Septic arthritis due to Streptococcus sanguis [Septički artritis uzrokovan Streptococcus sanguisom]

Mandac, Inga and Prkačin, Ingrid and Sabljar Matovinović, Mirjana and Šušterčić, Dunja (2010) Septic arthritis due to Streptococcus sanguis [Septički artritis uzrokovan Streptococcus sanguisom]. Collegium Antropologicum, 34 (2). pp. 661-664. ISSN 0350-6134

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Abstract

Septic arthritis may represent a direct invasion of joint space by various microorganisms, including bacteria, viruses and fungi. Although any infectious agent may cause bacterial arthritis, bacterial pathogens are the most significant because of their rapidly destructive nature. We present a case of septic arthritis in a 56-year old male patient due to Streptococcus viridans which is member of the viridans group streptococci. Patient was admitted to Our Hospital presented as fever of unknown origin, losing more than 30 kg of body weight during couple of months, and anemia of chronic disease as paraneoplastic process. He had long history of arterial hypertension and stroke. There was swelling and pain of the right sternoclavicular joint and precordial systolic murmur in physical status. A large diagnostic panel has been made, computerized tomography (CT) of right sternoclavicular joint showed widening of periarticular soft tissue and loss of clavicular corticalis. Cytologic analysis of synovial fluid showed more than 90% of polymorphonuclear leukocytes. There were no crystals on microscopic examination and Gram stain of fluid was negative. Blood cultures were positive for S. sanguis and there was a consideration about possible periodontal disease. Stomatologic examination verified periapical ostitis and extraction of potential cause of infection has been done. Therapy with benzilpenicilline was followed by the gradual improvement of clinical and laboratory parameters. Although viridans group streptococci and Streptococcus sanguis in particular are rare causes of septic arthritis in native joints, they should be considered in the differential diagnosis of periodontal disease.

Abstract in Croatian

Septički artritis može nastati nakon izravnog ulaska različitih mikroorganizama (bakterija, virusa, gljiva) u zglobni prostor. Bilo koji uzročnik infekcije može dovesti do bakterijskog artritisa, ali bakterijski patogeni su najznačajniji jer dovode do brzog uništenja zgloba. U radu prikazujemo slučaj 56-godišnjeg bolesnika sa septičkim artritisom uzrokovanog sa Streptococcus viridansom koji pripada viridans grupi streptokoka. Primljen je u bolnicu pod kliničkom slikom febriliteta nepoznate etiologije, a u anamnezi se isticao podatak o gubitku više od 30 kg tjelesne težine unazad nekoliko mjeseci i anemija kronične bolesti ili u sklopu paraneoplastičnog procesa. Duži niz godina se liječio od arterijske hipertenzije, a prebolio je i cerebrovaskularni inzult. U fizikalnom statusu nađena je oteklina i bol desnog sternoklavikularnog zgloba te sistolički šum prekordijalno. Učinjena je opsežna dijagnostička obrada. Kompjuterizirana tomografija desnog sternoklavikularnog zgloba pokazala je proširenje periartikularnog mekog tkiva i gubitak kortikalisa klavikule. Citološka analiza sinovijalne tekućine našla je više od 90% polimorfonuklearnih leukocita. Mikrobiološkom analizom sinovijalne tekućine nije nađeno izolata. Hemokulture su bile pozitivne na S. sanguis radi čega se posumnjalo na moguću infekciju zubnog tkiva. Stomatološkom obradom nađe se periapikalni ostitis te je učinjena ekstrakcija žarišta. Započeta je terapija benzilpenicilinom što je dovelo do postupnog poboljšanja kliničkih i laboratorijskih parametara. Iako su viridans streptokoki i S. sanguis rijetki uzročnici septičkog artritisa, potrebno ih je uzeti u obzir ukoliko postoji i periodontalna infekcija.

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