Salmonella enteridisSeptic Arthritis: A Report of Two Cases

Abstract

Introduction. Nontyphoidal salmonellosis causes significant morbidity, is transmitted via fecal-oral route, and is a worldwide cause of gastroenteritis, bacteremia, and local infections. Salmonella is a less common etiologic factor for septic arthritis compared with other gram-negative bacteria. Cases. We present two septic arthritis cases with Salmonella enteridis as a confirmed pathogen and also discuss the predisposing factors and treatment. Discussion. Septic arthritis is an orthopedic emergency. The gold standard treatment of septic arthritis is joint debridement, antibiotic therapy according to the culture results, and physiotherapy, which should start in the early postoperative period to prevent limitation of motion. Salmonella is an atypical agent for septic arthritis. It must be particularly kept in mind as an etiologic factor for the acute arthritis of a patient with sickle cell anemia and systemic lupus erythematosus. Clinicians should be cautious that the white blood cell count in synovial fluid can be under 50.000/mm3 in immune compromised individuals with septic arthritis. The inflammatory response can be deficient, or the microorganism may be atypical. Conclusion. Atypical bacteria such as Salmonella species in immune compromised patients can cause joint infections. Therefore, Salmonella species must always be kept in mind for the differential diagnosis of septic arthritis in a clinically relevant setting.

Salmonellainfection after anterior cruciate ligament reconstruction: A case report

“…Risk factors for bacterial blood-borne knee infections (old age, diabetes, polyarthritis and other immunodeficiency diseases as well as intravenous drug abuse) were not found in this patient, nor were other described risk factors such as concomitant meniscus resection or a history of surgery on the same knee[ 11 ].…”

Management of Salmonella Septic Bursitis in Renal Transplant Recipient

“…Septic bursitis on deep bursae may have been occurred in patients with bacteremia which is more common in the immunocompromised state. [2][3][4][5][6][7][8]16,20 Deep bursae includes subacromial, iliopsoas, trochanter bursa, direct inoculation to these structures are rare although iatrogenic infections may occur through injection procedure to the bursa, intra articular injection, acupuncture. 16,17 If no direct inoculation or iatrogenic course found, hematogenic seeding must be considered and impaired response to infection is one of the predisposing factor.…”

“…Bursa is an enclosed sac which contains a small amount of synovial fluid, lined with a cellular membrane similar to synovium. [1][2][3]7 Bursae may be divided based on its location into superficial and deep.…”

“…Septic bursitis on deep bursae may occurred in patients with bacteremia and more common in the immunocompromised state. [2][3][4][5][6][7][8]16,20 The patient is in immunosuppressive therapy on mycophenolate mofetil and cyclosporine secondary to post renal transplantation.…”

“…Bursal fluid aspiration is indicated if effusions and septic bursitis are present or suspicious. Laboratory analysis of bursal fluid consists of determination of the nucleated cell count (white cell count), Gram stain, and culture for bacteria 7,16.…”