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Correct diagnosis and treatment of septic arthritis (SA) are essential to achieve satisfactory results and avoid lifelong consequences. Diagnosing septic arthritis is not always easy, which is why new biomarkers have been sought. Another difficulty in diagnosis is the increase in septic arthritis due to Kingella Kingae, which does not show the same signs and symptoms as classic Staphylococcus aureus infections. Increasingly, magnetic resonance imaging plays a more fundamental role in diagnosing septic arthritis, and many studies are focused on this line, especially for the study of associated pathologies. Numerous studies have been published on less invasive treatments for septic arthritis, although the evidence suggests that the results should be taken cautiously. Although most of the published studies focus on the hip and knee, there have also been recent publications on SA in the upper limb, foot, and ankle. Finally, the literature also pays attention to SA in young children due to its different etiology and the greater difficulties in its diagnosis. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the antimicrobial resistance and clinical features of Staphylococcus aureus (S. aureus) in bone and joint infections (BJIs) among children under 14 years old, providing insights for optimal antibiotic usage. Methods: A retrospective analysis was conducted on the clinical data from children treated for BJIs at the Children's Hospital of Soochow University between January 2019 to December 2023. Bacterial cultures were examined, focusing on S. aureus. Clinical features of children with methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) infections were compared. Results: Among the 110 cases of culture-positive BJIs, 116 pathogenic strains were identified, with, S. aureus being the most prevalent (75.00%, 87/116). No resistance to quinupristin/dalfopristin, linezolid, vancomycin, tigecycline, rifampin or teicoplanin was detected. The resistance rate to penicillin was 90.80% (79/87), while resistance rates to clindamycin and erythromycin were 37.93% (33/87) and 36.78% (32/87), respectively. MRSA accounted for 28.74% (25/87) of S. aureus isolates. There were no significant differences in gender, age, infection site, clinical symptoms, laboratory indicators, hospital stay, or surgical intervention between MSSA and MRSA groups (p > 0.05). However, patients with positive X-ray findings were more likely to have MRSA infections (p = 0.033). Subgroup analysis revealed that children older than 48 months with positive X-ray results were more likely to have MRSA (p = 0.048). Conclusion: In China, S. aureus remains the predominant pathogen in children under 14 years old with BJIs. Among children older than 48 months, nearly one-third of BJIs are caused by MRSA, and positive X-ray findings may indicate a higher likelihood of MRSA in this age group. Further studies are required to validate these findings before they can be widely applied. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Background: An accurate diagnosis of septic versus reactive or autoimmune arthritis remains clinically challenging. A multi-omics strategy comprising metagenomic and proteomic technologies were undertaken for children diagnosed with presumed septic arthritis to advance clinical diagnoses and care for affected individuals. Methods: Twelve children with suspected septic arthritis were prospectively enrolled to compare standard of care tests with a rapid multi-omics approach. The multi-omics combined bacterial 16S rRNA metagenomics, single cell transcriptomics, and proteomics on knee joint fluid specimens. The diagnostic value of the multi-omics was ascertained relative to standard of care culture and PCR-negative results. Results: Ten children with suspected primary septic arthritis and two with acute hematogenous osteomyelitis (AHO) diagnoses were assessed. Joint fluid bacterial cultures were positive for 6/12 (50%) patients, consistent with elevated inflammatory markers (IL-4, IL-6, IL-17A, TNF-a, etc.). Metagenomic bacterial sequencing results were 100% concordant with the culture results. Six patients were culture- and PCR-negative. Multiomics analyses of the 6 culture negative patients established that 2/6 culture-negative children had inflammatory arthritis with potential Juvenile idiopathic arthritis (JIA) and 1 had post-Streptococcal Reactive Arthritis. The children without any bacteremia had autoantibodies (IgGs) in the joint-fluid targeting several nuclear antigens (i.e., dsDNA, histones, Jo-1, scl-70, Ro/SS-A, SmDs, CENP-A along with non-nuclear antigens i.e. Albumin, Collagens, Myosin, Laminin, etc. Single cell transcriptomics confirmed an abundance of CD4+ follicular helper T (Tfh), CD8 + T cells and B cells in the autoantibody positive subjects. The combination of 16S DNA sequencing (p = 0.006), cytokine assays (p = 0.009) and autoantibody profiling (p = 0.02) were significantly distinct between those children with and without infections. This improved the diagnostic confidence for 9 of 12 (75%) children, key for treatment decisions. Conclusions: The multiomics approach rapidly identified children with bacterial or autoimmune inflammatory conditions, improving diagnostic and treatment strategies for those with presumptive septic arthritis. [ABSTRACT FROM AUTHOR]

Introduction: Avian orthoreovirus (ARV) is a significant pathogen causing viral arthritis, leading to substantial economic losses in the poultry industry worldwide. Methods: A novel ARV strain, designated FJ202311, was isolated from a broiler farm in Fujian Province, China. Whole-genome sequencing was conducted using next-generation sequencing with MGI technology, and phylogenetic analysis of the sigma C amino acid sequence was performed. Comparative sequence analysis identified unique genetic features of FJ202311. Pathogenicity studies were carried out by inoculating broilers with the isolated strain and monitoring clinical signs, weight gain, and histopathological changes. Results: The complete genome of FJ202311 was determined to be 23,495 base pairs in length, encoding 12 major proteins. Phylogenetic analysis revealed that FJ202311 forms a distinct genotypic cluster, exhibiting only 47.1% to 59.3% sequence identity to 16 reference ARV strains. Notably, 50 unique amino acid substitutions were identified in the sigma C protein. Pathogenicity tests demonstrated that FJ202311 caused severe arthritis and tenosynovitis in broilers. Infected birds exhibited significant weight loss compared to controls, with reductions of 11.78% and 8.93% at 14 and 21 days post-infection, respectively. Discussion: This study highlights the unique molecular and pathogenic characteristics of the novel ARV strain FJ202311, contributing to our understanding of ARV diversity and epidemiology in China. These findings underscore the importance of continuous monitoring and provide insights for developing improved prevention and control strategies against ARV. [ABSTRACT FROM AUTHOR]

Introduction: Neonatal infectious arthritis (NIA) is a bacterial disease of lambs in the first month of life. NIA is associated with poor animal welfare, economic losses, and prophylactic antibiotic use. Farmers report problems with NIA despite following current guidance on prevention. The aim of this study was to estimate NIA UK incidence, describe current management practices for NIA control, and farm management risk factors associated with NIA. Methods: A cross-sectional, online questionnaire of UK sheep farmers was carried out between June and October 2020. Descriptive statistics, and univariable and multivariable risk factor analysis was undertaken. Results: Of the 322 respondents, 64% reported joint ill cases in the 2020 lambing period. The median within flock incidence was 1.4% (IQR 0.8–2.6%; 95% CI, 1.2–1.6). Seventeen percent of farmers estimated their current treatment efficacy for NIA was less than 50%. Eleven percent of farmers used prophylactic or metaphylactic antibiotics in all lambs to prevent NIA occurrence. Across all flocks, risk factor associated with NIA occurrence was the number of ewes lambed (301–600; OR, 3.9; 95% CI 1.9–8.0. >600; OR, 13.7; 95% CI, 5.4–34.4). In outdoor lambing flocks, increased risk of joint ill was associated with the number of ewes lambed (>600 ewes; OR, 34.7; 95% CI, 6.6–182.7), not providing outdoor shelter to lambing ewes (OR, 3.0; 95% CI, 1.2–7.8), and not cleaning ear tags (OR, 5.7; 95% CI, 1.5–21.4). Using antibiotics as a preventative measure was associated with a reduced risk of joint ill (OR, 0.1; 95% CI, 0.01–0.4). In indoor lambing flocks, increased risk of joint ill was associated with upland flocks (OR, 3.0; 95% CI, 1.3–6.8), number of lambs born alive (501–1,000; OR, 4.1; 95% CI, 1.6–10.7. >1,000; OR, 14.0; 95% CI, 4.0–48.9), and not washing hands (OR, 3.6; 95% CI, 1.2–10.6). Conclusion: NIA was reported in indoor and outdoor lambing flocks. A pattern of risk factors associated with increasing intensity of lambing was observed. Prophylactic antibiotic use was associated with a reduced risk of NIA in outdoor flocks, however, NIA still occurred in flocks where this was practiced. More veterinary involvement is advised in the diagnosis, treatment protocols, and prevention of NIA. [ABSTRACT FROM AUTHOR]

Streptococcus pneumoniae infection is considered an uncommon cause of arthritis in adults. To determine the clinical and microbiological characteristics of pneumococcal septic arthritis, we retrospectively studied a large series of cases among adult patients during the 2010-2018 conjugate vaccine era in France. We identified 110 patients (56 women, 54 men; mean age 65 years), and cases included 82 native joint infections and 28 prosthetic joint infections. Most commonly affected were the knee (50/110) and hip (25/110). Concomitant pneumococcal infections were found in 37.2% (38/102) and bacteremia in 57.3% (55/96) of patients, and underlying conditions were noted for 81.4% (83/102). Mortality rate was 9.4% (8/85). The proportion of strains not susceptible to penicillin was 29.1% (32/110). Of the 55 serotyped strains, 31 (56.4%) were covered by standard pneumococcal vaccines; however, several nonvaccine serotypes (mainly 23B, 24F, and 15A) had emerged, for which susceptibility to ß-lactams was low. [ABSTRACT FROM AUTHOR]

The performance of synovial fluid biomarker D-lactate to diagnose septic arthritis (SA) and differentiate it from crystal-induced arthritis (CA), other non-infectious rheumatic joint diseases (RD) and osteoarthrosis (OA) was evaluated. Consecutive adult patients undergoing synovial fluid aspiration due to joint pain were prospectively included in different German and Swiss centers. Synovial fluid was collected for culture, leukocyte count and differentiation, detection of crystals, and D-lactate concentration. Youden's J statistic was used to determine optimal D-lactate cut-off value on the receiver operating characteristic (ROC) curve by maximizing sensitivity and specificity. In total 231 patients were included. Thirty-nine patients had SA and 192 aseptic arthritis (56 patients with OA, 68 with CA, and 68 with RD). The median concentration of synovial fluid D-lactate was significantly higher in patients with SA than in those with OA, CA, and RD (p<0.0001, p<0.0001 and p<0.0001, respectively). The optimal cut-off of synovial fluid D-lactate to diagnose SA was 0.033 mmol/L with a sensitivity of 92.3 % and specificity of 85.4 % independent of previous antimicrobial treatment. Sensitivity and specificity of synovial fluid leukocyte count at a cut-off of 20,000 cells/µL was 81.1 % and 80.8 %, respectively. Synovial fluid D-lactate showed a high performance for diagnosing SA which was superior to synovial fluid leukocyte count. Given its high sensitivity and specificity, it serves as both an effective screening tool for SA and a differentiator between SA and RD, especially CA. [ABSTRACT FROM AUTHOR]

The article presents a case study of a recent increase in invasive Group A Streptococcus (iGAS) infections in children, observed at Ege University Children's Hospital in Turkey, involving six pediatric patients aged 6 months to 10 years. Topics discussed include the clinical presentations of iGAS infections, treatment protocols, and the potential link between the rise in infections and the easing of COVID-19 restrictions.

The article presents a rare case of multifocal Fusobacterium necrophorum infection in a previously healthy 16-year-old male, presenting atypically without jugular vein involvement characteristic of Lemierre Syndrome. Topics discussed include the diagnostic challenges of such infections, the effectiveness of double anaerobic antibiotic coverage, and the debated role of anticoagulation therapy in treatment.

Prompt diagnosis of equine septic arthritis is crucial for successful treatment. Serum amyloid A (SAA) has been suggested as a reliable biomarker. However, we previously found that synovial fluid SAA increases in nonaffected joints of horses with septic arthritis. We hypothesized that systemic SAA may leak into the nonaffected joints. If this is the case, we also hypothesized that locally produced joint SAA isoforms may be better candidates for septic arthritis biomarkers. Thus, our objectives were 1) to evaluate the temporal kinetics of systemic and synovial fluid SAA in horses with septic arthritis (n = 5), non-septic synovitis (n = 5), and systemic inflammation (n = 5), examining both affected and contralateral joints; and 2) investigate putative locally produced joint SAA isoforms and detect amino-acid differences between them. We confirmed that SAA increases significantly in synovial fluid in nonaffected joints of horses with systemic inflammation (≤352 mg/L), as well as in contralateral nonaffected joins in horses with septic arthritis (≤1,830 mg/L) compared to baseline at time 0 (<0.2 mg/L). We also identified a putative locally produced joint SAA peptide in synovial fluid (FGDSGHGAADSR) that differed in 1 amino acid from 2 systemic peptides found both in plasma and synovial fluid. The putative joint SAA isoform was present in joints of horses with both septic arthritis and systemic inflammation (ion intensities 104–106). Thus, the increase of synovial fluid SAA may be both due to the leakage of SAA from serum into joints and local production of joint SAA isoforms. [ABSTRACT FROM AUTHOR]

Introduction: Intra-articular injections, commonly used in osteoarthritis treatment, are debated due to their potential link to septic arthritis, though its incidence remains low. Lidocaine, used as a "carrier" for therapeutic substances like hyaluronan or triamcinolone, has pain-relieving and antimicrobial properties. This study investigates the concentration-dependent antimicrobial effects of lidocaine in combination with hyaluronan and triamcinolone in both standard and synovial fluid cultures. Methods: The antimicrobial efficacy of lidocaine against Staphylococcus aureus was investigated, with variations in bacterial and lidocaine concentrations. Bacterial growth was monitored using a UV/VIS spectrometer at 600 nm. Lidocaine solutions of 1% and 2% were tested, both alone and in combination with hyaluronic acid or Triam40, in tryptic soy broth (TSB), to reflect knee joint applications. The groups included pure lidocaine (L), Triam (T), hyaluronan (H), and combinations (LT, LH, TH, LTH) with 1% or 2% lidocaine. A bacterial inoculum of 300 CFU/mL was used, and samples were incubated for 12 and 24 h. Additional tests were conducted on Staphylococcus epidermidis and methicillin-resistant Staphylococcus aureus (MRSA), as well as on S. aureus in human synovial fluid. Results: Lidocaine showed a concentration-dependent antimicrobial effect, with greater inhibition at higher concentrations and lower bacterial densities. All lidocaine-containing combinations significantly reduced the bacterial levels of S. aureus in TSB. Similar results were seen for S. epidermidis and MRSA, with notable inhibition in synovial fluid after 12 h, especially with 2% lidocaine. Conclusions: Lidocaine exhibits dose-dependent antimicrobial effects against key pathogens responsible for septic arthritis. Its combination with Triam40 and hyaluronan may reduce the risk of septic arthritis, supporting its clinical relevance. [ABSTRACT FROM AUTHOR]

Septic arthritis is acute onset of monoarticular inflammation of a joint due to an infectious etiology. It is usually bacterial but can be viral or fungal. Septic arthritis causes significant morbidity and mortality and requires prompt diagnosis and treatment. Risk factors include age older than 80 years, smoking, comorbid conditions (eg, diabetes, rheumatoid arthritis, skin infection, HIV infection, osteoarthritis), and other factors (eg, recent joint surgery, joint prosthesis, previous intra-articular injection). The clinical presentation of septic arthritis can overlap with those of many other joint conditions, which can make diagnosis challenging. Poor functional outcomes, such as amputation, arthrodesis, prosthetic surgery, and severe functional deterioration, occur in approximately 24% to 33% of patients with septic arthritis. Due to the significant sequelae associated with septic arthritis, it is critical for physicians to maintain a high index of suspicion for this condition. Management involves a combination of medical and surgical treatments tailored to infection severity, causative pathogens, and overall patient condition. Medical treatment is not inferior to surgical treatment. However, 30% of patients with septic arthritis ultimately require surgical treatment. The 90-day mortality rate of knee septic arthritis is 7% in patients 79 years and younger and from 22% to 69% in patients older than 79 years. [ABSTRACT FROM AUTHOR]

Objective. Acute and chronic calcium pyrophosphate (CPP) crystal arthritis is characterized by the presence of synovial CPP crystals within a clinically inflamed joint. CPP crystals may be situated intracellularly or extracellularly; however, the clinical significance of their location remains understudied. The objective of this retrospective cohort study was to assess the relevance of the CPP crystal location in diagnosing acute/chronic CPP crystal arthritis. Methods. Data were collected from Waikato District Health Board to identify a study population with synovial fluid samples positive for CPP crystals. The cohort was stratified into 2 groups based on crystal location: intracellular and extracellular. The proportions of acute/chronic CPP crystal arthritis cases were compared between these groups. Acute/chronic CPP crystal arthritis was diagnosed when synovial CPP crystals were present, with objective evidence of joint inflammation and no other alternative diagnosis. Further analysis was made with respect to demographics, other laboratory results, and cartilage calcification. Results. This study included 134 patients: 108 with intracellular CPP crystals and 26 with extracellular CPP crystals. Acute/chronic CPP crystal arthritis was diagnosed in 85% of cases in the intracellular and 50% in the extracellular group (P < 0.001). Following exclusion of septic arthritis cases, acute/chronic CPP crystal arthritis was diagnosed in 97% of patients in the intracellular group and in 62% of those in the extracellular group (P < 0.001). Conclusion. The presence of intracellular CPP crystals is more strongly associated with acute/chronic CPP crystal arthritis than with extracellular CPP crystals alone. [ABSTRACT FROM AUTHOR]

Background: The consequences of septic arthritis of natural joints may be devastating. The purpose of this study was to evaluate the functional results of medical approach and surgical approach for septic arthritis of native joints, and to explore whether the number of drainage tubes after arthroscopic surgery will affect the knee function of patients. Methods: A single-center retrospective study was conducted on patients diagnosed with septic arthritis from January 2018 to January 2023. According to the improvement of clinical symptoms and daily activity ability of the joints, functional results of patients were divided into Complete recovery, Basic recovery, Minor recovery and No recovery. The main results are the joint function after medical and surgical approaches. The secondary outcome was knee function with different number of drainage tubes after arthroscopic surgery. Multivariate logistic regression analysis was used to determine the risk factors related to joint function. In addition, the types of bacteria were analyzed to explore whether they were related to the initial surgical failure rate. Results: Among the 77 patients with septic arthritis, 27 patients were treated with medical approach, and 50 patients were treated with surgical approach (knee arthroscopy + synovectomy). There was no significant difference in the results of joint function at discharge and 6 months after discharge. There was no significant difference in the number of drainage tubes after knee arthroscopy on the recovery of knee joint function. There were no risk factors independently associated with joint function outcomes in this study. In the cases of initial surgical failure, the treatment failure rate was 13.0% in the multidrug-sensitive bacteria group, 100% in the methicillin-resistant Staphylococcus aureus group, and 58.3% in the other multidrug-resistant bacteria group (P = 0.001). Conclusions: The results of this study indicate that medical methods may be as effective as surgical methods for functional recovery in patients with septic arthritis. The number of drainage tubes after knee arthroscopy had no significant effect on the recovery of knee joint function. Maybe the type of bacteria (gram negative or more aggressive ones) can play a role in the choice of treatment strategy. Further prospective studies with better methodology are needed. [ABSTRACT FROM AUTHOR]

Background & Methods: The aim of the study is to study role of high resolution ultrasound in evaluation of Paediatric musculoskeletal pathologies. A total of 100 patients were selected out of those presenting with paediatric musculoskeletal pathologies and evaluated in this study. Observation was made based on clinical history and high resolution ultrasound of the patient. Results: We were observed following musculoskeleteal pathologies: Septic arthritis (39%), DDH (20%), Intramuscular haematoma (10%), Transient synovitis of hip (16%), Tendinopathy (3%), Inflammatory (5%), Intramuscular lipoma (1%), Baker's cyst (1%), Fibromatosis Colli (3%), Muscle tear (1%) and Hemangioma (1%). Conclusion: In the present study the most common age group was 1-3 years. The majority participants consulted for hip pathologies closely followed by knee. The majority of the pathologies were found to be infective in nature. The majority participants had septic arthritis highlighting a need for adding measures for early inspection and correction in the affected age group. Muscle hematomas typically showed more involvement of thigh and hip region. [ABSTRACT FROM AUTHOR]

Background: Rheumatology has experienced notable changes in the last decades. New drugs, including biologic agents and Janus kinase (JAK) inhibitors, have blossomed. Concepts such as window of opportunity, arthralgia suspicious for progression, or difficult-to-treat rheumatoid arthritis (RA) have appeared; and new management approaches and strategies such as treat-to-target have become popular. Statistical learning methods, gene therapy, telemedicine, or precision medicine are other advancements that have gained relevance in the field. To better characterize the research landscape and advances in rheumatology, automatic and efficient approaches based on natural language processing (NLP) should be used. Objectives: The objective of this study is to use topic modeling (TM) techniques to uncover key topics and trends in rheumatology research conducted in the last 23 years. Design: Retrospective study. Methods: This study analyzed 96,004 abstracts published between 2000 and December 31, 2023, drawn from 34 specialized rheumatology journals obtained from PubMed. BERTopic, a novel TM approach that considers semantic relationships among words and their context, was used to uncover topics. Up to 30 different models were trained. Based on the number of topics, outliers, and topic coherence score, two of them were finally selected, and the topics were manually labeled by two rheumatologists. Word clouds and hierarchical clustering visualizations were computed. Finally, hot and cold trends were identified using linear regression models. Results: Abstracts were classified into 45 and 47 topics. The most frequent topics were RA, systemic lupus erythematosus, and osteoarthritis. Expected topics such as COVID-19 or JAK inhibitors were identified after conducting dynamic TM. Topics such as spinal surgery or bone fractures have gained relevance in recent years; however, antiphospholipid syndrome or septic arthritis have lost momentum. Conclusion: Our study utilized advanced NLP techniques to analyze the rheumatology research landscape and identify key themes and emerging trends. The results highlight the dynamic and varied nature of rheumatology research, illustrating how interest in certain topics has shifted over time. [ABSTRACT FROM AUTHOR]

Background: Septic arthritis (SA) of the hip joint is a serious infection that can result in irreversible complications. Distinguishing septic arthritis from transient synovitis, the most common cause of hip pain in children, is crucial for preventing severe outcomes. Existing research has primarily focused on identifying clinical signs and laboratory findings that indicate high-risk patients who may need invasive diagnostic procedures; however, results have been inconsistent. This study aims to evaluate the correlation of various clinical indicators in differentiating septic arthritis from pediatric transient synovitis of the hip. Methods: This study followed the PRISMA guidelines rigorously and was registered with PROSPERO. We conducted a systematic search of PubMed, Embase, and Cochrane Library databases for relevant literature up to September 2024. Studies included in the analysis were required to evaluate the predictive value of clinical indicators distinguishing septic arthritis and transient synovitis of the hip in children under 18 years of age. The risk of bias and quality of the included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and RevMan 5.3. Data synthesis was performed using Stata MP-64 18.0 software to facilitate meta-analysis. Results: A total of eleven studies were ultimately included for the final analysis, comprising 1810 cases. The results of meta-analysis revealed that history of fever emerged as a significant risk factor for differentiating septic arthritis from pediatric transient synovitis of the hip (OR = 6.04, 95% CI = 2.44–14.97, P < 0.001). Other notable risk factors included non-weight-bearing status (OR = 5.23, 95% CI = 1.38–19.75, P = 0.015), erythrocyte sedimentation rate (OR = 3.98, 95% CI = 1.29–12.30, P = 0.017), and serum white blood cell count (OR = 2.73, 95% CI = 1.23–6.03, P = 0.013). In contrast, C-reactive protein was not a significant risk factor (OR = 7.12, 95% CI = 0.59–85.70, P = 0.122). Conclusion: The clinical indicators involving a history of fever, non-weight-bearing status, erythrocyte sedimentation rate, and serum white blood cell count have been identified as cost-effective routine tests with potential value in differentiating septic arthritis from pediatric transient synovitis of the hip. To enhance the reliability of these findings, further prospective studies are essential. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

This case report underlines the diagnostic and therapeutic dilemmas in a 19-day-old neonate who had presented with features suggestive of chronic granulomatous disease (CGD). The baby had a history of fever, lethargy, and masses on the skin, for which an extensive diagnostic workup was needed to rule out infective etiology given no improvement with initial empiric therapy. Laboratory investigations, including imaging and genetic studies, confirmed the diagnosis of CGD. In addition to the very early manifestation of disease, which is quite rare, our case emphasizes the importance of maintaining a high index of suspicion for immunodeficiency disorders in neonates with severe infections. The report highlights the fact that a high level of suspicion for an underlying immunodeficiency, especially conditions like CGD, must be maintained in neonates with unexplained symptoms, and the diagnosis has to be multidisciplinary in terms of management. Considering its rare inflammatory complications in neonatal CGD, the present case adds important data to the pediatric medical literature. It emphasizes that critical clinical evaluation and detailed diagnostic procedures are mandatory in cases of rare neonatal sepsis and inflammatory disorders. [ABSTRACT FROM AUTHOR]

Purpose: Septic arthritis (SA) is a rare but significant clinical challenge in orthopedics that can impact patients' quality of life. This study aims to examine the clinical outcomes of patients undergoing two-stage total joint replacement (TJR) in hip and knee SA and analyze potential predictors of treatment failure. Methods: A retrospective analysis was conducted using data from a prospectively collected institutional arthroplasty registry from January 1st, 2012, to January 1st, 2019. Patients with hip or knee SA who underwent a two-stage TJR and had at least two years of follow-up were included. Demographic characteristics, surgical variables, and outcomes were collected and analyzed from clinical and surgical data. Statistical analysis was performed using IBM SPSS Statistics, with statistical significance at p < 0.05. Results: One hundred and fourteen patients (61 with hip SA, 53 with knee SA) were included in the study. The mean follow-up was 72.8 months. Postoperatively, both clinical and functional outcomes significantly improved, as indicated by the Hip Society Score (HHS) and Knee Society Score (KSS). The overall success rate of the two-stage protocol was 89.5%. Complications that did not require revision occurred in 21% of cases. The most identified pathogen was methicillin-sensitive Staphylococcus aureus (MSSA). Difficult-to-treat (DTT) infections and post-traumatic etiology were identified as predictors of treatment failure in patients undergoing two-stage TJR for hip and knee SA. Conclusions: Two-stage TJR in hip and knee SA demonstrated favorable clinical outcomes at mid-term follow-up. The procedure significantly improved functional scores and achieved a high success rate, while DTT infections and post-traumatic etiology were associated with a higher risk of treatment failure. [ABSTRACT FROM AUTHOR]

We explored the value of contrast-enhanced ultrasound (CEUS) in evaluating femoral head (FH) perfusion, guiding interventions and follow-up for infants with developmental dysplasia of the hip (DDH) and septic arthritis of the hip (SAH). The aim was to provide robust evidence for clinical assessment. Ten infants, including 7 with DDH and 3 with SAH, were prospectively enrolled, with their bilateral hips alternately scanned during the CEUS exams. Twenty hips were classified into the case group (n = 11) and the control group (n = 9). Pre- and post-interventional studies were performed in DDH infants requiring interventions. FH perfusion was assessed by the perfusion area ratio (PAR) and quadrant location of microbubble-defect regions. In the case group, 25 CEUS studies were conducted, including 11 baseline, 7 follow-up and 7 post-intervention studies. The PAR significantly decreased in the case group (49.79% vs. 100.00%, p < 0.05). The microbubble-defect regions averagely affected 2 quadrants, primarily quadrat No. 3 (30%) and No. 4 (32%). Seven hip abduction angle adjustments were made based on pre-interventional studies, resulting in a significant increase in PAR in post-interventional studies (37.63% vs. 60.24%, p < 0.05). PAR increased in follow-up studies compared to baseline values (45.61% vs. 76.07%, p < 0.05). The inter- and intra-observer reproducibility of PAR measurements were excellent (intraclass correlation coefficient, both 0.97). CEUS proves to be a promising technique for quantitatively detecting FH perfusion in DDH and SAH infants with high reproducibility. It is valuable for baseline, intra-intervention and follow-up studies, aiming in clinical conditions and therapeutic effect evaluation. [ABSTRACT FROM AUTHOR]

Background: Native knee joint infections, while uncommon, present a serious condition predominantly instigated by bacteria such as Staphylococcus aureus. Without timely intervention, they can result in joint destruction or sepsis, with risk factors encompassing preexisting medical conditions and iatrogenic procedures. The diagnostic process includes a comprehensive patient history, clinical evaluation, laboratory testing, imaging studies, and microbiological investigations. Treatment typically involves joint aspiration and arthroscopy. This study aims to examine and establish correlations between diagnostic criteria and treatment modalities, enhancing the speed and specificity of future therapeutic strategies. Materials and methods: The present study is a retrospective cohort study conducted at a 1200-bed university clinic between 2007 and 2017, with an in-depth examination of patient details, symptoms, treatments, and outcomes. A scoring system was developed to classify the severity of knee joint impairment, categorizing patients on the basis of hospital stay duration, surgeries, and postoperative factors such as recurring symptoms, pain, and range of motion. Results: This study of 116 patients with knee joint infections revealed that clinical symptoms such as pain, swelling, and effusion are common but not definitive for diagnosis. Laboratory analysis revealed no significant differences in CRP or leukocyte counts between cultures positive or negative for pathogens. Hospital stay and disease severity are influenced by factors such as age, sex, presence of polyarthritis, neutrophil count, and type of pathogen, with higher weight and cortisone treatment associated with poorer outcomes. Conclusions: This study highlights the diagnostic challenges in native knee joint infections, revealing the need for comprehensive approaches given the nonspecificity of clinical symptoms and laboratory findings. This underscores the importance of advancing research through standardized methodologies and prospective studies to increase the accuracy of diagnosis and the effectiveness of treatment in this field. [ABSTRACT FROM AUTHOR]

Musculoskeletal infection of pelvis can be confused with septic arthritis of the hip, irritable hip, sacroiliitis, and spondylodiscitis in the initial period. This study aimed to present the complete clinical picture of pelvic infective osteomyelitis (PIO) in children along with its natural course. Two researchers independently used PubMed and Scopus electronic databases for the literature review. This review includes all studies reporting PIO in the pediatric age group. The final inclusion of 11 eligible studies was done. A total of 277 patients were analyzed from the included studies with the majority of males (158/242, 65.2%). Hip and groin pain (147/195, 75.3%) and limp (155/249, 62.2%) were the common presenting symptoms. Increased systemic temperature (83/103, 80.5%) and localized tenderness at the hip joint area (90/121, 74.3%) were among the commonest signs. Magnetic resonance imaging was an investigation of choice for diagnosis (89/93, 95.6%). Blood culture showed growth in 47.6% (119/250) patients with Staphylococcus aureus (83/102, 81.3%) being the most common isolated organism. Treatment with sensitive antibiotics was the mainstay of management with surgery for debridement or biopsy being required in only 16.1% (23/142) of the patients. PIO in children is a rare condition mimicking several other disease processes affecting the neighboring tissues the diagnosis of which gets limited in low-resource settings. Further prospective clinical studies are the need of the hour to validate the guideline proposed. Explorative studies to define a clinical scoring system to differentiate septic arthritis of the hip from PIO may be considered. [ABSTRACT FROM AUTHOR]

Dalbavancin, a semi-synthetic lipoglycopeptide with an extended half-life that allows for weekly dosing, is currently approved for the treatment of bacterial skin and soft tissue infections caused by susceptible gram-positive organisms. This case report discusses the successful treatment of septic arthritis with dalbavancin in a 38-year-old obese male. Septic arthritis, commonly caused by Staphylococcus aureus and Streptococcus species, was diagnosed in this patient following a mechanical fall that led to worsening shoulder pain. Given the patient's morbid obesity and concerns about antibiotic penetration, dalbavancin 1500 mg IV biweekly was chosen for its extended half-life and ease of administration. This case underscores dalbavancin's efficacy in managing septic arthritis in obese patients, offering a convenient alternative to traditional therapies that require a peripherally inserted central catheter (PICC line), frequent dosing, therapeutic monitoring, and prolonged hospital stays. Despite its higher cost, dalbavancin's advantages include reduced need for PICC lines, additional staff and resources to monitor therapeutic drug levels, and fewer complications, which can offset some expenses. To our knowledge, this is the first documented case investigating the use of dalbavancin for enterococcal septic arthritis with a biweekly dosing regimen. [ABSTRACT FROM AUTHOR]

The aim of this paper is to present three case studies demonstrating several interesting pathologies of the sacroiliac joints (SIJ) that may be encountered in everyday clinical practice. As the case studies illustrate, these pathologies are not always considered initially, and diagnosis often requires comprehensive radiological and laboratory investigations. Given the location of the SIJ and the load placed upon them, degenerative joint disease is by far the most common pathology, particularly in older individuals. Other diagnoses are rare. In contrast, degenerative changes are unlikely in younger patients, and in the case of sacroiliac joint pain, thorough examination is essential to identify and promptly initiate appropriate treatment for any underlying pathology. [ABSTRACT FROM AUTHOR]

Bone and joint infection is an extremely common emergency procedure in paediatric orthopaedics. An arthrotomy is a surgical exploration of a joint and is commonly needed to be performed for septic arthritis on an emergency basis. Although there is an increasing trend towards arthroscopic irrigation and washout, open arthrotomy is still an important tool for orthopaedic surgeons. It also has other therapeutic purposes, and these include: debridement/removal of loose bodies, ligament reconstruction, fracture fixation, disarticulation, joint replacement and tumour excision. We describe the most commonly used approaches to perform arthrotomy in the hip, knee, ankle, shoulder, elbow, wrist, hand and fingers. Orthopaedic surgeons must be aware of common pitfalls and neurovascular structures present when performing an arthrotomy of common joints. This article provides an illustrative overview to approach each joint and will be a quick-reference guide especially for junior orthopaedic surgeons. [ABSTRACT FROM AUTHOR]

Mycoplasma hominis is usually found in urogenital tract infections and is associated with several extra-genitourinary infections, including septic arthritis, bacteremia, and meningitis. Here, we report a rare case of M. hominis induced bloodstream infection with thoracic inflammation in a surgical patient. Methods: A 56-year-old male who underwent surgery for multiple pelvic and rib fractures developed fever, pleural effusion, and wound exudation despite receiving prophylactic anti-infection treatment with cefotiam. Then, replacing the broad-spectrum antimicrobial drugs such as biapenem, imipenem, linezolid still had no obvious curative effect. Meanwhile, a total of 4 groups of blood cultures were collected from patients, of which 2 groups reported positive results 2 to 3 days after specimen collection. At the same time, the patient's pleural effusion and wound pus were also cultured, and transparent needle-like small colonies grew on Columbia blood agar plates within 2 to 3 days after inoculation. Results: The cultured transparent pinpoint-like small colonies were identified as M. hominis by matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16SrRNA sequencing. The results of antibiotic susceptibility testing (AST) showed that M. hominis was susceptible to doxycycline, minocycline, josamycin, sparfloxacin, and spectinomycin but resistant to azithromycin, clarithromycin, norfloxacin, roxithromycin, and ofloxacin. According to the AST results and clinical symptoms, moxifloxacin was selected as targeted therapy for M. hominis infection, and cefoperazone/sulbactam was combined to prevent the infection of other gram-negative bacteria. Finally, the patient was cured successfully. Conclusion: Although M. hominis bloodstream and thoracic infections are rare, they cannot be ignored. M. hominis is intrinsically resistant to agents that work on bacterial cell wall synthesis used. Fluoroquinolones could be kept as potential active and thus a likely curative factor. When routine empirical anti-infection treatment is ineffective, the pathogen should be identified as early as possible. If necessary, gene sequencing technology should be used for diagnosis and sensitive anti-infection drug treatment should be promptly administered to reduce the risk of bloodstream infections. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus is a common cause of bacterial infections of the skin, soft tissues, bones, bloodstream, and respiratory system. When the infection spreads to the joints, it is known as septic arthritis. The shoulder is the third most common location for septic arthritis in adults. Treatment is arthroscopic or open irrigation and debridement, but even after eradicating the bacteria, cartilage and bone destruction can occur. This article describes a patient who developed bilateral septic arthritis of the shoulders shortly after a urinary tract infection, and was treated with a relatively rare reverse shoulder hemiarthroplasty procedure. [ABSTRACT FROM AUTHOR]

Septic arthritis of the sternoclavicular joint is a rare condition. The diagnosis of sternoclavicular septic arthritis as a late complication of surgical tracheostomy is extremely uncommon. A case study is presented of a man in his 70s who experienced painful swelling of the right sternoclavicular joint three months after elective surgical tracheostomy. The diagnosis was made based on clinical history and examination. The patient achieved a full recovery following antibiotic treatment and surgical drainage. This report is the second documented case of sternoclavicular septic arthritis resulting from surgical tracheostomy. [ABSTRACT FROM AUTHOR]

Brucellosis is a zoonotic disease frequently observed in regions where animal husbandry is intensive in Eastern and Southeast Anatolia. The most common transmission route is raw milk and unpasteurized dairy products. The condition can affect many organs and systems in the body, and clinical findings can vary depending on the location. This condition should be considered in the differential diagnosis of acute joint pain due to unknown causes. Early diagnosis of Brucella septic arthritis in endemic regions is important to prevent serious complications. Here, clinical, laboratory, and imaging data of five healthy patients with acute joint involvement who visited the outpatient clinic were presented with the support of visuals and literature. [ABSTRACT FROM AUTHOR]

Study Design: Descriptive study of 17 patients with primary or secondary reconstruction using a supraclavicular flap. Objective: Describe the different options for primary and secondary reconstruction using the supraclavicular flap, as well as the complications that may arise. Methods: The present study analyzed the outcomes of 17 patients who underwent reconstruction using the supraclavicular artery island flap at the Maxillofacial Department of Hospital Universitario Virgen de las Nieves (Granada, Spain) from November 2017 to June 2023. Results: The SCAIF served as the primary reconstructive option in 9 cases, covering skin defects in the parotid region (4 patients), cervical area (1 patient), partial tongue defects (3 patients), and cheek defects (1 patient). Additionally, the flap was used as a secondary reconstructive option in 8 patients affected by osteoradionecrosis (ORN) with bone and plate exposure. Complications included a single case of shoulder joint septic arthritis and 3 patients who experienced cervical fistula and neck infection. Conclusions: The supraclavicular flap represents a highly effective option for oncological reconstruction within the head and neck region. This flap is particularly useful in patients with significant clinical concerns and contraindications, both local and systemic, for microsurgical free flap procedures due to its reliability, versatility, and safety. [ABSTRACT FROM AUTHOR]

Purpose: Ureaplasma urealyticum is a rare pathogen associated with septic arthritis that predominantly affects patients with hypogammaglobulinemia. Bacterial identification of fastidious organisms is challenging because they are undetectable by routine culture testing. To the best of our knowledge, this is the first report of septic arthritis induced by U. urealyticum infection in Japan. Case description: We describe the case of a 23-year-old Japanese female with secondary hypogammaglobulinemia (serum immunoglobulin level < 500 mg/dL), identified 8 years after treatment with rituximab. The patient presented with persistent fever and polyarthritis that were unresponsive to ceftriaxone and prednisolone. Contrast-enhanced computed tomography and gallium-67 scintigraphy revealed effusion and inflammation in the left sternoclavicular, hip, wrist, knee, and ankle joints. Although Gram staining and bacterial culture of the drainage fluid from the left hip joint were negative, the condition exhibited characteristics of purulent bacterial infection. The patient underwent empirical treatment with doxycycline, and her symptoms promptly resolved. Subsequent 16S ribosomal RNA (rRNA) gene sequencing of the joint fluid confirmed the presence of U. urealyticum, leading to the diagnosis of septic arthritis. Combination therapy with doxycycline and azithromycin yielded a favorable recovery from the inflammatory status and severe arthritic pain. Conclusion: This case highlights U. urealyticum as a potential causative agent of disseminated septic arthritis, particularly in patients with hypogammaglobulinaemia. The 16S rRNA gene analysis proved beneficial for identifying pathogens in culture-negative specimens, such as synovial fluid, in suspected bacterial infections. [ABSTRACT FROM AUTHOR]

Acute bacterial arthritis affects up to 1 in 10,000 children annually. It most often is the result of hematogenous spread to a synovial joint such as the knee, ankle, elbow, or shoulder. The hip is the most commonly infected, in up to 40% of cases. The knee, ankle, elbow, and shoulder also are commonly infected. Bacterial infection of fibrocartilaginous joints without synovial fluid, such as intervertebral joints, the pubic symphysis, and sacroiliac joints, is rare and difficult to diagnose. [ABSTRACT FROM AUTHOR]

Gemella morbillorum is a gram-positive coccus that is part of the normal microbiota of the human oral cavity and gastrointestinal tract. It is an opportunistic pathogen that can cause invasive infections, including septic arthritis. Septic arthritis caused by Gemella morbillorum is relatively rare, but when it occurs, it can lead to severe joint damage and other complications if not promptly diagnosed and treated. Here, we report a case of recurrent septic arthritis caused by Gemella morbillorum. [ABSTRACT FROM AUTHOR]

Bacterial biofilms are one of the major contributors to the refractoriness of septic arthritis. Although nitric oxide (NO)-enhanced photodynamic (PDT) therapy has been involved in biofilm eradication, the anti-biofilm efficacy is usually hindered by the short half-life and limited diffusion distance of active molecules. Herein, we report a three-arm structure using the photosensitive core chlorin e6 to integrate three α-cyclodextrin (α-CD) polyrotaxane chains as the supramolecular nanocarrier of NO-enhanced PDT therapy, in which NO was loaded on the cationic rings (α-CDs). Beneficial from the enhanced permeability of the nanocarrier due to the collective act on biofilms by the molecular motions (slide and rotation of rings) of three chains in different directions, NO capable of inducing biofilm dispersal and reactive oxygen species were efficiently delivered deep inside biofilms under 660 nm laser irradiation, and reactive nitrogen species with stronger bactericidal ability was produced in-situ, further accomplishing bacteria elimination inside biofilms. In-vivo therapeutic performance of this platform was demonstrated in a rat septic arthritis model by eliminating the methicillin-resistant Staphylococcus aureus infection, and potentiating the immune microenvironment regulation and bone loss inhibition, also providing a promising strategy to numerous obstinate clinical infections caused by biofilms. [ABSTRACT FROM AUTHOR]

Objectives: Investigate whether and which synoviocytes would acquire trained immunity characteristics that could exacerbate joint inflammation following a secondary Staphylococcus aureus infection. Methods: Lipopolysaccharide (LPS) and S. aureus were separately or double injected (21 days of interval) into the tibiofemoral joint cavity of male C57BL/6 mice. At different time points after these stimulations, mechanical nociception was analyzed followed by the analysis of signs of inflammation and damage in the affected joints. The trained immunity markers, including the glycolytic and mTOR pathway, were analyzed in whole tissue or isolated synoviocytes. A group of mice was treated with Rapamycin, an mTOR inhibitor before LPS or S. aureus stimulation. Results: The double LPS – S. aureus hit promoted intense joint inflammation and damage compared to single joint stimulation, including markers in synoviocyte activation, production of proinflammatory cytokines, persistent nociception, and bone damage, despite not reducing the bacterial clearance. The double LPS - S. aureus hit joints increased the synovial macrophage population expressing CX3CR1 alongside triggering established epigenetic modifications associated with trained immunity events in these cells, such as the upregulation of the mTOR signaling pathway (p-mTOR and HIF1α) and the trimethylation of histone H3. Mice treated with Rapamycin presented reduced CX3CR1+ macrophage activation, joint inflammation, and bone damage. Conclusions: There is a trained immunity phenotype in CX3CR1+ synovial macrophages that contributes to the exacerbation of joint inflammation and damage during septic arthritis caused by S. aureus. [ABSTRACT FROM AUTHOR]

Background: Facet joint septic arthritis (FJSA) is an uncommon cause of neck pain, most frequently occurring in the lumbosacral spine. Cervical facet joint septic arthritis is particularly rare. Symptoms typically include spinal or paraspinal pain and tenderness, with severe infections potentially causing neurological impairments. This condition can progress to discitis and osteomyelitis. High clinical suspicion is required for accurate diagnosis and timely treatment. Objective: To present the first known case of cervical spine FJSA caused by Moraxella species and provide an updated narrative review of cervical spine FJSA. Methods: A case study of a 66‐year‐old male with cervical spine FJSA caused by Moraxella osloensis is detailed. Additionally, a librarian‐assisted literature search was conducted on MEDLINE Pubmed, filtering for adult human trials and including various study types, resulting in the inclusion of 9 relevant manuscripts. Results: The patient's symptoms included neck, right upper thoracic, and periscapular pain, with episodes of numbness and tingling. MRI revealed septic arthritis at the C7‐T1 facet joint and associated osteomyelitis. Cultures identified Moraxella osloensis as the causative agent. The patient was successfully treated with antibiotics and experienced significant symptom improvement. Literature review highlights that Staphylococcus aureus is the most common causative agent of cervical FJSA, with diagnosis typically involving MRI and culture tests. Treatment generally includes long‐term antibiotics, with some cases requiring surgical intervention. Conclusions: This report underscores the need for high clinical suspicion in diagnosing FJSA and highlights the importance of early intervention. It documents the first known case of cervical spine FJSA caused by Moraxella osloensis, contributing valuable information to the limited literature on this rare condition. [ABSTRACT FROM AUTHOR]

Simple Summary: Black skimmers are state-threatened, colonial nesting seabirds that face numerous conservation health challenges. Through regular nest colony surveys, we observed a concerning pattern of annual fatalities among black skimmer juveniles that had grossly swollen joints at several nest colonies. This joint disease affected their mobility and ability to thrive and led to severe wasting and death in some individuals. Clinical and postmortem examinations of skimmers for four sequential years revealed that the joints were infected with a bacterium, Staphylococcus aureus, which normally cohabits the skin of many species (including humans) without causing disease. However, in this case, S. aureus likely gained entry to joints via skin injuries from sandspurs, which arise from vegetation that is common to many Florida beaches. S. aureus is also commonly detected as a sand and water contaminant in popular recreational beaches, which may also serve as a source of exposure in the skimmers. We recommend continued monitoring of black skimmer nest colonies for arthritic disease and other health-related challenges, with consideration of management techniques to reduce the risk of sandspur–skimmer interactions at nesting sites. The black skimmer (Rynchops niger) is a state-threatened, colonially nesting seabird in Florida, USA. Conservation threats include habitat alteration, human disturbances, severe weather, and predation. During nest monitoring (May–September, 2020–2022), black skimmer juveniles at colonies on Fort Myers Beach and Marco Island, Florida, had polyarthritis and died or were euthanized due to severe illness. Similarly-aged skimmers from geographically distant (considered unaffected) colonies were evaluated for comparison (2021–2023). We documented field, clinical, radiographical, and pathological findings to characterize disease and purported pathogenesis. The majority were lame and lethargic, in poor nutritional condition, and dehydrated. Additionally, 8/23 of the skimmers with dermatitis and arthritis from affected colonies also had penetrating sandspurs associated with skin ulceration, scabbing, and/or hemorrhage. The affected joints were often in limbs (interphalangeal and hock; less commonly stifle, elbow, carpus). A postmortem evaluation and bacteriology revealed Staphylococcal aureus-associated dermatitis, arthritis, tenosynovitis, and/or osteomyelitis in 21/22 of the juvenile skimmers from southwestern nest colonies. Staphylococcus aureus dissemination to internal organs occurred in 10/13 of the skimmers tested. Among skimmers evaluated from distant colonies, 5/10 that were examined histologically had skin crusting and inflammation but lacked arthritis. Occasional coinfections were documented (e.g., West Nile virus, Gram-negative bacilli). The results suggest that staphylococcal joint disease originated from sandspur-induced skin damage, followed by hematogenous dissemination to the joints and, occasionally, the internal organs. Additional nest sites should be tested to evaluate disease risk and potentially contributing environmental factors. We recommend that site managers employ techniques that reduce the risk of skimmer interactions with sandspurs. [ABSTRACT FROM AUTHOR]

Background Native joint septic arthritis (NJSA) is definitively diagnosed by a positive Gram stain or culture, along with supportive clinical findings. Preoperative antibiotics are known to alter synovial fluid cell count, Gram stain, and culture results and are typically postponed until after arthrocentesis to optimize diagnostic accuracy. However, data on the impact of preoperative antibiotics on operative culture yield for NJSA diagnosis are limited. Methods We retrospectively reviewed adult cases of NJSA who underwent surgery at Mayo Clinic facilities from 2012 to 2021 to analyze the effect of preoperative antibiotics on operative culture yield through a paired analysis of preoperative culture (POC) and operative culture (OC) results using logistic regression and generalized estimating equations. Results Two hundred ninety-nine patients with NJSA affecting 321 joints were included. Among those receiving preoperative antibiotics, yield significantly decreased from 68.0% at POC to 57.1% at OC (P <.001). In contrast, for patients without preoperative antibiotics there was a non-significant increase in yield from 60.9% at POC to 67.4% at OC (P =.244). In a logistic regression model for paired data, preoperative antibiotic exposure was more likely to decrease OC yield compared to non-exposure (odds ratio [OR] = 2.12; 95% confidence interval [CI] = 1.24–3.64; P =.006). Within the preoperative antibiotic group, additional antibiotic doses and earlier antibiotic initiation were associated with lower OC yield. Conclusions In patients with NJSA, preoperative antibiotic exposure resulted in a significant decrease in microbiologic yield of operative cultures as compared to patients in whom antibiotic therapy was held prior to obtaining operative cultures. [ABSTRACT FROM AUTHOR]

Background: This study aims to identify risk factors associated with Methicillin-resistant Staphylococcus aureus (MRSA) infection in children diagnosed with acute osteomyelitis (AO) and to elucidate the laboratory characteristics of these MRSA-infected children to enhance early targeted therapeutic interventions. Methods: We conducted a retrospective analysis involving 123 children with acute osteomyelitis treated at our hospital. Upon admission, we measured white blood cell (WBC) counts, C-reactive protein (CRP) levels, erythrocyte sedimentation rates (ESR), and platelet counts. Patients were categorized into two groups: the non-MRSA group (n = 73) and the MRSA group (n = 50), with values assigned as follows (non-MRSA group = 0, MRSA group = 1). Results: The MRSA group had a significantly higher average age compared to the non-MRSA group (P < 0.05). Notably, the incidence of suppurative arthritis was significantly lower in the MRSA group (P < 0.05). At the time of admission, CRP levels in the MRSA group were markedly elevated compared to those in the non-MRSA group (P < 0.01). After three days of empirical therapy, both WBC and CRP levels remained significantly higher in the MRSA group compared to the non-MRSA group (P < 0.05). Conclusions: In children newly admitted with acute osteomyelitis, a CRP level exceeding 73.23 µg/mL may indicate a high likelihood of MRSA infection. For children with AO who have been hospitalized for three days on empirical therapy, the presence of WBC > 10.95 × 10^9/L, CRP > 49.56 µg/mL, age > 3.5 years, and the absence of suppurative arthritis suggests a heightened risk of MRSA infection. [ABSTRACT FROM AUTHOR]

Introduction: Melioidosis caused by Burkholderia pseudomallei, often referred to as a great mimicker or escapist, evades not only the immune system, but also all manual identification methods in an under-equipped clinical microbiology laboratory due to its tedious identification process. This is a case report of disseminated melioidosis with septic arthritis, misdiagnosed both clinicoradiologically and microbiologically as disseminated tuberculosis or other bacterial infection. Case history: A middle-aged Asian diabetic male presented with high-grade fever and breathlessness for 4 days along with left knee and ankle swelling for 40 days. Previous hospitalization records revealed growth of pan-sensitive Acinetobacter spp. from ankle and a chest X-ray suspecting tuberculosis for which antibiotic and antitubercular regimen were initiated. After admission, repeated blood cultures and pus culture (ankle and knee joint) confirmed Burkholderia pseudomallei with VITEK-II automated identification system. Recommended therapy was initiated according to revised Darwin's guideline, leading to gradual cure of the patient. Conclusion: Misidentification leads to inadequate treatment, as melioidosis medication is different from other bacterial infections. Here initiation of meropenem- and cotrimoxazole-intensive therapy for 4 weeks, and 6-month eradication phase with cotrimoxazole, resulted in gradual recovery of the patient. It took around 21 days of intensive antibiotic therapy to get bacteriological clearance from blood, which signifies the tenacious nature of this infection. [ABSTRACT FROM AUTHOR]

Objective: Evaluate the microbial yield and factors predicting culture positivity for image-guided arthrocentesis of suspected septic sternoclavicular (SC) arthritis. Materials and methods: An electronic health record search identified image-guided SC joint aspirations for suspected septic arthritis. Data was extracted by retrospective chart review including patient demographics, procedure characteristics, pre-procedure lab testing, joint culture results, final SC joint diagnoses and any effect of positive synovial cultures on subsequent antibiotic therapy. Factors associated with positive joint fluid cultures were assessed using a Chi-squared test for categorical predictors and logistic regression for continuous predictors. Results: A total of 31 SC arthrocenteses met inclusion criteria with most (81%) performed using ultrasound guidance. Synovial fluid was successfully aspirated in 19/31 (61%) of cases, and in all other cases lavage fluid was successfully obtained. Synovial cultures were positive in 9/31 (29%) of cases. A final diagnosis of septic arthritis was assigned to 20/31 cases (65%) in which 9/20 (45%) had positive synovial cultures. There was no statistically significant association between synovial culture positivity and risk factors for septic arthritis, positive blood cultures, pre-aspiration antibiotics and whether synovial fluid or lavage fluid was cultured. Serum white blood cell count (WBC) and erythrocyte sedimentation rate (ESR) demonstrated statistically significant positive correlation with positive synovial cultures. Conclusion: Arthrocentesis is effective for microbial speciation in SC septic arthritis, and diagnostic yield may be increased with lavage when encountering a dry tap. Normal serum WBC and ESR values indicate an extremely low likelihood of positive synovial cultures. [ABSTRACT FROM AUTHOR]

This article comprehensively reviews current imaging concepts in spinal infection with primary focus on infectious spondylodiscitis (IS) as well as the less common entity of facet joint septic arthritis (FSA). This review encompasses the multimodality imaging appearances (radiographs, CT, MRI, and nuclear imaging) of spinal infection—both at initial presentation and during treatment—to aid the radiologist in guiding diagnosis and successful management. We discuss the pathophysiology of spinal infection in various patient populations (including the non-instrumented and postoperative spine) as well as the role of imaging-guided biopsy. We also highlight several non-infectious entities that can mimic IS (both clinically and radiologically) that should be considered during image interpretation to avoid misdiagnosis. These potential mimics include the following: Modic type 1 degenerative changes, acute Schmorl's node, neuropathic spondyloarthropathy, radiation osteitis, and inflammatory spondyloarthropathy (SAPHO syndrome). [ABSTRACT FROM AUTHOR]

In modern practice, imaging plays an integral role in the diagnosis, evaluation of extent, and treatment planning for lower extremity infections. This review will illustrate the relevant compartment anatomy of the lower extremities and highlight the role of plain radiographs, CT, US, MRI, and nuclear medicine in the diagnostic workup. The imaging features of cellulitis, abscess and phlegmon, necrotizing soft tissue infection, pyomyositis, infectious tenosynovitis, septic arthritis, and osteomyelitis are reviewed. Differentiating features from noninfectious causes of swelling and edema are discussed. [ABSTRACT FROM AUTHOR]

Musculoskeletal infections in the ER are not an uncommon presentation. The clinical context is critical in determining the suspicion for infection and degree of tissue involvement which can involve all layers from the skin to bones. The location, extent, and severity of clinically suspected infection directly relate to the type of imaging performed. Uncomplicated cellulitis typically does not require any imaging. Localized and superficial infections can mostly be evaluated with ultrasound. If there is a diffuse site (an entire extremity) or suspected deeper involvement (muscle/deep fascia), then CT is accurate in diagnosing, widely available, and performed quickly. With potential osseous involvement, MRI is the gold standard for diagnosing acute osteomyelitis; however, it has the drawbacks of longer scan times, artifacts including patient motion, and limited availability. [ABSTRACT FROM AUTHOR]

Upper extremity infections are frequently seen, especially in individuals with weakened immune system, posttraumatic events, and after surgery procedures. If not properly treated, such conditions can lead to serious consequences, such as movement impairment, amputation, and even mortality. These infections have the potential to spread extensively from their initial site of entry, traversing interconnected spaces either intra or extra-compartmental. Understanding the relevant anatomy is crucial to assess location and stage of infection, since surgical intervention and intravenous antibiotics are usually required. In this article, the authors provide a comprehensive review of the imaging findings of upper extremity infection, focusing on magnetic resonance imaging (MRI). Furthermore, this article sheds light on the pivotal role of radiology in managing hand, elbow, and shoulder infections offering an overview of available treatment options. Key findings: Various types of infections affecting the upper extremity will be discussed, including infectious tenosynovitis, deep space infections, septic arthritis, and osteomyelitis. Authors also highlight anatomical spaces, common pathogens, spread routes, and key radiological features of these conditions. [ABSTRACT FROM AUTHOR]

Case: This is a rare case describing the management of a traumatic chylous effusion discovered during operative fixation of a Sanders type III calcaneus fracture in a 58-year-old man, sustained after a fall from height. Chylous effusions are uncommon and can mimic septic arthritis. Given the concern for possible infection intraoperatively, provisional K-wire–assisted reduction was performed and definitively maintained through antibiotic mixed polymethylmethacrylate cement. Despite foregoing traditional fixation techniques, an excellent outcome was achieved. Conclusion: This case outlines the use of antibiotic cement as a reduction aid for an intra-articular calcaneus fracture in the setting of a traumatic chylous effusion. [ABSTRACT FROM AUTHOR]

Background: Septic arthritis of shoulder is a rare clinical entity as the metaphysis is extracapsular and there is no communication between epiphyseal and metaphyseal vessels. Septic arthritis of the shoulder joint is a diagnostic and surgical emergency because joint destruction develops rapidly and can cause significant morbidity and mortality. Unusual complications of septic arthritis of the shoulder joint may include extra‐articular abscess extension to the upper arm through the biceps groove and osteomyelitis of the greater tuberosity. Case Presentation: Septic arthritis of the shoulder, if left untreated, can lead to complications such as extra‐articular abscess extension and osteomyelitis. Three patients with septic arthritis of the shoulder joint with no clear history of trauma were reported in this study. The initial presentation was pseudoparalysis with upper arm swelling. MRI diagnosed septic arthritis of shoulder joint together with an upper arm abscess. Arthroscopic debridement with through irrigation and open drainage of the extra‐articular abscess extension to the upper arm improved both the shoulder pain and abscess completely. However, if shoulder pain or abnormalities in laboratory findings continue after initial treatment, uncontrolled septic arthritis or secondary osteomyelitis are possibilities that should be concerned. MRI is a useful tool for detecting those atypical complications. Conclusions: Rarely, septic arthritis of the shoulder joint can extend to the upper arm through the biceps tendon groove and cause an abscess. Also, acute osteomyelitis of the tuberosity should be considered in patients with long‐standing refractory septic arthritis of the shoulder joint who have continued pain and uncontrolled laboratory findings after initial treatment. [ABSTRACT FROM AUTHOR]

Cervical septic arthritis can lead to complications such as epidural abscess, which may result in respiratory failure. We present a case of a 78‑year‑old male with cervical septic arthritis complicated by epidural abscess, leading to severe diaphragm dysfunction. Ultrasound evaluation revealed dysfunction of the left hemidiaphragm and compensatory activation of accessory respiratory muscles. Treatment included antibiotic therapy and corticosteroids, alongside respiratory support. After 21 days, improvements were observed in diaphragmatic function and respiratory muscle activation. Our findings highlight the importance of assessing both diaphragm and accessory respiratory muscles in cases of cervical septic arthritis with respiratory complications. [ABSTRACT FROM AUTHOR]