Septic Arthritis Due to Streptococcus pneumoniae in Nottingham, United Kingdom, 1985-1998

Abstract

Pneumonia and meningitis are the 2 most frequent manifestations of Streptococcus neumoniae infection. Pneumococcal septic arthritis is considered to be relatively uncommon. Between 1985 and 1998, 32 (8. 2%) of 389 cases of septic arthritis seen in the 2 hospitals in Nottingham, United Kingdom, were due to S. pneumoniae. Six of 7 children with pneumococcal septic arthritis were aged <2 years. Of the 25 adults, 20 (80%) were aged >60 years, 11 (44%) had concomitant pneumococcal infection elsewhere, and 23 (92%) had articular or nonarticular diseases and/or other risk factors. In the elderly, a lack of febrile response was striking. S. pneumoniae was isolated from blood and joint cultures in >70% of cases, and gram-positive diplococci were seen in the joint fluids of 90% of patients. The mean duration of antimicrobial therapy for adults was twice as long as that for children. Eight (32%) of the adults died.

Infections ostéoarticulaires à Streptococcus pneumoniae chez l'adulte immunocompétent : à propos de deux observations

“…Les localisations ostéoarticulaires sont moins classiques [6]. Pourtant, l'é-tude de la littérature montre que ce germe est responsable de 3 à 10 % des arthrites septiques [1][2][3]5,7,8]. Il est en particulier fréquent dans les arthrites périphériques de l'enfant, notamment dans les atteintes de la hanche.…”

“…Les infections ostéoarticulaires à Streptococcus pneumoniae sont rares chez les adultes sains [1][2][3][4][5]. Dans la plupart des cas, elles surviennent chez des patients immunodéprimés et peuvent mettre en jeu le pronostic fonctionnel et vital.…”

What’s New in the Management of Bacterial Septic Arthritis?

“…However, this is not always the case, as shown in a prospective study where fever, sweats and rigors were recorded in only 34%, 15% and 6% respectively, of patients with positive synovial fluid cultures [1]. Fever is present in only 60% of patients presenting with septic arthritis [1,26,28,29].…”

“…Symptoms are usually present for less than 2 weeks [1,26,27], but delay may occur with low virulence organisms, tuberculosis or infected prosthesis [1,28]. These patients may have another focus of infection when they present with acute arthritis.…”

Bacterial and lyme arthritis

“…Streptococcus pneumoniae may also be increasing in importance as a cause of septic arthritis, accounting for up to 8% to 10% of cases in some recent studies [23,24]. As with septic arthritis caused by group B streptococci, pneumococcal septic arthritis is notable for a high frequency of bacteremia and polyarticular disease.…”