Primary Meningococcal Arthritis in a Prosthetic Knee Joint

Vikram, Holenarasipur R.; Buencamino, R.B.; Aronin, Steven I.

doi:10.1053/jinf.2001.0795

Cited by 15 publications

(17 citation statements)

References 9 publications

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“…Both the case described by Vikram et al [4] and the present description should be classified in the third category, where the germ's route of entry is supposedly haematogenous.…”

Section: Discussionmentioning

confidence: 73%

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Neisseria meningitidisInfecting a Prosthetic Knee Joint: A New Case of an Unusual Disease

Carral¹,

Manoja

López-Cárdenas³

et al. 2017

Case Reports in Infectious Diseases

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“…Both the case described by Vikram et al [4] and the present description should be classified in the third category, where the germ's route of entry is supposedly haematogenous.…”

Section: Discussionmentioning

confidence: 73%

“…Primary purulent arthritis caused by N. meningitidis is a rare but known disease. However, as far as we know, there is only one published case report of an arthroplasty infected with Neisseria meningitidis [4]. We hereby present a new case of this exceptional infection.…”

Section: Introductionmentioning

confidence: 82%

Neisseria meningitidisInfecting a Prosthetic Knee Joint: A New Case of an Unusual Disease

Carral¹,

Manoja

López-Cárdenas³

et al. 2017

Case Reports in Infectious Diseases

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“…Pre-existing joint disease is the foremost risk factor and is found in 47% of people who are diagnosed with septic arthritis. 2,17 Other categories of risk include conditions causing a loss of skin integrity, such as psoriasis or injection drug abuse, and any condition associated with compromised immunity. 2 In the realm of meningococcal infection, there are different serotypes that cause disease.…”

Section: -11mentioning

confidence: 99%

Primary Meningococcal Arthritis

Harwood

Womack

Kapur

2008

The Journal of the American Board of Family Medicine

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Meningitis and the clinical syndrome of acute meningococcemia are well-described sequelae from infections caused by Neisseria meningitidis. Within the realm of this syndrome, secondary sites of infection are not uncommon. There is a concomitant septic arthritis in 11% of cases of meningococcemia. 1 We describe below the rare clinical scenario of a 29-year-old woman with primary meningococcal arthritis without the clinical syndrome associated with meningococcemia. Case ReportA 29-year-old woman presented to the outpatient office with a chief complaint of an acutely painful and swollen left knee. On awaking that morning, she noted a decreased ability to flex and extend her left knee and extreme pain during ambulation. She had no medical or surgical history and was not on any medications. When doctors inquired about sexual contacts, she stated she had not been sexually active in the past 3 months. Three weeks before, she had a negative screening test for Neisseria gonorrhea and Chlamydia trachomatis during an annual gynecologic examination. She was afebrile and other vital signs were normal. She appeared to be well, but an erythematous, warm, swollen left knee that was diffusely tender to palpation was found. Active and passive range of motion was severely limited secondary to pain. An erythematous, macular rash was noted on the bilateral lower extremities. She was promptly transferred to the hospital with the diagnosis of septic arthritis.Orthopedic surgery consultation was obtained on arrival to the emergency department. Aspiration of the left knee yielded grossly purulent synovial fluid. It was sent for evaluation by Gram stain, culture, cell count, and crystal analysis. Serum laboratory testing for C-reactive protein, complete blood cell count, and 2 sets of blood cultures was performed (see Table 1). The patient was started on Vancomycin 1 g intravenously every 12 hours for Gram-positive bacteria, given the initial gram stain result. She was taken to the operating room for urgent arthroscopic incision, drainage, and lavage of the left knee. During transportation to the operating room, the patient developed pain in the left shoulder. Examination at that time revealed decreased range of motion secondary to pain. Arthrocentesis of the left shoulder, while the patient was under anesthesia, yielded grossly purulent fluid. Open incision and drainage of the left shoulder was performed, followed by arthroscopic incision and drainage of the left knee.On postoperative day 1, blood cultures and synovial fluid cultures collected from operative intervention revealed Gram-negative diplococci. Ceftriaxone 1 g intravenously every 24 hours was initiated for presumed gonococcal arthritis. Soon thereafter, the organisms were identified as Neisseria meningitides; vancomycin was discontinued. Two sets of blood cultures revealed N. meningitidis. The patient had fever of 102.9°F on postoperative day 2, but she remained stable and never showed signs or symptoms of meningitis or the clinical syndrome of meningococcemia during her hosp...

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“…As revealed in Table 1, haematogenous bacteria seeding implants are more common in knee prostheses. The time of onset of PJI ranged from few days to 3 weeks from the initial cause (Ryczak et al, 1987;Wollner et al, 1989;Raad & Peacock, 2004;Bertani et al, 2006;Roberts et al, 2013;Manolios et al, 2013;Söderquist, 2014;Bezwada et al, 2002;Limbird, 1985;Vikram et al, 2001). Ninety per cent were delayed but acute infections (6 months to more than 10 years after implantation) with a debridement and irrigation surgery strategy leading to a favourable outcome in most cases.…”

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confidence: 99%