technetium-tc-99m-medronate and Candidiasis

We reviewed 37 cases of septic arthritis in heroin users. Our data confirm the predominance of the fibrocartilaginous joint infections in this group (sacroiliac joint 39%, chondrosternocostal unions 37%). In Spain, Staphylococcus aureus is the most commonly isolated organism (73%). This emphasizes the geographic variations in the causative germs since, in contrast to other reports, we have not identified any gram negative bacillary arthritis in our population of heroin users. Our data show that the 67gallium citrate scintigraphy is positive earlier than the 99mTc-MDP bone scan in the poorly vascularized joints (p less than 0.0005). The early localization of the infectious focus by 67gallium citrate scintigraphy followed by a prompt bacteriologic diagnosis (blood, synovial fluid or tissue cultures) allowed good therapeutic results.

Topics: Adolescent; Adult; Arthritis, Infectious; Candidiasis; Female; Gallium Radioisotopes; Heroin Dependence; Humans; Joints; Male; Radionuclide Imaging; Staphylococcal Infections; Streptococcal Infections; Technetium Tc 99m Medronate

Nine cases of primary septic arthritis in heroin addicts are reported. Fibrous and cartilaginous joint localizations are prominent (four sternoarticular, three sacroiliac, one sacroccocygeal, and one knee). In all patients but one, conventional roentgenographic studies were negative. In six cases the causative agent was Staphylococcus aureus and in two cases, Candida albicans. In one case, it could not be determined. Our clinical observations, correlating the radioisotopic studies, suggest that in the first week of evolution the diagnostic procedure of choice is the [67Ga]citrate scintigram. Indeed, during this period the [99Tc]MDP bone scan is usually negative. The early demonstration and localization of the disease, together with the rapid bacteriologic diagnosis, allows for an early and more appropriate antibiotic treatment and better results.

Topics: Adolescent; Adult; Arthritis, Infectious; Bone and Bones; Candidiasis; Female; Gallium Radioisotopes; Heroin Dependence; Humans; Joints; Male; Radionuclide Imaging; Sacroiliac Joint; Staphylococcal Infections; Sternocostal Joints; Technetium Tc 99m Medronate; Time Factors

Topics: Aged; Candidiasis; Diphosphonates; Humans; Intervertebral Disc; Lumbar Vertebrae; Male; Osteomyelitis; Radiography; Radionuclide Imaging; Spondylitis; Technetium; Technetium Tc 99m Medronate