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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">El 15&#37; de las artritis s&#233;pticas corresponde a formas poliarticulares&#44; si bien son escasas las series publicadas&#46; Evaluamos las caracter&#237;sticas de los enfermos con artritis s&#233;ptica poliarticular recogidos en un servicio de reumatolog&#237;a&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todo</span><p class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis retrospectivo de las artritis pi&#243;genas con afecci&#243;n oligoarticular o poliarticular&#46; Se incluye &#250;nicamente a los enfermos con aislamiento del germen en el l&#237;quido articular&#46; Se analizan las variables cl&#237;nicas&#44; anal&#237;ticas y radiol&#243;gicas de la serie&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se registraron 19 casos &#40;14 varones y 5 mujeres&#41; con una media de edad de 55 a&#241;os&#46; La media del tiempo hasta el diagn&#243;stico fue 6 d&#237;as&#46; La articulaci&#243;n afectada con mayor frecuencia fue la rodilla&#44; seguida del tobillo&#46; La media de focos infecciosos por paciente fue 3 &#40;intervalo&#44; 2-6&#41;&#46; Los factores de riesgo m&#225;s frecuentes fueron la diabetes mellitus&#44; la insuficiencia renal cr&#243;nica&#44; la hepatopat&#237;a cr&#243;nica&#44; la gota y la artritis reumatoide&#46; Los g&#233;rmenes aislados fueron <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;47&#37;&#41;&#44; <span class="elsevierStyleItalic">S&#46; agalactiae</span> &#40;21&#37;&#41; y bacilos gramnegativos&#46; Los hemocultivos fueron positivos en el 52&#44;6&#37;&#44; y el 15&#44;8&#37; present&#243; shock s&#233;ptico&#46; La gammagraf&#237;a con <span class="elsevierStyleSup">99</span>Tc mostr&#243; la afecci&#243;n polit&#243;pica cuando fue realizada&#46; La duraci&#243;n media del tratamiento antibi&#243;tico fue 46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27 d&#237;as&#46; La evoluci&#243;n fue satisfactoria en el 52&#44;6&#37; y t&#243;rpida en el 26&#37;&#44; con mortalidad del 15&#44;8&#37; &#40;3 casos&#41;&#46; Se realiz&#243; artrotom&#237;a en el 21&#37;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La presencia de oligoartritis o poliartritis no excluye el diagn&#243;stico de artritis infecciosa&#46; Entre los factores de riesgo destacan las artropat&#237;as inflamatorias previas&#46; <span class="elsevierStyleItalic">S&#46; aureus</span> es el microorganismo causal m&#225;s frecuente&#46; La morbilidad y la mortalidad de esta forma de infecci&#243;n articular son importantes&#44; por lo que debe mantenerse un alto &#237;ndice de sospecha y realizar una exploraci&#243;n sistem&#225;tica de todas las articulaciones&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">Polyarticular septic arthritis accounts for 15&#37; of all septic arthritis&#44; but there are few references in the literature&#46; We describe characteristics of patients with polyarticular septic arthritis in a rheumatology service&#46;</p> <span class="elsevierStyleSectionTitle">Patients and method</span><p class="elsevierStyleSimplePara elsevierViewall">Retrospective analysis of patients with septic arthritis involving more than one joint&#46; Only patients with positive culture of synovial fluid were included&#46; Clinical&#44; analytical and radiological variables are reviewed&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">19 patients &#40;14 male&#41; had a polyarticular infection&#46; Mean age was 55 years&#46; Mean time from onset to diagnosis was 6 days&#46; The knee was the most commonly involved joint&#44; followed by ankle&#46; The mean number of joints involved per patient was 3&#46; Risk factors included diabetes&#44; chronic renal or hepatic disease&#44; gout and rheumatoid arthritis&#46; Most commonly isolated agents were <span class="elsevierStyleItalic">S&#46; aureus</span> &#40;47&#37;&#41; and <span class="elsevierStyleItalic">S&#46; agalactiae</span> &#40;21&#37;&#41;&#46; Blood cultures were positive in 52&#44;6&#37; and 15&#46;8&#37; had septic shock&#46; Scintygraphic bone scan showed a polyarticular uptake&#46; Mean duration of antibiotic therapy was 46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27 days&#46; Clinical outcome was good in 52&#44;6&#37;&#44; complicated in 26&#37;&#44; and mortality rate was 15&#46;8&#37; &#40;3 cases&#41;&#46; Joint debridement was performed in 21&#37;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Multiple joint involvement does not exclude the diagnosis of septic arthritis&#46; Inflammatory arthritis is an important risk factor&#46; S&#46; aureus in the main infectious agent&#46; The morbidity and mortality of this condition are important&#44; so we need to maintain a high index of suspicion for the condition&#46;</p>"
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Vol. 5. Núm. 1.
Páginas 18-22 (febrero - febrero 2009)
Original
Acceso a texto completo
Artritis séptica politópica: análisis de 19 casos
Polyarticular septic arthritis: analysis of 19 cases
Visitas
13821
Lourdes Mateo Soria
Autor para correspondencia
lmateo.germanstrias@gencat.net

Autor para correspondencia.
, Alejandro Olivé Marqués, Elisabet García Casares, Emma García Melchor, Susana Holgado Pérez, Xavier Tena Marsà
Sección de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
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Resumen
Objetivo

El 15% de las artritis sépticas corresponde a formas poliarticulares, si bien son escasas las series publicadas. Evaluamos las características de los enfermos con artritis séptica poliarticular recogidos en un servicio de reumatología.

Material y método

Análisis retrospectivo de las artritis piógenas con afección oligoarticular o poliarticular. Se incluye únicamente a los enfermos con aislamiento del germen en el líquido articular. Se analizan las variables clínicas, analíticas y radiológicas de la serie.

Resultados

Se registraron 19 casos (14 varones y 5 mujeres) con una media de edad de 55 años. La media del tiempo hasta el diagnóstico fue 6 días. La articulación afectada con mayor frecuencia fue la rodilla, seguida del tobillo. La media de focos infecciosos por paciente fue 3 (intervalo, 2-6). Los factores de riesgo más frecuentes fueron la diabetes mellitus, la insuficiencia renal crónica, la hepatopatía crónica, la gota y la artritis reumatoide. Los gérmenes aislados fueron Staphylococcus aureus (47%), S. agalactiae (21%) y bacilos gramnegativos. Los hemocultivos fueron positivos en el 52,6%, y el 15,8% presentó shock séptico. La gammagrafía con 99Tc mostró la afección politópica cuando fue realizada. La duración media del tratamiento antibiótico fue 46±27 días. La evolución fue satisfactoria en el 52,6% y tórpida en el 26%, con mortalidad del 15,8% (3 casos). Se realizó artrotomía en el 21%.

Conclusiones

La presencia de oligoartritis o poliartritis no excluye el diagnóstico de artritis infecciosa. Entre los factores de riesgo destacan las artropatías inflamatorias previas. S. aureus es el microorganismo causal más frecuente. La morbilidad y la mortalidad de esta forma de infección articular son importantes, por lo que debe mantenerse un alto índice de sospecha y realizar una exploración sistemática de todas las articulaciones.

Palabras clave:
Poliartritis séptica
Infección poliarticular
Embolia séptica
Abstract
Objective

Polyarticular septic arthritis accounts for 15% of all septic arthritis, but there are few references in the literature. We describe characteristics of patients with polyarticular septic arthritis in a rheumatology service.

Patients and method

Retrospective analysis of patients with septic arthritis involving more than one joint. Only patients with positive culture of synovial fluid were included. Clinical, analytical and radiological variables are reviewed.

Results

19 patients (14 male) had a polyarticular infection. Mean age was 55 years. Mean time from onset to diagnosis was 6 days. The knee was the most commonly involved joint, followed by ankle. The mean number of joints involved per patient was 3. Risk factors included diabetes, chronic renal or hepatic disease, gout and rheumatoid arthritis. Most commonly isolated agents were S. aureus (47%) and S. agalactiae (21%). Blood cultures were positive in 52,6% and 15.8% had septic shock. Scintygraphic bone scan showed a polyarticular uptake. Mean duration of antibiotic therapy was 46±27 days. Clinical outcome was good in 52,6%, complicated in 26%, and mortality rate was 15.8% (3 cases). Joint debridement was performed in 21%.

Conclusions

Multiple joint involvement does not exclude the diagnosis of septic arthritis. Inflammatory arthritis is an important risk factor. S. aureus in the main infectious agent. The morbidity and mortality of this condition are important, so we need to maintain a high index of suspicion for the condition.

Keywords:
Polyarticular septic arthritis
Infectious arthritis
Septic embolism
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Copyright © 2009. Elsevier España S.L. Barcelona
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