Olivier Cornu

Streptococcus gordonii septic arthritis: two cases and review of literature.

BackgroundDespite advances in antimicrobial and surgical therapy, septic arthritis remains a rheumatologic emergency that can lead to rapid joint destruction and irreversible loss of function. In adults, Staphylococcus aureus is the most common microorganism isolated from native joints. Streptococcus gordonii is a prominent member of the viridans group of oral bacteria and is among the bacteria most frequently identified as being primary agent of subacute bacterial endocarditis. To the best of our knowledge, Streptococcus gordonii has not yet been described as agent of septic arthritis.Case PresentationWe describe here two cases of septic arthritis due to Streptococcus gordonii. It gives us an opportunity to review epidemiology, diagnosis criteria and management of septic arthritis.ConclusionAlthough implication of S. gordonii as aetiologic agent of subacute endocarditis is well known, this organism is a rare cause of septic arthritis. In this case, the exclusion of associated endocarditis is warranted.

Ostéoarthrite tarsienne: une localisation rare de la tuberculose.

We report the case of a 39-year-old woman with an uneventful medical history who presented an inflammatory left foot with no notion of trauma or fever. The plain x-ray and magnetic resonance imaging demonstrated talonavicular and subtalar osteoarthritis. A surgical biopsy with excision of inflammatory and necrotic tissue and removal of a fistular tract was performed. Histology revealed the presence of granulomas with caseous central necrosis suggesting tuberculosis of the bone. The diagnosis was confirmed when bacteriology samples grew Mycobacterium tuberculosis. Antituberculosis drugs were administered for twelve months. At 24 months, the patient presents a painful stiff rear foot after the development of secondary talonavicular degeneration. This case illustrates a particular clinical presentation of tuberculosis. This diagnosis should be considered in the presence of atypical bony lesions with a chronic course. Early diagnosis enables proper therapeutic management. Useful diagnostic imaging techniques include plain x-rays, computed tomography, and magnetic resonance imaging. Certain diagnosis is based on bacteriological and histological examinations.

Inaccuracy in selection of massive bone allograft using template comparison method

The use of massive bone allografts is increasing year by year and selection method remains unchanged. Superposition of patient’s radiograph over allograft image and comparison of distances is the gold standard. Experiment was led to test selection procedure of a major european tissue bank. Four observers were asked to select an allograft for 10 fictive recipients. Nine allografts were provided. To simulate a perfect allograft, recipient himself was inserted in the pool of allografts (trap graft). The 10 potential bone transplants were classified in four categories (from adequate to unacceptable). In addition, observers were asked to choose the three best grafts for a given recipient. Quadratic kappa measuring agreement on classification between two observers ranged between 0.74 (substantial) and 0.47 (moderate). Trap graft was quoted by observers as adequate four times (10%) and was cited eight times (20%) among the three best matching allografts. None of the observers discovered that recipient was among allograft panel. This study demonstrates that current selection method is inaccurate for hemipelvic allograft selection. New methods should be developed and tested to assist tissue banks in bone allograft selection.

The neutrophil-to-lymphocyte ratio (NLR) after surgery for hip fracture (HF)

BACKGROUND The NLR is a prognostic factor for outcome and survival in cardiology, oncology and digestive surgery. NLR has not yet been studied in HF. METHODS Retrospective analysis of a prospective cohort of 247 consecutive patients, older than 65 years, operated for HF. Mortality at 12 months was registered, as the perioperative NLR values. RESULTS After hip surgery in the 247 patients (women 71%, median age 85 years, range: 66-102), the mortality was 27.2% [95%confidence interval (CI): 21.4-33.0] at 12 months. Univariate analysis detected four risk factors for mortality: age (Hazard Ratio (HR)--by 10 year-increments: 2.08 [95%CI: 1.37-3.17], P<0.001), male gender (HR: 1.92 [95%CI: 1.17-3.14], P=0.009, MCM (≥3) (HR: 1.71 [95%CI: 1.006-2.92], P=0.047 and NLR>5 at day 5 (HR: 1.8 [95%CI: 1.11-2.94], P=0.002). In multivariate analysis, two factors remained significantly associated with mortality: age (HR: 2.28 [95%CI: 1.49-3.47], P<0.001) and male gender (HR: 2.26 [95%CI: 1.38-3.72], P=0.001). Two independent risk factors of postoperative cardiovascular complications were identified: NLR>5 at day 5 (Odds Ratio (OR): 3.34 [95%CI: 2.33-4.80], P=0.001) and MCM (OR: 3.04 [95%CI: 2.16-4.29], P=0.006). A higher risk of infection was independently associated with a NLR>5 at day 5 (OR: 2.12 [95%CI: 1.44-3.11], P=0.02). CONCLUSIONS The NLR at fifth postoperative day is a risk factor of postoperative mortality and cardiovascular complications.

Osteomyelitis pubis caused by Kingella kingae in an adult patient: Report of the first case

BackgroundKingella kingae is the second most common pathogen causing paediatric arthritis and is described to be the causative bacteria in some paediatric osteomyelitis. Its microbiological detection is particularly difficult due to its slow growing. To our best knowledge this is the first case description of osteomyelitis pubis caused by this microorganism.Case presentationWe report the unusual case of pubic osteomyelitis with soft tissue abcess caused by Kingella kingae in an adult patient of 66 years with a history of end-stage renal disease and breast carcinoma. Diagnosis was based on imaging and the microorganism was isolated from Computed Tomography-guided aspiration of synovial fluid. The infection resolved completely after twelve weeks of treatment with oral amoxicillin.ConclusionThis case description highlights the importance in osteoarticular infections of systematic inoculation of synovial liquid in BACTEC vials to optimise the detection of causative organisms, which can necessitate specific treatments.

Does the quantitative functional assessment allow to better guide the treatment of the patient with severe hip osteoarthritis

Osteoarthritis (OA) is the most common degenerative joint disorder in the elderly, becoming a major public health problem. In Europe, more than 20% of the population older than 60 years live with disability attributed to osteoarthritis (Eumusc project 2015). Hip OA is characterized by severe musculoskeletal pain and limitation of articular movement gradually decreasing autonomy and quality of life of these patients. For example, the gait is illustrated by abnormal gait patterns associated with a reduced walking speed, a reduction of the hip muscle strength, and higher energetical costs relative to asymptomatic adults (e.g. Eitzen et al. 2012; Foucher et al. 2012; Schmitt et al. 2015). Quantitative and exhaustive functional assessment of these patients, according to the International Classification of Functioning, Disability and Health (ICF), therefore proves to be necessary as recommended by the World Health Organization. To our knowledge, only few studies (Hampson et al. 1994; Botha-Scheepers et al. 2006) have adopted this overall approach to investigate the repercussion of hip OA on activity limitation and restriction of participation in daily life. However, these studies are based only on qualitative assessment. Therefore, the purpose of this study was to investigate and highlight the interest of a quantitative functional assessment based on the ICF model as reference framework in order to measure and quantify disability in patients with severe hip OA. We hypothesized that more great is alteration of gait mechanism worst are clinical scores and more severe restriction of participation. 2. Methods