, S; Bosch, J; Mensa, J; Soriano, A

    2015-08-01

    Debridement, irrigation and antibiotic treatment form the current approach in early prosthetic joint infection (PJI). Our aim was to design a score to predict patients with a higher risk of failure. From 1999 to 2014 early PJIs were prospectively collected and retrospectively reviewed. The primary end-point was early failure defined as: 1) the need for unscheduled surgery, 2) death-related infection within the first 60 days after debridement or 3) the need for suppressive antibiotic treatment. A score was built-up according to the logistic regression coefficients of variables available before debridement. A total of 222 patients met the inclusion criteria. The most frequently isolated microorganisms were coagulase-negative staphylococci (95 cases, 42.8%) and Staphylococcus aureus (81 cases, 36.5%). Treatment of 52 (23.4%) cases failed. Independent predictors of failure were: chronic renal failure (OR 5.92, 95% CI 1.47-23.85), liver cirrhosis (OR 4.46, 95% CI 1.15-17.24), revision surgery (OR 4.34, 95% CI 1.34-14.04) or femoral neck fracture (OR 4.39, 95% CI1.16-16.62) compared with primary arthroplasty, C reactive protein >11.5 mg/dL (OR 12.308, 95% CI 4.56-33.19), cemented prosthesis (OR 8.71, 95% CI 1.95-38.97) and when all intraoperative cultures were positive (OR 6.30, 95% CI 1.84-21.53). A score for predicting the risk of failure was designed using preoperative factors (KLIC-score: Kidney, Liver, Index surgery, Cemented prosthesis and C-reactive protein value) and it ranged between 0 and 9.5 points. Patients with scores of ≤2, >2-3.5, 4-5, >5-6.5 and ≥7 had failure rates of 4.5%, 19.4%, 55%, 71.4% and 100%, respectively. The KLIC-score was highly predictive of early failure after debridement. In the future, it would be necessary to validate our score using cohorts from other institutions.

  10. [Recommendations of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) on the prevention of invasive fungal infection due to filamentous fungi].

    PubMed

    Ruiz-Camps, Isabel; Aguado, Jose María; Almirante, Benito; Bouza, Emilio; Ferrer Barbera, Carmen; Len, Oscar; López-Cerero, Lorena; Rodríguez-Tudela, Juan Luis; Ruiz, Miguel; Solé, Amparo; Vallejo, Carlos; Vázquez, Lourdes; Zaragoza, Rafael; Cuenca-Estrella, Manuel

    2010-03-01

    Invasive fungal infections (IFI) due to filamentous fungi still have high rates of mortality associated with the difficulties of early detection of the infection and their therapeutic limitations. Consequently, a useful approach is to prevent patients at risk of fungal infection from getting in contact with conidia of Aspergillus and other mould species. This document describes the recommendations to prevent IFI due to filamentous fungi, prepared by Spanish experts from different medical and professional fields. The paper reviews the incidence of the IFI in different risk populations and the questions related to environmental measures of prevention, control of hospital infections, additional procedures for prevention, prevention of IFI outside hospitals, as well as antifungal prophylaxis.

  11. Recipient-born bloodstream infection due to extensively drug-resistant Acinetobacter baumannii after emergency heart transplant: report of a case and review of the literature.

    PubMed

    Andini, Roberto; Agrusta, Federica; Mattucci, Irene; Malgeri, Umberto; Cavezza, Giusi; Utili, Riccardo; Durante-Mangoni, Emanuele

    2015-10-01

    Infections due to drug-resistant Gram-negative rods are an emerging risk factor for increased mortality after solid organ transplant. Extensively drug-resistant (XDR) Acinetobacter baumannii (Acb) is a major threat in several critical care settings. The limited available data on the outcome of XDR Acb infections in organ transplant recipients mostly comes from cases of donor-derived infections. However, recipients of life-saving organs are often critically ill patients, staying long term in intensive care units, and therefore at high risk for nosocomial infections. In this report, we describe our experience with the exceedingly complex management of a recipient-born XDR Acb bloodstream infection clinically ensued shortly after heart transplant. We also review the current literature on this mounting issue relevant for intensive care, transplant medicine and infectious diseases.

  12. Forced-air warming and ultra-clean ventilation do not mix: an investigation of theatre ventilation, patient warming and joint replacement infection in orthopaedics.

    PubMed

    McGovern, P D; Albrecht, M; Belani, K G; Nachtsheim, C; Partington, P F; Carluke, I; Reed, M R

    2011-11-01

    We investigated the capacity of patient warming devices to disrupt the ultra-clean airflow system. We compared the effects of two patient warming technologies, forced-air and conductive fabric, on operating theatre ventilation during simulated hip replacement and lumbar spinal procedures using a mannequin as a patient. Infection data were reviewed to determine whether joint infection rates were associated with the type of patient warming device that was used. Neutral-buoyancy detergent bubbles were released adjacent to the mannequin's head and at floor level to assess the movement of non-sterile air into the clean airflow over the surgical site. During simulated hip replacement, bubble counts over the surgical site were greater for forced-air than for conductive fabric warming when the anaesthesia/surgery drape was laid down (p = 0.010) and at half-height (p < 0.001). For lumbar surgery, forced-air warming generated convection currents that mobilised floor air into the surgical site area. Conductive fabric warming had no such effect. A significant increase in deep joint infection, as demonstrated by an elevated infection odds ratio (3.8, p = 0.024), was identified during a period when forced-air warming was used compared to a period when conductive fabric warming was used. Air-free warming is, therefore, recommended over forced-air warming for orthopaedic procedures.

  13. Matrix-assisted laser desorption ionization time of flight mass spectrometry and diagnostic testing for prosthetic joint infection in the clinical microbiology laboratory.

    PubMed

    Peel, Trisha N; Cole, Nicolynn C; Dylla, Brenda L; Patel, Robin

    2015-03-01

    Identification of pathogen(s) associated with prosthetic joint infection (PJI) is critical for patient management. Historically, many laboratories have not routinely identified organisms such as coagulase-negative staphylococci to the species level. The advent of matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS) has enhanced clinical laboratory capacity for accurate species-level identification. The aim of this study was to describe the species-level identification of microorganisms isolated from periprosthetic tissue and fluid specimens using MALDI-TOF MS alongside other rapid identification tests in a clinical microbiology laboratory. Results of rapid identification of bacteria isolated from periprosthetic joint fluid and/or tissue specimens were correlated with clinical findings at Mayo Clinic, Rochester, Minnesota, between May 2012 and May 2013. There were 178 PJI and 82 aseptic failure (AF) cases analyzed, yielding 770 organisms (median, 3/subject; range, 1-19/subject). MALDI-TOF MS was employed for the identification of 455 organisms (59%) in 197 subjects (123 PJIs and 74 AFs), with 89% identified to the species level using this technique. Gram-positive bacteria accounted for 68% and 93% of isolates in PJI and AF, respectively. However, the profile of species associated with infection compared to specimen contamination differed. Staphylococcus aureus and Staphylococcus caprae were always associated with infection, Staphylococcus epidermidis and Staphylococcus lugdunensis were equally likely to be a pathogen or a contaminant, whereas the other coagulase-negative staphylococci were more frequently contaminants. Most streptococcal and Corynebacterium isolates were pathogens. The likelihood that an organism was a pathogen or contaminant differed with the prosthetic joint location, particularly in the case of Propionibacterium acnes. MALDI-TOF MS is a valuable tool for the identification of bacteria isolated from patients

  14. Infective endocarditis due to Abiotrophia defectiva and Granulicatella spp. complicated by infectious intracranial cerebral aneurysms: a report of three cases and review of the literature.

    PubMed

    Rhodes, Heather M; Hirigoyen, Diane; Shabnam, Lubna; Williams, David N; Hansen, Glen T

    2016-06-01

    Nutritionally variant streptococci, now classified as Abiotrophia defectivaor Granulicatella spp., are thought to account for 2 % of all infective endocarditis cases but estimates of their frequency are complicated by changes in nomenclature and difficulties in obtaining positive microbiology cultures. Their growth characteristics and difficulty undertaking antibiotic susceptibility testing may impede optimal antibiotic treatment decisions. We describe three patients with definite infective endocarditis due to these organisms seen at our hospital between 2005 and 2010, all of whom presented with neurological symptoms due to infectious intracranial cerebral aneurysms. We recommend that, for patients with left-sided infective endocarditis due to A. defictiva and Granulicatella spp., clinicians should consider imaging the central nervous system.

  15. Active co-infection with HBV and/or HCV in South African HIV positive patients due for cancer therapy.

    PubMed

    Musyoki, Andrew M; Msibi, Thembeni L; Motswaledi, Mojakgomo H; Selabe, Selokela G; Monokoane, Tshweu S; Mphahlele, M Jeffrey

    2015-02-01

    Human immunodeficiency virus (HIV), Hepatitis B virus (HBV) and Hepatitis C virus (HCV) share routes of transmission. There is limited data on the incidence of active co-infection with HBV and/or HCV in cancer patients infected with HIV in Africa. This was a prospective study based on 34 patients with varied cancer diagnosis, infected with HIV and awaiting cancer therapy in South Africa. HIV viral load, CD4+ cell counts, Alanine-aminotransferase and aspartate aminotransferase levels were tested. Exposure to HBV and HCV was assessed serologically using commercial kits. Active HBV and/or HCV co-infection was detected using viral specific nested PCR assays. HCV 5'-UTR PCR products were sequenced to confirm active HCV infection. Active viral infection was detected in 64.7% of patients for HBV, 38.2% for HCV, and 29.4% for both HBV and HCV. Occult HBV infection was observed in 63.6% of the patients, while seronegative HCV infection was found in 30.8% of patients. In addition, CD4+ cell count < 350 cells/µl was not a risk factor for increased active HBV, HCV or both HBV and HCV co-infections. A total of 72.7%, 18.2% and 9.1% of the HCV sequences were assigned genotype 5, 1 and 4 respectively.The study revealed for the first time a high active HBV and/or HCV co-infection rate in cancer patients infected with HIV. The findings call for HBV and HCV testing in such patients, and where feasible, appropriate antiviral treatment be indicated, as chemotherapy or radiotherapy has been associated with reactivation of viral hepatitis and termination of cancer therapy.

  16. Impaired B cell function during viral infections due to PTEN-mediated inhibition of the PI3K pathway.

    PubMed

    Getahun, Andrew; Wemlinger, Scott M; Rudra, Pratyaydipta; Santiago, Mario L; van Dyk, Linda F; Cambier, John C

    2017-04-03

    Transient suppression of B cell function often accompanies acute viral infection. However, the molecular signaling circuitry that enforces this hyporesponsiveness is undefined. In this study, experiments identify up-regulation of the inositol phosphatase PTEN (phosphatase and tensin homolog) as primarily responsible for defects in B lymphocyte migration and antibody responses that accompany acute viral infection. B cells from mice acutely infected with gammaherpesvirus 68 are defective in BCR- and CXCR4-mediated activation of the PI3K pathway, and this, we show, is associated with increased PTEN expression. This viral infection-induced PTEN overexpression appears responsible for the suppression of antibody responses observed in infected mice because PTEN deficiency or expression of a constitutively active PI3K rescued function of B cells in infected mice. Conversely, induced overexpression of PTEN in B cells in uninfected mice led to suppression of antibody responses. Finally, we demonstrate that PTEN up-regulation is a common mechanism by which infection induces suppression of antibody responses. Collectively, these findings identify a novel role for PTEN during infection and identify regulation of the PI3K pathway, a mechanism previously shown to silence autoreactive B cells, as a key physiological target to control antibody responses.

  17. [Adaptation and development of German recommendations on the prevention and control of nosocomial infections due to multiresistant pathogens].

    PubMed

    Simon, A; Christiansen, B

    2012-11-01

    The Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute developed evidence-based recommendations for the prevention and control of nosocomial infections in Germany. Considering the growing impact of multiresistant pathogens (MRE) on morbidity and mortality related to nosocomial infections, the prevention and control of MRE is one of the most important topics on the current agenda. Currently, the German recommendations on methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) are being re-evaluated and a recommendation discussing options for the prevention and control of MR Gram-negative pathogens is awaited and will be published in the next months.

  18. [Septic shock due to a community acquired Clostridium difficile infection. A case study and a review of the literature].

    PubMed

    Bermejo, C; Maseda, E; Salgado, P; Gabilondo, G; Gilsanz, F

    2014-04-01

    The epidemiology of Clostridium difficile infection has changed in the past decade. The incidence rate of community acquired cases has increased in patients with no typical risk factors. We present a patient who was diagnosed with community-acquired Clostridium difficile infection who presented with acute abdominal pain, and subsequently developed acute renal failure and septic shock. We describe the diagnosis, treatment and outcome and brief review of the literature.

  19. Persisting arthralgia due to Mayaro virus infection in a traveler from Brazil: is there a risk for attendants to the 2014 FIFA World Cup?

    PubMed

    Slegers, C A D; Keuter, M; Günther, S; Schmidt-Chanasit, J; van der Ven, A J; de Mast, Q

    2014-07-01

    The 2014 FIFA World Cup and the 2016 Olympic Games will attract large groups of visitors to Brazil. These visitors will be at risk for different arboviral infections, some of which not well known outside endemic areas. We report a case of a 52-year-old Dutch woman who presented with persistent arthralgia due to a Mayaro virus (MAYV) infection which she contracted in the Amazon basin in Brazil. MAYV is a mosquito-borne alphavirus which primarily circulates in humid tropical forests of South America. Infections are rarely reported in travelers and are characterized by an acute febrile illness which is often followed by a prolonged and sometimes incapacitating polyarthralgia. Both travelers and physicians should be aware of the risk of these arboviral infections and the importance of mosquito bite prevention should be stressed.

  20. 49 CFR 213.121 - Rail joints.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... joint, insulated joint, and compromise joint shall be of a structurally sound design and dimensions for... accommodate expansion and contraction due to temperature variations. When no-slip, joint-to-rail...

  1. 49 CFR 213.121 - Rail joints.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... joint, insulated joint, and compromise joint shall be of a structurally sound design and dimensions for... accommodate expansion and contraction due to temperature variations. When no-slip, joint-to-rail...

  2. 49 CFR 213.121 - Rail joints.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... joint, insulated joint, and compromise joint shall be of a structurally sound design and dimensions for... accommodate expansion and contraction due to temperature variations. When no-slip, joint-to-rail...

  3. Successful treatment of skin and soft tissue infection due to carbapenem-resistant Acinetobacter baumannii by ampicillin-sulbactam and meropenem combination therapy.

    PubMed

    Hiraki, Yoichi; Yoshida, Mayumi; Masuda, Yoko; Inoue, Daisuke; Tsuji, Yasuhiro; Kamimura, Hidetoshi; Karube, Yoshiharu; Takaki, Kazutaka; Kawano, Fumio

    2013-12-01

    In recent years, carbapenem-resistant Acinetobacter baumannii infections have been responsible for outbreaks in medical facilities. A 35-year-old Japanese woman developed a skin and soft tissue infection due to carbapenem-resistant A. baumannii. The isolate was resistant to antibiotics other than ampicillin-sulbactam and colistin, suggesting drug resistance due to carbapenemase production by OXA-23. We selected a combination therapy consisting of intravenous ampicillin-sulbactam and meropenem. No changes were observed in aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, or serum creatinine during therapy, and carbapenem-resistant A. baumannii was not detected in wound exudates 3 days after therapy initiation. In our patient's case, combination therapy with ampicillin-sulbactam and meropenem was successful. Thus, combination therapy with ampicillin-sulbactam and meropenem is effective against skin and soft tissue infection due to carbapenem-resistant A. baumannii. Combination therapy with intravenous ampicillin-sulbactam and meropenem may be an option for skin and soft tissue infections due to carbapenem-resistant A. baumannii.

  4. Correction of a Hyperextension Deformity at the Metacarpophalangeal Joint by Arthroplasty for Osteoarthritis of the Thumb Carpometacarpal Joint Followed by External Fixator: A Case Series: Modified Ilizarov Method for Correction of a Collapsed Thumb Deformity Due to Carpometacarpal Osteoarthritis.

    PubMed

    Hamada, Yoshitaka; Kobayashi, Anna; Sairyo, Koichi; Sato, Ryosuke; Hibino, Naohito

    2015-06-01

    A hyperextension deformity in the advanced stages of carpometacarpal (CMC) arthritis of the thumb could affect the outcomes of thumb CMC joint arthroplasty. We introduce the interesting approach for treating severely collapsed thumb deformities with gradual distraction and coordinated correction of the MCP and CMC joints by means of external fixators. We divided 8 cases into 3 groups according to the angle of passive flexion of the hyperextended MCP joint: group 1, 10-20°, group 2a, 20-40°, and group 2b, >40°, retrospectively. We first performed CMC arthroplasty with trapezium excision. In group 1, we corrected the MCP hyperextension deformity by manual passive flexion and fixed the joint with an extension block Kirshner wire (K-wire) for 2 months. However, deformities recurred in 2 of 5 cases after removing the K-wire. These patients received corrective percutaneous osteotomy with external fixators at the metacarpal neck. In groups 2a and 2b, we performed CMC arthroplasty and set external fixators at the same time. All cases in groups 1 and 2a have been without recurrence for more than 2 years, while a deformity recurred in group 2b. The results of this small case series encouraged us to propose an interesting approach for collapsed zigzag thumb deformity. Good outcomes with excellent maintenance of active MCP movement and no recurrence are highly anticipated if the hyperextended thumb has no obvious degenerative changes and can be corrected by <40° of passive flexion. Our results also indicate a risk of recurrence associated with extension block by K-wire.

  5. Lavage with Allicin in Combination with Vancomycin Inhibits Biofilm Formation by Staphylococcus epidermidis in a Rabbit Model of Prosthetic Joint Infection

    PubMed Central

    Zhai, Haohan; Pan, Jianchao; Pang, En; Bai, Bo

    2014-01-01

    Background and Aim The present anti-infection strategy for prosthetic joint infections (PJI) includes the use of antibiotics and surgical treatments, but the bacterial eradication rates are still low. One of the major challenges is the formation of biofilm causing poor bacterial eradication. Recently it has been reported that allicin (diallyl thiosulphinate), an antibacterial principle of garlic, can inhibit bacteria adherence and prevent biofilm formation in vitro. However, whether allicin could inhibit biofilm formation in vivo is unknown. The aim of this study was to investigate the effects of allicin on biofilm formation, and whether allicin could potentiate the bactericidal effect of vancomycin in a rabbit PJI model. Methods A sterile stainless-steel screw with a sterile ultra-high molecular weight polyethylene washer was inserted into the lateral femoral condyle of the right hind knee joint of rabbit, and 1 mL inoculum containing 104 colony-forming units of Staphylococcus epidermidis was inoculated into the knee joint (n = 32). Fourteen days later, rabbits randomly received one of the following 4 treatments using continuous lavages: normal saline, vancomycin (20 mcg/mL), allicin (4 mg/L), or allicin (4 mg/L) plus vancomycin (20 mcg/mL). Three days later, the washer surface biofilm formation was examined by scanning electron microscopy (SEM). The bacterial counts within the biofilm of implanted screws were determined by bacterial culture. Results The lowest number of viable bacterial counts of Staphylococcus epidermidis recovered from the biofilm was in the rabbits treated with allicin plus vancomycin (P<0.01 vs. all other groups). The biofilm formation was significantly reduced or undetectable by SEM in rabbits receiving allicin or allicin plus vancomycin. Conclusion Intra-articular allicincan inhibit biofilm formation and enhance the bactericidal effect of vancomycin on implant surface in vivo. Allicin in combination with vancomycin may be a useful anti-infection

  6. A Cluster of CNS Infections Due to B. cereus in the Setting of Acute Myeloid Leukemia: Neuropathology in 5 Patients.

    PubMed

    Vodopivec, Ivana; Rinehart, Elizabeth M; Griffin, Gabriel K; Johncilla, Melanie E; Pecora, Nicole; Yokoe, Deborah S; Feske, Steven K; Milner, Danny A; Folkerth, Rebecca D

    2015-10-01

    Bacillus cereus typically causes a self-limited foodborne gastrointestinal (GI) illness. Severe invasive infection occurs rarely, mainly among immunocompromised hosts. We describe a cluster of B. cereus infections among 5 patients with acute myeloid leukemia and chemotherapy-induced neutropenia. The initial case presented with occipital lobe abscess and was found on biopsy to have organisms consistent with Bacillus species. Within 1 week, a second patient died of fulminant brain swelling and hemorrhage. Neuropathologic autopsy and culture revealed B. cereus; hospital infection control and public health officials were notified. Three more patients died within the subsequent 9 months (2 patients had rapid massive hemorrhage and many bacilli reminiscent of Bacillus anthracis infection, and 1 patient had sparse bacilli, petechial hemorrhages, and border zone infarcts). Blood cultures yielded positive results in 3 of 5 cases. A possible route of infection was hematogenous dissemination via GI mucosal breaches (GI symptoms occurred in 3 of 5 cases, and postmortem GI ulceration was found in 3 of 4 cases). Bacilli were seen in 2 of 3 GI ulcerations. Epidemiologic work-up, including a site visit conducted by the Centers for Disease Control and Prevention, did not identify a clear common source but suggested the possibility of bananas as a food source. Bacillus cereus causes a rapidly progressive, hemorrhagic meningoencephalitis with high mortality among patients with neutropenia. Neuropathologists can play a key role in the detection of outbreaks.

  7. Emergence of increased frequency and severity of multiple infections by viruses due to spatial clustering of hosts

    NASA Astrophysics Data System (ADS)

    Taylor, Bradford P.; Penington, Catherine J.; Weitz, Joshua S.

    2016-12-01

    Multiple virus particles can infect a target host cell. Such multiple infections (MIs) have significant and varied ecological and evolutionary consequences for both virus and host populations. Yet, the in situ rates and drivers of MIs in virus-microbe systems remain largely unknown. Here, we develop an individual-based model (IBM) of virus-microbe dynamics to probe how spatial interactions drive the frequency and nature of MIs. In our IBMs, we identify increasingly spatially correlated clusters of viruses given sufficient decreases in viral movement. We also identify increasingly spatially correlated clusters of viruses and clusters of hosts given sufficient increases in viral infectivity. The emergence of clusters is associated with an increase in multiply infected hosts as compared to expectations from an analogous mean field model. We also observe long-tails in the distribution of the multiplicity of infection in contrast to mean field expectations that such events are exponentially rare. We show that increases in both the frequency and severity of MIs occur when viruses invade a cluster of uninfected microbes. We contend that population-scale enhancement of MI arises from an aggregate of invasion dynamics over a distribution of microbe cluster sizes. Our work highlights the need to consider spatially explicit interactions as a potentially key driver underlying the ecology and evolution of virus-microbe communities.

  8. Endoscopic ultrasonography-guided transmural drainage of an infected hepatic cyst due to Edwardsiella tarda: a case report.

    PubMed

    Taguchi, Hiroki; Tamai, Tsutomu; Numata, Masatsugu; Maeda, Hitomi; Ohshige, Akihiko; Iwaya, Hiromichi; Hashimoto, Shinichi; Kanmura, Shuji; Funakawa, Keita; Fujita, Hiroshi; Ido, Akio; Tsubouchi, Hirohito

    2014-10-01

    Infected hepatic cysts are very rare compared to simple liver cysts and abscesses. We treated a 77-year-old man with an infected hepatic cyst in the lateral segment caused by Edwardsiella tarda, which has not been previously reported as a pathogenic organism associated with infected hepatic cysts. Percutaneous drainage was temporarily effective, but infection recurred after the drainage tube was removed. We then inserted two drainage tubes into the cyst using an endoscopic ultrasonography (EUS)-guided technique, which was developed from EUS-guided fine needle aspiration (EUS-FNA). The internal drainage tube was a 7 Fr double pigtail stent, and the external tube was a 6 Fr nasobiliary drainage tube. Lavage through the external drainage tube was carried out for one week. The external drainage tube was discontinued when the patient's condition improved significantly. Sixteen days after tube insertion, he was discharged with the internal tube draining the hepatic cyst into the stomach. Fifteen months after EUS-guided drainage, CT examination showed no recurrence of the hepatic cyst. EUS-guided drainage is an effective treatment for infected hepatic cysts.

  9. Joint swelling

    MedlinePlus

    Swelling of a joint ... Joint swelling may occur along with joint pain . The swelling may cause the joint to appear larger or abnormally shaped. Joint swelling can cause pain or stiffness. After an ...

  10. The molecular and cellular aspects of arthritis due to alphavirus infections: lesson learned from Ross River virus.

    PubMed

    Rulli, Nestor E; Melton, Julian; Wilmes, Anja; Ewart, Gary; Mahalingam, Suresh

    2007-04-01

    Alphaviruses such as the Sindbis-group viruses, Scandinavian Ockelbo virus, the African Asian chikungunya virus, the African O'nyong-nyong virus, the South American Mayaro virus, and the Australasian Barmah Forest and Ross River viruses, are commonly associated with outbreaks of acute and persistent arthritis and arthralgia in humans. The mechanisms by which these viruses cause arthritis/arthralgia are poorly understood. This chapter summarizes our current understanding of viral arthritides using our newly developed mouse model of Ross River virus-induced joint and muscle inflammation.

  11. Community-acquired infections due to Staphylococcus argenteus lineage isolates harbouring the Panton-Valentine leucocidin, France, 2014.

    PubMed

    Dupieux, C; Blondé, R; Bouchiat, C; Meugnier, H; Bes, M; Laurent, S; Vandenesch, F; Laurent, F; Tristan, A

    2015-06-11

    We describe two cases of human infections caused by Staphylococcus aureus clonal complex (CC) 75, also called Staphylococcus argenteus, harbouring the Panton-Valentine leucocidin (PVL). These two sporadic cases were community-acquired, and identified in France in 2014. Both had an epidemiological link with Mayotte, an overseas department of France located in the Indian Ocean off the south-eastern African coast. This report illustrates that, contrary to previous descriptions, S. argenteus can acquire important virulence factors and be responsible for severe infections.

  12. Common skin infection due to Panton-Valentine leucocidin-producing Staphylococcus aureus strains in asylum seekers from Eritrea: a genome-based investigation of a suspected outbreak.

    PubMed

    Jaton, L; Pillonel, T; Jaton, K; Dory, E; Prod'hom, G; Blanc, D S; Tissot, F; Bodenmann, P; Greub, G

    2016-08-01

    Since late 2014, multiple cases of abscesses and boils due to methicillin-susceptible Staphylococcus aureus (MSSA) expressing the Panton-Valentine leucocidin (PVL) were observed in Eritrean asylum seekers in Lausanne, Switzerland. Strains isolated from infected Eritrean and non-Eritrean patients were compared by whole genome sequencing to determine whether these numerous cases result from an outbreak. The genome of S. aureus PVL-producing strains were sequenced and compared. Clinical and epidemiological characteristics of patients infected by PVL-producing strains were investigated. This work reports 15 cases of infections due to PVL-producing strains affecting mostly asylum seekers (n = 10), people working with refugees and/or exposed to Africans (n = 3). Most infections were due to closely related strains of CC152 (n = 8) and CC15 (n = 3), two distantly related (>34 000 core single nucleotide polymorphisms) clonal complexes. An epidemiological link between the 15 cases could be ruled out by whole genome sequencing (33 to 172 core single nucleotide polymorphisms between the different strains of a given complex). Altogether, these results reflect the probable high incidence of CC15 and CC152 PVL-producing strains in eastern Africa. Clinicians facing unusual skin infections in African refugees (or in any person returning from this region of high endemicity) should consider S. aureus PVL-producer before suspecting rare infections such as leishmaniasis or rickettsiosis. Clinicians should also remember that PVL are frequently expressed by MSSA in some regions of the world and that antibiotics that are efficient on toxin expression, such as clindamycin, represent the best therapeutic option.

  13. Chronic Periprosthetic Hip Joint Infection. A Retrospective, Observational Study on the Treatment Strategy and Prognosis in 130 Non-Selected Patients

    PubMed Central

    Troelsen, Anders; Søballe, Kjeld

    2016-01-01

    Introduction Limited information is available regarding the treatment strategy and prognosis of non-selected patients treated for chronic periprosthetic hip joint infection. Such information is important as no head-to-head studies on treatment strategies are available. The purpose of this study is to report on the treatment strategy and prognosis of a non-selected, consecutive patient population Methods We identified 130 patients in the National Patient Registry, consecutively treated for a chronic periprosthetic hip joint infection between 2003–2008 at 11 departments of orthopaedic surgery. We extracted information regarding patient demographics, treatment and outcome. 82 patients were re-implanted in a two-stage revision (national standard), the remaining 48 were not re-implanted in a two-stage revision. We were able to collect up-to-date information on all patients to date of death or medical chart review with a minimum of 5 years follow-up by the nationwide electronic patient record system Results After primary revision surgery, 53 patients (41%) had a spacer in situ, 64 (50%) had a resection arthroplasty and 13 (9%) did not have the infected implant removed. 63% were re-implanted in a two-stage revision. Re-implantation was performed after an interim period of 14 weeks (IQR 10–18). Patients re-implanted were younger (p-value 0.0006), had a lower CCS score (p-value 0.005), a lower ASA score (p-value 0.0001) and a 68% lower mortality risk in the follow-up period (p-value <0.00001). After adjusting for selected confounders, the mortality risk was no longer significantly different. The 5-year re-infection rate after re-implantation was 14.6% (95%CI 8.0–23.1). Re-infections occurred mainly within 3 years of follow-up. The overall 1-year survival rate was 92% (95%CI 86–96) and the overall 5-year survival rate was 68% (95%CI 59–75). The 5-year survival rate after a two-stage revision was 82% (95%CI 71–89) and in those not re-implanted 45% (95%CI 30–58

  14. Executive summary of management of prosthetic joint infections. Clinical practice guidelines by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC).

    PubMed

    Ariza, Javier; Cobo, Javier; Baraia-Etxaburu, Josu; Benito, Natividad; Bori, Guillermo; Cabo, Javier; Corona, Pablo; Esteban, Jaime; Horcajada, Juan Pablo; Lora-Tamayo, Jaime; Murillo, Oscar; Palomino, Julián; Parra, Jorge; Pigrau, Carlos; Del Pozo, José Luis; Riera, Melchor; Rodríguez, Dolores; Sánchez-Somolinos, Mar; Soriano, Alex; Del Toro, M Dolores; de la Torre, Basilio

    2017-03-01

    The incidence of prosthetic joint infection (PJI) is expected to increase in the coming years. PJI has serious consequences for patients, and high costs for the health system. The complexity of these infections makes it necessary to organize the vast quantity of information published in the last several years. The indications for the choice of a given surgical strategy and the corresponding antimicrobial therapy are specifically reviewed. The authors selected clinically relevant questions and then reviewed the available literature in order to give recommendations according to a pre-determined level of scientific evidence. The more controversial aspects were debated, and the final composition was agreed at an ad hoc meeting. Before its final publication, the manuscript was made available online in order that all SEIMC members were able to read it and make comments and suggestions.

  15. Infections due to Yersinia enterocolitica serotypes O:2,3 and O:4 acquired in South Florida.

    PubMed Central

    Chester, B; Sanderson, T; Zeller, D J; Pestana, O A

    1981-01-01

    Four recent cases of Yersinia enterocolitica infections from Florida are discussed. Two of the cases presented as acute mesenteric lymphadenitis, and the other two presented as septicemia. Three of the isolates were an uncommon serotype, O:2,3, and the fourth was serotype O:5. The increasing occurrence of Y. enterocolitica in semitropical areas of the United States is emphasized. PMID:7240401

  16. Risk of infection and associated influenza-like disease among abattoir workers due to two Leptospira species.

    PubMed

    Dreyfus, A; Heuer, C; Wilson, P; Collins-Emerson, J; Baker, M G; Benschop, J

    2015-07-01

    The aims of this study were to determine the annual incidence of infection with Leptospira interrogans serovar Pomona and/or Leptospira borgpetersenii serovar Hardjo and its association with influenza-like illness (ILI) in meat workers in New Zealand. Sera were collected twice, 50-61 weeks apart, from 592 workers at eight abattoirs slaughtering sheep (n = 4), cattle (n = 2) and deer (n = 2), and tested by the microscopic agglutination test for Hardjo and Pomona. Forty-nine (8·3%) participants either seroconverted or had at least a twofold increased serological titre against either serovar. The worker infection risk was higher in sheep abattoirs (11·9%) than in abattoirs processing deer (0%) or cattle (1·2%) (P < 0·01). The annualized risk of mild (ILI) or severe clinical disease attributable to the two Leptospira serovars was 2·7%. This study has demonstrated that meat workers are at substantial risk of infection and clinical disease, suggesting further investigation of infection sources and preventive measures are warranted.

  17. Over Troubled Water: An Outbreak of Infection Due to a New Species of Mycobacterium following Implant-Based Breast Surgery.

    PubMed

    Scheflan, Michael; Wixtrom, Roger N

    2016-01-01

    Mycobacterial infection is a rare complication associated with breast surgery using implants. Over the course of 5 months, one center experienced 12 such cases, 10 of which were linked to a single surgeon. Most presented 3 to 6 weeks postoperatively with clear serous drainage from the incision, minimal local redness, no fever or other systemic signs of infection, and negative standard bacterial cultures. Patients were given empiric broad-spectrum oral antibiotic therapy. In eight cases, implants were removed and exchanged for new devices after irrigation of the pocket with antibiotics; these patients nonetheless experienced recurrent infection, which led to explantation (without immediate exchange for new implants). The last two patients proceeded straight to explantation. Because mycobacteria grow in water, the water supply and air-conditioning system were initially suspected as the source, and both were disinfected. However, this did not stop the outbreak. Eventually, the source was traced to a new species of mycobacteria isolated from a garden hot tub. These bacteria had then been unwittingly transferred to patients during surgery. A Triclosan-containing shampoo effectively ended the outbreak. This series is unique in several respects: the novelty of the pathogen, the heavy colonization of the surgeon, and the mechanism of transmission (the first occurrence of human-to-human mycobacterial transfer published in the plastic surgery literature). Surgeons who perform breast surgery with implants should be aware of the possibility of mycobacterial infection. Proactive culturing of the organism, use of antibiotics, and reoperation are essential to good outcomes.

  18. Enhanced knee joint function due to accelerated rehabilitation exercise after anterior cruciate ligament reconstruction surgery in Korean male high school soccer players

    PubMed Central

    Lee, Myungchun; Sung, Dong Jun; Lee, Joohyung; Oh, Inyoung; Kim, Sojung; Kim, Seungho; Kim, Jooyoung

    2016-01-01

    This study was conducted on Korean male high school soccer players who underwent anterior cruciate ligament reconstruction (ACLR) to identify the effects of an accelerated rehabilitation exercise (ARE) program on knee joint isometric strength, thigh circumference, Lysholm score, and active balance agility. We assigned eight test participants each to a physical therapy group (PTG) and an accelerated rehabilitation exercise group (AREG), and compared differences between the groups. Both the PTG and AREG showed significant increases in 30° away and 60° toward isometric strength after treatment. In addition, significant differences were observed in these strength tests between the two groups. Both groups also showed significant increases in thigh circumference, Lysholm score, and active balance agility after treatment, but no significant differences were observed between the two groups. We conclude that the ARE treatment was more effective for improving isometric strength of the knee joint than that of physical therapy, and that an active rehabilitation exercise program after ACLR had positive effects on recovery performance of patients with an ACL injury and their return to the playing field. PMID:26933657

  19. Mortality in Captive Rhesus Monkeys (Macaca mulatta) in China Due to Infection with Yersinia pseudotuberculosis Serotype O:1a.

    PubMed

    Zhao, Na; Li, Meng; Amer, Said; Liu, Shelan; Luo, Jing; Wang, Shan; He, Hongxuan

    2016-09-01

    The most common serotypes of Yersinia pseudotuberculosis infecting non-human primates are serotypes O:1b, O:3, O:4, and O:7. The O:1a serotype has never been reported in non-human primates. The present study describes an outbreak of serotype O:1a with high fatality (6/18) in captive rhesus monkeys in China. Bacteria were isolated from different organs of the carcasses using standard microbiological procedures. The strain was identified using conventional and molecular techniques such as morphological and biochemical identification, serotype determination, PCR-sequence analysis based on the 16S rRNA gene, detection of virulence genes, and antimicrobial susceptibility testing. The pathogenicity was determined after experimental infection in mice. Taken together, the obtained data indicate that Y. pseudotuberculosis O:1a is a pathogen of concern and represents a potential threat to monkey conservation efforts.

  20. Urinary infection due to Balantioides coli: a rare accidental zoonotic disease in an addicted and diabetic young female in Iran

    PubMed Central

    Roudi, Abdolghayyoum Movahhedi; Raeisalsadati, Seyedeh Sara

    2016-01-01

    Background: Balantiosis, a rare zoonotic infection resulting in dysentery, is caused by the large ciliated protozoan parasite Balantioides coli. Humans acquire this organism via the faecal–oral route. Very rarely, extraintestinal infections can occur in the urinary tract system. There are very few case reports of urinary balantiosis in humans. Case presentation: Here, an interesting case of urinary balantiosis in a 35-year-old addicted woman with multiple health problems including spontaneous abortion and diabetes is reported. Her midstream urine sample, collected while all sterile precautions were being taken, demonstrated B. coli along with Trichomonas vaginalis and bacteria. B. coli was identified by its characteristic morphology and rapid rotary motility in the urinary tract, which is an abnormal site for invasion by this parasite. Conclusion: To the best of our knowledge, this is only the eighth case described in literature in which B. coli was detected in urine sediment; it is reported for its rarity and for future reference. PMID:28348744

  1. First Case Report of Bloodstream Infection Due to a Candida Species Closely Related to the Novel Species Candida pseudorugosa

    PubMed Central

    Córdoba, Susana; Isla, Guillermina; Fernández, Norma; García, Susana; Mazza, Mariana; Murisengo, Omar Alejandro; Vivot, Walter; Szusz, Wanda; Davel, Graciela; Tiraboschi, Iris Nora; Bosco-Borgeat, María Eugenia

    2012-01-01

    Candida pseudorugosa is a novel species closely related to Candida rugosa for which only one case has been reported. We report the first case of a bloodstream infection in humans caused by a Candida sp. closely related to C. pseudorugosa. We contribute evidence to show this organism as a potential human pathogen that may be misidentified by conventional methods, also pointing out its lower sensitivity to azoles and other antifungal agents. PMID:22461681

  2. Prosthetic knee arthritis due to Granulicatella adiacens after dental treatment.

    PubMed

    Mougari, F; Jacquier, H; Berçot, B; Hannouche, D; Nizard, R; Cambau, E; Zadegan, F

    2013-10-01

    We report prosthetic knee arthritis in a 55-year-old diabetic man due to Granulicatella adiacens, a micro-organism present in the oral flora, usually described in endocarditis but rarely in prosthesis joint infection. This patient had undergone a dental extraction without antibiotic prophylaxis one month before, and an aseptic loosening of the prosthesis had been diagnosed previously. If antimicrobial prophylaxis against infective endocarditis for dental procedures is well established, such an approach is still controversial for joint prosthesis and should be considered in some conditions.

  3. Alpha-1-antitrypsin (AAT) anomalies are associated with lung disease due to rapidly growing mycobacteria and AAT inhibits Mycobacterium abscessus infection of macrophages.

    PubMed

    Chan, Edward D; Kaminska, Aleksandra M; Gill, Wendy; Chmura, Kathryn; Feldman, Nicole E; Bai, Xiyuan; Floyd, Corinne M; Fulton, Kayte E; Huitt, Gwen A; Strand, Matthew J; Iseman, Michael D; Shapiro, Leland

    2007-01-01

    Rapidly growing mycobacteria (RGM) are ubiquitous in the environment but cause lung disease in only a fraction of exposed individuals. This variable susceptibility to disease implies vulnerability to RGM infection due to weakness in host defense. Since most persons who contract RGM lung disease have no known host defense defect, it is likely that uncharacterized host deficiencies exist that predispose to RGM infection. Alpha-1-antitrypsin (AAT) is a host factor that may protect individuals from respiratory infections. Therefore, we assessed AAT protein anomalies as a risk factor for RGM lung disease. In a cohort of 100 patients with RGM lung disease, Mycobacterium (M.) abscessus was the most prevalent organism, isolated in 64 (64%) subjects. Anomalous AAT proteins were present in 27% of the cohort, which is 1.6 times the estimated prevalence of anomalous AAT proteins in the United States population (p=0.008). In in vitro studies, both AAT and a synthetic inhibitor of serine proteases suppressed M. abscessus infection of monocyte-derived macrophages by up to 65% (p<0.01). AAT may be an anti-RGM host-defense factor, and anomalous AAT phenotypes or AAT deficiency may constitute risk factors for pulmonary disease due to RGM.

  4. Infection

    DTIC Science & Technology

    2010-09-01

    standing, diagnosis, and treatment of musculoskeletal infections. Key Words: musculoskeletal infection, biofilm , bacteria, biomaterial (J Orthop Trauma...form a biofilm , or slime layer.1 The recurrence of infections is often the result of microbial biofilm formation on the implant, enabling the persistence...Klebsiella pneumoniae). Staphylococcus species is by far the most studied pathogen in musculoskeletal infections and can produce a multilayered biofilm

  5. Production of thyrotropin receptor antibodies in acute phase of infectious mononucleosis due to Epstein-Barr virus primary infection: a case report of a child.

    PubMed

    Nagata, Keiko; Okuno, Keisuke; Ochi, Marika; Kumata, Keisuke; Sano, Hitoshi; Yoneda, Naohiro; Ueyama, Jun-Ichi; Matsushita, Michiko; Kuwamoto, Satoshi; Kato, Masako; Murakami, Ichiro; Kanzaki, Susumu; Hayashi, Kazuhiko

    2015-01-01

    Various autoantibodies have been reported to be detected during the progression of infectious mononucleosis. We observed a case of infectious mononucleosis due to Epstein-Barr virus primary infection for 2 months, and noticed the transiently increased titer of thyrotropin receptor autoantibodies detected at the acute phase on the 3rd day after admission. At that time, real-time quantitative PCR also revealed the mRNA expressions of an immediate early lytic gene, BZLF1, and a latent gene, EBNA2. The expression of BZLF1 mRNA means that Epstein-Barr virus infects lytically, and EBNA2 protein has an important role in antibody production as well as the establishment of Epstein-Barr virus latency. These results suggest that Epstein-Barr virus lytic infection is relevant to thyrotropin receptor autoantibody production. Thyrotropin receptor autoantibodies stimulate thyroid follicular cells to produce excessive thyroid hormones and cause Graves' disease. Recently, we reported the thyrotropin receptor autoantibody production from thyrotropin receptor autoantibody-predisposed Epstein-Barr virus-infected B cells by the induction of Epstein-Barr virus lytic infection in vitro. This case showed in vivo findings consistent with our previous reports, and is important to consider the pathophysiology of Graves' disease and one of the mechanisms of autoimmunity.

  6. Nonredundant Roles of Interleukin-17A (IL-17A) and IL-22 in Murine Host Defense against Cutaneous and Hematogenous Infection Due to Methicillin-Resistant Staphylococcus aureus

    PubMed Central

    Chan, Liana C.; Chaili, Siyang; Filler, Scott G.; Barr, Kevin; Wang, Huiyuan; Kupferwasser, Deborah; Edwards, John E.; Xiong, Yan Q.; Ibrahim, Ashraf S.; Miller, Lloyd S.; Schmidt, Clint S.; Hennessey, John P.

    2015-01-01

    Staphylococcus aureus is the leading cause of skin and skin structure infections (SSSI) in humans. Moreover, the high frequency of recurring SSSI due to S. aureus, particularly methicillin-resistant S. aureus (MRSA) strains, suggests that infection induces suboptimal anamnestic defenses. The present study addresses the hypothesis that interleukin-17A (IL-17A) and IL-22 play distinct roles in immunity to cutaneous and invasive MRSA infection in a mouse model of SSSI. Mice were treated with specific neutralizing antibodies against IL-17A and/or IL-22 and infected with MRSA, after which the severity of infection and host immune response were determined. Neutralization of either IL-17A or IL-22 reduced T cell and neutrophil infiltration and host defense peptide elaboration in lesions. These events corresponded with increased abscess severity, MRSA viability, and CFU density in skin. Interestingly, combined inhibition of IL-17A and IL-22 did not worsen abscesses but did increase gamma interferon (IFN-γ) expression at these sites. The inhibition of IL-22 led to a reduction in IL-17A expression, but not vice versa. These results suggest that the expression of IL-17A is at least partially dependent on IL-22 in this model. Inhibition of IL-17A but not IL-22 led to hematogenous dissemination to kidneys, which correlated with decreased T cell infiltration in renal tissue. Collectively, these findings indicate that IL-17A and IL-22 have complementary but nonredundant roles in host defense against cutaneous versus hematogenous infection. These insights may support targeted immune enhancement or other novel approaches to address the challenge of MRSA infection. PMID:26351278

  7. Fluoroquinolone and Third-Generation-Cephalosporin Resistance among Hospitalized Patients with Urinary Tract Infections Due to Escherichia coli: Do Rates Vary by Hospital Characteristics and Geographic Region?

    PubMed Central

    Bidell, Monique R.; Palchak, Melissa; Mohr, John

    2016-01-01

    This analysis of nearly 10,000 hospital-associated urinary tract infection (UTI) episodes due to Escherichia coli showed that fluoroquinolone and third-generation-cephalosporin resistance rates were 34.5% and 8.6%, respectively; the rate of concurrent resistance to both agents was 7.3%. Fluoroquinolone resistance rates exceeded 25% regardless of geographic location or hospital characteristics. The findings suggest that fluoroquinolones should be reserved and third-generation cephalosporins be used with caution as empirical agents for hospitalized patients with UTIs due to E. coli. PMID:26926640

  8. The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements.

    PubMed

    Fink, B; Makowiak, C; Fuerst, M; Berger, I; Schäfer, P; Frommelt, L

    2008-07-01

    We analysed the serum C-reactive protein level, synovial fluid obtained by joint aspiration and five synovial biopsies from 145 knee replacements prior to revision to assess the value of these parameters in diagnosing late peri-prosthetic infection. Five further synovial biopsies were used for histological analysis. Samples were also obtained during the revision and incubated and analysed in an identical manner for 14 days. A total of 40 total knee replacements were found to be infected (prevalence 27.6%). The aspiration technique had a sensitivity of 72.5% (95% confidence interval (CI) 58.7 to 86.3), a specificity of 95.2% (95% CI 91.2 to 99.2), a positive predictive value of 85.3% (95% CI 73.4 to 100), a negative predictive value of 90.1% (95% CI 84.5 to 95.7) and an accuracy of 89%. The biopsy technique had a sensitivity of 100%, a specificity of 98.1% (95% CI 95.5 to 100), a positive predictive value of 95.2% (95% CI 88.8 to 100), a negative predictive value of 100% and an accuracy of 98.6%. C-reactive protein with a cut-off-point of 13.5 mg/l had a sensitivity of 72.5% (95% CI 58.7 to 86.3), a specificity of 80.9% (95% CI 73.4 to 88.4), a positive predictive value of 59.2% (95% CI 45.4 to 73.0), a negative predictive value of 88.5% (95% 81.0 to 96.0 CI) and an accuracy of 78.1%. We found that biopsy was superior to joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements.

  9. Clinical response to glycyrrhizinic acid in genital infection due to human papillomavirus and low-grade squamous intraepithelial lesion

    PubMed Central

    Valencia, Marcelino Hernández; Pacheco, Adia Carrillo; Quijano, Tomás Hernández; Girón, Antonio Vargas; López, Carlos Vargas

    2011-01-01

    Human papilloma virus (HPV) can infect any of the mucosal areas of the body and cause cervical cancer. Until recently, no specific treatments were available for this condition; therefore, any damaged tissue had to be removed or destroyed, which may have presented obstetrical repercussions for some women. Recently, new drugs have been developed that have shown to be effective for the cure of HPV infection. Glycyrrhizinic acid (GA) has shown fewer side effects and its systemic use makes it possible to reach difficult-to-treat lesions. The purpose of this study was to evaluate the clinical outcome of GA to eliminate the epithelial lesion and HPV. We carried out a longitudinal, descriptive study that included women of reproductive age who were diagnosed with HPV associated with low-grade squamous intraepithelial lesion (LSIL). Subjects began treatment based on GA using two routes of administration - systemic (oral) and topical (spray) - with assessments every month to determine the clinical changes of the lesions through colposcopy and Papanicolaou (Pap) smear. Simple statistics were used along with two-tailed Student's t-test; P<0.05 was considered statistically significant before and after treatment. There were 70 eligible patients, of whom 62 fulfilled the inclusion criteria. Age of subjects was 27.8±9.5 years. At the time of the study, 100% of the patients had HPV infection, 40% were associated with LSIL, and only 16% used a barrier contraceptive (condom) method. Resolution was achieved in all patients from 4 weeks of treatment initiation and improvement was achieved in the majority of patients at 12 weeks (74%) (P<0.001). However, there was persistence of LSIL in 27.7% of patients and only one patient progressed to cervical intraepithelial neoplasia (CIN) II. The use of GA proved to be effective in resolving clinical HPV lesions. For cervical lesions with epithelial changes (LSIL), treatment may be required for a longer period as with other drugs used for this

  10. Spiral swimming behavior due to cranial and vertebral lesions associated with Cytophaga psychrophila infections in salmonid fishes

    USGS Publications Warehouse

    Kent, M.L.; Groff, J.M.; Morrison, J.K.; Yasutake, W.T.; Holt, R.A.

    1989-01-01

    C. psychrophila infections of the cranium and anterior vertebrae in salmonid fishes were associated with ataxia, spiral swimming along the axis of the fish, and death. The syndrome was observed in 2-10% of underyearling coho salmon Oncorhynchus kisutch, rainbow troutSalmo gairdneri, and steelhead trout S. gairdneri at several private, state, and federal hatcheries in Washington and Oregon, USA, between 1963 and 1987. Affected fish did not recover and ultimately died. Histological examination consistently revealed subacute to chronic periostitis, osteitis, meningitis, and ganglioneuritis. Inflammation and periosteal proliferation of the anterior vertebrae at the junction of the vertebral column with the cranium with extension into the cranial case was a consistent feature. The adjacent nervous tissue, particularly the medulla, was often compressed by the proliferative lesion, and this may have caused the ataxia. Though bacteria were seldom observed in these lesions. C. psychrophilawas isolated in culture from the cranial cavity of all affected fish that were tested. Epidemiological observations suggested that this bacterium is the causative agent because the spiral swimming behaviour and lesions were observed only in populations that had recovered from acute C. psychrophila infections.

  11. Concurrent Resolution of Chronic Diarrhea Likely Due to Crohn’s Disease and Infection with Mycobacterium avium paratuberculosis

    PubMed Central

    Singh, Shoor V.; Kuenstner, J. Todd; Davis, William C.; Agarwal, Prabhat; Kumar, Naveen; Singh, Devendra; Gupta, Saurabh; Chaubey, Kundan K.; Kumar, Ashok; Misri, Jyoti; Jayaraman, Sujatha; Sohal, Jagdip S.; Dhama, Kuldeep

    2016-01-01

    Examination of samples of stool from a 61-year-old male patient, presenting with the clinical symptoms of Crohn’s disease (CD), revealed massive shedding of acid fast bacilli with the morphology of Mycobacterium avium paratuberculosis (MAP), the causative agent of Johne’s disease in cattle. MAP was cultured from the stool. Biotyping of the bacterium isolated from cultures of stool demonstrated, it was the Indian Bison biotype of MAP, the dominant biotype infecting livestock and humans in India. Based on this finding and because the patient was unresponsive to standard therapy used in India to treat patients with gastrointestinal inflammatory disorders, the patient was placed on a regimen of multi-antibiotic therapy, currently used to treat tuberculosis and CD. After 1 year of treatment, the patient’s health was restored, concurrent with cessation of shedding of MAP in his stool. This patient is the first case shown to shed MAP from the stool who was cured of infection with antibiotics and who was concurrently cured of clinical signs of CD. PMID:27833911

  12. Evaluation of antibiotic resistance to orally administrable antibiotics in staphylococcal bone and joint infections in one of the largest university hospitals in Germany: is there a role for fusidic acid?

    PubMed

    Klein, Sabrina; Nurjadi, Dennis; Eigenbrod, Tatjana; Bode, Konrad A

    2016-02-01

    Bone and joint infections (BJIs) are often difficult to treat. Staphylococcus spp. is the major pathogen causing these infections, which is often associated with biofilm formation on prosthetic materials. Therapeutic measures are complex, ranging from surgical intervention to initial intravenous and supportive long-term oral antibiotic therapy. The options for oral antimicrobial therapy are limited, mainly due to the resistance profile of the causative pathogen and the unfavourable pharmacodynamic and pharmacokinetic properties of most antibiotics in biofilm. Data analysis over a 5-year period was performed on staphylococci isolated from BJI patients in the Orthopaedic Department of the University Hospital Heidelberg (Heidelberg, Germany) to assess the plausibility of fusidic acid (FA)-based alternative oral treatment regimens. Six percent of BJIs were caused by meticillin-resistant Staphylococcus aureus (MRSA), and multiresistance was common. Over 75% of MRSA in BJIs were resistant to the commonly used rifampicin (RIF)-based combinations. Resistance to FA-based combinations was high. However, over 80% were susceptible to the combination RIF+FA. In coagulase-negative staphylococci, resistance to RIF-based combinations was similar to FA-based combinations. Almost two-thirds of the isolates tested were susceptible to RIF+FA. These data suggest FA as a possible option as a substitution for RIF or as a combination companion in case of resistance or unavailability.

  13. Diagnosis and therapy of Candida infections: joint recommendations of the German Speaking Mycological Society and the Paul-Ehrlich-Society for Chemotherapy.

    PubMed

    Ruhnke, Markus; Rickerts, Volker; Cornely, Oliver A; Buchheidt, Dieter; Glöckner, Andreas; Heinz, Werner; Höhl, Rainer; Horré, Regine; Karthaus, Meinolf; Kujath, Peter; Willinger, Birgit; Presterl, Elisabeth; Rath, Peter; Ritter, Jörg; Glasmacher, Axel; Lass-Flörl, Cornelia; Groll, Andreas H

    2011-07-01

    Invasive Candida infections are important causes of morbidity and mortality in immunocompromised and hospitalised patients. This article provides the joint recommendations of the German-speaking Mycological Society (Deutschsprachige Mykologische Gesellschaft, DMyKG) and the Paul-Ehrlich-Society for Chemotherapy (PEG) for diagnosis and treatment of invasive and superficial Candida infections. The recommendations are based on published results of clinical trials, case-series and expert opinion using the evidence criteria set forth by the Infectious Diseases Society of America (IDSA). Key recommendations are summarised here: The cornerstone of diagnosis remains the detection of the organism by culture with identification of the isolate at the species level; in vitro susceptibility testing is mandatory for invasive isolates. Options for initial therapy of candidaemia and other invasive Candida infections in non-granulocytopenic patients include fluconazole or one of the three approved echinocandin compounds; liposomal amphotericin B and voriconazole are secondary alternatives because of their less favourable pharmacological properties. In granulocytopenic patients, an echinocandin or liposomal amphotericin B is recommended as initial therapy based on the fungicidal mode of action. Indwelling central venous catheters serve as a main source of infection independent of the pathogenesis of candidaemia in the individual patients and should be removed whenever feasible. Pre-existing immunosuppressive treatment, particularly by glucocorticosteroids, ought to be discontinued, if feasible, or reduced. The duration of treatment for uncomplicated candidaemia is 14 days following the first negative blood culture and resolution of all associated symptoms and findings. Ophthalmoscopy is recommended prior to the discontinuation of antifungal chemotherapy to rule out endophthalmitis or chorioretinitis. Beyond these key recommendations, this article provides detailed recommendations

  14. Quantifying the risk of human Toxoplasma gondii infection due to consumption of fresh pork in the United States

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Toxoplasma gondii is one of the leading foodborne pathogens in the United States. The Centers for Disease Control and Prevention (CDC) reported that T. gondii accounts for 24% of deaths due to foodborne illness in the United States. Consumption of undercooked pork products in which T. gondii has enc...

  15. Cholesterol granuloma associated with otitis media and leptomeningitis in a cat due to a Streptococcus canis infection.

    PubMed

    Van der Heyden, Sara; Butaye, Patrick; Roels, Stefan

    2013-01-01

    Cholesterol granuloma in the middle ear is a pathological condition often associated with otitis media in humans. Cholesterol granulomas in cats are rarely described. To our knowledge, this is the first report of middle ear cholesterol granuloma in a cat, associated with otitis media and leptomeningitis due to a Streptococcus canis septicemia.

  16. Phaeohyphomycosis due to Exophiala xenobiotica as a cause of fungal arthritis in an HIV-infected patient.

    PubMed

    Morio, Florent; Berre, Jean-Yves Le; Garcia-Hermoso, Dea; Najafzadeh, Mohammad Javad; de Hoog, Sybren; Benard, Laurent; Michau, Christophe

    2012-07-01

    Black yeasts including Exophiala species are increasingly recognized as agents of human disease. In recent years, progress in molecular phylogeny and taxonomy of the genus Exophiala has led to the description of numerous novel species. The 'classical' but highly variable species Exophiala jeanselmei was split into a number of morphological siblings, which, however, were phylogenetically and clinically remote from each other. E. jeanselmei was restricted to an uncommon species causing subcutaneous infections. Hence only limited information is available on the segregants, among which is E. xenobiotica. We describe a case of an HIV-patient presenting with fungal arthritis and subcutaneous nodules caused by the latter species, which was identified by means of phenotypic and molecular methods.

  17. Cushing's disease due to mixed pituitary adenoma-gangliocytoma of the posterior pituitary gland presenting with Aspergillus sp. sinus infection.

    PubMed

    Bridenstine, Mark; Kerr, Janice M; Lillehei, Kevin O; Kleinschmidt-DeMasters, Bette K

    2013-01-01

    Gangliocytic lesions of the pituitary gland producing Cushing's disease are extremely rare entities that may exist with or without a pituitary adenoma. The latter have been designated mixed pituitary adenoma-gangliocytomas, the majority of which produce growth hormone, not adrenocorticotropin (ACTH), and are localized to the anterior gland. We now report an immunocompetent woman with hypercortisolism who presented with an intranasal aspergilloma eroding the bony sellar floor. The fungal ball was contiguous with, and extended into, a large neurohypophyseal-centered mass. Transsphenoidal resection revealed a gangliocytic lesion of the posterior gland with small clusters of intimately admixed ACTH-immunoreactive adenoma cells as the cause of her Cushing's disease. Rare transitional sizes and shapes of cells coupled with immunohistochemical findings supported interpretation as advanced neuronal metaplasia within an ACTH adenoma. This mixed ACTH adenoma-gangliocytoma is the first example to present clinically with an opportunistic infection.

  18. Severe meningoencephalitis co-infection due to Cryptococcus neoformans and Mycobacterium tuberculosis in a child with systemic lupus erythematosus.

    PubMed

    Martinez-Longoria, Cesar Adrián; Rubio-Perez, Nadina Eugenia; Rios-Solis, Josue Emmanuel; Garcia-Rodriguez, Fernando

    2015-04-01

    The incidences of infection with Mycobacterium tuberculosis and Cryptococcus neoformans in immunocompromised patients have increased, but there are few documented cases of their coexistence. We present the case of a 9-year-old female with systemic lupus erythematosus (SLE), treated with prednisone and cyclophosphamide, who was admitted to the emergency department with a 2-week history of fever, headache, malaise, fatigue, and diplopia 3 years after diagnosis. Physical examination showed limitation of abduction of the right eye, Kernig and Brudzinski signs, and hyporeflexia. Magnetic resonance imaging showed hyperdense lesions located in the caudate nucleus, and lumbar puncture showed pleocytosis, a low glucose level, and increased protein level. Cerebrospinal fluid culture identified C. neoformans and PCR detect M. tuberculosis. Treatment was started with isoniazid, rifampin, pyrazinamide, ethambutol, and amphotericin B. We found two similar reports in adults, but no data were found for either pediatric or SLE patients.

  19. Clinical and Molecular Characterization of Community-Onset Urinary Tract Infections Due to Extended-Spectrum Cephalosporin-Resistant Enterobacteriaceae.

    PubMed

    Anesi, Judith A; Lautenbach, Ebbing; Nachamkin, Irving; Garrigan, Charles; Bilker, Warren B; Wheeler, Mary; Tolomeo, Pam; Han, Jennifer H

    2016-12-01

    OBJECTIVE To evaluate risk factors for and molecular characteristics of community-onset extended-spectrum cephalosporin-resistant (ESC-R) Enterobacteriaceae (EB) urinary tract infections (UTIs) in a US health system. DESIGN Case-control study. PARTICIPANTS All patients presenting to the emergency department or outpatient practices with EB UTIs from December 21, 2010, through April 22, 2013, were included. Case patients had ESC-R EB UTIs. Control patients had ESC-susceptible EB UTIs and were matched 1:1 on study year. METHODS Risk factors for ESC-R EB UTI were assessed using multivariable conditional logistic regression. A subset of case isolates was evaluated for extended-spectrum beta-lactamases. RESULTS A total of 302 patients with community-onset EB UTI were included, of which 151 were cases. On multivariable analysis, risk factors for ESC-R EB UTI included trimethoprim-sulfamethoxazole use in the prior 6 months (odds ratio, 2.40 [95% CI, 1.22-4.70]; P=.01), older age (1.03 [1.01-1.04]; P<.001), diabetes (2.91 [1.32-6.41]; P=.008), and presentation to the emergency department ( 2.42 [1.31-4.46]; P=.005). The prevalence of extended-spectrum beta-lactamases among 120 case isolates was 52% CTX-M, 29% TEM, 20% OXA, and 13% SHV. The prevalence of AmpC was 25%. Pulsed-field gel electrophoresis of the CTX-M Escherichia coli isolates showed no distinct clusters. CONCLUSIONS Use of trimethoprim-sulfamethoxazole, older age, diabetes, and presentation to the emergency department were associated with community-onset ESC-R EB UTI. There was a high prevalence of CTX-M among our community isolates. Further studies are needed to determine strategies to limit emergence of these organisms in the community. Infect Control Hosp Epidemiol 2016;1433-1439.

  20. Genetic, immunological, and clinical features of patients with bacterial and fungal infections due to inherited IL-17RA deficiency.

    PubMed

    Lévy, Romain; Okada, Satoshi; Béziat, Vivien; Moriya, Kunihiko; Liu, Caini; Chai, Louis Yi Ann; Migaud, Mélanie; Hauck, Fabian; Al Ali, Amein; Cyrus, Cyril; Vatte, Chittibabu; Patiroglu, Turkan; Unal, Ekrem; Ferneiny, Marie; Hyakuna, Nobuyuki; Nepesov, Serdar; Oleastro, Matias; Ikinciogullari, Aydan; Dogu, Figen; Asano, Takaki; Ohara, Osamu; Yun, Ling; Della Mina, Erika; Bronnimann, Didier; Itan, Yuval; Gothe, Florian; Bustamante, Jacinta; Boisson-Dupuis, Stéphanie; Tahuil, Natalia; Aytekin, Caner; Salhi, Aicha; Al Muhsen, Saleh; Kobayashi, Masao; Toubiana, Julie; Abel, Laurent; Li, Xiaoxia; Camcioglu, Yildiz; Celmeli, Fatih; Klein, Christoph; AlKhater, Suzan A; Casanova, Jean-Laurent; Puel, Anne

    2016-12-20

    Chronic mucocutaneous candidiasis (CMC) is defined as recurrent or persistent infection of the skin, nails, and/or mucosae with commensal Candida species. The first genetic etiology of isolated CMC-autosomal recessive (AR) IL-17 receptor A (IL-17RA) deficiency-was reported in 2011, in a single patient. We report here 21 patients with complete AR IL-17RA deficiency, including this first patient. Each patient is homozygous for 1 of 12 different IL-17RA alleles, 8 of which create a premature stop codon upstream from the transmembrane domain and have been predicted and/or shown to prevent expression of the receptor on the surface of circulating leukocytes and dermal fibroblasts. Three other mutant alleles create a premature stop codon downstream from the transmembrane domain, one of which encodes a surface-expressed receptor. Finally, the only known missense allele (p.D387N) also encodes a surface-expressed receptor. All of the alleles tested abolish cellular responses to IL-17A and -17F homodimers and heterodimers in fibroblasts and to IL-17E/IL-25 in leukocytes. The patients are currently aged from 2 to 35 y and originate from 12 unrelated kindreds. All had their first CMC episode by 6 mo of age. Fourteen patients presented various forms of staphylococcal skin disease. Eight were also prone to various bacterial infections of the respiratory tract. Human IL-17RA is, thus, essential for mucocutaneous immunity to Candida and Staphylococcus, but otherwise largely redundant. A diagnosis of AR IL-17RA deficiency should be considered in children or adults with CMC, cutaneous staphylococcal disease, or both, even if IL-17RA is detected on the cell surface.

  1. Successful cessation of transmitting healthcare-associated infections due to Burkholderia cepacia complex in a neonatal intensive care unit in a Japanese children's hospital

    PubMed Central

    2011-01-01

    Background Burkholderia cepacia strains have been known to possess the capability to cause serious infections especially in neonatal intensive care units (NICUs), and their multi-drug resistances become a severe threat in hospital settings. The aim of this investigation was to evaluate the B. cepacia complex infections in the NICU in Nagano Children's Hospital, Azumino 399-8288, Japan, and to report the intervention leading to the successful cessation of the outbreak. Methodology The incidence of isolation and antimicrobial susceptibilities of nosocomial Burkholderia cepacia complex strains during a four-year period were retrospectively examined by clinical microbiological records, and by pulsed-field gel electrophoresis analyses along with the bacteriological verification of disinfectant device itself and procedures for its maintenance routinely used in the NICU. Results During the period surveyed between 2007 and 2009, only an isolate per respective year of B. cepacia complex was recovered from each neonate in the NICU. However, in 2010, the successive 6 B. cepacia complex isolates were recovered from different hospitalized neonates. Among them, an isolate was originated from peripheral blood of a neonate, apparently giving rise to systemic infection. In addition, the hospitalized neonate with bacteremia due to B. cepacia complex also exhibited positive cultures from repeated catheterized urine samples together with tracheal aspirate secretions. However other 5 isolates were considered as the transients or contaminants having little to do with infections. Moreover, the 5 isolates between July and October in 2010 revealed completely the same electrophoresis patterns by means of pulsed-field gel electrophoresis analyses, strongly indicating that they were infected through the same medical practices, or by transmission of the same contaminant. Conclusions A small outbreak due to B. cepacia complex was brought about in the NICU in 2010, which appeared to be

  2. Synovial Fluid C-reactive Protein as a Diagnostic Marker for Periprosthetic Joint Infection: A Systematic Review and Meta-analysis

    PubMed Central

    Wang, Chi; Wang, Qi; Li, Rui; Duan, Jin-Yan; Wang, Cheng-Bin

    2016-01-01

    Background: Periprosthetic joint infection (PJI) is the main cause of failure following total joint arthroplasty. Until now, the diagnosis of PJI is still confronted with technical limitations, and the question of whether synovial fluid biomarker, C-reactive protein (CRP), can provide high value in the diagnosis of PJI remains unanswered and, therefore, was the aim of the study. Methods: First, we conducted a systematic review on CRP in the diagnosis of PJI by searching online databases using keywords such as “periprosthetic joint infection”, “synovial fluid”, and “C-reactive protein”. Eligible studies providing sufficient data to construct 2 × 2 contingency tables were then selected based on the list of criteria and the quality of included studies was assessed subsequently. Finally, the reported sensitivity, specificity, diagnostic odds ratio (DOR), summary receiver operating characteristic (SROC) curve, and the area under the SROC (AUSROC) were pooled together and used to evaluate overall diagnostic performance. Results: Seven studies were included in our review, six of which comprising a total of 456 participants were further investigated in our meta-analysis. The pooled sensitivity, specificity, and DOR were 0.92 (95% confidence interval [CI]: 0.86–0.96), 0.90 (95% CI: 0.87–0.93), and 101.40 (95% CI: 48.07–213.93), respectively. The AUSROC was 0.9663 (standard error, 0.0113). Conclusions: Synovial fluid CRP is a good biomarker for the diagnosis of PJI with high sensitivity and specificity. PMID:27503025

  3. Health Care Needs and Support for Patients Undergoing Treatment for Prosthetic Joint Infection following Hip or Knee Arthroplasty: A Systematic Review

    PubMed Central

    Beswick, Andrew D.; Peters, Tim J.; Gooberman-Hill, Rachael; Whitehouse, Michael R.; Blom, Ashley W.

    2017-01-01

    Background Hip and knee arthroplasty are common interventions for the treatment of joint conditions, most notably osteoarthritis. Although many patients benefit from surgery, approximately 1% of patients develop infection afterwards known as deep prosthetic joint infection (PJI), which often requires further major surgery. Objective To assess support needs of patients undergoing treatment for PJI following hip or knee arthroplasty and to identify and evaluate what interventions are routinely offered to support such patients. Design Systematic review Data sources MEDLINE, EMBASE, Web of Science, PsycINFO, Cinahl, Social Science Citation Index, The Cochrane Library, and reference lists of relevant studies from January 01, 1980 to October 05, 2016. Selection criteria Observational (prospective or retrospective cohort, nested case-control or case-control) studies, qualitative studies, or clinical trials conducted in patients treated for PJI and/or other major adverse occurrences following hip or knee arthroplasty. Review methods Data were extracted by two independent investigators and consensus was reached with involvement of a third. Given the heterogeneous nature of study designs, methods, and limited number of studies, a narrative synthesis is presented. Results Of 4,213 potentially relevant citations, we identified one case-control, one prospective cohort and two qualitative studies for inclusion in the synthesis. Patients report that PJI and treatment had a profoundly negative impact affecting physical, emotional, social and economic aspects of their lives. No study evaluated support interventions. Conclusion The findings demonstrate that patients undergoing treatment for PJI have extensive physical, psychological, social and economic support needs. The interpretation of study results is limited by variation in study design, outcome measures and the small number of relevant eligible studies. However, our review highlights a lack of evidence about support

  4. Epidemiology of Blood Stream Infection due to Candida Species in a Tertiary Care Hospital in Japan over 12 Years: Importance of Peripheral Line-Associated Candidemia

    PubMed Central

    Ishikane, Masahiro; Hayakawa, Kayoko; Kutsuna, Satoshi; Takeshita, Nozomi; Ohmagari, Norio

    2016-01-01

    Background Candidemia is an important cause of mortality in healthcare settings. Peripheral lines are a source of candidemia, yet few studies have reported on the clinico-epidemiological features of candidemia due to peripheral-line associated blood stream infection (PLABSI). Methods We conducted a single-centre retrospective cohort study of all patients with candidemia between 2002 and 2013. PLABSI was defined as the presence of at least one of the following: the presence of phlebitis or the resolution of clinical symptoms after peripheral-line withdrawal, with careful exclusion of an alternative explanation for bacteraemia. We described the epidemiology of candidemia and assessed predictive factors of PLABSI due to Candida spp., peripheral line-associated candidemia (PLAC), compared with non-PLAC. Results A total of 301 episodes of candidemia, including 37 of PLAC, were diagnosed during the study period. Central-line associated blood stream infection, intra-abdominal infection, and infection of unknown source accounted for the remaining 233, 14, and 17 cases, respectively. The overall incidence rate of candidemia was 0.11/1000 patient-days. In multivariate analysis, cephalosporin exposure (odds ratio [OR] = 2.22, 95% CI 1.04–4.77), polymicrobial bacteraemia/fungaemia (OR = 2.87, 95% CI 1.02–8.10), and ID specialist consultation (OR = 2.40, 95% CI 1.13–5.13) were identified as independent predictors of PLAC. Although non-PLAC had a higher mortality, the length of hospital stay after candidemia was similar between the two groups and candidemia duration was longer in the PLAC group. Conclusion PLACs are an important cause of candidemia in hospitalized patients. Appropriate identification and management of PLAC are crucial. PMID:27798663

  5. Bone and joint infections caused by mucormycetes: A challenging osteoarticular mycosis of the twenty-first century.

    PubMed

    Taj-Aldeen, Saad J; Gamaletsou, Maria N; Rammaert, Blandine; Sipsas, Nikolaos V; Zeller, Valerie; Roilides, Emmanuel; Kontoyiannis, Dimitrios P; Henry, Michael; Petraitis, Vidmantas; Moriyama, Brad; Denning, David W; Lortholary, Olivier; Walsh, Thomas J

    2017-01-03

    Osteomyelitis and arthritis caused by mucormycetes are rare diseases that rank among the most challenging complications in orthopedic and trauma surgery. The aim of this work is to review the epidemiological, clinical, diagnostic, and therapeutic aspects of the osteoarticular mucormycosis with particular emphasis on high-risk patients. A systematic review of osteoarticular mucormycosis was performed using PUBMED and EMBASE databases from 1978 to 2014. Among 34 patients with median age 41 (0.5-73 years), 24 (71%) were males. While 12 (35%) were immunocompromised patients, 14 (41%) had prior surgery, and seven (21%) suffered trauma. Other underlying conditions included diabetes mellitus, hematological malignancies, transplantation, and corticosteroid therapy. The median diagnostic delay from onset of symptoms and signs was 60 (10-180) days. The principal mechanism of the infection was direct inoculation (n = 19; 56%), and in immunocompromised patients was usually hematogenous disseminated. The long bones were infected by trauma or surgery, while a wide variety of bones were involved by hematogenous dissemination. Combined surgery and amphotericin B treatment were implemented in 28 (82%) and eight (23%) had an unfavorable outcome. Osteoarticular mucormycosis occurs most frequently after trauma or surgical procedures. These infections are progressively destructive and more virulent in individuals with impaired immune systems. Early diagnosis, timely administration of amphotericin B, control of underlying conditions, and surgical debridement of infected tissue are critical for successful management of osteoarticular mucormycosis.

  6. Do perceived job insecurity and annoyance due to air and noise pollution predict incident self-rated poor health? A prospective analysis of independent and joint associations using a German national representative cohort study

    PubMed Central

    Riedel, Natalie; Loerbroks, Adrian; Bolte, Gabriele; Li, Jian

    2017-01-01

    Background Current economic and social change has contributed to increasing job insecurity and traffic-related pollution in residential areas. Both job insecurity and exposure to noise and air pollution are known determinants of population health and can concur in peoples' lives. This may hold true particularly for socially disadvantaged subpopulations. Nevertheless, the potential independent and joint links of those exposures to health have been rarely examined so far. We aimed to contribute to the scarce body of evidence. Methods Information on perceived job insecurity and exposures to noise and air pollution as expressed by annoyance as well as on self-rated health were gathered from 2 waves of the population-based German Socio-Economic Panel (2009 and 2011, N=6544). We performed multivariable Poisson regression to examine the independent and joint risk of poor health in 2011 by perceived job insecurity and annoyance due to noise and air pollution in 2009. Results After the 2-year follow-up in 2011, 571 (8.7%) participants rated their health as poor. The risk of reporting incident poor health was increased by roughly 40% in employees reporting high versus low perceived job insecurity and annoyance due to noise and air pollution, respectively. This risk increased when both exposures were present at higher levels (risk ratio=1.95 (1.49 to 2.55)). Conclusions Work-related and environmental exposures may accumulate and have a joint health impact. Elaboration on the link between occupational and residential exposures is warranted in the light of their concurrence and their implications for health inequities. PMID:28115332

  7. Geographical Variability in the Likelihood of Bloodstream Infections Due to Gram-Negative Bacteria: Correlation with Proximity to the Equator and Health Care Expenditure

    PubMed Central

    Carmeli, Yehuda; Perencevich, Eli; Tuite, Ashleigh R.; Mermel, Leonard A.

    2014-01-01

    Objective Infections due to Gram-negative bacteria exhibit seasonal trends, with peak infection rates during warmer months. We hypothesized that the likelihood of a bloodstream infection due to Gram-negative bacteria increases with proximity to the equator. We tested this hypothesis and identified geographical, climatic and social factors associated with this variability. Design We established a network of 23 international centers in 22 cities. Setting: De-identified results of positive blood cultures from 2007–2011 and data sources for geographic, climatic and socioeconomic factors were assembled for each center. Participants Patients at the 23 centers with positive blood cultures. Main outcome Due to variability in the availability of total culture volumes across sites, our primary outcome measure was the fraction of positive blood cultures that yielded Gram-negative bacteria; sources of variability in this outcome measure were explored using meta-regression techniques. Results The mean fraction of bacteremia associated with Gram-negative bacteria was 48.4% (range 26.4% to 61.8%). Although not all sites displayed significant seasonality, the overall P-value for seasonal oscillation was significant (P<0.001). In univariate meta-regression models, temperature, latitude, latitude squared, longitude, per capita gross domestic product and percent of gross domestic product spent on healthcare were all associated with the fraction of bacteremia due to Gram-negative bacteria. In multivariable models, only percent of gross domestic product spent on healthcare and distance from the equator (ie. latitude squared) were significantly associated with the fraction of bacteremia due to Gram-negative bacteria. Conclusions The likelihood of bacteremia due to Gram-negative bacteria varies markedly between cities, in a manner that appears to have both geographic (latitude) and socioeconomic (proportion gross domestic product devoted to health spending) determinants. Thus, the

  8. [Chonic diarrhea and malabsorption due to common variable immunodeficiency, gastrectomy and giardiasis infection: a difficult nutritional management].

    PubMed

    Domínguez-López, M E; González-molero, I; Ramírez-Plaza, C P; Soriguer, F; Olveira, G

    2011-01-01

    Gastric cancer is a frequent cause of cancer-related mortality in the world. Surgery is the only potentially curative therapy, although the adverse effects of surgery are common and considerable. Common variable immunodeficiency is in many cases cause of gastrointestinal system problems such as chronic diarrhea caused by infestation with giardia lamblia, nodular lymphoid hiperplasia ad loss of villi leading frequently to malapsortion and malnutrition. Nutritional deficiencies due to malapsorption (postgastrectomy and secondary to loss of villi, giardiasis and common variable inmunodeficiency) are common. We present the case of a patient with gastric cancer who underwent a gastrectomy with common variable hipogammaglobulinemia and chronic infestation by giardia lamblia, with serious diarrhea resistant to treatment and malabsorption.

  9. Systemic and extraintestinal forms of human infection due to non-typhoid salmonellae in Bulgaria, 2005-2010.

    PubMed

    Asseva, G; Petrov, P; Ivanova, K; Kantardjiev, T

    2012-11-01

    The purpose of this investigation was to review the clinical cases diagnosed as systemic or extraintestinal salmonellosis between 2005 and 2010 in Bulgaria, to determine the antimicrobial resistance of the causative salmonellae, and to analyze the pulsed field gel electrophoresis (PFGE) profiles of extraintestinal Salmonella Corvallis isolates. Culture, biochemical tests, and serotyping were performed. Resistance to 12 antimicrobial agents was studied with the Bauer-Kirby disk diffusion method. The double-disk synergy method was used for the screening of the presence of extended-spectrum beta-lactamases (ESBLs). PFGE typing and analysis of the dendrogram was performed for the comparative investigation of Salmonella Corvallis isolates. Between 2005 and 2010, 2,227 human non-typhoid Salmonella isolates were investigated at the National Reference Laboratory of Enteric Pathogens, Sofia, Bulgaria. Thirty-three strains (1.48 %) from nine national regions were isolated from patients with systemic and extraintestinal forms of salmonellosis. The serotype distribution was as follows: S. enteritidis (n = 21), S. choleraesuis (diphasic n = 3; monophasic n = 3), S. typhimurium (n = 2), Salmonella Corvallis (n = 2), Salmonella Montevideo (n = 1), and S. javiana (n = 1). Eight patients developed severe forms of infections: sepsis (n = 2), septic shock (n = 1 with fatal outcome), meningitis (n = 3), and acute renal failure (n = 2). Twenty-two percent of isolates were resistant to ampicillin and gentamicin, 17.64 % to tetracycline, 14.28 % to nalidixic acid, and 10 % to chloramphenicol. All isolates were susceptible to ciprofloxacin. One Salmonella Corvallis isolate recovered from a patient with chronic hemolytic anemia produced an ESBL and its PFGE profile demonstrated less than 96 % similarity to fecal and wound Salmonella Corvallis with susceptible phenotypes. S. enteritidis was the most common cause of systemic and

  10. Infection

    MedlinePlus

    ... 23(4):251-69. Association for Professionals in Infection Control and Epidemiology (APIC) guideline. Back to Top Administration ... : Hospital Scope | Glossary | References | Site Map | Credits Freedom of ...

  11. Interaction of Cutibacterium ( formerly Propionibacterium) acnes with bone cells: a step toward understanding bone and joint infection development

    PubMed Central

    Aubin, Guillaume Ghislain; Baud’huin, Marc; Lavigne, Jean-Philippe; Brion, Régis; Gouin, François; Lepelletier, Didier; Jacqueline, Cédric; Heymann, Dominique; Asehnoune, Karim; Corvec, Stéphane

    2017-01-01

    Cutibacterium acnes (formerly Propionibacterium acnes) is recognized as a pathogen in foreign-body infections (arthroplasty or spinal instrumentation). To date, the direct impact of C. acnes on bone cells has never been explored. The clade of 11 C. acnes clinical isolates was determined by MLST. Human osteoblasts and osteoclasts were infected by live C. acnes. The whole genome sequence of six isolates of this collection was analyzed. CC36 C. acnes strains were significantly less internalized by osteoblasts and osteoclasts than CC18 and CC28 C. acnes strains (p ≤ 0.05). The CC18 C. acnes ATCC6919 isolate could survive intracellularly for at least 96 hours. C. acnes significantly decreased the resorption ability of osteoclasts with a major impact by the CC36 strain (p ≤ 0.05). Genome analysis revealed 27 genes possibly linked to these phenotypic behaviors. We showed a direct impact of C. acnes on bone cells, providing new explanations about the development of C. acnes foreign-body infections. PMID:28218305

  12. Comparative evaluation of two vaccine candidates against experimental leishmaniasis due to Leishmania major infection in four inbred mouse strains.

    PubMed

    Benhnini, Fouad; Chenik, Mehdi; Laouini, Dhafer; Louzir, Hechmi; Cazenave, Pierre André; Dellagi, Koussay

    2009-11-01

    Experimental leishmaniasis in BALB/c and C57BL/6 mice are the most investigated murine models that were used for the preclinical evaluation of Leishmania vaccine candidates. We have previously described two new inbred mouse strains named PWK and MAI issued from feral founders that also support the development of experimental leishmaniasis due to L. major. In this study, we sought to determine whether different mouse inbred strains generate concordant or discordant results when used to evaluate the potential of Leishmania proteins to protect against experimental leishmaniasis. To this end, two Leishmania proteins, namely, LACK (for Leishmania homolog of receptor for activated C kinase) and LmPDI (for L. major protein disulfide isomerase) were compared for their capacity to protect against experimental leishmaniasis in PWK, MAI, BALB/c, and C57BL/6 inbred mouse strains. Our data show that the capacity of Leishmania proteins to confer protection depends on the mouse strain used, stressing the important role played by the genetic background in shaping the immune response against the pathogen. These results may have important implications for the preclinical evaluation of candidate Leishmania vaccines: rather than using a single mouse strain, a panel of different inbred strains of various genetic backgrounds should be tested in parallel. The antigen that confers protection in the larger range of inbred strains may have better chances to be also protective in outbred human populations and should be selected for clinical trials.

  13. Ocular complications and loss of vision due to herpes zoster ophthalmicus in patients with HIV infection and a comparison with HIV-negative patients.

    PubMed

    Nithyanandam, S; Joseph, M; Stephen, J

    2013-02-01

    The aim of the work is to describe the occurrence of ocular complications and loss of vision due to herpes zoster ophthalmicus (HZO) in HIV-positive patients who received early antiviral therapy for HZO.This is a post hoc analysis of prospectively collected data.Twenty-four HIV-positive patients with HZO were included in this report; male to female ratio was 3.8:1; mean age was 33.5 (±14.9) years. The visual outcome was good, with 14/24 patients having 6/6 vision; severe vision loss (≤6/60) occurred in only 2/24. There was no statistical difference in the visual outcome between the HIV-positive and -negative patients (P = 0.69), although severe vision loss was more likely in HIV-infected patients. The ocular complications of HZO in HIV-infected patients were: reduced corneal sensation (17/24), corneal epithelial lesions (14/24), uveitis (12/24), elevated intraocular pressure (10/24) and extra-ocular muscle palsy (3/24). The severity of rash was similar in the two groups but multidermatomal rash occurred only in HIV-infected patients (4/24). There was no difference in the occurrence of ocular complications of HZO between HIV-positive and HIV-negative patients. HZO associated ocular complications and visual loss is low in HIV-infected patients if treated with HZO antiviral therapy and was comparable with HIV-negative patients. Early institution of HZO antiviral therapy is recommended to reduce ocular complication and vision loss.

  14. Failure of Urological Implants in Spinal Cord Injury Patients due to Infection, Malfunction, and Implants Becoming Obsolete due to Medical Progress and Age-Related Changes in Human Body Making Implant Futile: Report of Three Cases.

    PubMed

    Vaidyanathan, Subramanian; Soni, Bakul; Singh, Gurpreet; Hughes, Peter; Selmi, Fahed; Mansour, Paul

    2013-01-01

    Any new clinical data, whether positive or negative, generated about a medical device should be published because health professionals should know which devices do not work, as well as those which do. We report three spinal cord injury patients in whom urological implants failed to work. In the first, paraplegic, patient, a sacral anterior root stimulator failed to produce erection, and a drug delivery system for intracavernosal administration of vasoactive drugs was therefore implanted; however, this implant never functioned (and, furthermore, such penile drug delivery systems to produce erection had effectively become obsolete following the advent of phosphodiesterase type 5 inhibitors). Subsequently, the sacral anterior root stimulator developed a malfunction and the patient therefore learned to perform self-catheterisation. In the second patient, also paraplegic, an artificial urinary sphincter was implanted but the patient developed a postoperative sacral pressure sore. Eight months later, a suprapubic cystostomy was performed as urethral catheterisation was very difficult. The pressure sore had not healed completely even after five years. In the third case, a sacral anterior root stimulator was implanted in a tetraplegic patient in whom, after five years, a penile sheath could not be fitted because of penile retraction. This patient was therefore established on urethral catheter drainage. Later, infection with Staphylococcus aureus around the receiver block necessitated its removal. In conclusion, spinal cord injury patients are at risk of developing pressure sores, wound infections, malfunction of implants, and the inability to use implants because of age-related changes, as well as running the risk of their implants becoming obsolete due to advances in medicine. Some surgical procedures such as dorsal rhizotomy are irreversible. Alternative treatments such as intermittent catheterisations may be less damaging than bladder stimulator in the long term.

  15. [Chronic diseases of the ankle joint].

    PubMed

    Rand, T; Trattnig, S; Breitenseher, M; Kreuzer, S; Wagesreither, S; Imhof, H

    1999-01-01

    The etiology of chronic diseases of the ankle joint comprises a wide spectrum including chronic inflammatory processes and chronic degenerative, tumorous and neuropathic processes, as well as some specific syndromes based on chronic changes of the ankle joint. Of the inflammatory processes, chronic juvenile arthritis (JVC) is the most common disease. However, also Reiter disease, psoriasis or chronic monoarthritid diseases such as gout, as well as granulomatous diseases (tuberculosis, sarcoidosis) and fungal infections, may affect the ankle joint in a chronic course. Chronic degenerative changes are usually secondary due to abnormal positioning of the joint constituents or repetitive trauma. Neuropathic changes, as frequently seen in the course of diabetes, present with massive osseous destruction and malposition of the articular constituents. Chronic osseous as well as cartilaginous and synovial changes are seen in hemophilic patients. Chronic traumatic changes are represented by pigmented villonodular synovitis (PVNS), and chondromatosis, both with a predilection for the ankle joint. Due to the possibilities of magnetic resonance imaging (MRI), diagnosis of chronic ankle changes includes chronic ligamentous, tendinous and soft tissue changes. With the use of MRI, specific syndromes can be defined which particularly affect the ankle joint in a chronic way, such as the os trigonum syndrome, the anterolateral impingement syndrome and the sinus tarsi syndrome. Nevertheless, plain film radiographs are still the basic element of any investigation. MRI, however, can be potentially used as a second investigation, saving an unnecessary cascade of investigations with ultrasound and CT. The latter investigations are used only with very specific indications, for instance CT for subtle bone structures and sonography for a limited investigation of tendons or evaluation of fluid. Particularly due to the possibilities of MRI and the development of special gradient-echo imaging

  16. Novel Lesions of Bones and Joints Associated with Chikungunya Virus Infection in Two Mouse Models of Disease: New Insights into Disease Pathogenesis

    PubMed Central

    Goupil, Brad A.; McNulty, Margaret A.; Martin, Matthew J.; McCracken, Michael K.; Christofferson, Rebecca C.; Mores, Christopher N.

    2016-01-01

    Chikungunya virus is an arbovirus spread predominantly by Aedes aegypti and Ae. albopictus mosquitoes, and causes debilitating arthralgia and arthritis. While these are common manifestations during acute infection and it has been suggested they can recur in patients chronically, gaps in knowledge regarding the pathogenesis still exist. Two established mouse models were utilized (adult IRF 3/7 -/- -/- and wild-type C57BL/6J mice) to evaluate disease manifestations in bones and joints at various timepoints. Novel lesions in C57BL/6J mice consisted of periostitis (91%) and foci of cartilage of necrosis (50% of mice at 21 DPI). Additionally, at 21 DPI, 50% and 75% of mice exhibited periosteal bone proliferation affecting the metatarsal bones, apparent via histology and μCT, respectively. μCT analysis did not reveal any alterations in trabecular bone volume measurements in C57BL/6J mice. Novel lesions demonstrated in IRF 3/7 -/- -/- mice at 5 DPI included focal regions of cartilage necrosis (20%), periosteal necrosis (66%), and multifocal ischemic bone marrow necrosis (100%). Contralateral feet in 100% of mice of both strains had similar, though milder lesions. Additionally, comparison of control IRF 3/7 -/- -/- and wild-type C57BL/6J mice demonstrated differences in cortical bone. These experiments demonstrate novel manifestations of disease similar to those occurring in humans, adding insight into disease pathogenesis, and representing new potential targets for therapeutic interventions. Additionally, results demonstrate the utility of μCT in studies of bone and joint pathology and illustrate differences in bone dynamics between mouse strains. PMID:27182740

  17. Establishing a role for vancomycin powder application for prosthetic joint infection prevention-results of a wear simulation study.

    PubMed

    Qadir, Rabah; Ochsner, J Lockwood; Chimento, George F; Meyer, Mark S; Waddell, Bradford; Zavatsky, Joseph M

    2014-07-01

    Topical vancomycin powder (VP) has shown efficacy and safety in decreasing post-operative spine infections. VP use in arthroplasty has not been established. Concerns remain for third-body wear with the addition of crystalline substrate at the implant interface. The study's purpose was to compare wear behavior of CoCr on UHMWPE to identical wear couples with VP. A six-station wear simulator was utilized and cyclic articulations were run for 10 million cycles (Mc). UHMWPE wear was measured using photography, stereomicroscopy, and gravimetric measurement. There were no differences in wear mark length (P = 0.43), width (P = 0.49), or gravimetric wear at 10 Mc (P = 0.98). VP and control groups lost 0.32 and 0.33 mg, respectively. VP may have a role in PJI prevention. A well-designed clinical study is needed.

  18. Infection,

    DTIC Science & Technology

    1980-10-16

    inapparent infection. A refeeding program may thus become complicated by the sudden appearance of a life-threatening infectious illness (3). (3) The...Beisel, W. R. 23 Unusually low serum concentrations of inorganic phosphate have been reported in patients with gram-negative sepsis and in Reye’s syndrome ...infection should be corrected by a well-managed program of convalescent-period refeeding . This aspect of nutritional support is too often ignored. On the

  19. Renal trematode infection due to Paratanaisia bragai in zoo housed Columbiformes and a red bird-of-paradise (Paradisaea rubra)☆

    PubMed Central

    Unwin, Steve; Chantrey, Julian; Chatterton, James; Aldhoun, Jitka A.; Littlewood, D. Timothy J.

    2012-01-01

    Trematode infections affect a diverse range of avian species and the organs that are parasitised are also very varied. The family Eucotylidae contains seven genera of renal flukes that parasitise various birds. In birds, mild to severe lesions have been reported for species of the genus Paratanaisia, which was originally described from columbiform and galliform specimens collected in South America and has been identified in a number of wild avian species. This paper investigates eight cases of renal trematode infection at Chester Zoo in the UK due to Paratanaisia bragai in five previously unreported species: red bird-of-paradise, Socorro dove, Mindanao bleeding heart dove, laughing dove and emerald dove. Pathological changes, which varied between species, are discussed. A known intermediate snail host Allopeas clavulinum was present in the enclosures but there was no direct evidence of trematode infection. The size of the snails, possible low prevalence and the difficulty of visualising sporocysts contributed to this. Thus the development and application of further molecular diagnostic markers that can be applied to snail tissues is warranted. Parasite identification was confirmed utilizing DNA amplification from formalin-fixed paraffin-embedded tissues using PCR and trematode specific primers. Sequencing full ssrDNA and D1-D3 lsrDNA confirmed the identity in all cases as P. bragai. However, the short 310 bp fragment used provides insufficient variation or sequence length for wider application. The epidemiology, pathology and consequences for the management of these endangered species are discussed. Preliminary work on developing an effective ante mortem diagnostic PCR test kit is also highlighted. PMID:24533313

  20. Bacteremia due to Pasteurella dagmatis acquired from a dog bite, with a review of systemic infections and challenges in laboratory identification

    PubMed Central

    Xiong, Jianhui; Krajden, Sigmund; Kus, Julianne V; Rawte, Prasad; Blondal, John; Downing, Mark; Zurawska, Urszula; Chapman, William

    2015-01-01

    A case of bacteremia in a 74-year-old man, which was caused by Pasteurella dagmatis and complicated by thrombocytopenia, is presented. Microorganism identification was performed by the provincial reference laboratory using traditional biochemical profiling, completmented with both the sequencing of the 16S ribosomal RNA gene and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry; antibiotic-susceptibility testing was also performed. After treatment with the appropriate antibiotics, the patient fully recovered. Systemic infections attributed to this organism are rarely reported in the literature. Other reported cases of bacteremia due to P dagmatis are reviewed and compared with the present case. The challenges of relying on standard automatic identification are discussed, with alternative methodologies provided. PMID:26600817

  1. Hospitalizations due to selected infections caused by opportunistic premise plumbing pathogens (OPPP) and reported drug resistance in the United States older adult population in 1991-2006.

    PubMed

    Naumova, Elena N; Liss, Alexander; Jagai, Jyotsna S; Behlau, Irmgard; Griffiths, Jeffrey K

    2016-12-01

    The Flint Water Crisis-due to changes of water source and treatment procedures-has revealed many unsolved social, environmental, and public health problems for US drinking water, including opportunistic premise plumbing pathogens (OPPP). The true health impact of OPPP, especially in vulnerable populations such as the elderly, is largely unknown. We explored 10(8) claims in the largest US national uniformly collected data repository to determine rates and costs of OPPP-related hospitalizations. In 1991-2006, 617,291 cases of three selected OPPP infections resulted in the elderly alone of $0.6 billion USD per year of payments. Antibiotic resistance significantly increased OPPP illness costs that are likely to be underreported. More precise estimates for OPPP burdens could be obtained if better clinical, microbiological, administrative, and environmental monitoring data were cross-linked. An urgent dialog across governmental and disciplinary divides, and studies on preventing OPPP through drinking water exposure, are warranted.

  2. Hospitalizations due to selected infections caused by opportunistic premise plumbing pathogens (OPPP) and reported drug resistance in the United States older adult population in 1991-2006.

    PubMed

    Naumova, Elena N; Liss, Alexander; Jagai, Jyotsna S; Behlau, Irmgard; Griffiths, Jeffrey K

    2016-09-12

    The Flint Water Crisis-due to changes of water source and treatment procedures-has revealed many unsolved social, environmental, and public health problems for US drinking water, including opportunistic premise plumbing pathogens (OPPP). The true health impact of OPPP, especially in vulnerable populations such as the elderly, is largely unknown. We explored 10(8) claims in the largest US national uniformly collected data repository to determine rates and costs of OPPP-related hospitalizations. In 1991-2006, 617,291 cases of three selected OPPP infections resulted in the elderly alone of $0.6 billion USD per year of payments. Antibiotic resistance significantly increased OPPP illness costs that are likely to be underreported. More precise estimates for OPPP burdens could be obtained if better clinical, microbiological, administrative, and environmental monitoring data were cross-linked. An urgent dialog across governmental and disciplinary divides, and studies on preventing OPPP through drinking water exposure, are warranted.

  3. Short- versus long-duration levofloxacin plus rifampicin for acute staphylococcal prosthetic joint infection managed with implant retention: a randomised clinical trial.

    PubMed

    Lora-Tamayo, Jaime; Euba, Gorane; Cobo, Javier; Horcajada, Juan Pablo; Soriano, Alex; Sandoval, Enrique; Pigrau, Carles; Benito, Natividad; Falgueras, Luis; Palomino, Julián; Del Toro, María Dolores; Jover-Sáenz, Alfredo; Iribarren, José Antonio; Sánchez-Somolinos, Mar; Ramos, Antonio; Fernández-Sampedro, Marta; Riera, Melchor; Baraia-Etxaburu, Josu Mirena; Ariza, Javier

    2016-09-01

    Levofloxacin plus rifampicin (L+R) is the treatment of choice for acute staphylococcal prosthetic joint infection (PJI) managed with debridement and implant retention (DAIR). Long courses have been empirically recommended, but some studies have suggested that shorter treatments could be as effective. Our aim was to prove that a short treatment schedule was non-inferior to the standard long schedule. An open-label, multicentre, randomised clinical trial (RCT) was performed. Patients with an early post-surgical or haematogenous staphylococcal PJI, managed with DAIR and initiated on L+R were randomised to receive 8 weeks of treatment (short schedule) versus a long schedule (3 months or 6 months for hip or knee prostheses, respectively). The primary endpoint was cure rate. From 175 eligible patients, 63 were included (52% women; median age, 72 years): 33 patients (52%) received the long schedule and 30 (48%) received the short schedule. There were no differences between the two groups except for a higher rate of polymicrobial infection in the long-schedule group (27% vs. 7%; P = 0.031). Median follow-up was 540 days. In the intention-to-treat analysis, cure rates were 58% and 73% in patients receiving the long and short schedules, respectively (difference -15.7%, 95% CI -39.2% to 7.8%). Forty-four patients (70%) were evaluable per-protocol: cure rates were 95.0% and 91.7% for the long and short schedules, respectively (difference 3.3%, 95% CI -11.7% to 18.3%). This is the first RCT suggesting that 8 weeks of L+R could be non-inferior to longer standard treatments for acute staphylococcal PJI managed with DAIR.

  4. First Experience of a Multicenter External Quality Assessment of Molecular 16S rRNA Gene Detection in Bone and Joint Infections

    PubMed Central

    Bémer, Pascale; Valentin, Anne Sophie; Héry-Arnaud, Geneviève; Tandé, Didier; Jolivet-Gougeon, Anne; Vincent, Pascal; Kempf, Marie; Lemarié, Carole; Guinard, Jérôme; Bret, Laurent; Cognée, Anne Sophie; Gibaud, Sophie; Burucoa, Christophe; Corvec, Stéphane

    2014-01-01

    The objective of this study was to assess the performance of seven French laboratories for 16S rRNA gene detection by real-time PCR in the diagnosis of bone and joint infection (BJI) to validate a large multicenter study. External quality control (QC) was required owing to the differences in extraction procedures and the molecular equipment used in the different laboratories. Three proficiency sets were organized, including four bacterial DNA extracts and four bead mill-pretreated osteoarticular specimens. Extraction volumes, 16S rRNA gene primers, and sequencing interpretation rules were standardized. In order to assess each laboratory's ability to achieve the best results, scores were assigned, and each QC series was classified as optimal, acceptable, or to be improved. A total of 168 QCs were sent, and 160 responses were analyzed. The expected results were obtained for 93.8%, with the same proportion for extracts (75/80) and clinical specimens (75/80). For the specimens, there was no significant difference between manual and automated extraction. This QC demonstrated the ability to achieve good and homogeneous results using the same 16S rRNA gene PCR with different equipment and validates the possibility of high-quality multicenter studies using molecular diagnosis for BJI. PMID:25411177

  5. How Many Samples and How Many Culture Media To Diagnose a Prosthetic Joint Infection: a Clinical and Microbiological Prospective Multicenter Study

    PubMed Central

    Léger, Julie; Tandé, Didier; Plouzeau, Chloé; Valentin, Anne Sophie; Jolivet-Gougeon, Anne; Lemarié, Carole; Kempf, Marie; Héry-Arnaud, Geneviève; Bret, Laurent; Juvin, Marie Emmanuelle; Giraudeau, Bruno; Burucoa, Christophe

    2015-01-01

    Although numerous perioperative samples and culture media are required to diagnose prosthetic joint infection (PJI), their exact number and types have not yet been definitely determined with a high level of proof. We conducted a prospective multicenter study to determine the minimal number of samples and culture media required for accurate diagnosis of PJI. Over a 2-year period, consecutive patients with clinical signs suggesting PJI were included, with five perioperative samples per patient. The bacteriological and PJI diagnosis criteria were assessed using a random selection of two, three, or four samples and compared with those obtained using the recommended five samples (references guidelines). The results obtained with two or three culture media were then compared with those obtained with five culture media for both criteria. The times-to-positivity of the different culture media were calculated. PJI was confirmed in 215/264 suspected cases, with a bacteriological criterion in 192 (89%). The PJI was monomicrobial (85%) or polymicrobial (15%). Percentages of agreement of 98.1% and 99.7%, respectively, for the bacteriological criterion and confirmed PJI diagnosis were obtained when four perioperative samples were considered. The highest percentages of agreement were obtained with the association of three culture media, a blood culture bottle, a chocolate agar plate, and Schaedler broth, incubated for 5, 7, and 14 days, respectively. This new procedure leads to significant cost saving. Our prospective multicenter study showed that four samples seeded on three culture media are sufficient for diagnosing PJI. PMID:26637380

  6. How Many Samples and How Many Culture Media To Diagnose a Prosthetic Joint Infection: a Clinical and Microbiological Prospective Multicenter Study.

    PubMed

    Bémer, Pascale; Léger, Julie; Tandé, Didier; Plouzeau, Chloé; Valentin, Anne Sophie; Jolivet-Gougeon, Anne; Lemarié, Carole; Kempf, Marie; Héry-Arnaud, Geneviève; Bret, Laurent; Juvin, Marie Emmanuelle; Giraudeau, Bruno; Corvec, Stéphane; Burucoa, Christophe

    2016-02-01

    Although numerous perioperative samples and culture media are required to diagnose prosthetic joint infection (PJI), their exact number and types have not yet been definitely determined with a high level of proof. We conducted a prospective multicenter study to determine the minimal number of samples and culture media required for accurate diagnosis of PJI. Over a 2-year period, consecutive patients with clinical signs suggesting PJI were included, with five perioperative samples per patient. The bacteriological and PJI diagnosis criteria were assessed using a random selection of two, three, or four samples and compared with those obtained using the recommended five samples (references guidelines). The results obtained with two or three culture media were then compared with those obtained with five culture media for both criteria. The times-to-positivity of the different culture media were calculated. PJI was confirmed in 215/264 suspected cases, with a bacteriological criterion in 192 (89%). The PJI was monomicrobial (85%) or polymicrobial (15%). Percentages of agreement of 98.1% and 99.7%, respectively, for the bacteriological criterion and confirmed PJI diagnosis were obtained when four perioperative samples were considered. The highest percentages of agreement were obtained with the association of three culture media, a blood culture bottle, a chocolate agar plate, and Schaedler broth, incubated for 5, 7, and 14 days, respectively. This new procedure leads to significant cost saving. Our prospective multicenter study showed that four samples seeded on three culture media are sufficient for diagnosing PJI.

  7. First experience of a multicenter external quality assessment of molecular 16S rRNA gene detection in bone and joint infections.

    PubMed

    Plouzeau, Chloé; Bémer, Pascale; Valentin, Anne Sophie; Héry-Arnaud, Geneviève; Tandé, Didier; Jolivet-Gougeon, Anne; Vincent, Pascal; Kempf, Marie; Lemarié, Carole; Guinard, Jérôme; Bret, Laurent; Cognée, Anne Sophie; Gibaud, Sophie; Burucoa, Christophe; Corvec, Stéphane

    2015-02-01

    The objective of this study was to assess the performance of seven French laboratories for 16S rRNA gene detection by real-time PCR in the diagnosis of bone and joint infection (BJI) to validate a large multicenter study. External quality control (QC) was required owing to the differences in extraction procedures and the molecular equipment used in the different laboratories. Three proficiency sets were organized, including four bacterial DNA extracts and four bead mill-pretreated osteoarticular specimens. Extraction volumes, 16S rRNA gene primers, and sequencing interpretation rules were standardized. In order to assess each laboratory's ability to achieve the best results, scores were assigned, and each QC series was classified as optimal, acceptable, or to be improved. A total of 168 QCs were sent, and 160 responses were analyzed. The expected results were obtained for 93.8%, with the same proportion for extracts (75/80) and clinical specimens (75/80). For the specimens, there was no significant difference between manual and automated extraction. This QC demonstrated the ability to achieve good and homogeneous results using the same 16S rRNA gene PCR with different equipment and validates the possibility of high-quality multicenter studies using molecular diagnosis for BJI.

  8. Decontamination of breast pump milk collection kits and related items at home and in hospital: guidance from a Joint Working Group of the Healthcare Infection Society & Infection Prevention Society*

    PubMed Central

    Price, E; Weaver, G; Hoffman, P; Jones, M; Gilks, J; O’Brien, V; Ridgway, G

    2015-01-01

    Introduction: A variety of methods are in use for decontaminating breast pump milk collection kits and related items associated with infant feeding. This paper aims to provide best practice guidance for decontamination of this equipment at home and in hospital. It has been compiled by a joint Working Group of the Healthcare Infection Society and the Infection Prevention Society. Methods: The guidance has been informed by a search of the literature in Medline, the British Nursing Index, the Cumulative Index to Nursing & Allied Health Literature, Midwifery & Infant Care and the results of two surveys of UK neonatal units in 2002/3 and 2006, and of members of the Infection Prevention Society in 2014. Since limited good quality evidence was available from these sources much of the guidance represents good practice based on the consensus view of the Working Group. Key recommendations: Breast pump milk collection kits should not be reused by different mothers unless they have been sterilized in a Sterile Services Department between these different users. When used by the same mother, a detergent wash followed by thorough rinsing and drying after each use gives acceptable decontamination for most circumstances, as long as it is performed correctly. Additional decontamination precautions to washing, rinsing and drying may be used if indicated by local risk assessments and on advice from the departmental clinicians and Infection Prevention and Control Teams. The microbiological quality of the rinse water is an important consideration, particularly for infants on neonatal units. If bottle brushes or breast/nipple shields are used, they should be for use by one mother only. Decontamination should be by the processes used for breast pump milk collection kits. Dummies (soothers, pacifiers or comforters) needed for non-nutritive sucking by infants on neonatal units, should be for single infant use. Manufacturers should provide these dummies ready-to-use and individually packaged

  9. Fatal case of hemolytic-uremic syndrome in an adult due to a rare serogroup O91 Entero hemorrhagic Escherichia coli associated with a Clostridium difficile infection. More than meets the eye.

    PubMed

    Guillard, Thomas; Limelette, Anne; Le Magrex-Debar, Elisabeth; Wynckel, Alain; Gouali, Malika; Mariani-Kurkdjian, Patricia; Guyot-Colosio, Charlotte; de Champs, Christophe

    2015-08-01

    Hemolytic-uremic syndrome due to enterohemorrhagic Escherichia coli, belonging to serogroup O91 has rarely been described. We report here a case of post-diarrheal HUS due to EHEC O91 in an elderly patient for whom diagnosis was delayed given a previously diagnosed C. difficile infection. This case highlights the usefulness of Shiga-toxin detection.

  10. Joint pain

    MedlinePlus

    ... that may be done include: CBC or blood differential C-reactive protein Joint x-ray Sedimentation rate ... chap 256. Schaible H-G. Joint pain: basic mechanisms. In: McMahon SB, Koltzenburg M, Tracey I, Turk ...

  11. Joint Interdiction

    DTIC Science & Technology

    2016-09-09

    Purpose This publication has been prepared under the direction of the Chairman of the Joint Chiefs of Staff. It sets forth joint doctrine to govern the...governmental and nongovernmental organizations, multinational forces, and other interorganizational partners. It provides military guidance for the...exercise of authority by combatant commanders and other joint force commanders (JFCs), and prescribes joint doctrine for operations and training. It

  12. Influence of daily dosage and frequency of administration of rifampicin-levofloxacin therapy on tolerance and effectiveness in 154 patients treated for prosthetic joint infections.

    PubMed

    Nguyen, S; Robineau, O; Titecat, M; Blondiaux, N; Valette, M; Loiez, C; Beltrand, E; Migaud, H; Senneville, E

    2015-08-01

    Data on the tolerance and effectiveness of rifampicin-levofloxacin combination therapy (RLCT) in patients treated for prosthetic joint infections (PJIs) according to daily dosage are lacking. A review of the clinical data from patients treated with RLCT for PJIs in a French referent center for PJIs was conducted. A total of 154 patients (75 F/79 M), with a median age of 64.1 years and median body weight of 83.1 kg, were included. The median daily dosages of rifampicin and levofloxacin were, respectively, 1,200 mg (range 300-2,100) and 750 mg (range 500-1,500), corresponding to a mean daily dose per kg of, respectively, 16.2 ± 4.3 mg/kg and 10.1 ± 3.0 mg/kg. After a mean follow-up period of 55.6 ± 27.1 months (range 24-236), 127 patients (82.5 %) were in remission. Adverse events attributable to rifampicin and levofloxacin were reported in 48 (31.2 %) and 13 (8.4 %) patients (p < 0.001), respectively. Patients who experienced rifampicin-related adverse events had been given higher rifampicin daily doses than the other patients (p = 0.04). The rifampicin daily dosage did not influence patient outcome and nor did the levofloxacin daily dosage on both tolerance and patient outcome. Our results suggest that adjusting rifampicin daily doses to the patient total body weight when combined with levofloxacin for the treatment of PJIs is associated with a poor tolerance. High daily doses of rifampicin (>600 mg) and levofloxacin (750 mg) do not improve patient outcome when compared to lower daily doses in this setting.

  13. Evaluation of 16S rRNA Gene PCR Sensitivity and Specificity for Diagnosis of Prosthetic Joint Infection: a Prospective Multicenter Cross-Sectional Study

    PubMed Central

    Plouzeau, Chloé; Tande, Didier; Léger, Julie; Giraudeau, Bruno; Valentin, Anne Sophie; Jolivet-Gougeon, Anne; Vincent, Pascal; Corvec, Stéphane; Gibaud, Sophie; Juvin, Marie Emmanuelle; Héry-Arnaud, Genevieve; Lemarié, Carole; Kempf, Marie; Bret, Laurent; Quentin, Roland; Coffre, Carine; de Pinieux, Gonzague; Bernard, Louis; Burucoa, Christophe

    2014-01-01

    There is no standard method for the diagnosis of prosthetic joint infection (PJI). The contribution of 16S rRNA gene PCR sequencing on a routine basis remains to be defined. We performed a prospective multicenter study to assess the contributions of 16S rRNA gene assays in PJI diagnosis. Over a 2-year period, all patients suspected to have PJIs and a few uninfected patients undergoing primary arthroplasty (control group) were included. Five perioperative samples per patient were collected for culture and 16S rRNA gene PCR sequencing and one for histological examination. Three multicenter quality control assays were performed with both DNA extracts and crushed samples. The diagnosis of PJI was based on clinical, bacteriological, and histological criteria, according to Infectious Diseases Society of America guidelines. A molecular diagnosis was modeled on the bacteriological criterion (≥1 positive sample for strict pathogens and ≥2 for commensal skin flora). Molecular data were analyzed according to the diagnosis of PJI. Between December 2010 and March 2012, 264 suspected cases of PJI and 35 control cases were included. PJI was confirmed in 215/264 suspected cases, 192 (89%) with a bacteriological criterion. The PJIs were monomicrobial (163 cases [85%]; staphylococci, n = 108; streptococci, n = 22; Gram-negative bacilli, n = 16; anaerobes, n = 13; others, n = 4) or polymicrobial (29 cases [15%]). The molecular diagnosis was positive in 151/215 confirmed cases of PJI (143 cases with bacteriological PJI documentation and 8 treated cases without bacteriological documentation) and in 2/49 cases without confirmed PJI (sensitivity, 73.3%; specificity, 95.5%). The 16S rRNA gene PCR assay showed a lack of sensitivity in the diagnosis of PJI on a multicenter routine basis. PMID:25056331

  14. Evaluation of 16S rRNA gene PCR sensitivity and specificity for diagnosis of prosthetic joint infection: a prospective multicenter cross-sectional study.

    PubMed

    Bémer, Pascale; Plouzeau, Chloé; Tande, Didier; Léger, Julie; Giraudeau, Bruno; Valentin, Anne Sophie; Jolivet-Gougeon, Anne; Vincent, Pascal; Corvec, Stéphane; Gibaud, Sophie; Juvin, Marie Emmanuelle; Héry-Arnaud, Genevieve; Lemarié, Carole; Kempf, Marie; Bret, Laurent; Quentin, Roland; Coffre, Carine; de Pinieux, Gonzague; Bernard, Louis; Burucoa, Christophe

    2014-10-01

    There is no standard method for the diagnosis of prosthetic joint infection (PJI). The contribution of 16S rRNA gene PCR sequencing on a routine basis remains to be defined. We performed a prospective multicenter study to assess the contributions of 16S rRNA gene assays in PJI diagnosis. Over a 2-year period, all patients suspected to have PJIs and a few uninfected patients undergoing primary arthroplasty (control group) were included. Five perioperative samples per patient were collected for culture and 16S rRNA gene PCR sequencing and one for histological examination. Three multicenter quality control assays were performed with both DNA extracts and crushed samples. The diagnosis of PJI was based on clinical, bacteriological, and histological criteria, according to Infectious Diseases Society of America guidelines. A molecular diagnosis was modeled on the bacteriological criterion (≥ 1 positive sample for strict pathogens and ≥ 2 for commensal skin flora). Molecular data were analyzed according to the diagnosis of PJI. Between December 2010 and March 2012, 264 suspected cases of PJI and 35 control cases were included. PJI was confirmed in 215/264 suspected cases, 192 (89%) with a bacteriological criterion. The PJIs were monomicrobial (163 cases [85%]; staphylococci, n = 108; streptococci, n = 22; Gram-negative bacilli, n = 16; anaerobes, n = 13; others, n = 4) or polymicrobial (29 cases [15%]). The molecular diagnosis was positive in 151/215 confirmed cases of PJI (143 cases with bacteriological PJI documentation and 8 treated cases without bacteriological documentation) and in 2/49 cases without confirmed PJI (sensitivity, 73.3%; specificity, 95.5%). The 16S rRNA gene PCR assay showed a lack of sensitivity in the diagnosis of PJI on a multicenter routine basis.

  15. Joint Disorders

    MedlinePlus

    A joint is where two or more bones come together, like the knee, hip, elbow, or shoulder. Joints can be damaged by many types of injuries or diseases, including Arthritis - inflammation of a joint. It causes pain, stiffness, and swelling. Over time, ...

  16. Infratemporal Space Infection Following Maxillary Third Molar Extraction in an Uncontrolled Diabetic Patient

    PubMed Central

    Mesgarzadeh, Ali Hossein; Ghavimi, Mohammad Ali; Gok, Gulşen; Zarghami, Afsaneh

    2012-01-01

    Infratemporal space infection is a rare but serious sequel of odontogenic infection. The diagnosis is difficult due to non spe-cific signs and symptoms. Diabetes mellitus as a definitive risk factor for odontogenic infections needs more consideration during clinical procedures. We report a case of an undiagnosed diabetic patient with isolated infratemporal space infection after tooth extraction with presentation of similar signs and symptoms of temporomandibular joint and muscle problem. PMID:22991649

  17. A Multinational, Preregistered Cohort Study of β-Lactam/β-Lactamase Inhibitor Combinations for Treatment of Bloodstream Infections Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae

    PubMed Central

    Gutiérrez-Gutiérrez, Belén; Pérez-Galera, Salvador; Salamanca, Elena; de Cueto, Marina; Calbo, Esther; Almirante, Benito; Viale, Pierluigi; Oliver, Antonio; Pintado, Vicente; Gasch, Oriol; Martínez-Martínez, Luis; Pitout, Johann; Akova, Murat; Molina, José; Hernández, Alicia; Venditti, Mario; Prim, Nuria; Origüen, Julia; Bou, German; Tacconelli, Evelina; Tumbarello, Mario; Hamprecht, Axel; Giamarellou, Helen; Almela, Manel; Pérez, Federico; Schwaber, Mitchell J.; Bermejo, Joaquín; Lowman, Warren; Hsueh, Po-Ren; Mora-Rillo, Marta; Natera, Clara; Souli, Maria; Bonomo, Robert A.; Carmeli, Yehuda; Paterson, David L.; Pascual, Alvaro

    2016-01-01

    The spread of extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) is leading to increased carbapenem consumption. Alternatives to carbapenems need to be investigated. We investigated whether β-lactam/β-lactamase inhibitor (BLBLI) combinations are as effective as carbapenems in the treatment of bloodstream infections (BSI) due to ESBL-E. A multinational, retrospective cohort study was performed. Patients with monomicrobial BSI due to ESBL-E were studied; specific criteria were applied for inclusion of patients in the empirical-therapy (ET) cohort (ETC; 365 patients), targeted-therapy (TT) cohort (TTC; 601 patients), and global cohort (GC; 627 patients). The main outcome variables were cure/improvement rate at day 14 and all-cause 30-day mortality. Multivariate analysis, propensity scores (PS), and sensitivity analyses were used to control for confounding. The cure/improvement rates with BLBLIs and carbapenems were 80.0% and 78.9% in the ETC and 90.2% and 85.5% in the TTC, respectively. The 30-day mortality rates were 17.6% and 20% in the ETC and 9.8% and 13.9% in the TTC, respectively. The adjusted odds ratio (OR) (95% confidence interval [CI]) values for cure/improvement rate with ET with BLBLIs were 1.37 (0.69 to 2.76); for TT, they were 1.61 (0.58 to 4.86). Regarding 30-day mortality, the adjusted OR (95% CI) values were 0.55 (0.25 to 1.18) for ET and 0.59 (0.19 to 1.71) for TT. The results were consistent in all subgroups studied, in a stratified analysis according to quartiles of PS, in PS-matched cases, and in the GC. BLBLIs, if active in vitro, appear to be as effective as carbapenems for ET and TT of BSI due to ESLB-E regardless of the source and specific species. These data may help to avoid the overuse of carbapenems. (This study has been registered at ClinicalTrials.gov under registration no. NCT01764490.) PMID:27139473

  18. A Multinational, Preregistered Cohort Study of β-Lactam/β-Lactamase Inhibitor Combinations for Treatment of Bloodstream Infections Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae.

    PubMed

    Gutiérrez-Gutiérrez, Belén; Pérez-Galera, Salvador; Salamanca, Elena; de Cueto, Marina; Calbo, Esther; Almirante, Benito; Viale, Pierluigi; Oliver, Antonio; Pintado, Vicente; Gasch, Oriol; Martínez-Martínez, Luis; Pitout, Johann; Akova, Murat; Peña, Carmen; Molina, José; Hernández, Alicia; Venditti, Mario; Prim, Nuria; Origüen, Julia; Bou, German; Tacconelli, Evelina; Tumbarello, Mario; Hamprecht, Axel; Giamarellou, Helen; Almela, Manel; Pérez, Federico; Schwaber, Mitchell J; Bermejo, Joaquín; Lowman, Warren; Hsueh, Po-Ren; Mora-Rillo, Marta; Natera, Clara; Souli, Maria; Bonomo, Robert A; Carmeli, Yehuda; Paterson, David L; Pascual, Alvaro; Rodríguez-Baño, Jesús

    2016-07-01

    The spread of extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) is leading to increased carbapenem consumption. Alternatives to carbapenems need to be investigated. We investigated whether β-lactam/β-lactamase inhibitor (BLBLI) combinations are as effective as carbapenems in the treatment of bloodstream infections (BSI) due to ESBL-E. A multinational, retrospective cohort study was performed. Patients with monomicrobial BSI due to ESBL-E were studied; specific criteria were applied for inclusion of patients in the empirical-therapy (ET) cohort (ETC; 365 patients), targeted-therapy (TT) cohort (TTC; 601 patients), and global cohort (GC; 627 patients). The main outcome variables were cure/improvement rate at day 14 and all-cause 30-day mortality. Multivariate analysis, propensity scores (PS), and sensitivity analyses were used to control for confounding. The cure/improvement rates with BLBLIs and carbapenems were 80.0% and 78.9% in the ETC and 90.2% and 85.5% in the TTC, respectively. The 30-day mortality rates were 17.6% and 20% in the ETC and 9.8% and 13.9% in the TTC, respectively. The adjusted odds ratio (OR) (95% confidence interval [CI]) values for cure/improvement rate with ET with BLBLIs were 1.37 (0.69 to 2.76); for TT, they were 1.61 (0.58 to 4.86). Regarding 30-day mortality, the adjusted OR (95% CI) values were 0.55 (0.25 to 1.18) for ET and 0.59 (0.19 to 1.71) for TT. The results were consistent in all subgroups studied, in a stratified analysis according to quartiles of PS, in PS-matched cases, and in the GC. BLBLIs, if active in vitro, appear to be as effective as carbapenems for ET and TT of BSI due to ESLB-E regardless of the source and specific species. These data may help to avoid the overuse of carbapenems. (This study has been registered at ClinicalTrials.gov under registration no. NCT01764490.).

  19. [Guidelines for the diagnosis and treatment of latent tuberculosis infection and active tuberculosis in patients with inflammatory joint diseases proposed for treatment with tumour necrosis factor alpha antagonist drugs].

    PubMed

    Fonseca, João Eurico; Lucas, Helena; Canhão, Helena; Duarte, Raquel; Santos, Maria José; Villar, Miguel; Faustino, Augusto; Raymundo, Elena

    2006-01-01

    The Portuguese Society of Rheumatology (SPR) and the Portuguese Society of Pulmonology (SPP) have developed guidelines for the diagnosis and treatment of latent tuberculosis infection (LTBI) and active tuberculosis (AT) in patients with inflammatory joint diseases (IJD), namely rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, treated with tumour necrosis factor alpha (TNF-a) antagonists. Due to the high risk of tuberculosis (TB) in patients with IJD, LTBI and AT screening should be performed as soon as possible, ideally at the moment of IJD diagnosis. Even if TB screening was performed at the beginning of the disease, the evaluation should be repeated before starting anti-TNF-a therapy. When TB (LTBI or AT) treatment is indicated, it should be performed before the beginning of anti-TNF-a therapy. If the IJD activity requires urgent anti-TNF-a therapy, these drugs can be started after two months of antituberculosis therapy in AT cases, or after one month in LTBI cases. Chest X-ray is mandatory for all patients. If abnormal, e.g. Gohn complex, the patient should be treated as LTBI; residual lesions require the exclusion of AT and patients with history of untreated or incomplete TB treatment should be treated as LTBI. In cases of suspected active lesions, AT diagnosis should be confirmed and adequate therapy initiated. Tuberculin skin test (TST), with two units of RT23, should be performed in all patients. If induration is less than 5 mm, the test should be repeated after 1 to 2 weeks, on the opposite forearm, and should be considered negative if the result is again inferior to 5 mm. Positive TST implicates LTBI treatment. If TST is performed in immunosuppressed IJD patients, LTBI treatment should be offered to the patient before starting anti-TNF-a therapy, even in the presence of a negative test.

  20. YMDD Motif Mutation Profile Among Patients Receiving Liver Transplant Due to Hepatitis B Virus Infection With Long Term Lamivudine/Immunoglobulin Therapy

    PubMed Central

    Rahimi, Rahim; Hosseini, Seyed Younes; Fattahi, Mohammad Reza; Sepehrimanesh, Masood; Safarpour, Alireza; Malekhosseini, Seyed Ali; Nejabat, Maryam; Khodadad, Mahboobeh; Ardebili, Maryam

    2015-01-01

    Background: Recurrence of Hepatitis B Virus infection in patients undergoing liver transplanted (LT) is a serious and often fatal problem. Lamivudine (LAM) and Hepatitis B Immunoglobulin (HBIG) are widely used to manage hepatitis B recurrence after liver transplantation. However, the outcomes in patients are less elucidated. Objectives: The current study aimed to evaluate the YMDD motif mutations profile among the patients undergoing LT infected with HBV and treated with LAM/HBIG at least for one year. Patients and Methods: Thirty patients with liver transplantation due to HBV were enrolled, while DNA level remained under detection limit of 50 IU/mL before transplantation and abnormal higher levels of liver enzymes after LT. The HBV genome detection was performed by two different Polymerase Chain Reaction methods following viral quantification by commercial Real-Time PCR. HbsAg detection, besides liver function tests were conducted as complementary assays. To assess nucleotide analogue mutations, the major part of polymerase gene (aa 80 - 240) was amplified by Nested-PCR, introduced to sequencing and subjected to phylogenetic analysis. Results: Totally, according to the laboratory criteria there were 13 cases with detectable HBV genome, while the mean liver enzyme levels were higher in recurrent patients and HBsAg was detected only in four out of the 13 cases. Phylogenetic analysis demonstrated that all isolated genomes belonged to genotype D. Critical M204I mutation, as a proof for resistance to LAM, was detected among 46% of the subjects and natural entecavir resistance (S202I) was also distinguished in one subject. Viral quantification showed higher titer in LAM resistant group in comparison to the group with undetectable drug resistance mutant (P > 0.05). Conclusions: Although the patients carrying M204I mutation were more likely to show lack of responses to LAM therapy, LAM replacing by other nucleoside/tide analogs plus HBIG maybe still effective in

  1. A glass fiber-reinforced composite - bioactive glass cranioplasty implant: A case study of an early development stage implant removed due to a late infection.

    PubMed

    Posti, Jussi P; Piitulainen, Jaakko M; Hupa, Leena; Fagerlund, Susanne; Frantzén, Janek; Aitasalo, Kalle M J; Vuorinen, Ville; Serlo, Willy; Syrjänen, Stina; Vallittu, Pekka K

    2015-03-01

    This case study describes the properties of an early development stage bioactive glass containing fiber-reinforced composite calvarial implant with histology that has been in function for two years and three months. The patient is a 33-year old woman with a history of substance abuse, who sustained a severe traumatic brain injury later unsuccessfully treated with an autologous bone flap and a custom-made porous polyethylene implant. She was thereafter treated with developmental stage glass fiber-reinforced composite - bioactive glass implant. After two years and three months, the implant was removed due to an implant site infection. The implant was analyzed histologically, mechanically, and in terms of chemistry and dissolution of bioactive glass. Mechanical integrity of the load bearing fiber-reinforced composite part of the implant was not affected by the in vivo period. Bioactive glass particles demonstrated surface layers of hydroxyapatite like mineral and dissolution, and related increase of pH was considerably less after two and three months period than that for fresh bioactive glass. There was a difference in the histology of the tissues inside the implant areas near to the margin of the implant that absorbed blood during implant installation surgery, showed fibrous tissue with blood vessels, osteoblasts, collagenous fibers with osteoid formation, and tiny clusters of more mature hard tissue. In the center of the implant, where there was less absorbed blood, only fibrous tissue was observed. This finding is in line with the combined positron emission tomography - computed tomography examination with (18F)-fluoride marker, which demonstrated activity of the mineralizing bone by osteoblasts especially at the area near to the margin of the implant 10 months after implantation. Based on these promising reactions found in the bioactive glass containing fiber-reinforced composite implant that has been implanted for two years and three months, calvarial

  2. Prospective Multicenter Study of Community-Associated Skin and Skin Structure Infections due to Methicillin-Resistant Staphylococcus aureus in Buenos Aires, Argentina

    PubMed Central

    López Furst, María José; de Vedia, Lautaro; Fernández, Silvina; Gardella, Noella; Ganaha, María Cristina; Prieto, Sergio; Carbone, Edith; Lista, Nicolás; Rotryng, Flavio; Morera, Graciana I.; Mollerach, Marta; Stryjewski, Martín E.

    2013-01-01

    Background Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is now the most common cause of skin and skin structure infections (SSSI) in several world regions. In Argentina prospective, multicenter clinical studies have only been conducted in pediatric populations. Objective Primary: describe the prevalence, clinical and demographic characteristics of adult patients with community acquired SSSI due to MRSA; secondary: molecular evaluation of CA-MRSA strains. Patients with MRSA were compared to those without MRSA. Materials and Methods Prospective, observational, multicenter, epidemiologic study, with molecular analysis, conducted at 19 sites in Argentina (18 in Buenos Aires) between March 2010 and October 2011. Patients were included if they were ≥14 years, were diagnosed with SSSI, a culture was obtained, and there had no significant healthcare contact identified. A logistic regression model was used to identify factors associated with CA-MRSA. Pulse field types, SCCmec, and PVL status were also determined. Results A total of 311 patients were included. CA-MRSA was isolated in 70% (218/311) of patients. Clinical variables independently associated with CA-MRSA were: presence of purulent lesion (OR 3.29; 95%CI 1.67, 6.49) and age <50 years (OR 2.39; 95%CI 1.22, 4.70). The vast majority of CA-MRSA strains causing SSSI carried PVL genes (95%) and were SCCmec type IV. The sequence type CA-MRSA ST30 spa t019 was the predominant clone. Conclusions CA-MRSA is now the most common cause of SSSI in our adult patients without healthcare contact. ST30, SCCmec IV, PVL+, spa t019 is the predominant clone in Buenos Aires, Argentina. PMID:24324543

  3. IgG RF and anti-CCP2 antibody can be positive in undifferentiated arthritis due to streptococcal infection, hepatitis B virus, tuberculosis, trauma and hypothyroidism: a preliminary study.

    PubMed

    Singh, Usha; Verma, Pamod Kumar; Bhagat, Priyanka; Singh, Sangeeta; Singh, Suman; Singh, Nand Kumar

    2012-09-01

    Anti-CCP2 antibody and rheumatoid (RF) tests are used for the diagnosis of rheumatoid arthritis (RA). Out of these two, anti-CCP2 antibody is supposed to be more specific for RA. Aim of the study was to present 33 cases of undifferentiated arthritis (UA) in which features of RA were not present, but anti-CCP2 antibody was positive. Out of the 33 cases of UA, 19 had well-known disease like hyperthyroidism, hypothyroidism, tubercular arthritis, traumatic arthritis, pneumonia with arthritis, varicose vein with pain in legs, cervical spondylitis and SSA. The duration of disease was more than one year in 67.86% cases. Majority of the patients were females (63.64%). Knee joint involvement was seen in maximum number (i.e. 20 cases). All 33 cases were positive for anti-CCP2 Ab. Maximum number of cases (78.78%) had involvement of one or two joints. CRP positivity was seen in 23.07% cases. Morning stiffness was present in (36.36%) cases, while swelling of the joint was present in 33.33% cases. In 16 cases, only serum sample was available for further analysis. About 62.5% cases showed IgG RF positivity. Antitubercular IgM and IgG were detected in 18.75% cases; ASO was elevated in 12.5% cases, and HBs Ag was positive in 6.25% cases. None of the controls (30 cases) were positive for these infections, anti-CCP2 antibody or RF. Thus, our study concludes that chronic infections like streptococcus, hepatitis B, tuberculosis and autoimmune thyroid diseases can produce raised levels of anti-CCP2 antibody and IgG RF.

  4. Pregnancy Loss Following Coxsackievirus B3 Infection in Mice during Early Gestation Due toHigh Expression of Coxsackievirus-Adenovirus Receptor (CAR) in Uterus and Embryo

    PubMed Central

    Hwang, Ji Young; Lee, Kyung Min; Kim, Yun Hwa; Shim, Hye Min; Bae, Young Kyung; Hwang, Jung Hye; Park, Hosun

    2014-01-01

    Coxsackieviruses are important pathogens in children and the outcomes of neonatal infection can be serious or fatal. However, the outcomes of coxsackievirus infection during early gestation are not well defined. In this study, we examined the possibility of vertical transmission of coxsackievirus B3 (CVB3) and the effects of CVB3 infection on early pregnancy of ICR mice. We found that the coxsackievirus and adenovirus receptor (CAR) was highly expressed not only in embryos but also in the uterus of ICR mice. CVB3 replicated in the uterus 1 to 7 days post-infection (dpi), with the highest titer at 3 dpi. The pregnancy loss rate in mice infected with CVB3 during early gestation was 38.3%, compared to 4.7% and 2.7% in mock-infected and UV-inactivated-CVB3 infected pregnant mice, respectively. These data suggest that the uterus and embryo, which express abundant CAR, are important targets of CVB3 and that the vertical transmission of CVB3 during early gestation induces pregnancy loss. PMID:24521864

  5. Pregnancy loss following coxsackievirus b3 infection in mice during early gestation due to high expression of coxsackievirus-adenovirus receptor (CAR) in uterus and embryo.

    PubMed

    Hwang, Ji Young; Lee, Kyung Min; Kim, Yun Hwa; Shim, Hye Min; Bae, Young Kyung; Hwang, Jung Hye; Park, Hosun

    2014-01-01

    Coxsackieviruses are important pathogens in children and the outcomes of neonatal infection can be serious or fatal. However, the outcomes of coxsackievirus infection during early gestation are not well defined. In this study, we examined the possibility of vertical transmission of coxsackievirus B3 (CVB3) and the effects of CVB3 infection on early pregnancy of ICR mice. We found that the coxsackievirus and adenovirus receptor (CAR) was highly expressed not only in embryos but also in the uterus of ICR mice. CVB3 replicated in the uterus 1 to 7 days post-infection (dpi), with the highest titer at 3 dpi. The pregnancy loss rate in mice infected with CVB3 during early gestation was 38.3%, compared to 4.7% and 2.7% in mock-infected and UV-inactivated-CVB3 infected pregnant mice, respectively. These data suggest that the uterus and embryo, which express abundant CAR, are important targets of CVB3 and that the vertical transmission of CVB3 during early gestation induces pregnancy loss.

  6. Enhanced resistance of CXCR3 deficient mice to ocular HSV-1 infection is due to control of replication in the brain ependyma.

    PubMed

    Kroll, Chandra M; Zheng, Min; Carr, Daniel J J

    2014-11-15

    CXCR3 deficient (CXCR3(-/-)) mice are resistant to ocular HSV-1 infection in that less mice develop encephalitis and succumb to infection in comparison to wild type (WT) animals. A region of the brain previously identified to be crucial for development of encephalitis was evaluated in HSV-1-infected CXCR3(-/-) and WT mice. In this region, known as the ependyma, viral titer, infiltrating leukocyte populations, and key anti-viral cytokine message levels were evaluated. We found that CXCR3(-/-) mice possessed significantly less HSV-1 and expressed significantly more IFN-β mRNA in the brain ependyma compared to WT animals during the development of encephalitis.

  7. Pressure vessel flex joint

    NASA Technical Reports Server (NTRS)

    Kahn, Jon B. (Inventor)

    1992-01-01

    An airtight, flexible joint is disclosed for the interfacing of two pressure vessels such as between the Space Station docking tunnel and the Space Shuttle Orbiter bulkhead adapter. The joint provides for flexibility while still retaining a structural link between the two vessels required due to the loading created by the internal/external pressure differential. The joint design provides for limiting the axial load carried across the joint to a specific value, a function returned in the Orbiter/Station tunnel interface. The flex joint comprises a floating structural segment which is permanently attached to one of the pressure vessels through the use of an inflatable seal. The geometric configuration of the joint causes the tension between the vessels created by the internal gas pressure to compress the inflatable seal. The inflation pressure of the seal is kept at a value above the internal/external pressure differential of the vessels in order to maintain a controlled distance between the floating segment and pressure vessel. The inflatable seal consists of either a hollow torus-shaped flexible bladder or two rolling convoluted diaphragm seals which may be reinforced by a system of straps or fabric anchored to the hard structures. The joint acts as a flexible link to allow both angular motion and lateral displacement while it still contains the internal pressure and holds the axial tension between the vessels.

  8. Is abortive infection by bacteriophage BF23 of Escherichia coli harboring ColIb plasmids due to cell killing by internally liberated colicin Ib?

    PubMed Central

    McCorquodale, D J; Shaw, A R; Moody, E E; Hull, R A; Morgan, A F

    1979-01-01

    Infection of Escherichia coli harboring ColIb+ plasmids with bacteriophage BF23+ is abortive and resulted in changes of membrane permeability as measured by efflux of nucleotides and K+. A single pre-early gene product of BF23+ was necessary and sufficient to elicit the abortive response. Appropriate mutations in this pre-early gene allowed a productive infection in ColIb+ cells. Appropriate mutations in the ColIb plasmid also allowed a productive infection with BF23+. A comparison of changes occurring during abortive infection and during killing of sensitive cells by external colicin Ib or Ia, together with certain genetic data, has led to the conclusion that membrane changes accompanying the two phenomena are the result of a common mechanism, namely, the interaction of free colicin with the cytoplasmic membrane. Images PMID:387978

  9. Marked increase in incidence for bloodstream infections due to Escherichia coli, a side effect of previous antibiotic therapy in the elderly

    PubMed Central

    van der Mee-Marquet, Nathalie L.; Blanc, Dominique S.; Gbaguidi-Haore, Houssein; Dos Santos Borges, Sandra; Viboud, Quentin; Bertrand, Xavier; Quentin, Roland

    2015-01-01

    We conducted a survey including 3334 bloodstream infections (BSIs) due to E. coli diagnosed in 2005–2014 at a stable cohort of hospitals. Marked increases in incidence were observed for community-acquired (CA) BSIs in patients aged >75 years, CA-BSIs of digestive origin in patients aged 60–74 years, healthcare-associated BSIs, and BSIs associated with ESBL (extended-spectrum B-lactamase)-producing E. coli (ESBLEc). Using MLST, we studied the genetic diversity of 412 BSI isolates recovered during the 2014 survey: 7 major sequence type complexes (STCs) were revealed in phylogenetic group B2, 3 in group A/B1 and 2 in group D. Among the 31 ESBLEc isolates, 1/3 belonged to STC 131. We searched for possible associations between clonal groups, clinical determinants and characteristics of BSIs: isolates from groups B2 (except STC 131) and D were susceptible to antibiotics and associated with BSIs of urinary origin in patients <60 years. STC 131 and group A/B1 isolates were multi-drug resistant and associated with CA-BSIs of digestive origin in patients aged 60–74 with a recent history of antibiotic treatment. STC 131 isolates were associated with HCA-BSIs in patients with recent/present hospitalization in a long-stay unit. We provide a unique population-based picture of the epidemiology of E. coli BSI. The aging nature of the population led to an increase in the number of cases caused by the B2 and D isolates generally implicated in BSIs. In addition, the association of a trend toward increasing rates of gut colonization with multi drug-resistant isolates revealed by the rise in the incidence of BSIs of digestive origin caused by STC 131 and A/B1 (STCs 10, 23, and 155) isolates, and a significant increase in the frequency of BSIs in elderly patients with recent antibiotic treatment suggested that antibiotic use may have contributed to the growing incidence of BSI. PMID:26175721

  10. Male and couple fertility impairment due to HPV-DNA sperm infection: update on molecular mechanism and clinical impact--systematic review.

    PubMed

    Gizzo, Salvatore; Ferrari, Bruno; Noventa, Marco; Ferrari, Emanuele; Patrelli, Tito Silvio; Gangemi, Michele; Nardelli, Giovanni Battista

    2014-01-01

    Recent evidences identify Human Papillomavirus (HPV) sperm infection as a possible cause of male and couple infertility. It acts through different mechanisms at various steps of human conception and early gestational development. We performed a systematic review to assess the role of HPV semen infection on male and couple infertility. Analysis of available and eligible data does not permit us to fund clear evidences about clinical impact of HPV infection on fertility, although sperm parameters impairment is the most widely recognized effect. Regarding biomolecular implications, the available data are often conflicting. More studies are required to define the role of HPV sperm infection in clinical practice. The great majority of evidences are obtained by in vitro studies and this fact represents a limitation for the clinical management of HPVDNA sperm infection. Understanding the biological significance of HPV-DNA semen infection could permit us to explain most of the idiopathic male and couple infertility, leading to a better management of infertile men and a better timing for sperm banking storage before ART cycles.

  11. Synergistic Antibacterial Activity of Plant Peptide MBP-1 and Silver Nanoparticles Combination on Healing of Infected Wound Due to Staphylococcus aureus

    PubMed Central

    Salouti, Mojtaba; Mirzaei, Fatemeh; Shapouri, Reza; Ahangari, Azam

    2016-01-01

    Background: Wound infection is a common problem in hospitals and is typically caused by the antibiotic-resistant Staphylococcus aureus, which is a major pathogen for skin and soft tissue infections worldwide. Objectives: The aim of this study was to investigate the synergistic antibacterial effect of plant peptide MBP-1 and silver nanoparticles on infected wounds caused by S. aureus. Materials and Methods: The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of MBP-1 and silver nanoparticles both on their own and in combination form were determined against S. aureus via macrodilution and microdilution methods. The synergistic antibacterial effect of silver nanoparticles and MBP-1 was investigated on infected wounds caused by S. aureus in a mouse model. Results: The MIC and MBC of MBP-1 were found to be 0.6 and 0.7 mg/mL, respectively. MIC and MBC of silver nanoparticles were determined to be 6.25 and 12.5 mg/L, respectively. MIC and MBC of the silver nanoparticles and MBP-1 combination were found to be 3.125 mg/mL, 0.5 mg/L; and 6.25 mg/mL, 0.6 mg/L, respectively. The infected wound healed properly after the combined use of MBP-1 and silver nanoparticles. Conclusions: The synergistic effect was found on the healing of infected wounds caused by S. aureus by using an MBP-1 and silver nanoparticles combination in a mouse model. PMID:27099683

  12. Ceramic joints

    DOEpatents

    Miller, Bradley J.; Patten, Jr., Donald O.

    1991-01-01

    Butt joints between materials having different coefficients of thermal expansion are prepared having a reduced probability of failure of stress facture. This is accomplished by narrowing/tapering the material having the lower coefficient of thermal expansion in a direction away from the joint interface and not joining the narrow-tapered surface to the material having the higher coefficient of thermal expansion.

  13. Determination of Parachute Joint Factors using Seam and Joint Testing

    NASA Technical Reports Server (NTRS)

    Mollmann, Catherine

    2015-01-01

    This paper details the methodology for determining the joint factor for all parachute components. This method has been successfully implemented on the Capsule Parachute Assembly System (CPAS) for the NASA Orion crew module for use in determining the margin of safety for each component under peak loads. Also discussed are concepts behind the joint factor and what drives the loss of material strength at joints. The joint factor is defined as a "loss in joint strength...relative to the basic material strength" that occurs when "textiles are connected to each other or to metals." During the CPAS engineering development phase, a conservative joint factor of 0.80 was assumed for each parachute component. In order to refine this factor and eliminate excess conservatism, a seam and joint testing program was implemented as part of the structural validation. This method split each of the parachute structural joints into discrete tensile tests designed to duplicate the loading of each joint. Breaking strength data collected from destructive pull testing was then used to calculate the joint factor in the form of an efficiency. Joint efficiency is the percentage of the base material strength that remains after degradation due to sewing or interaction with other components; it is used interchangeably with joint factor in this paper. Parachute materials vary in type-mainly cord, tape, webbing, and cloth -which require different test fixtures and joint sample construction methods. This paper defines guidelines for designing and testing samples based on materials and test goals. Using the test methodology and analysis approach detailed in this paper, the minimum joint factor for each parachute component can be formulated. The joint factors can then be used to calculate the design factor and margin of safety for that component, a critical part of the design verification process.

  14. 49 CFR 213.351 - Rail joints.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... sound design and dimensions for the rail on which it is applied. (b) If a joint bar is cracked, broken... contraction due to temperature variations. When no-slip, joint-to-rail contact exists by design,...

  15. 49 CFR 213.351 - Rail joints.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... sound design and dimensions for the rail on which it is applied. (b) If a joint bar is cracked, broken... contraction due to temperature variations. When no-slip, joint-to-rail contact exists by design,...

  16. 49 CFR 213.351 - Rail joints.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... sound design and dimensions for the rail on which it is applied. (b) If a joint bar is cracked, broken... contraction due to temperature variations. When no-slip, joint-to-rail contact exists by design,...

  17. Measurement of Resistive Torques in Major Human Joints

    DTIC Science & Technology

    1979-04-01

    Joints Knee Joint Resistive Torques Hip Joint Resistive Moments Elbow Joint Ankle Joint 20. ABSTRACT (Continue on reverse side if necessary and...applications. The major articulating Joints which are considered are the shoulder, knee, hip, elbow and ankle. Due DD I J 1473 EDITION OF I NOV 65 IS OBSOLETE...47 Force is being applied by means of the GFA on the subject’s lower arm for the elbow joint resistive force and moment data collection

  18. Neurological and behavioral abnormalities, ventricular dilatation, altered cellular functions, inflammation, and neuronal injury in brains of mice due to common, persistent, parasitic infection

    PubMed Central

    Hermes, Gretchen; Ajioka, James W; Kelly, Krystyna A; Mui, Ernest; Roberts, Fiona; Kasza, Kristen; Mayr, Thomas; Kirisits, Michael J; Wollmann, Robert; Ferguson, David JP; Roberts, Craig W; Hwang, Jong-Hee; Trendler, Toria; Kennan, Richard P; Suzuki, Yasuhiro; Reardon, Catherine; Hickey, William F; Chen, Lieping; McLeod, Rima

    2008-01-01

    Background Worldwide, approximately two billion people are chronically infected with Toxoplasma gondii with largely unknown consequences. Methods To better understand long-term effects and pathogenesis of this common, persistent brain infection, mice were infected at a time in human years equivalent to early to mid adulthood and studied 5–12 months later. Appearance, behavior, neurologic function and brain MRIs were studied. Additional analyses of pathogenesis included: correlation of brain weight and neurologic findings; histopathology focusing on brain regions; full genome microarrays; immunohistochemistry characterizing inflammatory cells; determination of presence of tachyzoites and bradyzoites; electron microscopy; and study of markers of inflammation in serum. Histopathology in genetically resistant mice and cytokine and NRAMP knockout mice, effects of inoculation of isolated parasites, and treatment with sulfadiazine or αPD1 ligand were studied. Results Twelve months after infection, a time equivalent to middle to early elderly ages, mice had behavioral and neurological deficits, and brain MRIs showed mild to moderate ventricular dilatation. Lower brain weight correlated with greater magnitude of neurologic abnormalities and inflammation. Full genome microarrays of brains reflected inflammation causing neuronal damage (Gfap), effects on host cell protein processing (ubiquitin ligase), synapse remodeling (Complement 1q), and also increased expression of PD-1L (a ligand that allows persistent LCMV brain infection) and CD 36 (a fatty acid translocase and oxidized LDL receptor that mediates innate immune response to beta amyloid which is associated with pro-inflammation in Alzheimer's disease). Immunostaining detected no inflammation around intra-neuronal cysts, practically no free tachyzoites, and only rare bradyzoites. Nonetheless, there were perivascular, leptomeningeal inflammatory cells, particularly contiguous to the aqueduct of Sylvius and hippocampus

  19. Severe Bloodstream Infection due to KPC-Producer E coli in a Renal Transplant Recipient Treated With the Double-Carbapenem Regimen and Analysis of In Vitro Synergy Testing: A Case Report.

    PubMed

    Oliva, Alessandra; Cipolla, Alessia; Gizzi, Francesca; D'Abramo, Alessandra; Favaro, Marco; De Angelis, Massimiliano; Ferretti, Giancarlo; Russo, Gianluca; Iannetta, Marco; Mastroianni, Claudio M; Mascellino, Maria T; Vullo, Vincenzo

    2016-02-01

    Transplant recipients are at high risk of infections caused by multidrug resistant microorganisms. Due to the limited therapeutic options, innovative antimicrobial combinations against carbapenem-resistant Enterobacteriaceae causing severe infections are necessary.A 61-year-old woman with a history of congenital solitary kidney underwent renal transplantation. The postoperative course was complicated by nosocomial pneumonia due to Stenotrophomonas maltophilia and pan-sensitive Escherichia coli, successfully treated with antimicrobial therapy. On postoperative day 22, diagnosis of surgical site infection and nosocomial pneumonia with concomitant bacteremia due to a Klebisella pneumoniae carbapenemase-producer E coli was made. The patient was treated with the double-carbapenem regimen (high dose of meropenem plus ertapenem) and a potent synergistic and bactericidal activity of this un-conventional therapeutic strategy was observed in vitro. Despite a microbiological response with prompt negativity of blood cultures, the patient faced a worse outcome because of severe hemorrhagic shock.The double-carbapenem regimen might be considered as a rescue therapy in those subjects, including transplant recipients, in whom previous antimicrobial combinations failed or when colistin use might be discouraged. Performing in vitro synergy testing should be strongly encouraged in cases of infections caused by pan-drug resistant strains, especially in high-risk patients.

  20. Severe Bloodstream Infection due to KPC-Producer E coli in a Renal Transplant Recipient Treated With the Double-Carbapenem Regimen and Analysis of In Vitro Synergy Testing

    PubMed Central

    Oliva, Alessandra; Cipolla, Alessia; Gizzi, Francesca; D’Abramo, Alessandra; Favaro, Marco; De Angelis, Massimiliano; Ferretti, Giancarlo; Russo, Gianluca; Iannetta, Marco; Mastroianni, Claudio M.; Mascellino, Maria T.; Vullo, Vincenzo

    2016-01-01

    Abstract Transplant recipients are at high risk of infections caused by multidrug resistant microorganisms. Due to the limited therapeutic options, innovative antimicrobial combinations against carbapenem-resistant Enterobacteriaceae causing severe infections are necessary. A 61-year-old woman with a history of congenital solitary kidney underwent renal transplantation. The postoperative course was complicated by nosocomial pneumonia due to Stenotrophomonas maltophilia and pan-sensitive Escherichia coli, successfully treated with antimicrobial therapy. On postoperative day 22, diagnosis of surgical site infection and nosocomial pneumonia with concomitant bacteremia due to a Klebisella pneumoniae carbapenemase-producer E coli was made. The patient was treated with the double-carbapenem regimen (high dose of meropenem plus ertapenem) and a potent synergistic and bactericidal activity of this un-conventional therapeutic strategy was observed in vitro. Despite a microbiological response with prompt negativity of blood cultures, the patient faced a worse outcome because of severe hemorrhagic shock. The double-carbapenem regimen might be considered as a rescue therapy in those subjects, including transplant recipients, in whom previous antimicrobial combinations failed or when colistin use might be discouraged. Performing in vitro synergy testing should be strongly encouraged in cases of infections caused by pan-drug resistant strains, especially in high-risk patients. PMID:26886594

  1. Lack of transmission of a human influenza virus with avian receptor specificity between ferrets is not due to decreased virus shedding but rather a lower infectivity in vivo.

    PubMed

    Roberts, Kim L; Shelton, Holly; Scull, Margaret; Pickles, Raymond; Barclay, Wendy S

    2011-08-01

    Influenza virus attaches to host cells by sialic acid (SA). Human influenza viruses show preferential affinity for α2,6-linked SA, whereas avian influenza viruses bind α2,3-linked SA. In this study, mutation of the haemagglutinin receptor-binding site of a human H3N2 influenza A virus to switch binding to α2,3-linked SA did not eliminate infection of ferrets but prevented transmission, even in a co-housed model. The mutant virus was shed from the noses of ferrets directly inoculated with virus in the same amounts and for the same length of time as wild-type virus. Mutant virus infection was localized to the same anatomical regions of the upper respiratory tract of directly inoculated animals. Interestingly, wild-type virus was more readily neutralized than the mutant virus in vitro by ferret nasal washes containing mucus. Moreover after inoculation of equal doses, the mutant virus grew poorly in ex vivo ferret nasal turbinate tissue compared with wild-type virus. The dose of mutant virus required to establish infection in the directly inoculated ferrets was 40-fold higher than for wild-type virus. It was concluded that minimum infectious dose is a predictor of virus transmissibility and it is suggested that, as virus passes from one host to another through stringent environmental conditions, viruses with a preference for α2,3-linked SA are unlikely to inoculate a new mammalian host in sufficient quantities to initiate a productive infection.

  2. Radiosynovectomy of Painful Synovitis of Knee Joints Due to Rheumatoid Arthritis by Intra-Articular Administration of (177)Lu-Labeled Hydroxyapatite Particulates: First Human Study and Initial Indian Experience.

    PubMed

    Shinto, Ajit S; Kamaleshwaran, K K; Chakraborty, Sudipta; Vyshakh, K; Thirumalaisamy, S G; Karthik, S; Nagaprabhu, V N; Vimalnath, K V; Das, Tapas; Banerjee, Sharmila

    2015-01-01

    The aim of this study is to assess the effectiveness of Radiosynovectomy (RSV) using (177)Lu-labeled hydroxyapatite ((177)Lu-HA) in the treatment of painful synovitis and recurrent joint effusion of knee joints in rheumatoid arthritis (RA). Ten patients, diagnosed with RA and suffering from chronic painful resistant synovitis of the knee joints were referred for RSV. The joints were treated with 333 ± 46 MBq of (177)Lu-HA particles administered intra-articularly. Monitoring of activity distribution was performed by static imaging of knee joint and whole-body gamma imaging. The patients were evaluated clinically before RSV and at 6 months after the treatment by considering the pain improvement from baseline values in terms of a 100-point visual analog scale (VAS), the improvement of knee flexibility and the pain remission during the night. RSV response was classified as poor (VAS < 25), fair (VAS ≥ 25-50), good (VAS ≥ 50-75) and excellent (VAS ≥ 75), with excellent and good results considered to be success, while fair and poor as failure and also by range of motion. Three phase bone scan (BS) was repeated after 6 months and changes in the second phase of BS3 were assessed visually, using a four-degree scale and in the third phase, semiquantitatively with J/B ratio to see the response. Biochemical analysis of C-reactive protein (CRP) and fibrinogen was repeated after 48 h, 4 and 24 weeks. In all 10 patients, no leakage of administered activity to nontarget organs was visible in the whole-body scan. Static scans of the joint at 1 month revealed complete retention of (177)Lu-HA in the joints. All patients showed decreased joint swelling and pains, resulting in increased joint motion after 6 months. The percentage of VAS improvement from baseline values was 79.5 ± 20.0% 6 months after RS and found to be significantly related to patients' age (P = 0.01) and duration of the disease (P = 0.03). Knees with Steinbrocker's Grades 0 and I responded better than those

  3. Radiosynovectomy of Painful Synovitis of Knee Joints Due to Rheumatoid Arthritis by Intra-Articular Administration of 177Lu-Labeled Hydroxyapatite Particulates: First Human Study and Initial Indian Experience