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Background: Infective arthritis is an orthopaedic surgical emergency. Staphylococcus aureus remains the commonest causative bacteria across all age groups. Prevotella spp. as a cause of infective arthritis is extremely rare. Case report: We present our case of a 30-year-old African male patient who presented with mild signs of infective arthritis of the left hip. His risk factors were his background retroviral disease, intravenous drug abuse, and a previous episode of left hip arthrotomy which healed expectantly with intervention. The current presentation was treated with arthrotomy of the hip, fluid lavage, and skeletal traction based on our clinical findings and the rarity of the presentation was seen to be mobilising non-weight bearing with crutches, and pain-free on the left hip. Conclusion: A high index of suspicion for Prevotella Septic Arthritis (PSA) should be exercised when treating infective arthritis patients with background joint arthropathies, and intravenous drug abuse, especially in individuals with significant immunosuppression and/or recent tooth extraction. Fortunately, although rare an entity, good outcomes can be expected with early diagnosis and classic treatment principles of joint decompression and lavage as well as guided antibiotic therapy. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) of hip constitutes nearly 15% of all cases of osteoarticular tuberculosis. We report a retrospective study carried out on 43 children with hip TB. Materials and Methods: Forty-three children of TB hip treated between 1971 and 2000 were analysed. Twenty-four children of the early series were treated with streptomycin (S), isoniazid (H) and PAS (Pa) for 18 months (3HPaS, 15 HPa), while 19 children in the later series were treated with isoniazid (H), rifampicin (R) and ethambutol (E) or pyrazinamide (Z) for 12 months [(12 RHE(Z)]. Five out of 18 children with radiologically normal appearing type hip TB were treated with chemotherapy alone and 38 children were subjected to surgery; simple synovectomy alone in 31 hips, joint debridement in six hips, and proximal femoral varisation osteotomy in one. After surgery hips were immobilized in cast for one to three months according to the severity of the disease and patients pain tolerance, and then were mobilized under leg traction in bed gradually till pain subsided completely. Results: TB of hip healed with minimum sequelae in all children. In 18 Type one hip TB, normal hip (synovial form) anatomy was maintained, and in 25 patients with advanced lesions some defect in the femoral head and acetabulum was noticed, though painless good hip motion was maintained. Excellent to good results were obtained in 31 children (73.1%), fair in eight (18.6%), and poor in four (9.3%). In four patients with poor results, there was some residual morphological defect in the hip. None developed ankylosis of hip. Conclusion: We achieved good outcome with minimum sequelae in this series. The management goal should be aimed not only to heal the disease but also to maintain a painless mobile hip and anatomical cephalocotyloid relationship until maturity, and retard the development of secondary osteoarthritis. [ABSTRACT FROM AUTHOR]

Musculoskeletal infection is one of the common manifestations of patients infected with human immunodeficiency virus and acquired immunodeficiency syndrome. With immune deficiency, patients are susceptible to a variety of nonopportunistic and opportunistic infections that can result in significant morbidity and mortality. Infection can involve any anatomical compartments resulting in infectious arthritis, osteomyelitis, pyomyositis, and soft tissue and skin infection. Imaging plays an important role in the early diagnosis and treatment planning for these patients. This article reviews the clinical manifestations of musculoskeletal infection together with reported causative organisms. We discuss the role of imaging and present radiological examples. [ABSTRACT FROM AUTHOR]

Melioidosis is an infectious disease caused by Burkholderia pseudomallei, mostly affecting patients in Southeast Asia and northern Australia. The disease has been increasingly recognized around the world due to the increased levels of travel and population movement. Clinical manifestations of melioidosis range from fulminant septicemic illness to an indolent local infection. The disease often involves multiple organs, including the lung, spleen, liver, and other visceral organs. Musculoskeletal infection is usually seen as a part of multiorgan involvement, but localized musculoskeletal involvement may occur. The most common manifestation of musculoskeletal melioidosis is septic arthritis, followed by osteomyelitis, pyomyositis, and soft tissue abscesses. The clinical and radiological manifestations of musculoskeletal melioidosis are nonspecific, and the diagnosis needs a high level of suspicion. Associated infection of lungs and visceral organs is suggestive of melioidosis. The disease requires special laboratory facilities and treatment. Inappropriate or inadequate treatment leads to high mortality rate or long-term relapse of the disease. The causative organism of melioidosis, clinical manifestations, and imaging features of musculoskeletal melioidosis are reviewed. [ABSTRACT FROM AUTHOR]

This study aims to determine the current practices and beliefs of United Kingdom (UK)-based rheumatologists and orthopedic surgeons (OS) in managing septic arthritis (SA) and to determine awareness levels of national guidance. Two-hundred OS and 200 rheumatologists were sent a link to a web-based survey tool via email. Questions posed related to the management of SA, including the respondent's views on antibiotic therapy, joint drainage, which specialty should manage these cases, and also the clinician's evidence base. There were 354 functioning addresses with 182 responses (51%). One hundred fifty-one (77 OS, 74 rheumatologists) (43%) responses were complete and included for analysis. Eighty percent of rheumatologists and 82% of OS recommended 6-weeks total antibiotic therapy. Seventy-three percent in each group recommended 1-2 weeks intravenous therapy initially followed by oral continuation therapy. In patients at risk of methicillin-resistant Staphylococcus aureus (MRSA), 25% rheumatologists and 14% OS would ensure MRSA cover. Seventy-seven percent of rheumatologists and 66% of OS recommended surgical joint drainage; 22% and 27%, respectively, recommended repeated closed needle aspiration as their chosen method of joint drainage. Sixty-six percent of rheumatologists and 65% of OS believed OS should manage SA. Twenty-three percent of rheumatologists and 22% of OS quoted published guidance as their main evidence base in the treatment of SA. Only 24% of rheumatologists and 34% of OS quoted British Society of Rheumatology (BSR) guidance when asked if they were aware of any guidelines. Views of rheumatologists and OS are not that dissimilar in managing SA. Surprisingly, rheumatologists are more aggressive regarding the recommendation for surgical joint drainage. Within both groups, significant variation in management principles exists often discrepant to recommendations laid out by the BSR. There are poor awareness levels of the BSR guidelines. [ABSTRACT FROM AUTHOR]

We report an unusual case of a man with two episodes of infection—the first a mycetoma of the foot and the second a mycotic arthritis of the knee joint. [ABSTRACT FROM PUBLISHER]