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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Case histories, results of synovial fluid analyses, treatment regimens and outcome are described for 15 adult Standardbred horses with confirmed post-injection septic arthritis. Joint sepsis followed injection of corticosteroids, hyaluronic acid, polysulphated glycosaminoglycan, or local anaesthetic. The median interval from injection to appearance of clinical signs was 2.5 days, and median interval from injection to referral was 9 days. The median initial synovial leucocyte count on admission was 57 x 10(9)/litre, but there was a wide range of values (18-258 x 10(9)/litre). The median synovial neutrophil percentage was 95% (77-99%). All bacterial isolates were Gram-positive cocci, 86% of which were staphylococci. All treated horses (12/15) initially received broad-spectrum parenteral antibiotic therapy, and the articulations of all horses except one were lavaged, either with non-surgical through-and-through techniques only (N = 3), or surgically with arthrotomy (N = 1) or arthroscopy (N = 7). The owners of all treated horses were contacted and racing records were consulted. Eleven of 12 horses returned to racing. Outcome was judged as either satisfactory (3/12) if the horse had returned to racing levels similar to or better than before treatment, or unsatisfactory (9/12) if the horse had poorer performance or could not return to racing. The 3 horses with satisfactory follow-up had been treated with arthroscopy and post-surgical closed suction drainage. The results of bacterial cultures suggest that the initial antimicrobial agents used should be effective against penicillin-resistant staphylococci.
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PMID:Septic arthritis in 15 standardbred racehorses after intra-articular injection. 145 51

In acute septic arthritis, the synovial fluid is usually frankly purulent. However, the presence of pus does not always imply the presence of infection, and some synovial fluids are easily mistaken for pus. An exaggeration of the normal leucocyte response in inflammatory joint fluids may alone simulate sepsis; marked increases in certain lipid fractions of the fluid may produce similar appearances. We describe a patient who presented with two examples of such 'pseudoseptic arthritis'.
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PMID:Pseudosepsis in rheumatoid arthritis due to cellular and lipid abnormalities in synovial fluid. 152 30

A 6-month-old 300-kg Quarter Horse filly was treated for septic arthritis of the distal interphalangeal joint and septic navicular bursitis that developed as a result of a deep puncture to the foot. Initial treatment consisted of establishing ventral drainage for the navicular bursa, lavage of the distal interphalangeal joint, and administration of broad-spectrum antimicrobial drugs and non-steroidal anti-inflammatory drugs. Because of continuing sepsis in the distal interphalangeal joint, subsequent treatment included packing the defect in the bottom of the foot with cancellous bone in an attempt to prevent ascending contamination of the joint, placing the limb in a short limb cast, and inserting a Penrose drain into the joint for passive drainage of septic exudate. The goal of treatment was to encourage ankylosis of the distal interphalangeal joint. Because of the filly's persistent lameness and laxity of the lateral collateral ligament in the contralateral carpus, the palmar nerves of the affected foot were injected with a long-acting local anesthetic at the level of the proximal sesamoid bones to encourage weight-bearing. Ankylosis of the distal interphalangeal joint was complete 9 months after the puncture, but a grade-2 lameness remained and the horse had a varus deformity resulting from ligamentous laxity of the lateral collateral ligament in the contralateral carpus.
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PMID:Ankylosis of the distal interphalangeal joint in a horse after septic arthritis and septic navicular bursitis. 157 52

Ten episodes of musculoskeletal sepsis have been seen in nine patients with HIV infection. Seven patients had AIDS, circulating CD4-positive lymphocyte counts being less than 0.1 x 10(9)/l in six. Septic arthritis recurred in seven patients, osteomyelitis in three and pyomyositis and bursitis each occurred in one patient. Staphylococcus aureus was isolated from four patients, atypical micro-organisms being found in three. Presentation of musculoskeletal infection in this patient group may be atypical but rapid diagnosis is important as early antimicrobial therapy is often successful.
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PMID:Septic bone, joint and muscle lesions associated with human immunodeficiency virus infection. 159

Twenty cases of osteomyelitis and/or septic arthritis caused by multiply resistant Staphylococcus aureus were documented in an Australian tertiary neonatal unit between 1981 and 1987. Eighteen (90%) occurred in the 3 years 1985 to 1987, an incidence of 9.6/1000 admissions in that period. All osteomyelitis and/or septic arthritis occurred in sick premature infants requiring intensive support. Eleven (55%) had a birth weight of less than 1500 g. An intravascular device was the most common portal of entry (14 of 20, 70%). Systemic symptoms were prominent at presentation, with local signs developing later in 18 (90%), usually within a week. Radiologic changes were almost always present by 10 days; radionuclide bone scanning was insensitive and did not hasten diagnosis. Osteomyelitis was multifocal in 11 cases (55%), with the long bones, particularly of the upper limb, most commonly affected. Large joint involvement was uncommon (15%). Intravenous vancomycin for a mean of 32 days was associated with low mortality (1 of 20) and toxicity; surgical drainage was not performed. Follow-up at a minimum of 4 months (mean, 25.5 months) showed residual signs in the affected limb in 30%, none with significantly impaired function. Skeletal infection should be searched for rigorously in neonatal multiply resistant S. aureus sepsis. In the absence of large joint disease, vancomycin therapy alone for a minimum of 3 weeks gives good short term results with minimal toxicity.
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PMID:Bone and joint infections caused by multiply resistant Staphylococcus aureus in a neonatal intensive care unit. 174 Dec 3

Risk factors, clinical syndromes and the case-fatality rates associated with Group B Streptococcus (GBS) infections in infants managed at the University of Rochester Medical Center during 1979 to 1989 were reviewed. Overall 92 episodes of early onset disease (EOD) and 54 of late onset disease (LOD) were diagnosed in 143 infants (3 infants with EOD presented later with LOD). About one-third of patients with EOD and controls were non-white compared with two-thirds of patients with LOD that occurred in racial minority groups. Prematurity and low birth weight were significantly more common in patients with invasive GBS disease than in controls. Eighty-three of 92 (90%) cases of EOD were detected during the first day of life and 10 of 54 (19%) cases of LOD occurred in infants older than 3 months of age. At the time of diagnosis 4% of infants with EOD were asymptomatic, 54% had respiratory disease, 27% had sepsis without a focus, 15% had meningitis and 1% had urinary tract infection or omphalitis. Among infants with LOD 46% had sepsis, 37% meningitis, 7% urinary tract infection, 6% osteomyelitis and/or septic arthritis and 4% cellulitis or pneumonia. Leukopenia and shift to the left were observed in 43 and 61% of episodes of EOD and in 28 and 57% of episodes of LOD, respectively. All infants were promptly treated with antibiotics and vigorous supportive therapy. The case-fatality rate was 13% in EOD and 0 in LOD.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The changing spectrum of group B streptococcal disease in infants: an eleven-year experience in a tertiary care hospital. 174 91

Antibiotic therapy and immediate drainage of the infected joint are established practice in the treatment of septic arthritis. The best method of drainage (repeated puncture, arthroscopy or surgical discharge) remains controversial. We analyze 34 patients with septic arthritis admitted to our hospital from 1984 to 1988. The pathogen was Staphylococcus aureus in 19 cases (56%), streptococcus in 6 (18%), pneumococcus in 2 (6%), other bacteria in (9%) and unknown in 4 (12%). In 62% the infection was blood-borne. The knee was affected in 12 cases (35%) and the shoulder in 10 (30%). A preceding joint puncture was the main source of infection. In 24 patients (70%) the initial joint drainage was by repeated puncture, while in 10 cases (30%) surgical drainage was the initial treatment. In 11 of the 24 patients initially treated by repeated puncture, surgical drainage was needed in the course of treatment because of persistent local infection of the joint. In only 13 (39%) was "medical" treatment alone effective. 5 patients died (14.7), 3 (8.8%) due to the infection. All deaths occurred in the "medical" group. 21 patients were asked about symptoms in the affected joint. In 71% there were no problems or only minimal ones, while in 29% there were distinct problems. 5 of the 6 patients with severe symptoms had been treated by repeated puncture. We conclude that surgical drainage of an infected joint is prescribed too rarely in departments of rheumatology and internal medicine. Arthroscopic or surgical drainage is indicated in cases of coxarthritis, omarthritis, in cases where symptoms last longer than 7 days and in patients with severe sepsis.
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PMID:[Therapy and prognosis of bacterial arthritis: a retrospective analysis]. 186 7

Many discriminative experimental animal models of infection have been utilized in the evaluation of newer fluoroquinolones. In vivo efficacy of many of the newer agents has been shown in experimental models of meningitis, endocarditis, pneumonia, urinary tract infections, pyelonephritis, osteomyelitis, abscesses of various types, septic arthritis, gastroenteritis, salmonellosis, listeriosis, tuberculosis, syphilis, sinusitis, prostatitis and burn wound sepsis, among others. This review focuses on recent developments in a few selected areas. Although the limitations of animal model studies are well described, these results provide a rationale for the appropriate clinical usage of the newer fluoroquinolones in humans.
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PMID:Evaluation of quinolones in experimental animal models of infections. 186 88

Four patients with osteoarthritis of the hip, who developed septic arthritis of the affected joint, are reported. The septic arthritis developed insidiously and was diagnosed with difficulty. One patient died, two required subsequent joint excision, and one arthrodesis despite antibiotics. The presence of a recognised predisposing factor to septic arthritis, such as rheumatoid arthritis or a surgically replaced joint, can provide a diagnostic pointer. These cases suggest that osteoarthritis, similarly, is a predisposing factor. It is concluded that joint sepsis should be considered if a patient with osteoarthritis develops new symptoms from a single joint with associated systemic features.
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PMID:Septic arthritis complicating hip osteoarthritis. 161 47

Fourteen neonates were diagnosed to have Citrobacter sepsis during 1986-89, representing 4.6% of all cases with bacteriologically proven sepsis. Most of these infants were low birth weight (mean 2046 gm, +/- 750) and preterm (mean 34.8 weeks, +/- 3.8). Mean age at onset of sepsis was five days. In 10 cases the hematological profile was suggestive of sepsis. Infants had clinical evidence of multisystem infection; 2 with septic arthritis and 3 meningitis. The case fatality rate was 61%. Resistance to antibiotics was frequent. Citrobacter species were also cultured from other sites: umbilical stumps, eye swabs, urine, skin pustules and umbilical catheter tips. The epidemiological features and virulence of this organism call for vigilance and strict control measures.
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PMID:Neonatal citrobacter sepsis: clinical and epidemiological aspects. 213 9


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