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Closed-space hand infections are considered an emergency requiring prompt management to avoid debilitating consequences and potential morbidity. Septic arthritis of the wrist is particularly uncommon in comparison to the large joints that are usually affected. We report a case of a 64-year-old female with known rheumatoid arthritis and neuropathic wrist, with superimposed septic arthritis of the wrist, complicated by abscess formation. Ultrasound and Magnetic resonance imaging revealed spread of infection to the midpalmar region and the space of Parona. Although collections in this space are extremely rare, if left untreated, they may lead to permanent disability. Incision and drainage of the abscess along with synovectomy of the affected wrist joint was performed. Streptococcus pneumoniae was the causative organism, despite the fact that Non-gonococcal and Staphylococcus aureus bacteria are the main causative agents of septic arthritis in adults.

Vesico-acetabular fistula formation is a rare condition typically associated with total hip arthroplasty. Clinical features can include pain of the hip and flank, haematuria, and dysuria. We report the case of a 67-year-old female with a past medical history of bilateral pelvic fractures and calcium hydroxyapatite deposition disease of the hip joint, who developed vesico-acetabular fistula in the absence of surgery. This was then complicated by septic arthritis. We highlight the ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) findings of the case and review the previous case reports describing the vesico-acetabular fistula.

Septic arthritis (SA) is more severe in patients with rheumatoid arthritis, joint surgical issues, or a weakened immune system. Timely diagnosis of SA is crucial for effective treatment. Traditional diagnostic methods such as ELISA, white blood cell counting, blood culture, qPCR, and imaging techniques are often less accurate and time-consuming. Researchers are focusing on developing highly sensitive biosensors for SA using blood-based biomarkers. Procalcitonin is a protein and a well-established biomarker for SA. This research focuses on developing a procalcitonin interdigitated electrode (IDE) biosensor using a probe made of an aptamer and antibody-modified gold nanoparticle (AuNP) complex. The probe was attached to the IDE through an amine linker and then interacted with procalcitonin. AuNPs increased the attachment of the aptamer and antibody to the IDE, enabling the detection of procalcitonin at levels as low as 10 ng/mL, with a linear regression curve ranging from 10 to 100 ng/mL [y = 4.0691x - 2.1887; R2 = 0.9937]. Furthermore, procalcitonin-spiked serum elevated the current level with increasing procalcitonin concentrations, while control performances did not enhance the current, indicating the selective and specific detection of procalcitonin. This AuNP-aptamer-antibody complexed biosensor effectively identifies procalcitonin at low levels and aids in the diagnosis of SA.

Objective: Studies focusing on bone and joint infections (BJIs) in young infants are rare. Some cases of BJI are accompanied by sepsis. This study aimed to identify the clinical and bacteriological features of sepsis in neonates and young infants with BJIs. Methods: Neonates and infants younger than 3 months diagnosed with BJI in the present institution from 2014 to 2021 were retrospectively reviewed. Patient characteristics, clinical data, and outcomes were documented and compared between those with and without sepsis. Results: Twenty-five patients with a mean age of 34.8 days were included. Nine BJI cases had concomitant sepsis (group A), and 16 had BJI without sepsis (group B). Within group A, staphylococcus aureus was the major pathogenic germ (5 cases, of which 4 were of the methicillin-resistant staphylococcus aureus (MRSA) type). There was no statistical difference in male-to-female ratio, age, history of hospitalization, anemia, birth asphyxia, peripheral leukocyte counts, C-reactive protein on admission, and sequelae between groups. Univariate analyses indicated a significant difference in the incidence of septic arthritis (SA) combined with osteomyelitis (OM) (88.9% vs 37.5%), congenital deformities (44.4% vs 0%), and mean duration of symptoms (2.83 days vs 9.21 days) in comparisons between groups A and B. Conclusion: Staphylococcus aureus is the main pathogenic bacteria in BJI cases complicated with sepsis in neonates and young infants. Among infants younger than 3 months diagnosed with BJI, those with concurrent SA and OM, MRSA infection, or congenital deformities are more likely to develop sepsis.

Introduction: Septic arthritis caused by primitive leech therapy is an unusual and infrequent occurrence. Detecting this condition late can cause serious problems like joint damage and reduced mobility. This case report intends to showcase a rare instance of septic arthritis in the knee joint caused by primitive leech therapy, detailing its successful management. Case report: A 35-year-old female sought medical attention after undergoing primitive external leech therapy, presenting with symptoms of fever, severe progressive pain, and swelling in her left knee. Hematological examination revealed elevated total leukocyte count and c-reactive protein values. Arthroscopic debridement and joint lavage were performed, and synovial fluid analysis and histopathological examination of the tissue mass obtained from the affected joint confirmed the diagnosis of septic arthritis. Despite negative findings in gram staining, aerobic and anaerobic culture, and sensitivity reports, empirical therapy with 1 g of cefuroxime, a systemic intravenous antibiotic, was administered without any adverse events. Regular follow-ups were conducted, and evaluations of CRP and total count showed a complete resolution of the disease process. Conclusion: A high index of suspicion for septic arthritis should be maintained when dealing with primitive invasive intra-articular procedures like leech therapy. Appropriate scientific interventions and public awareness are crucial in reducing morbidity and preventing further complications associated with this rare condition.

Gouty stone ulcers inducing bloodstream infections leading to chest wall and mediastinal abscesses and progression to sepsis and hemophagocytic syndrome are extremely rare in clinical practice. Keep in mind the possibility of coexistence of gout and septic arthritis. Prompt and accurate diagnosis and treatment of hemophagocytic syndrome (HPS), a highly fatal disease with acquired immunoregulatory abnormalities and release of large amounts of inflammatory factors, are important to save the patient's life.

A 37-year-old immunocompetent man was admitted to the emergency department due to recurrent pain and oedema of his right knee. Two months earlier, he had undergone surgery to repair his meniscus. Arthroscopic joint lavage was performed and Candida dubliniensis was recovered in culture. The authors describe the first case of septic arthritis caused by Candida dubliniensis.

Background: Melioidosis is one of the emerging infections in India and is often neglected due to lack of awareness among clinicians. The diseases usually present as multifocal or focal abscesses with bacteremia, yet the isolated septic monoarthritic complicated with septic venous thrombosis is a rare presentation. Case: This case report describes a 48-year-old male business executive with diabetes and alcoholism who developed septic arthritis caused by Burkholderia pseudomallei and no clear history of exposure to the organism. The patient initially experienced fever, chills, fatigue, reduced urine output, and signs of early sepsis. Despite initial improvement with fluid therapy and antibiotics, the patient's fever persisted. Meticulous clinical examination revealed signs of inflammation and movement restriction in the left shoulder which letter on became obvious and the main complaints of patient. Blood cultures confirmed the presence of B. pseudomallei. Imaging showed septic arthritis, osteomyelitis, lymphadenitis, and venous thrombosis in the left shoulder. Surgical debridement was performed, and the tissue cultures showed the growth of the same pathogen. This led to significant clinical improvement and with prolonged course of antibiotics, complete resolution of symptoms and normal joint function was achieved. Conclusion: This case report serves to highlight the rare and atypical presentation of Melioidosis and the importance of suspecting this infection in nonendemic regions underscoring the probable impact of climate change. Early diagnosis, effective source control measures and prolonged antibiotic therapy, emerges as pivotal factors contributing to favorable outcomes in such cases.

We report a case of a native knee septic arthritis and subsequent osteomyelitis due to a CO2-dependent (capnophilic) multidrug-resistant E. coli ST131 O25:H4 strain. Capnophilic phenotype made microbiology investigation challenging; susceptibility testing could not be performed and the organism did not grow in the urine culture using standard method. The combination of unique virotype and capnophilia may have contributed to the aggressiveness of this organism and the initial unsuccessful carbapenem course, leading to recurrent infection.

Background: Bone and joint infections (BJI) are common in immunocompetent children, however in children with acute leukaemia the epidemiology, optimal diagnostic pathway and medical and surgical treatment is poorly described. We review the presentation, management and outcomes of BJI in this special population. Methods: Systematic literature review of BJI in children with acute leukaemia was performed using Medline, EMBASE and PubMed databases from 1946 to June, 2023. Titles and abstracts were independently screened by 3 reviewers. Studies were included if they reported data on children (≤18 years) with leukaemia who had a diagnosis of osteomyelitis (radiological diagnosis) or septic arthritis (culture proven or managed as infection by treating clinician). Results: Twenty-two articles describing 33 episodes of confirmed or suspected bacterial BJI were included. Of these, microbiological diagnosis was confirmed in 27 episodes (82%) and included Gram-positive (9/33), Gram-negative (8/33), mycobacterial (5/33), Mycoplasmatota (1/33) and polymicrobial (4/33). The femur was the most common site of infection (33%) and there were 18 episodes (55%) of multifocal disease. Duration of treatment varied from 3 weeks to 2.5 years in patients with culture confirmed infection (82%) and from 3 to 8 weeks in patients with culture-negative infection (18%). Clinical cure was documented in 31 episodes (94%). Conclusion: Bone and joint infections in children with acute leukaemia are often caused by atypical pathogens, with a higher predilection for multifocal disease and/or involvement of unusual sites in comparison with immunocompetent children. It is unclear whether this population requires prolonged antibiotic treatment due to periods of intensive chemotherapy or neutropenia. Monitoring response to therapy may be challenging as inflammatory markers such as CRP and ESR may take longer to normalise, making it difficult to assess for clinical cure.

The presence of antibiotic resistance has increased the urgency for more effective treatments of bacterial infections. Biofilm formation has complicated this issue as biofilm bacteria become tolerant to antibiotics due to environmental factors such as nutrient deprivation and adhesion. In septic arthritis, a disease with an 11% mortality rate, bacteria in synovial fluid organize into floating, protein-rich, bacterial aggregates (mm-cm) that display depressed metabolism and antibiotic tolerance. In this study, Staphylococcus aureus (S. aureus), which is the most common pathogen in septic arthritis, was tested against different inhibitors that modulate bacterial surface protein availability and that should decrease bacterial aggregation. One of these, berberine, a quaternary ammonium compound, was found to reduce bacterial counts by 3–7 logs in human synovial fluid (aggregating medium) with no effect in tryptic soy broth (TSB, non-aggregating). Unlike traditional antibiotics, the bactericidal activity of berberine appeared to be independent of bacterial metabolism. To elucidate the mechanism, we used synovial fluid fractionation, targeted MRSA transposon insertion mutants, dyes to assess changes in membrane potential (DiSC3(5)) and membrane permeability (propidium iodide (PI)), colony counting, and fluorescence spectroscopy. We showed that berberine's activity was dependent on an alkaline pH and berberine killed both methicillin-sensitive S. aureus and MRSA in alkaline media (pH 8.5–9.0; p

Microbiological diagnosis of osteoarticular infections (OI) is crucial for a successful treatment. A prospective multicenter study including 262 synovial fluids with suspicion of acute OI was performed between July 2021 and October of 2022. BioFire Joint Infection Panel multiplex-PCR test was performed and results were compared with conventional cultures of synovial fluid specimens. In total, 136 microorganisms were detected, and fourteen samples were positive for more than one microorganism. In monomicrobial infections (n = 87) agreement with culture was 69%. In 26 samples, the multiplex PCR yield an additional positive result when culture result was negative. It helped in the detection of fastidious microorganisms as K. kingae and N. gonorrhoeae. This multiplex PCR has proven to be a useful technique that can be used for patients with high suspicion of acute OI in a rapid and automated manner.

An 89-year-old male with a background of metastatic transitional cell carcinoma presented acutely with new hydronephrosis and deranged renal function secondary to high pressure chronic urinary retention. A recent urine culture was positive for Escherichia coli (E.coli). Co-incidentally, the patient's primary presenting symptom was right shoulder pain following recent low velocity trauma. X-ray demonstrated air density within the glenohumeral joint, with Magnetic Resonance Imaging (MRI) confirming features of septic arthritis. Surgical debridement was undertaken with tissue microscopy and culture identifying the presence of E. coli, confirming the diagnosis of disseminated urinary tract infection.

Introduction: Glenohumeral septic arthritis is most caused by hematogenous seeding of the joint by S. Aureus, and also as a result of previous surgery or intra-articular injection. Although rare, septic arthritis of the glenohumeral joint has poor prognosis. In patients who survive the infection, the potential to cause rapid and catastrophic damage to articular cartilage, frequently causes lifelong morbidity. Methods: Four consecutive patients (five shoulders) treated at our institution between December 2019 to September 2020 were identified for the study. Medical records were reviewed, and basic demographics of the patient series included age, sex, race, BMI were collected. Information such as comorbidities, inciting injuries, history of presentation, examination findings, biochemical results, radiological findings, aspiration results and cultures, intra-operative findings, as well as blood cultures were extracted. Results: Four patients (age range of 65–83 years old) underwent a single arthroscopic washout of the glenohumeral joint. All four patients (3 female, 1 male) presented with acute swollen should joint/s with raised inflammatory markers (ESR, CRP and WBC). Staph Aureus was identified in 50% (n ​= ​2) of the cases with Mycobacterium Kansasii and Group B Streptococcus isolated in the other 2 patients. Half of the cases (n ​= ​2) were deemed to be caused by direct spread of pathogens whereas the other half of the cases (n ​= ​2) were deemed to be due to hematogenous spread. All patients exhibit resolution of clinical infection following the treatment. MRI were done for all patients which aided in the diagnosis of a septic shoulder joint. Conclusion: Our case series shown that single arthroscopic washout and debridement provides acceptable to good short-term outcomes for septic arthritis of the glenohumeral joint. In this case series, the authors have found MRI to be a useful radiographic aid to diagnosis. Level of evidence: Case series.

We report on a 34-year-old female whose normal spontaneous vaginal delivery was complicated by Group B streptococcus (GBS) colonization. She developed postpartum, bilateral, rapidly destructive septic hip arthritis. She was treated with bilateral articulating, antibiotic-impregnated spacers, 6 weeks of parenteral antibiotics, and subsequent conversion to total hip arthroplasties. In pregnant women, GBS can result in bacteremia, urinary tract infection, endometritis, and pneumonia. Less commonly, GBS can lead to endocarditis, sacroiliitis, or septic arthritis. Septic arthritis of the hip following pregnancy has been described in a limited number of case reports, yet none, to our knowledge, with rapid bilateral destruction requiring two-staged conversion to total hip replacement.

In this report, we describe a case of septic arthritis caused by the newly described Mycobacterium persicum (formerly Mycobacterium kansasii complex). The patient's only significant exposure was home gardening. To our knowledge, this represents the first documented case of M. persicum infection in the United States and first septic arthritis.

Urosymphyseal fistula (UF) is an uncommon complication in patients with prostate cancer who undergo radiation therapy. UF formation can lead to complications such as symphyseal septic arthritis or osteomyelitis with consequences of severe illness and pain. Often major surgical correction is required, however this case report demonstrates that a less invasive approach may be successful in select patients.

Aerococcus urinae is a Gram-positive, catalase-negative coccus, rarely responsible for urinary tract infections and seldom described for musculoskeletal infections like spondylodiscitis. An 86-year-old man presented to our hospital for groin pain without fever. Pelvic CT-guided biopsy revealed an A. urinae pubic symphysis osteomyelitis. He received a treatment by amoxicillin per os for six weeks, and did not need any surgery. An eight –month- follow-up showed a favorable evolution.Pubic symphysis infection can be induced by a wide variety of pathogens, and may have very different clinical presentations. Some authors recommend systematic surgery, but in case of susceptible pathogen associated with a low level of joint destruction, medical treatment alone should be sufficient to cure and make surgery unnecessary.

Roseomonas gilardii rarely causes infection in humans. We report that a patient with underlying rheumatoid arthritis and diabetes developed wrist septic arthritis and osteomyelitis due to Roseomonas after steroid joint injection. After antibiotic and surgical treatment, the condition of the patient improved. We reviewed previously reported cases of soft tissue, joint and bone infection related to Roseomonas to understand the characteristics of joint and bone infection of Roseomonas.

Capnocytophaga canimorsus, oral inhabitants of dogs and cats is a cause of zoonotic infections. It is transmitted to humans by bites, scratches, licks, or close exposure to these animals. Infections due to Capnocytophaga canimorsus have a wide range of severity and can sometimes be fatal. We report the case of an 89-years-old man who suffered from a sudden swollen native right shoulder. The blood test revealed an inflammatory syndrome and cytologic evaluation of joint aspiration showed an elevated nucleated cells count suspicious of infection. A Gram-negative bacillus grew after 48 h in the arthrocentesis and was identified as Capnocytophaga canimorsus. After 4 days, blood culture also grew Capnocytophaga canimorsus leading to the diagnosis of hematogenous septic arthritis of a non-prosthetic right shoulder. Antimicrobial therapy was empirically started with cefuroxime then switched to doxycycline for seven weeks with good clinical outcomes. It is important to inquire about patients’ environment including their proximity to animals as it can lead to zoonotic infections that can be of high severity. Moreover, hygiene rules must be applied when dog scratches or lick wounds occurred to avoid the spread of zoonotic germs. Prophylactic antibiotic therapy should be given for animal bites.

Pasteurella multocida is a facultative anaerobic and gram-negative bacteria. It lives in the upper airway of animals, especially dogs and cats. P. multocida infection commonly results in regional cellulitis, although septic shock complication is uncommon. Here, we report on a fatal case of septic shock developing from a natural knee joint infection.

Nocardiosis is a bacterial infection caused by organisms of the Nocardia genus. The disease typically involves the skin, central nervous system or pulmonary system. Very rarely nocardiosis can cause disease of other organs including bone and joints. Nocardiosis is typically a chronic, somewhat indolent infection, occurring in patients with defective cell mediated immunity. We describe a 78-year-old female with right shoulder septic arthritis resulting from Nocardia farcinica with associated involvement of her skin and lungs as well. She was treated with surgical debridement and combination antibiotic therapy. We also share a literature review of bone and joint infection caused by the N. farcinica species, highlighting its rarity. Understanding uncommon manifestations of nocardiosis allows for early recognition and treatment of the condition and optimal patient care.

Background: The treatment of osteoarticular infections in pediatric patients with sickle cell disease (SCD) is a challenging task for the practitioner. The aim of this study is to evaluate cefixime for the treatment of osteoarticular infections in pediatric SCD patients by retrospective design. Methods: This study was done in the pediatric hospital of King Saud Medical City, Riyadh, Saudi Arabia. The data was obtained from medical records of patients aged 1–16 years admitted between January 2019 to December 2020, diagnosed with SCD and received cefixime for the treatment of OI. A descriptive study for pediatric patients admitted between January 2019 to December 2020 diagnosed with sickle cell disease and diagnosed with osteoarticular infection. All patients were treated with cefixime. Medians and interquartile ranges (IQRs) were used for the descriptive analysis. Results: A total of 260 patients were screened, and 51 cases [osteomyelitis (OM), n = 43, and septic arthritis (SA), n = 8] met the inclusion criteria. The median age of OM patients was 7 years, with males making up 67.4% of the cohort. The median length of IV antibiotics and hospital stays were 10 days and 11 days, respectively. The median total duration of antibiotic use was 37 and 25 days for OM and SA, respectively. The treatment success rate was 88% in OM cases and 100% in SA patients. Readmission was noted in 39.5% of the OM patients, while only 25% of the SA patients were recorded for reinfection. Conclusion: The study's findings revealed that Cefixime is a viable oral alternative for treating osteoarticular infection in pediatric SCD patients. Nonetheless, a prospective investigation is required to corroborate the findings of this study.

Background: Septic arthritis of the hip is a serious infection in children. However, blood and joint fluid cultures are often negative, which makes the diagnosis and treatment challenging. We analyzed the clinical features of children with septic arthritis of the hip with negative bacterial cultures and identified the risk factors for poor outcomes., Methods: The clinical data of children with septic arthritis of the hip with negative bacterial cultures who were treated at our hospital from January 2010 to December 2020 were retrospectively analyzed. The clinical characteristics and outcomes of the culture-negative cohort were compared with those of children with positive bacterial cultures treated during the same period. Culture-negative patients were divided into a group with good outcomes and a group with poor outcomes. The differences between the two groups were compared., Results: Thirty-nine children with culture-negative septic arthritis of the hip were compared with 37 children with culture-positive sepsis. Compared with the culture-positive group, the culture-negative group had a significantly younger mean age and a significantly lower mean serum C-reactive protein concentration. Logistic regression analysis of culture-negative patients with good versus poor outcomes revealed that the independent risk factors for poor outcomes were an increased serum C-reactive protein concentration and prolonged time from onset to surgery. The cut-off values for predicting a poor outcome in the culture-negative group were a time from onset to surgery of greater than 21 days and a C-reactive protein concentration of greater than 23 mg/L., Conclusions: Culture-negative septic arthritis of the hip has similar clinical features to culture-positive septic arthritis of the hip and can result in sequelae of varying severity. Therefore, active anti-infective and hip drainage therapy should be performed when children present with clinical symptoms, inflammatory marker concentrations, and imaging findings that are clinically diagnostic for septic arthritis of the hip., Level of Evidence: Level II, retrospective study., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest., (Copyright © 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Closed-space hand infections are considered an emergency requiring prompt management to avoid debilitating consequences and potential morbidity. Septic arthritis of the wrist is particularly uncommon in comparison to the large joints that are usually affected. We report a case of a 64-year-old female with known rheumatoid arthritis and neuropathic wrist, with superimposed septic arthritis of the wrist, complicated by abscess formation. Ultrasound and Magnetic resonance imaging revealed spread of infection to the midpalmar region and the space of Parona. Although collections in this space are extremely rare, if left untreated, they may lead to permanent disability. Incision and drainage of the abscess along with synovectomy of the affected wrist joint was performed. Streptococcus pneumoniae was the causative organism, despite the fact that Non-gonococcal and Staphylococcus aureus bacteria are the main causative agents of septic arthritis in adults., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Objectives: To assess the performance of the rapid syndromic BioFire® Joint Infection Panel (BF-JIP) to detect bacterial and fungal pathogens, as well as antibiotic resistance genes, directly in synovial fluid specimens collected from patients with acute arthritis., Methods: The study was conducted in six French bacteriological laboratories. To assess the performances of BF-JIP, results were compared with those of synovial fluid 14-day culture and, in case of discrepancy, with those of complementary molecular methods and intraoperative samples. A total of 308 synovial fluid specimens were tested after collection from 308 adults and children presenting with clinical and biological suspicion of acute arthritis; patients presenting with acute periprosthetic joint infection were included according to the European Bone and Joint Infection Society 2021 criteria., Results: Only one specimen failed (no result). On the basis of the consolidated data, the BF-JIP was concordant with the 14-day culture in 280 (91.2%) of the 307 specimens finally included in the study. The positive percentage agreement was 84.9% (95% CI, 78.8-89.8%) and the negative percentage agreement was 100% (95% CI, 97.2-100%). The positive predictive value was extremely high (100%; 95% CI, 97.6-100%), whereas the negative predictive value was lower (82.6%; 95% CI, 75.7-88.2%), partially explained by the missing target species in the panel., Discussion: The BF-JIP showed high performances to detect pathogens involved in acute arthritis., (Copyright © 2024 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Corynebacterium striatum occasionally causes nosocomial infections, such as catheter-related bloodstream infection and pneumonia; however, C. striatum-related infective endocarditis or septic arthritis is uncommon. We present the case of an 85-year-old woman with infective endocarditis at the native valve and septic arthritis at the native shoulder joint caused by C. striatum. The patient was admitted for a 10-day history of fever and right shoulder pain. She had no history of artificial device implantation, injury, arthrocentesis, or hospitalization. A physical examination revealed conjunctival petechiae, a systolic heart murmur, and right shoulder joint swelling. C. striatum was observed in two blood culture sets. Transesophageal echocardiography revealed vegetation in the right aortic coronary cusp. Arthrocentesis at the right shoulder aspirated pyogenic fluid and C. striatum was detected in the culture. The patient was diagnosed with infective endocarditis and septic arthritis caused by C. striatum, and ampicillin was administered based on antimicrobial susceptibility test results. The patient's condition was initially stable; however, she developed pulmonary congestion on day 56 and eventually died. An autopsy demonstrated perforation of the aortic left coronary cusp with vegetation. C. striatum may cause native valve endocarditis and native joint septic arthritis., Competing Interests: Declarations of competing interest None., (Copyright © 2023 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved.)

Background: Mycobacterium mucogenicum is a non-tuberculous mycobacterium that is found ubiquitously in the environment. This article is the first report of septic arthritis caused by M. mucogenicum. Case report: A 44-year-old female healthcare worker presented with atraumatic left knee pain and systemic features suggestive of septic arthritis in the context of recent left knee trauma and arthroscopic debridement. Over the course of five months, she underwent four arthroscopic or open procedures and received eight different antibiotics in pursuit of a definitive diagnosis and curative treatment. Intraoperative cultures grew multiple organisms, including methicillin resistant Staphylococcus aureus and M. mucogenicum. Follow-up at three months revealed complete resolution of symptoms and good mobility of the joint. Conclusion: As an atypical organism that is difficult to detect, good culture facilities and a high level of suspicion is required to diagnose Mycobacterium mucogenicum infection. The delay in antimicrobial sensitivity availability necessitates empirical antibiotics, and the ability of the pathogen to form biofilms necessitates aggressive synovectomy for local control. Identifying contributing risk factors such as immunosuppressive therapy or an underlying condition is crucial for achieving a cure. The need for synergistic antibiotic and orthopaedic treatment highlights the need for a multidisciplinary approach involving both specialized Infectious Diseases and Orthopaedic teams to treat this hardy pathogen.

Resumen: Las infecciones osteorticulares (IOA) en el niño son una causa importante de morbilidad y secuelas. Su pesquisa oportuna y el tratamiento eficiente pueden lograr excelentes resultados. La mejoría en las condiciones de salud de la población, y el cambio de los agentes etiológicos han variado la forma de presentación y tratamiento. La existencia de gérmenes como Kingella kingae y Staphilococcus aureus multiresistente, contribuyen a la variabilidad de presentación de las infecciones osteoarticulares.El manejo de estas patologías requiere de un conocimiento del cuadro clínico, de los métodos de diagnóstico y las herramientas terapéuticas. Para obtener buenos resultados es requisito básico el enfrentamiento de estos pacientes en un equipo multidisciplinario de especialistasEn este manuscrito revisaremos los aspectos fundamentales de las infecciones osteoarticulares, según el enfoque que aplicamos en nuestros pacientes Summary: Osteoarticular infections are a substantial cause of morbidity and sequelae in children. Early diagnosis and efficient treatment can achieve excellent results. The improvement in the health conditions of the population and the change in the etiological agents have produced changes in their presentation and their required treatment. The existence of germs like Kingella kingae and Staphilococcus aureus multiresistant contribute to the variability of presentation of osteoarticular infections.The appropriate management of these pathologies requires knowledge of the clinical picture, diagnostic methods, and therapeutic tools. To obtain good results, it is a basic requirement that these patients be confronted by a multidisciplinary team of specialists.In this manuscript we will review the most fundamental aspects of osteoarticular infections according to the approach we apply to our patients.

Background: Patients with advanced knee arthritis who develop a septic joint are not adequately treated with irrigation and debridement and intravenous antibiotics because of antecedent cartilage damage. The gold standard treatment has been a 2-stage approach. The periprosthetic joint infection literature has demonstrated the superiority of articulating spacers, and metal-on-poly (MOP) spacers are being used with increasing frequency. The purpose of this study was to compare the postoperative outcomes of patients with infected, arthritic knees treated by a 2-stage approach to those of patients who received single-stage treatment with a MOP spacer. Methods: Sixteen patients with native knee septic arthritis treated with an antibiotic spacer between 1998 and 2019 were reviewed. Demographic data, clinical data, knee motion, Knee Society score, Timed-Up-and-Go, and pain scores were collected. Survivorship of final implants was compared. Results: Six of 16 knees (38%) received single-stage treatment, and 10 received 2-stage treatment (62%). Five of 6 MOP spacers (83%) were retained at a mean follow-up of 3 ± 1.2 years. Nine of 10 (90%) receiving static spacers had subsequent reconstruction, with 9 (100%) surviving at mean follow-up of 7 ± 3.2 years. The patients who received MOP spacers trended toward greater terminal flexion, higher Knee Society score, and faster Timed-Up-and-Go at final follow-up. Conclusion: Infection in a native, arthritic knee may be effectively treated using single-stage MOP spacer. Postoperative outcomes of single-stage MOP spacers compare favorably to staged static spacers and with those undergoing revision surgery for other indications. Longer follow-up is needed to evaluate durability of MOP spacers.

Background: Septic abortion with multisystem involvement is associated with significant morbidity and mortality. Access to care and legalization of abortion have greatly diminished the incidence of serious sequelae worldwide. Two complications, infective endocarditis and septic arthritis, are rarely encountered in contemporary practice. Case: A 30-year-old woman developed infective endocarditis, septic arthritis, and reactive arthritis concurrently one week after undergoing dilation and curettage for an incomplete abortion with perioperative administration of doxycycline. She required systemic antibiotics, drainage and debridement of her right ankle, and a robotic-assisted mitral valve replacement due to septic vegetation. Conclusion: Septic abortion with life-threatening systemic complications is rarely encountered in modern practice. Prompt surgical uterine evacuation and broad-spectrum antibiotics are indicated to prevent systemic complications. Multispecialty consultation is usually required when endocarditis, arthritis, and other systemic complications are encountered.

Resumen: Antecedentes y objetivo: El 40-50% de estas artritis sépticas se producen en la rodilla, y a pesar del rápido tratamiento médico-quirúrgico, del 24 al 50% van a acabar en un pobre resultado clínico. No está claro qué técnica de desbridamiento por artrotomía o por artroscopia es más eficaz para el control de la infección, ni si la artrosis previa empeora o no el resultado. El objetivo de este estudio en artritis séptica de rodilla artrósica es analizar qué técnica de desbridamiento quirúrgico, artroscopia o artrotomía, es más eficaz, cuál es la evolución clínica y radiográfica de los pacientes y cuántos van a necesitar la implantación de una PTR tras la curación de la infección. Material y método: Se realizó un estudio retrospectivo en 27 pacientes con artritis séptica nativa de rodilla. Dieciocho eran hombres y la edad media fue de 64,8 años (30-89 años). Quince pacientes fueron desbridados por artrotomía y 12 por artroscopia. Se analizó la eficacia del desbridamiento para el control de la infección, la progresión radiográfica de la artrosis en la escala de Ahlbäch, la necesidad de protetización posterior y el dolor y el estado funcional mediante la escala EVA y WOMAC a los 52,8 ± 11,2 meses de evolución. Resultados: El 93 y el 92% de los pacientes controlaron la infección, el 13 y el 42% requirieron dos o más cirugías para el control de la infección, y el 18 y el 44,4% mostraron progresión de la artrosis en el grupo artrotomía y artroscopia, respectivamente. Un paciente de cada grupo requirió que se le implantara una prótesis de rodilla. La escala EVA fue superior en el grupo artrotomía y no hubo diferencias en la escala de WOMAC. Conclusión: El desbridamiento por artrotomía en el área de urgencias por cirujanos no subespecializados en rodilla es más eficaz que el artroscópico para controlar la artritis séptica de rodilla. El desbridamiento quirúrgico de las artritis sépticas en rodillas con artrosis previa permite controlar la infección con ausencia de dolor a pesar de la progresión de la artrosis. Abstract: Background and objective: 40%-50% of this septic arthritis occurs in the knee, despite rapid medical surgical treatment, 24%-50% will have a poor clinical outcome. It is not clear which debridement technique, by arthrotomy or arthroscopy, is more effective in controlling infection, or whether or not previous osteoarthritis worsens the outcome. The objective of this study on septic arthritis of the osteoarthritic knee was to analyse which surgical debridement technique, arthroscopy or arthrotomy, is more effective, the clinical and radiographic outcomes of the patients, and how many go on to require a TKR after the infection has healed. Material and methods: A retrospective study was performed in 27 patients with native septic arthritis of the knee. Eighteen were men and the mean age was 64.8 years (30-89 years). Fifteen patients were debrided by arthrotomy and 12 by arthroscopy. The effectiveness of debridement in controlling infection, the radiographic progression of the osteoarthritis on the Ahlbäch scale, the need for subsequent replacement, and pain and functional status were analysed using the VAS and WOMAC scales at 52.8 ± 11.2-month follow-up. Results: The infection was controlled in 93% and 92% of the patients, 13% and 42% required 2 or more surgeries for infection control, 18% and 44.4% showed progression of arthritis in the arthrotomy and arthroscopy groups, respectively. One patient in each group required a knee replacement. The VAS score was superior in the arthrotomy group and there were no differences in WOMAC score. Conclusion: Debridement by arthrotomy in the emergency department by non-sub-specialist knee surgeons is more effective than arthroscopic debridement in controlling septic arthritis of the knee. Surgical debridement of septic arthritis in knees with previous osteoarthritis enabled control of the infection with no pain despite the progression of the osteoarthritis.

Resumen: Introducción: En 2014 se publicó el Documento de Consenso desarrollado por SEIP-SERPE-SEOP para el diagnóstico y el tratamiento de las infecciones osteoarticulares (IOA). En 2015 se constituyó RIOPed como red nacional multidisciplinar para la investigación en IOA. El objetivo del estudio ha sido valorar el grado de adecuación a las recomendaciones establecidas en el consenso durante un año de seguimiento. Material y métodos: Estudio prospectivo multicéntrico nacional realizado entre septiembre de 2015 y septiembre de 2016 en 37 hospitales con inclusión de pacientes menores de 16 años diagnosticados de IOA, confirmada mediante aislamiento microbiológico, o probable: artritis séptica (AS) con > 40.000 leucocitos en líquido sinovial u osteomielitis (OM)/osteoartritis (OA)/espondilodiscitis (ED) con prueba de imagen compatible. Los resultados se compararon con los obtenidos en el estudio retrospectivo realizado entre 2008 y 2012. Resultados: Se incluyeron 255 casos: 131 OM, 79 AS, 30 OA y 15 ED. Respecto a las pruebas complementarias que el consenso consideró de obligada realización, la radiografía se llevó a cabo en el 87,8% de los casos, el hemocultivo en el 91,6% y el cultivo de líquido sinovial en el 99% de AS. Se realizó RM en el 71% de las OM. La elección del tratamiento antibiótico intravenoso empírico se adecuó a las recomendaciones en el 65,1% de los casos, y en el 62,3% para el tratamiento oral. Se llevó a cabo cirugía en el 36,8% de las AS (85,7% artrotomía), con un descenso significativo respecto al estudio retrospectivo (p = 0,014). Solo el 58,5% de casos se ajustaron a las recomendaciones de duración del tratamiento; sin embargo, se comprobó una menor duración del tratamiento intravenoso. Conclusiones: En general, el grado de adecuación a las recomendaciones que marcaron el grupo de expertos es bueno para las pruebas complementarias y aceptable respecto a la elección del tratamiento antibiótico, aun detectándose casi un 40% de inadecuación. Se ha conseguido un descenso de la estancia hospitalaria. Abstract: Introduction: In 2014 the Consensus Document produced by the Spanish Paediatric Societies (SEIP-SERPE-SEOP) was published to help in the diagnosis and treatment of osteoarticular infections (OAI). In 2015 the RIOPed was considered as a multidisciplinary national network for the investigation into OAI. The aim of this study was to assess the level of adaption to the recommendations established in the Consensus during one year of follow-up. Material and methods: A prospective, national multicentre study was carried out in 37 hospitals between September 2015 and September 2016. The study included patients > 16 years-old with a diagnosis of OAI, confirmed by microbiological isolation, or probable: septic arthritis (SA) with > 40,000 white cells in synovial fluid, or osteomyelitis (OM)/spondylodiscitis (SD) with a compatible imaging test. The results were compared with those obtained in a retrospective study conducted between 2008 and 2012. Results: A total of 235 cases were included, of which 131 were OM, 79 SA, 30 OA, and 15 SD. As regards the complementary tests that the Consensus considered mandatory to perform, radiography was carried out on 87.8% of the cases, a blood culture on 91.6%, and culture of the synovial fluid in 99% of SA. A magnetic resonance (MR) was performed on 71% of the OM cases. The choice of intravenous empirical antibiotic treatment was adapted to the recommendations in 65.1% of cases, and in 62.3% for the oral treatment. Surgery was performed in 36.8% of SA cases (85.7% arthrotomy), with a significant decrease compared to the retrospective study (P = .014). Only 58.5% of cases followed the recommendations on the duration of the treatment; however, a lower duration of intravenous treatment was observed. Conclusions: In general, the level of adaptation to the recommendations that were set by the Expert Group, is good for the complementary tests, and acceptable as regards the choice of antibiotic treatment, although inadequate in almost 40% of cases. A decrease in hospital stay was achieved.

A 61-year-old woman with severe gout, chronic kidney disease, type II diabetes, and heart failure with reduced ejection fraction was admitted with acute onset bilateral hand swelling and pain following a trauma. She was managed for a severe gout flare, but her symptoms, leukocytosis, and inflammatory markers did not improve. Six days into the hospital course, she developed fevers. Blood cultures grew Streptococcus pneumoniae. Intravenous antibiotics were started, and the patient underwent multiple incision and debridements of the bilateral hands with improvement in symptoms and clinical status. Septic arthritis secondary to S. pneumoniae is uncommon. We highlight this case to recognize that septic arthritis should always be considered when a patient presents with a painful, erythematous joint. Pneumococcal vaccination reduces the incidence of invasive pneumococcal disease, and should be prioritized for those at high risk for invasive disease and who are immunocompromised.

Osteomyelitis in neonates is quite uncommon and often appears without a typical sign. Clinicians' late diagnosis and inappropriate treatment may result in severe sequelae. We report a rare case of osteomyelitis and septic arthritis infant with a mother's previous medical history of systemic lupus erythematosus at nine years old. Anti Lupus Anticoagulant (LA) result shows the infant also suffers from neonatal lupus erythematosus (NLE). Early diagnosis and proper management of the patient may produce better outcomes.

Objectives: This retrospective observational cohort study aimed to characterise and compare the demographics, initial laboratory tests and outcomes between patients with large-joint bacterial septic arthritis (BSA) and tuberculous septic arthritis (TBSA). Methods: All patients with a culture from a large, native joint growing either non-mycobacterial bacteria or Mycobacterium tuberculosis between 1 January 2012 and 1 October 2018 in our institution were included. Clinical details and admission laboratory values were obtained from patient records. Comparisons were made by Mann-Whitney U, chi-squared tests, and logistic regression analysis. Results: We identified 64 BSA and 29 TBSA. On average, the BSA cases were older, had higher CRP levels and neutrophil counts and lower albumin levels. The odds ratio for having a BSA was 46 in cases with a CRP greater than 100 mg/L (95% confidence interval (CI) 8.5–850, p

Purpose: Septic arthritis (SA) of the hip joint is a serious infection which can lead to more irreversible complications. Differentiating Septic arthritis from Transient synovitis (which is the most common cause of painful hip in children) is difficult and very important to prevent serious complications which can occur with Septic arthritis. The aim of this study was to find out the MRI findings which can differentiate between these two conditions. Methods: Systematic literature search was conducted according to the PRISMA guidelines on MEDLINE(PubMed), Google Scholar, ScienceDirect, and world Health Organization Virtual Health Library, up to April 2022. Studies that compared MRI findings between Septic Arthritis and Transient Synovitis of hip joint in children were included. The pooled sensitivity and specificity estimates of these findings were calculated using MetaDTA version 2.0. Results: Six studies were included in qualitative analysis and five were included in quantitative analysis. Pooled sensitivity and specificity of synovial enhancement were 94.2 % (95 % CI, 45.2–99.7 %) and 60.6 % (95% CI, 6–97.4 %) respectively. Soft tissue changes had pooled sensitivity and specificity of 75 % (95% CI, 57.5–86.9 %) and 69.9 % (95 % CI, 46.5–86.2 %) respectively. Pooled sensitivity and specificity of femoral head changes were 41.5 % (95 % CI, 15.9–72.7 %) and 87.3 % (95 % CI, 75.5–93.8 %) respectively. Bone marrow changes had pooled sensitivity and specificity of 70 % (95 % CI, 26.8–93.7 %) and 99.9 % (95 % CI, 28.7–100 %) respectively. Conclusion: MRI findings especially bone marrow changes were found to be useful in differentiating septic arthritis from transient synovitis among children presented with painful hip after exclusion of other causes.

Primary septic arthritis of the Acromioclavicular joint is an unusual disorder and is seldom seen even in an immunocompromised person. We report a case of primary septic arthritis of the acromioclavicular (A-C) joint caused by Staphylococcus aureus. The patient was admitted with pain in the left shoulder, restricted movements and fever. Laboratory parameters showed elevated C-reactive protein, raised erythrocyte sedimentation rate and leukocytosis. Ultrasound revealed a 32 mm collection at the acromioclavicular joint. Patient underwent incision and drainage of abscess. Culture and sensitivity revealed moderate growth of Staphylococcus-aureus. Patient was started on appropriate intravenous antibiotics. Magnetic resonance imaging (MRI) done after 2 weeks revealed marked erosion in the lateral end of clavicle with soft tissue collection along the posteromedial aspect A-C joint. The patient had to undergo repeat drainage of the abscess along with the decompression of lateral end of clavicle. The patient was successfully treated with 8 weeks of appropriate antibiotics with complete resolution of infection.

Bacteria of the genus Nocardia are implicated in several disease processes but are a rare cause of septic arthritis. Typically, the cause of Nocardia septic arthritis is dissemination from a pulmonary infection in an immunocompromised host. Herein we present a case of a 64-year-old male who had received a long course of prednisone for membranous nephropathy and developed a septic arthritis due to Nocardia brasiliensis. He was treated sequentially with trimethoprim-sulfamethoxazole and amoxicillin-clavulanate, linezolid and amoxicillin-clavulanate, tigecycline and amoxicillin-clavulanate, and omadacycline and amoxicillin-clavulanate. To our knowledge, only two prior cases of Nocardia brasiliensis septic arthritis without antecedent trauma to the joint or local skin breakdown have been reported. A review of the literature identified 19 other cases of Nocardia septic arthritis. This case reinforces the need to consider Nocardia infection in the differential diagnosis in the immunocompromised patient with concurrent pulmonary infection and septic arthritis.

Background: Patients with a history of degenerative joint disease secondary to an acute or remote episode of septic arthritis of the native knee or hip present a unique challenge for the orthopaedic surgeon. This study describes our experience with two-stage primary arthroplasty for such patients. Methods: We reviewed 42 patients with a history of septic arthritis treated with two-stage primary arthroplasty between 2008 and 2018. Patients were evaluated using modified Harris Hip Score, Knee Society Score (KSS), and KSS functional component (KSSF). Paired t-tests were used to compare changes for continuous variables within cohorts. Multivariate linear and logistic regression models were constructed to determine predictors of outcomes and complications. Results: At a mean of 3.3-year follow-up, there were 14 (33.3%) complications and the infection cure rate was 95.2%. On average, patients improved in the modified Harris Hip Score (42.9 ± 11.8 vs 83.3 ± 11.1, P < .001), KSS (35.9 ± 16.9 vs 80.1 ± 16.6, P < .001), KSSF (38.0 ± 15.1 vs 71.5 ± 24.0, P < .001), knee flexion (90.9 ± 14.9 vs 100.5 ± 17.1), and hip flexion (73.8 ± 21.2 vs 102.1 ± 11.8, P < .001). Age (β: −0.78, P = .004) was independently associated with lower Harris Hip Score in the hip cohort. There were no independent predictors of the KSS or KSSF. The erythrocyte sedimentation rate (odds ratio: 1.07, P = .043) and C-reactive protein (odds ratio: 1.43, P = .018) at stage 2 were independently associated with a higher likelihood of complications at the final follow-up. Conclusions: Patients with a history of native septic arthritis of the hip and knee, and secondary end-stage degenerative joint disease, showed significant postoperative improvements and a high rate of complications after two-stage primary total joint arthroplasty. Despite improvements, some patients may necessitate a third operation because of the incidence of reinfection and spacer exchange. This information should be used to counsel patients who present with this challenging clinical scenario.

Background: Septic arthritis (SA) is an infection characterized by significant epidemiologic and microbiologic differences between developed and developing regions and between age groups. Objectives: To determine the epidemiologic, clinical, microbiologic and therapeutic aspects of pediatric SA in Southern Israel. Methods: A retrospective case-series study based on the records of children

Septic Arthritis is a medical emergency with a significant mortality and morbidity. Infection usually occurs via haematogenous seeding of microorganisms or via injury, such as trauma or surgery. The aim of management is to minimise the risk of irreversible joint damage and to preserve function. Septic arthritis is usually bacterial in origin, most commonly Staphylococcus aureus, but Mycobacteria or fungi can also be responsible. Neisseria meningitidis is an aerobic Gram-Negative Diplococcus that normally inhabits the naso and oropharynx and has the potential to cause meningitis, septicaemia, septic arthritis and endocarditis.We present the case of a 63 year old lady admitted with bilateral knee pain and swelling, lower limb rash and a fever who was initially managed as a Reactive Arthritis but subsequent Polymerase Chain Reaction (PCR) molecular analysis revealed capsular group B N. meningitidis in bilateral knee aspirates.We discuss the diagnostic challenges in differentiating Septic Arthritis from inflammatory arthritis, and the role of PCR molecular analysis in that process.

Treating tibial bone defects in the setting of recalcitrant native knee arthritis presents a challenging biomechanical problem for orthopaedic surgeons. A dynamic antibiotic spacer offers an effective solution to preserve patient function and manage infection. However, severe bone loss may compromise the fixation of the dynamic spacer. We describe the application of acetabular screws as rebar in a case of an Anderson Orthopaedic Research Institute type 3 defect of the medial tibial plateau. Additionally, we outline a facile method for fabricating the tibial stem component to ensure optimal fit within the intramedullary canal. Short-term follow-up (8 months) indicates successful fixation of the tibial component, absence of knee pain, and a knee range of motion up to 100 degrees., (© 2024 The Authors.)

Trueperella bernardiae is a skin flora organism with few reported cases of pathology. Most cases have been described in urinary tract infections and skin and soft-tissue infections. We present the first known case of T. bernardiae as a causative agent of a prosthetic hip infection with subsequent hip abscess.

We present a case series comprising three patients with concomitant septic arthritis of the knee and osteomyelitis of the femur. Early advanced imaging rendered the accurate diagnosis of the condition and the appropriate surgical approach and technique used to treat the infection. Repeated extensive surgical debridement, irrigation and insertion of antibiotic-impregnated cement rod into the femur were required, in addition to long term antibiotics. The infection in all three cases was eradicated successfully. Following a period of physical rehabilitation, they had fairly preserved independent ambulatory function. We advocate a high index of suspicion of this condition with subsequent early advanced imaging for a timely diagnosis. In addition, we described our challenges in the fabrication process of the antibiotic-impregnated cement rod.

Background: Tuberculous septic arthritis is an infection that occurs inside the joint or synovial fluid and joint tissues caused by Mycobacterium tuberculosis. It may show wide variability of clinical symptoms and imaging appearance, ranging from asymptomatic with a normal radiographic examination to severe joint pain along with joint destruction, osteomyelitis, and abscess formation. This article presents radiographic and MR imaging appearance from a case of tuberculous septic arthritis with large abscess formation mimicking soft tissue tumor. Case presentation: We reported a 32-year-old female with a slowly enlarging lump on her right proximal thigh within the last 4 months along with slowly progressing joint pain. Both radiographic and MR images showed destruction of the femoral head and acetabular roof, with a formation of large rim-enhanced abscess that extending superficially and distally until mid-thigh. The patient underwent open drainage surgery and excisional biopsy. Histopathological examination showed chronic granulomatous inflammation caused by tuberculous infection. Conclusion: MR imaging combined with radiographic and clinical information played a very important role in the diagnosis of tuberculous septic arthritis with abscess, and to differentiate it from soft tissue neoplasms.

This report outlines a multidisciplinary approach of ENT and Maxillofacial (OMFS) in the management of septic arthritis in a patient suffering with Necrotising Otitis Externa. The patient presented with persistent intermittent pain from his left ear and was diagnosed with septic arthritis of the left TMJ. The management procedure adopted was open joint wash out of the TMJ, performed in emergency theatre. The treatment proved successful and the patient was discharged on antibiotics administered via peripherally inserted central catheter (PICC).

Prototheca species have been reported to cause infections in human. Typically, clinical symptoms of protothecosis include cutaneous infection, olecranon bursitis, tenosynovitis and disseminated systemic disease. We report a case of septic arthritis in which Prototheca zopfii was isolated from blood. Joint aspirate was also sent for cultures but did not yield any growth. No other organisms were isolated from this patient during his admission. The blood isolate was identified to species level via Polymerase Chain Reaction (PCR) method. The patient improved with administration of intravenous itraconazole.

A 65-year-old woman with chronic osteoarthritis of the knees presented with a one-week history of acutely worsening right knee pain and swelling. Arthrocentesis was performed and synovial fluid was indicative of septic arthritis with a negative Gram stain for bacteria. Magnetic Resonance Imaging (MRI) was obtained, revealing a large anterior periarticular abscess with concomitant septic arthritis. Orthopedic surgeons performed urgent incision and drainage of the abscess and washout of the joint. Synovial fluid culture grew Kingella kingae and the patient was treated with four weeks of ceftriaxone with improvement in both clinical symptoms and laboratory values. Kingella kingae is a common cause of pediatric bone and joint infection but remains an exceedingly rare cause of native joint septic arthritis among immunocompetent adults. Kingella spp are largely susceptible to beta-lactam antimicrobials.

A 2-year-old, previously healthy, male presented with an insidious history of intermittent left knee pain and edema who had been evaluated in the emergency department on multiple occasions with unremarkable imaging and normal laboratory results. On the day of presentation, he had mild edema of the left knee and inability to bear weight. Synovial fluid analysis showed an elevated white cell count with neutrophil predominance and mildly elevated inflammatory markers, consistent with septic arthritis. He underwent knee arthrotomy with irrigation and debridement and was initiated on broad spectrum antibiotics. Cultures were negative, polymerase chain reaction for MRSA and Kingella kingae were negative. He was started on a fifth-generation cephalosporin with resolution of symptoms, marked clinical improvement and normalization of inflammatory markers. The identification of the etiologic agent was possible due to detection of bacterial 16S rRNA gene amplification by PCR for Moraxella nonliquefaciens in the synovial fluid. He completed a course of 3 weeks of parenteral antibiotics at home with full recovery.