Case Report
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A Case of Septic Arthritis of Shoulder Joint Due to Streptococcus anginosus Following Dental Treatment

Year 2019, Volume: 33 Issue: 1, 31 - 35, 30.04.2019

Ali Ilgın Olut , Funda Balaylar Mehmet Umut Çayıröz Taşkın Altay

https://doi.org/10.5222/ankem.2019.191

Abstract

Septic arthritis is classified in acute rheumatologic emergencies and prompt diagnosis and treatment is critical for prognosis since the infection may lead to permanent destruction. Etiology varies due to routes of infection and host factors. Gram positive cocci are responsible in most of the cases (75-80 %) but in case of immune supression, elderly patients, intravenous drug usage and iatrogenic cases, Gram negative bacilli may also be involved. S.anginosus group are non-motile, facultative anaerobe and catalase-negative Gram-positive cocci that are recognized as normal flora of the human oral cavity and gastrointestinal tract. The unique characteristic of the S.anginosus group that sets these streptococci apart from other pathogenic streptococci is their ability to cause abscesses and should be considered as true pathogens when isolated. Infections vary from dental abscesses, gingivitis and other periodontal infections to deep neck infections, metastatic lung, liver, intra-abdominal and brain abscesses. In the literature soft tissue infections, septic arthritis and osteomyelitis are very rarely reported. In this case report we present a case of septic arthritis due to S.anginosus in an otherwise immunocompetant 64 year old woman that presented with pain and swelling of the left shoulder one month after a dental treatment. The sinoviyal fluid analyses revealed a WBC count of 26,000/mm3 with 82 % polymorphonuclear leukocytes with a negative Gram stain. The patient was started on ampirical intravenous treatment with piperacilin-tazobactam and daptomycine. At the fourth day, the synovial fluid culture results yielded S.anginosus, then piperacilin-tazobactam was stopped and daptomycine continued till the 14th day. The patient was discharged with oral amoxiciline-clavulanic acid 1 gr/day for 14 days. After two weeks the therapy was stopped due to clinical improvement.

Keywords

dental treatment septic arthritis Streptococcus anginosus

References

  • Al-Himdani S, Woodnutt D. Group C streptococcal septic arthritis of a prosthetic hip joint following dental treatment. BMJ Case Rep. 2015;22:1-4. https://doi.org/10.1136/bcr-2015-211203
  • Balentine LT, Papasian CJ, Burdick C. Septic arthritis of the knee due to Streptococcus anginosus. Diagn Microbiol Infect Dis. 1989;12(2):189-91. https://doi.org/10.1016/0732-8893(89)90012-6
  • Blankstein A, Amsallem JL, Rubinstein E, et al. Septic arthritis of the acromioclavicular joint. Arch Orthop Trauma Surg. 1985;103(6):417-8. https://doi.org/10.1007/BF00435451
  • Edson RS, Osmon DR, Berry DJ. Septic arthritis due to Streptococcus sanguis. Mayo Clin Proc. 2002;77(7):709-10. https://doi.org/10.4065/77.7.709
  • Fazili T, Riddell S, Kiska D, et al. Streptococcus anginosus group bacterial infections. Am J Med Sci. 2017;354(3):257-61. https://doi.org/10.1016/j.amjms.2017.05.011
  • Goldenberg DL, Reed JI. Bacterial arthritis. N Engl J Med. 1985;312(12):764-71. https://doi.org/10.1056/NEJM198503213121206
  • Houston BD, Crouch ME, Finch RG. Streptococcus MG-intermedius (Streptococcus milleri) septic arthritis in a patient with rheumatoid arthritis. J Rheumatol. 1980;7(1):89-92.
  • Hynd RF, Klofkorn RW, Wong JK. Streptococcus anginosus-constellatus infection of the sternoclavicular joint. J Rheumatol. 1984;11(5):713-5.
  • Jacobson JJ, Matthews LS. Bacteria isolated from late prosthetic joint infections: dental treatment and chemoprophylaxis. Oral Surg Oral Med Oral Pathol. 1987;63(1):122-6. https://doi.org/10.1016/0030-4220(87)90352-5
  • Johnson CC, Tunkel AR. Viridans streptococci, groups C and G streptococci, and Gemella morbillorum, “Mandell GL, Bennett JE, Dolin R (eds): Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases 6.baskı“ kitabında s.2434-51, Churchill Livingstone, Philadelphia (2005).
  • Kaandorp CJ, Dinant HJ, van de Laar MA, et al. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis. 1997;56(8):470-5. https://doi.org/10.1136/ard.56.8.470
  • Lever AM, Owen T, Forsey J. Pneumoarthropathy in septic arthritis caused by Streptococcus milleri. Br Med J. 1982;285(6334):24. https://doi.org/10.1136/bmj.285.6334.24
  • Maderazo EG, Judson S, Pasternak H. Late infections of total joint prostheses: a review and recommendations for prevention. Clin Orthop. 1988;229(229):131-42. https://doi.org/10.1097/00003086-198804000-00017
  • Papaioannides D, Boniatsi L, Korantzopoulos P, et al. Acute septic arthritis due to Streptococcus sanguis. Med Princ Pract. 2006;15(1):77-9. https://doi.org/10.1159/000089391
  • Patrick MR, Lewis D. Short of a length: Streptococcus sanguis knee infection from dental source. Br J Rheumatol. 1992;31(8):569. https://doi.org/10.1093/rheumatology/31.8.569-a
  • Peters RH, Rasker JJ, Jacobs JW, et al. Bacterial arthritis in a district hospital. Clin Rheumatol. 1992;11(3):351-5. https://doi.org/10.1007/BF02207192
  • Pioro MH, Mandell BF. Septic arthritis. Rheum Dis Clin North Am. 1997;23(2):239-58. https://doi.org/10.1016/S0889-857X(05)70328-8
  • Ross JJ. Septic arthritis of native joints. Infect Dis Clin North Am. 2017;31(2):203-18. https://doi.org/10.1016/j.idc.2017.01.001
  • Seviour PW, Dieppe PA. Sternoclavicular joint infecti on as a cause of chest pain. Br Med J. 1984;288(6411): 133-4. https://doi.org/10.1136/bmj.288.6411.133
  • Stratton CV, Sexton D, Baron EL. Infections due to the Streptococcus anginosus (Streptococcus milleri) group. Uptodate, Literature review current through Nov 2018.
  • Sullivan PM, Johnston RC, Kelley SS. Late infection after total hip replacement, caused by an oral organism after dental manipulation: a case report. J Bone Joint Surg Am. 1990;72:121-3. https://doi.org/10.2106/00004623-199072010-00019
  • Vartian C, Lerner PI, Shlaes DM, et al. Infections due to Lancefield group G streptococci. Medicine (Baltimore) 1985;64(2):75-88. https://doi.org/10.1097/00005792-198503000-00001

Diş Tedavisini Takiben Gelişen, Streptococcus anginosus’a Bağlı, Omuz Eklemini Tutan Bir Septik Artrit Olgusu

Year 2019, Volume: 33 Issue: 1, 31 - 35, 30.04.2019

Ali Ilgın Olut , Funda Balaylar Mehmet Umut Çayıröz Taşkın Altay

https://doi.org/10.5222/ankem.2019.191

Abstract

Romatolojik acil durumlar içinde sınıflanan septik ya da piyojenik artrit olarak da bilinen bakteriyel artritler erken tanı konulamaz ve uygun tedavi yapılamazsa kalıcı eklem harabiyetine yol açabilmektedir. Enfeksiyonun oluşma yolu ve hastaya bağlı risk faktörlerine göre enfeksiyon etkenleri değişkenlik gösterir. Tüm olgularda en sık görülen etkenler % 75-80 oranında Gram pozitif koklardır ancak immün yetmezlik, iv ilaç alışkanlığı, ileri yaşlar veya iatrojenik olgularda gram negatif basiller de etken olabilirler.
Streptococcus anginosus grubu bakteriler hareketsiz, fakültatif anaerop, diğer tüm streptokoklar gibi katalaz negatif gram pozitif koklar olup özellikle ağız boşluğu olmak üzere tüm gastrointestinal sistemin normal florasında bulunur. S.anginosus’a bağlı enfeksiyonların diğer streptokok enfeksiyonlarından farklı olarak en önemli karakteristiği apse oluşturma eğilimidir ve diğer düşük virülanslı streptokoklardan farklı olarak izolasyonunda gerçek patojen olarak kabul edilmelidir. Diş apseleri, gingivit gibi minör oral kavite enfeksiyonlarından, derin boyun enfeksiyonlarına, metastatik akciğer, karaciğer, beyin apselerine yol açabilmektedir. Literatürde kemik ve eklem tutulumu çok nadiren bildirilmiştir.
Bu sunumda sol omuzda şişlik ve ağrı şikayeti ile başvuran immün kompetan, 64 yaşındaki kadın hastada, diş tedavisinden bir ay sonra gelişen septik artrit tablosu bildirilmektedir. Hastanın başvurusundaki sinoviyal sıvı incelemesinde 26,000 lökosit/mm3, % 82 polimorfonükleer lökosit saptanması ve gram boyamada mikroorganizma görülmemesi üzerine ampirik piperasilintazobaktam+daptomisin iv tedavisi başlanmıştır. Kültür sonucunda dördüncü günde S.anginosus üremesi saptanınca piperasilin-tazobaktam kesilip tedaviye iv daptomisin ile devam edilerek 14 güne tamamlanmıştır. Hasta amoksisilin-klavulanik asit 1000 mg 2x1 oral antibiyoterapi ile taburcu edilmiş, iki hafta sonunda kontrolünde klinik iyileşme saptanarak tedavisi sonlandırılmıştır.

Keywords

diş tedavisi septik artrit Streptococcus anginosus

References

  • Al-Himdani S, Woodnutt D. Group C streptococcal septic arthritis of a prosthetic hip joint following dental treatment. BMJ Case Rep. 2015;22:1-4. https://doi.org/10.1136/bcr-2015-211203
  • Balentine LT, Papasian CJ, Burdick C. Septic arthritis of the knee due to Streptococcus anginosus. Diagn Microbiol Infect Dis. 1989;12(2):189-91. https://doi.org/10.1016/0732-8893(89)90012-6
  • Blankstein A, Amsallem JL, Rubinstein E, et al. Septic arthritis of the acromioclavicular joint. Arch Orthop Trauma Surg. 1985;103(6):417-8. https://doi.org/10.1007/BF00435451
  • Edson RS, Osmon DR, Berry DJ. Septic arthritis due to Streptococcus sanguis. Mayo Clin Proc. 2002;77(7):709-10. https://doi.org/10.4065/77.7.709
  • Fazili T, Riddell S, Kiska D, et al. Streptococcus anginosus group bacterial infections. Am J Med Sci. 2017;354(3):257-61. https://doi.org/10.1016/j.amjms.2017.05.011
  • Goldenberg DL, Reed JI. Bacterial arthritis. N Engl J Med. 1985;312(12):764-71. https://doi.org/10.1056/NEJM198503213121206
  • Houston BD, Crouch ME, Finch RG. Streptococcus MG-intermedius (Streptococcus milleri) septic arthritis in a patient with rheumatoid arthritis. J Rheumatol. 1980;7(1):89-92.
  • Hynd RF, Klofkorn RW, Wong JK. Streptococcus anginosus-constellatus infection of the sternoclavicular joint. J Rheumatol. 1984;11(5):713-5.
  • Jacobson JJ, Matthews LS. Bacteria isolated from late prosthetic joint infections: dental treatment and chemoprophylaxis. Oral Surg Oral Med Oral Pathol. 1987;63(1):122-6. https://doi.org/10.1016/0030-4220(87)90352-5
  • Johnson CC, Tunkel AR. Viridans streptococci, groups C and G streptococci, and Gemella morbillorum, “Mandell GL, Bennett JE, Dolin R (eds): Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases 6.baskı“ kitabında s.2434-51, Churchill Livingstone, Philadelphia (2005).
  • Kaandorp CJ, Dinant HJ, van de Laar MA, et al. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis. 1997;56(8):470-5. https://doi.org/10.1136/ard.56.8.470
  • Lever AM, Owen T, Forsey J. Pneumoarthropathy in septic arthritis caused by Streptococcus milleri. Br Med J. 1982;285(6334):24. https://doi.org/10.1136/bmj.285.6334.24
  • Maderazo EG, Judson S, Pasternak H. Late infections of total joint prostheses: a review and recommendations for prevention. Clin Orthop. 1988;229(229):131-42. https://doi.org/10.1097/00003086-198804000-00017
  • Papaioannides D, Boniatsi L, Korantzopoulos P, et al. Acute septic arthritis due to Streptococcus sanguis. Med Princ Pract. 2006;15(1):77-9. https://doi.org/10.1159/000089391
  • Patrick MR, Lewis D. Short of a length: Streptococcus sanguis knee infection from dental source. Br J Rheumatol. 1992;31(8):569. https://doi.org/10.1093/rheumatology/31.8.569-a
  • Peters RH, Rasker JJ, Jacobs JW, et al. Bacterial arthritis in a district hospital. Clin Rheumatol. 1992;11(3):351-5. https://doi.org/10.1007/BF02207192
  • Pioro MH, Mandell BF. Septic arthritis. Rheum Dis Clin North Am. 1997;23(2):239-58. https://doi.org/10.1016/S0889-857X(05)70328-8
  • Ross JJ. Septic arthritis of native joints. Infect Dis Clin North Am. 2017;31(2):203-18. https://doi.org/10.1016/j.idc.2017.01.001
  • Seviour PW, Dieppe PA. Sternoclavicular joint infecti on as a cause of chest pain. Br Med J. 1984;288(6411): 133-4. https://doi.org/10.1136/bmj.288.6411.133
  • Stratton CV, Sexton D, Baron EL. Infections due to the Streptococcus anginosus (Streptococcus milleri) group. Uptodate, Literature review current through Nov 2018.
  • Sullivan PM, Johnston RC, Kelley SS. Late infection after total hip replacement, caused by an oral organism after dental manipulation: a case report. J Bone Joint Surg Am. 1990;72:121-3. https://doi.org/10.2106/00004623-199072010-00019
  • Vartian C, Lerner PI, Shlaes DM, et al. Infections due to Lancefield group G streptococci. Medicine (Baltimore) 1985;64(2):75-88. https://doi.org/10.1097/00005792-198503000-00001
There are 22 citations in total.

Details

Primary Language Turkish
Subjects Clinical Microbiology
Journal Section Case Reports
Authors

Ali Ilgın Olut 0000-0003-4129-6453

Funda Balaylar 0000-0002-1884-2121

Mehmet Umut Çayıröz 0000-0002-5493-5499

Taşkın Altay 0000-0002-6917-934X

Publication Date April 30, 2019
Published in Issue Year 2019 Volume: 33 Issue: 1

Cite

Vancouver Olut AI, Balaylar F, Çayıröz MU, Altay T. Diş Tedavisini Takiben Gelişen, Streptococcus anginosus’a Bağlı, Omuz Eklemini Tutan Bir Septik Artrit Olgusu. ANKEM Derg. 2019;33(1):31-5.
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