SYNOPSISThe haemagglutination test for antileucocidin is frequently positive in cases of bone tuberculosis in the absence of obvious staphylococcal infection. This test is therefore of little practical use in the differentiation of staphylococcal and tuberculous bone disease, and its use has been discontinued at the Royal National Orthopaedic Hospital.The antigamma haemolysin test in bone tuberculosis appears to give rise to few false positive results. Our observations confirm that the anti-alpha haemolysin and antigamma haemolysin tests used together reveal about 80% of cases of staphylococcal bone infection on first presentation or relapse.
A 64-year-old woman with a 3-year history of seropositive, erosive, rheumatoid arthritis was admitted for a carpal tunnel release operation. She was on aspirin, alcofenac, and prednisone. Two days later she developed a high fever with malaise, culminating in severe pain in her right knee. The knee was hot and tender, with swelling extending from the joint to the lower tibia, where there were 2 small dry wounds. These had been caused by a bite from her pet cat 2 weeks earlier. Purulent fluid was aspirated from the right knee. Gram stain showed numerous pus cells and Gram-negative coccobacilli. Horseblood-agar plate culture yielded Pasteurella multocida. Blood cultures were sterile. The white blood count showed a moderate polymorphonuclear leucocytosis and lymphopenia. A fasting glucose was normal. X-ray of the knee showed only the effusion.Antibiotic therapy was begun with flucloxicillin and sodium fusidate, but when bacteriological results became available it was changed to ampicillin 500 mg 4 times a day, with further clinical improvement. The cultured organism was sensitive to ampicillin, cephalexin, tetracycline, and cotrimoxazole, and resistant to penicillin G, fusidic acid, and cloxacillin. The knee was rested in a back slab splint. After 2 weeks full mobilisation was gradually achieved. With the isolated organism as antigen titres of agglutinating antibody increased to a
A case of Petriellidium boydii (synonym: Allescheria boydii) infection of the knee joint is described. It followed a penetrating soft tissue injury with a pitchfork. Such infections are rare in this country and bone involvement has not been recorded previously except in maduramycosis contracted in tropical areas.
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