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[Bacterial arthritis with E. coli in an elderly patient]
1Dept. of Medicine B, Chaim Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel Aviv University.
Harefuah
|December 15, 1994
Summary
Elderly patients with fever may have infectious arthritis, even without immune deficiency. Early diagnosis of Gram-negative bacterial joint infections is crucial to prevent irreversible joint damage.
Area of Science:
- Medicine
- Infectious Diseases
- Rheumatology
Background:
- Infectious arthritis typically results from Gram-positive bacteria, often affecting damaged joints.
- An increasing trend of Gram-negative bacterial joint infections is observed, particularly in immunocompromised individuals.
- Gram-negative infections are associated with systemic diseases like malignancy, cirrhosis, and HIV.
Observation:
- An 84-year-old male presented with fever and pneumonia, later developing right knee pain.
- Physical examination revealed local inflammation of the knee.
- Synovial fluid, blood, and urine cultures confirmed E. coli infection originating from the urinary tract.
Findings:
- The patient, despite being elderly, lacked underlying systemic diseases that typically predispose to Gram-negative infections.
- This case highlights a Gram-negative infectious arthritis in an elderly patient without apparent immune deficiency.
- Successful treatment involved intravenous antibiotics and surgical drainage of the knee.
Implications:
- This case underscores the importance of considering infectious arthritis in febrile elderly patients, even without typical risk factors.
- Deeply located joint infections (hip, shoulder, vertebrae) may present subtly, delaying diagnosis.
- Prompt recognition and treatment are essential to prevent severe joint damage and long-term complications.