Objective/Aim: Septic arthritis is an uncommon but important disease with significant morbidity and mortality, especially if inadequately managed. The aim of this epidemiological study was to identify the characteristics and outcomes of patients treated for septic arthritis at Mater Dei Hospital, Malta, over a 10-year period. Methods: This was a retrospective observational study. Patients diagnosed with septic arthritis between 2008 and 2018 were recruited. Cases were identified by reviewing all inhospital episodes of patients diagnosed with septic arthritis according to Newman criteria. Results: There were 124 cases of native joint septic arthritis and 138 of prosthetic joint infection. Cases were present amongst all age groups, with the highest incidence amongst those aged 61–70 years for both native and prosthetic infections. Fever was present in around 40% of cases. Raised white cell count was prevalent in 66.9% of native joint infections and 52.9% of prosthetic joints. Elevated C-reactive protein was overwhelmingly seen in most cases, present in 93.5% (median=159.5 mg/L; IQR=85.8–291) of native joints and 92.0% of prosthetic joint infections (median=68.7 mg/L; IQR=20.5–186). Over 55% of patients had one or more risk factors for joint sepsis, diabetes mellitus being the most prevalent clinical comorbidity (22.6% and 24.6% for native and prosthetic joint infections respectively). Synovial cultures were positive in 66% and 82% of native and prosthetic joint aspirates respectively. Staphylococcus aureus was the most commonly isolated organism from both native and prosthetic joint infection, followed by streptococcal infections in native joints and coagulase negative staphylococci and gram-negative infections in prosthetic joints. Fifteen deaths were directly attributed to joint sepsis. Conclusion: Absence of fever and elevated white cell count does not exclude the diagnosis. The mortality rate due to septic arthritis in this cohort of patients was found to be 5.7%. All deaths occurred in elderly patients with clinical comorbidities suggesting that this group is at highest risk.
Background Inflammatory Bowel Disease(IBD) and Irritable Bowel Syndrome(IBS) are gastrointestinal disorders which differ in pathophysiology and management. The use of immunomodulatory drugs brings concerns which increased during the pandemic. Similarly, patients with IBS may have concerns about the effect of infection and vaccine on their wellbeing. The aim of this study was to assess for any differences in swabbing, vaccine uptake, COVID-19 infection, hospitalisation rates and outcomes in patients with IBD on immunomodulatory treatment and patients with IBS. Methods Patients were recruited through the local database (March, 2020 – August, 2021). All IBD patients had a histological diagnosis while IBS patients were diagnosed according to ROME IV criteria. All patients were offered vaccination. Apart from demographic data the following was collected: number of COVID-19 swabs taken, vaccination rates, type of vaccine administered, infection secondary to COVID-19, hospitalization and outcomes. Results Overall, 250 IBD patients (43.6% female) and, 250 patients with IBS (78.4% female) were recruited. The mean patient age in the IBS cohort was, 40.6 years (SD ±, 11.99) whilst the mean patient age in the IBD cohort was, 40.7 years (SD±15.7). Patients with IBD underwent significantly more COVID-19 swab tests (n=759) than patients with IBS (n=615) (p =0.02). Patients with IBD were having the following biological therapy:, 62.8% Infliximab, 24.8% Adalimumab, 10% Vedolizumab and, 2.4% Ustekinumab. There was no significant difference in COVID-19 infection rate between the IBS cohort (8.8%; n=22 patients;, 2 patients not vaccinated) and the IBD cohort (6.4%; n=16 patients;, 3 patients not vaccinated)(p=0.3). The vaccine uptake rate was similar (IBD:, 91.2%, IBS: 90%). Table, 1 demonstrates the type of vaccine administered to both cohorts. In the IBS cohort, 1 patient was admitted to hospital in view of symptomatic hypoxaemia. The patient was treated with oxygen and dexamethasone, but did not require ventilatory support. Within the IBD cohort, 3 patients requiring admission for IBD related treatment, tested positive asymptomatically on pre-admission COVID-19 screening. All had an uneventful outcome. Conclusion This study demonstrates that vaccine uptake, Covid-19 infection rates and outcomes were similar in patients with IBS and IBD patients on immunosuppressive therapy. However, IBD patients underwent significantly more swabbing than patients with IBS and this was generally due to patient concern of acquiring Covid-19 while being on immunosuppresive medications. This added psychological burden may further impact patients’ psychological state and thus their quality of life.
A 76-year-old woman presented with a 2-hour history of pleuritic chest pain with no other associated symptoms. Blood investigations revealed raised inflammatory markers and an elevated white cell count. On chest radiograph, an airspace shadow indicative of a consolidation was prominent. This was followed by a CT scan of her thorax which showed a spiculated lesion in the right upper lobe, a lesion in the posterior segment of the left lower lobe and mildly enlarged right hilar lymph nodes. She was started on dual antibiotic therapy; however, the patient’s clinical status and inflammatory markers did not improve. A bronchoscopy was performed which excluded malignancy and atypical pathogens. CT-guided biopsy confirmed the presence of cryptogenic organising pneumonia. Prednisolone 50 mg daily was prescribed with quick resolution of symptoms.
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