ro13-9904 and Arthralgia

Borrelia burgdorferi is a major cause of morbidity in wooded area in western Europe and the eastern seaboard of the U.S.A. Diagnosis of late stage infection and associated disorders may be difficult and often requires an array of different diagnostic procedures. Here we report an 11-year-old girl with acrodermatitis chronica atrophicans affecting all four limbs and parts of the trunk. The diagnosis was made on the basis of clinical appearance, serological and histopathological findings, and the lesional detection of B. burgdorferi-specific gene segments by polymerase chain reaction. This very unusual, severe case illustrates that despite being a late manifestation of tick-borne B.burgdorferi infection, usually occurring in adults, acrodermatitis chronica atrophicans may already appear at a young age and may be characterized by extensive skin involvement.

Topics: Acrodermatitis; Antibodies, Bacterial; Arthralgia; Borrelia burgdorferi; Ceftriaxone; Cephalosporins; Child; Enzyme-Linked Immunosorbent Assay; Female; Humans; Immunoglobulin G; Immunoglobulin M; Lyme Disease

Optimal treatment remains uncertain for patients with cognitive impairment that persists or returns after standard IV antibiotic therapy for Lyme disease.. Patients had well-documented Lyme disease, with at least 3 weeks of prior IV antibiotics, current positive IgG Western blot, and objective memory impairment. Healthy individuals served as controls for practice effects. Patients were randomly assigned to 10 weeks of double-masked treatment with IV ceftriaxone or IV placebo and then no antibiotic therapy. The primary outcome was neurocognitive performance at week 12-specifically, memory. Durability of benefit was evaluated at week 24. Group differences were estimated according to longitudinal mixed-effects models.. After screening 3368 patients and 305 volunteers, 37 patients and 20 healthy individuals enrolled. Enrolled patients had mild to moderate cognitive impairment and marked levels of fatigue, pain, and impaired physical functioning. Across six cognitive domains, a significant treatment-by-time interaction favored the antibiotic-treated group at week 12. The improvement was generalized (not specific to domain) and moderate in magnitude, but it was not sustained to week 24. On secondary outcome, patients with more severe fatigue, pain, and impaired physical functioning who received antibiotics were improved at week 12, and this was sustained to week 24 for pain and physical functioning. Adverse events from either the study medication or the PICC line were noted among 6 of 23 (26.1%) patients given IV ceftriaxone and among 1 of 14 (7.1%) patients given IV placebo; these resolved without permanent injury.. IV ceftriaxone therapy results in short-term cognitive improvement for patients with posttreatment Lyme encephalopathy, but relapse in cognition occurs after the antibiotic is discontinued. Treatment strategies that result in sustained cognitive improvement are needed.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Arthralgia; Brain; Ceftriaxone; Cognition Disorders; Double-Blind Method; Drug Administration Schedule; Female; Humans; Injections, Intravenous; Lyme Neuroborreliosis; Male; Middle Aged; Neuropsychological Tests; Placebo Effect; Placebos; Recurrence; Time; Treatment Outcome

Whipple's disease is a chronic, rare, multisystemic, infectious entity, described for the first time in 1907. Its aetiological agent is the Gram-negative rod,

Topics: Abdominal Pain; Administration, Intravenous; Aged; Anti-Bacterial Agents; Arthralgia; Biopsy; Ceftriaxone; Diarrhea; Duodenum; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Whipple Disease

Our patient's signs and symptoms developed one week after being bitten by a rat that she was feeding to her son's pet snake.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Arthralgia; Ceftriaxone; Dyspnea; Female; Fever; Humans; Middle Aged; Purpura; Rat-Bite Fever; Rats

Arthralgia is a rare but recognised complication of meningococcal septicaemia. We report a case of a 29-year-old man presenting with a 24 h history of fever, joint swelling and subsequent development of a non-blanching, petechial rash. He was treated for probable meningococcal septicaemia and the causative pathogen was later identified as Neisseria meningitidis. He was treated with ceftriaxone and after 10 days the pain and swelling in his joints improved.

Topics: Adult; Anti-Bacterial Agents; Arthralgia; Bacteremia; Ceftriaxone; Humans; Male; Meningococcal Infections; Neisseria meningitidis; Treatment Outcome

Streptococcus agalactiae is not only a well-known cause of severe infections in the first 3 months of life but also an unusual organism to be isolated in case of septic arthritis, especially in children. We report a case of a monoarticular arthritis in a 6-month-old girl.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Arthralgia; Arthritis, Infectious; Ceftriaxone; Female; Humans; Infant; Knee Joint; Rifampin; Streptococcal Infections; Streptococcus agalactiae; Ultrasonography

Topics: Adolescent; Anti-Bacterial Agents; Arthralgia; Ceftriaxone; Clindamycin; Diagnosis, Differential; Drainage; Empyema; Fever; Follow-Up Studies; Fusobacterium necrophorum; Humans; Knee Joint; Lemierre Syndrome; Lung; Male; Pharyngitis; Pleural Effusion; Shock, Septic; Tomography, X-Ray Computed; Treatment Outcome

Topics: Acetaminophen; Analgesics, Non-Narcotic; Ankle Joint; Anti-Bacterial Agents; Arthralgia; Ceftriaxone; Child, Preschool; Diagnosis, Differential; Emergency Nursing; Exanthema; Fever; Fluid Therapy; Humans; Ibuprofen; IgA Vasculitis; Lower Extremity; Male; Sodium Chloride; Triage

Topics: Adult; Anti-Bacterial Agents; Arthralgia; Biopsy; Ceftriaxone; Diagnosis, Differential; Gonorrhea; Humans; Male; Neisseria gonorrhoeae; Skin

Abdominal pain is common feature of Henoch-Schonlein purpura, which may mimic appendicitis, leading to unnecessary laparotomy. Accordingly, the diagnosis must be confirmed by ultrasonography or computed tomography scan before laparotomy is performed. The authors report a case of simultaneous occurrence of Henoch-Schonlein Purpura and gangrenous appendicitis in an 18 year-old boy. The patient was admitted with abdominal pain, cramps, and mild dehydration. He also complained of small reddish purple on his lower limbs, bilateral knee pain, low-grade fever, as well as bloody stools. The symptoms subsided completely. Eight days later, he returned with nonbloody, nonbilious emesis, abdominal cramps, and right lower quadrant abdominal tenderness. Abdominal ultrasound evaluation was performed to rule out an intussusception but demonstrated appendiceal dilatation with a possible appendicolith without any evidence of intussusception. A laparotomy was undertaken, and appendectomy was performed for gangrenous appendicitis. Simultaneous occurrence of Henoch-Schonlein purpura and acute appendicitis is rarely observed. Clinical features of the patients may mislead the clinicians, resulting in delayed diagnosis or misdiagnosis. The use of ultrasonography and computed tomography scan would confirm the diagnosis before surgery.

Topics: Abdominal Pain; Adolescent; Anti-Bacterial Agents; Appendectomy; Appendicitis; Arthralgia; Ceftriaxone; Combined Modality Therapy; Diagnosis, Differential; False Negative Reactions; Fever; Gangrene; Gastrointestinal Hemorrhage; Humans; Hydrocortisone; IgA Vasculitis; Intussusception; Male; Metronidazole; Prednisone; Ultrasonography

Lyme borreliosis is an endemic disease in Slovenia with an incidence of around 150 patients per 100,000 inhabitants. Although the large joints are most typically affected in Lyme borreliosis, there are also periods of disease activity with arthritis or arthralgias involving smaller joints, including the temporo-mandibular joint.. During the years between 2000 and 2003, two patients with Lyme borreliosis affecting the temporo-mandibular joints were treated. The patients presented with fatigue and pain in diverse muscle groups accompanied by arthralgia, which was most pronounced in the temporomandibular joint area. None of the patients were febrile or had joint effusions.. Both patients were examined by means of biochemical and serological examinations for Borrelia burgdorferi using ELISA assay and Western blot test (both for IgM and IgG), plain radiographs, MR and CT scans, and scinti-scan of the temporo-mandibular joints They both had positive serum markers for an acute B. burgdorferi infection and were treated with intravenous ceftriaxone.. None of the patients had clinical or laboratory signs of chronic Lyme disease activity two and four years following therapy, respectively. Roentgenographic and nuclear magnetic resonance imaging of the temporo-mandibular joints had not shown any persistent sign of acute inflammation.. There are only few reports of patients with manifest temporo-mandibular joint involvement of Lyme borreliosis in the literature. This report emphasizes the importance of differential diagnosis of acute temporo-mandibular joint arthralgia, of early diagnosis of Lyme borreliosis, and of the necessity for prompt antibiotic treatment.

Topics: Anti-Bacterial Agents; Antibodies, Bacterial; Arthralgia; Biomarkers; Borrelia burgdorferi; Ceftriaxone; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Immunoglobulin G; Immunoglobulin M; Lyme Disease; Magnetic Resonance Imaging; Male; Middle Aged; Temporomandibular Joint Disorders; Tomography, X-Ray Computed

Whipple's disease is a rare chronic multi-systemic infectious disorder caused by the Gram-positive bacillus, Tropheryma whippelii. Infection may involve any organ in the body, and most commonly affects white men in the fourth to sixth decades of life. The most common presenting symptoms are gastrointestinal and include abdominal pain, diarrhoea, anorexia and associated weight loss. However, the variability in presentation is considerable and some patients may present with intermittent low-grade fever, neurological abnormalities (nystagmus, ophthalmoplegia, cranial nerve defects), migratory arthralgia, lymphadenopathy, or involvement of the cardiovascular system. In typical Whipple's disease, the most severe changes are seen in the proximal small intestine and biopsy reveals mucosal and lymph node infiltration with large, foamy histocytes, containing granules that stain positive with periodic acid-Schiff (PAS) reagent and represent intact or partially degraded bacteria. Extended antibiotic treatment (up to 1-year) is indicated. Life-long surveillance for recurrence is essential, once primary treatment has been completed. We report the case of a 58-year-old man who developed a rare infection with the actinobacterium, T. whippelii. The patient had suffered intermittent episodes of varying clinical symptoms associated with multiple hospital admissions and clinical diagnoses, spanning a period of 22 years. Historically, arthralgia was the primary manifestation in this patient and also was the chief complaint for which he was first hospitalized 22 years ago. At his most recent admission to our hospital department, his presenting symptoms were persistent fatigue, weight loss, arthralgia and diarrhoea. Thus, it is essential that clinicians retain a high index of suspicion for T. whippelii infection in patients who have a long-term history of arthritis, fever and diarrhoea.

Topics: Anti-Bacterial Agents; Arthralgia; Ceftriaxone; Diagnosis, Differential; Diarrhea; Doxycycline; Drug Therapy, Combination; Duodenoscopy; Duodenum; Fever; Humans; Intestinal Mucosa; Male; Middle Aged; Periodic Acid-Schiff Reaction; Treatment Outcome; Weight Loss; Whipple Disease

A previously well 30-year-old man presented with severe progressive back pain, joint pain and fever. Magnetic resonance imaging confirmed an epidural abscess. A sexual history revealed both risk factors for and previous symptoms of a sexually acquired infection. Neisseria gonorrhoeae was isolated from a rectal swab and from a wrist aspirate, consistent with disseminated gonococcal infection. The epidural abscess resolved clinically and radiologically after treatment for N. gonorrhoeae with ceftriaxone.

Topics: Adult; Anti-Bacterial Agents; Arthralgia; Back Pain; Ceftriaxone; Epidural Abscess; Fever; Gonorrhea; Humans; Male; Medical History Taking; Neisseria gonorrhoeae; Treatment Outcome