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Streptococcal endocarditis initially seen as septic arthritis
Abstract:
Two patients were initially seen with culture-positive streptococcal arthritis as an early manifestation of bacterial endocarditis. The organisms were an alpha-hemolytic, nongroup D streptococcus and a beta-hemolytic, group b streptococcus. One patient had a persistent septic monarthritis; the other had migratory arthritis in which a positive synovial culture was followed by a negative culture from the same joint before antimicrobial treatment was started. This experience suggests that some sterile synovial aspirates encountered in patients with bacterial endocarditis may be explained by delay of arthrocentesis.
Insights
Bacterial endocarditis can present as streptococcal arthritis. Delayed joint fluid analysis may lead to false-negative results in septic arthritis associated with endocarditis.
Area of Science:
- Infectious Diseases
- Rheumatology
- Cardiology
Background:
- Bacterial endocarditis is a serious infection affecting heart valves.
- Arthritis can be an uncommon early manifestation of bacterial endocarditis.
- Streptococcal species are known pathogens in infective endocarditis.
Observation:
- Two cases of culture-positive streptococcal arthritis as an early sign of bacterial endocarditis are presented.
- One patient experienced persistent septic monarthritis.
- The second patient presented with migratory arthritis, showing a transient positive synovial culture.
Findings:
- The identified streptococci were an alpha-hemolytic, nongroup D strain and a beta-hemolytic, group B strain.
- A key observation was a positive synovial fluid culture followed by a negative culture from the same joint prior to antibiotic therapy in one patient.
- This suggests that the timing of joint fluid aspiration is critical.
Implications:
- The study suggests that delayed arthrocentesis (joint fluid aspiration) may result in sterile synovial fluid findings in patients with bacterial endocarditis.
- This highlights the importance of considering bacterial endocarditis in patients presenting with unexplained arthritis, even with initially negative joint cultures.
- Early and appropriate diagnostic procedures are crucial for timely diagnosis and treatment of infective endocarditis and its musculoskeletal manifestations.