Simon Jamard , Marion Lacasse , Louis Bernard, Adrien Lemaignen
{"title":"Les centres de référence des infections ostéoarticulaires (CRIOAC) en France","authors":"Simon Jamard , Marion Lacasse , Louis Bernard, Adrien Lemaignen","doi":"10.1016/j.monrhu.2022.02.002","DOIUrl":"10.1016/j.monrhu.2022.02.002","url":null,"abstract":"<div><p>Bone and joint infections (BJI) are rare but have a high morbidity and economic burden. The complexity of these infections is the consequence of their heterogeneous clinical presentation and is responsible for significant heterogeneity in their management. Risk factors for failure were identified based on the analysis of pre-existing registries and led to the emergence of a new definition : Complex-BJI. This definition has allowed a better categorization of these infections and the targeting of those with a more serious vital and functional prognosis and a high economic impact. In order to offer a homogeneous and optimal management of these infections, the need for a multidisciplinary expertise became apparent and the Ministry of Health, supported by the healthcare societies, set up a national network of referral centers for complex bone and joint infections in 2008. These centers have been implemented sequentially throughout the French territory and, currently, 9 reference centers and 21 associate centers were certified. Their role are: 1) to provide advice on the management of BJI at a local and regional level and especially for Complex-BJI through periodic multidisciplinary meetings involving at least an infectious diseases specialist, an orthopedic surgeon and a microbiologist; 2) to organize learning sessions for BJI management with the creation of a postgraduate diploma and the organization of a national scientific meetings focused on these infections; 3) to promote clinical research and technological development by conducting national-wide clinical trials and epidemiological analysis based on the data from multidisciplinary meetings recorded in a national registry.</p></div>","PeriodicalId":101125,"journal":{"name":"Revue du Rhumatisme Monographies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76464555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Imagerie du rachis infectieux","authors":"Valérie Bousson, Grégoire Attané, Nicolas Benoist, Laetitia Perronne, Bassam Hamzé, Valérie Chicheportiche","doi":"10.1016/j.monrhu.2022.01.004","DOIUrl":"10.1016/j.monrhu.2022.01.004","url":null,"abstract":"<div><p>Musculoskeletal infection is a severe infection, especially when it involves the spine. It is multifaceted: spondylodiscitis, spondylitis, arthritis, and epidural abscesses. It always necessitates fast diagnostic and therapeutic interventions. It affects elderly subjects. A poor clinical status, a poor clinical tolerance, the presence of neurological signs, and location of the disease at the cervical spine, are factors of severity. Imaging aims at making a positive diagnosis of infection, at depicting extension of the disease, and help to isolate the pathogen. The most common pathogens remain <em>Staphylococcus aureus, Streptococci, Mycobacterium tuberculosis.</em></p></div>","PeriodicalId":101125,"journal":{"name":"Revue du Rhumatisme Monographies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88249213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Infections ostéo-articulaires à bactéries rares ou atypiques","authors":"Sophie Godot , Valérie Zeller , Beate Heym , Pascal Chazerain","doi":"10.1016/j.monrhu.2022.01.003","DOIUrl":"10.1016/j.monrhu.2022.01.003","url":null,"abstract":"<div><p>Microbiological identification is essential for the management of bone and joint infections. However, the detection of the pathogen is sometimes difficult. In case of a negative sample and/or depending on the context, the presence of so-called atypical bacteria is to be mentioned and looked for. This article reports the main characteristics of osteoarticular infections caused by atypical mycobacteria, <em>Brucella</em> sp., <em>Pasteurella</em> sp., <em>Bartonella henselae</em> and <em>Kingella kingae</em>. Tuberculosis infections and Whipple's disease will be discussed in other articles in the journal.</p></div>","PeriodicalId":101125,"journal":{"name":"Revue du Rhumatisme Monographies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89340628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Prise en charge d’une spondylodiscite infectieuse (hors mal de Pott)","authors":"Benoit Le Goff","doi":"10.1016/j.monrhu.2021.10.007","DOIUrl":"10.1016/j.monrhu.2021.10.007","url":null,"abstract":"<div><p>Management of vertebral osteomyelitis remains challenging and complex. Occurring mainly in elderly and frail patients, it needs a multidisciplinary approach with rheumatologists, infectious disease physicians, bacteriologists and surgeons. The corner stone of the management remains the antibiotics that are ideally introduced after bacterial identification. Initial clinical and imaging evaluation is necessary to decide the type and duration of immobilization. A rapid rehabilitation of the patient is necessary to prevent complications associated with the prolonged bed rest and its well-known morbidity. Presence of neurological complications or soft tissue abscesses are potential indications for surgery that needs to be discussed at the initial phase of the management and during the course of the disease. Finally, monitoring of the efficacy and tolerance of the therapy over the short, middle and long terms remains necessary to detect any possible sequelae. In the review, we will discuss each step of this management.</p></div>","PeriodicalId":101125,"journal":{"name":"Revue du Rhumatisme Monographies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84647080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Maladie de Whipple : généralités et manifestations articulaires","authors":"David Luque-Paz, Pierre Tattevin","doi":"10.1016/j.monrhu.2021.10.005","DOIUrl":"10.1016/j.monrhu.2021.10.005","url":null,"abstract":"<div><p>Whipple disease is a rare chronic infection due to <em>Trophyrema whipplei</em>, potentially lethal in the absence of appropriate anti-infective treatment. The clinical presentation is either of classical Whipple disease or of localized infection. Symptoms of classic Whipple disease include weight loss, diarrhea and arthralgia. Arthropathy is usually migratory, seronegative and non-destructive joint disease affecting preferentially large peripheral joints.</p><p>Polymorphous and non-specific symptoms and signs, combined with its low incidence and the failure to grow on standard culture media make Whipple disease a hard-to-diagnose infection, with a diagnosis delay of several years after symptoms onset in most cases. The diagnosis of classical Whipple's disease is based on PCR using sample fluids (stool, saliva, urine and blood) and has to be confirmed by duodenal biopsies.</p><p>To date, there are no guidelines available for the treatment of <em>T.</em> <em>whipplei</em> infections. Current anti-infective treatment is based on third generation cephalosporins on initial course, and then be followed by oral doxycyclin (or sulfamethoxazole-trimethoprim) for at least twelve months. Relapses and immune reconstitution inflammatory syndrome are the main complications.</p></div>","PeriodicalId":101125,"journal":{"name":"Revue du Rhumatisme Monographies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76474416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Les microbes en rhumatologie : la suite !","authors":"Pascal Guggenbuhl","doi":"10.1016/j.monrhu.2022.02.003","DOIUrl":"10.1016/j.monrhu.2022.02.003","url":null,"abstract":"","PeriodicalId":101125,"journal":{"name":"Revue du Rhumatisme Monographies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85635076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erick Legrand, Emmanuel Hoppé, Iden Al Sabty, Nicolas Rosine, Béatrice Bouvard
{"title":"Particularités des infections ostéo-articulaires tuberculeuses","authors":"Erick Legrand, Emmanuel Hoppé, Iden Al Sabty, Nicolas Rosine, Béatrice Bouvard","doi":"10.1016/j.monrhu.2022.01.005","DOIUrl":"10.1016/j.monrhu.2022.01.005","url":null,"abstract":"<div><p>Bone, articular or spinal tuberculosis is rare (200 to 300 cases per year in France) but should not be forgotten, in particular in patients with an osteoarticular infection, with negative initial bacteriology. The risk of tuberculosis is higher in foreign patients, immunosuppressed, homeless, prisoners or people living in precarious conditions. The destructive bone involvement of tuberculosis can mimic tumor pathology, emphasizing the importance of quality histological analysis, in front of a solid or multifocal lytic image. Tuberculous monoarthritis, subacute or chronic, looks like the onset of inflammatory rheumatism, justifying the performance, in the slightest doubt, of a synovial biopsy. The possibility of performing a PCR, from bone, joint or spinal samples, saves time for the initiation of a complex antibiotic therapy, which is effective but source of potentially serious side effects. Methodical, close, clinical, radiographic and biological monitoring is essential to support the patient for 6 to 9 months.</p></div>","PeriodicalId":101125,"journal":{"name":"Revue du Rhumatisme Monographies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79915025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"La pyomyosite, au-delà des tropiques","authors":"Charles Masson","doi":"10.1016/j.monrhu.2021.10.003","DOIUrl":"10.1016/j.monrhu.2021.10.003","url":null,"abstract":"<div><p>Pyomyositis, a bacterial infection of one or more skeletal muscles of the trunk, limbs, or pelvis, is most often caused by <em>Staphylococcus aureus</em>, apparently expressing the Panton and Valentine leukocidin toxin. Initially described as a tropical disease, it can occur in all climates, with a clear increase in its incidence, both in children and adults. It progresses in three anatomical stages leading to an abscessed collection. Risk factors exist but are inconsistent. It may be complicated by septic emboli depending on the delay in diagnosis and therefore management or the frailty of the patient. The presence of septic arthritis in the vicinity leads to discussion of the origin of the infection, primary versus secondary pyomyositis. Effective imaging includes ultrasound of the painful area, CT-scan and especially MRI. The microroganism is identified quite rarely on blood cultures, possibly on puncture under ultrasound or CT-scan of the infected muscle. Other bacteria than <em>Staphylococcus aureus</em> can be responsible. Sometimes pyomyositis is multi-bacterial. A PCR research by 16S ribosomal RNA in the muscle sampling material is proposed. Single muscle involvement with inflammatory syndrome also leads to discussion of focal myositis or muscle infarction. Pyomyositis implies systematic antibiotic therapy given for a period of three to four weeks, focused initially on S<em>taphylococcus aureus</em>, but sometimes also on a <em>negative bacillus</em> in the case of immunosuppression, and adapted subsequently according to bacteriological results/evolution. An abscessed fluid collection can be drained under ultrasound or CT-scan, and sometimes if necessary in the operating room.</p></div>","PeriodicalId":101125,"journal":{"name":"Revue du Rhumatisme Monographies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77917278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jean-Guillaume Letarouilly , Alice Clowez , Eric Senneville , Bernard Cortet , René-Marc Flipo
{"title":"Épidémiologie et écologie des infections ostéoarticulaires bactériennes","authors":"Jean-Guillaume Letarouilly , Alice Clowez , Eric Senneville , Bernard Cortet , René-Marc Flipo","doi":"10.1016/j.monrhu.2022.01.002","DOIUrl":"10.1016/j.monrhu.2022.01.002","url":null,"abstract":"<div><p>Septic arthritis and infectious spondylodiscitis are a classic cause of hospital admission in rheumatology, orthopedics or infectious diseases departments with a high morbimortality. Their incidence is increasing as well as the number of patients with comorbidities such as diabetes. There has not been much change in ecology over the past thirty years with a predominance of staphylococci and streptococci. The association with endocarditis remains classic, especially for staphylococcal and streptococcal infections. The search for microbiological documentation is therefore fundamental to treat the patients with the appropriate antibiotic therapy to limit the morbidity of these osteoarticular infections.</p></div>","PeriodicalId":101125,"journal":{"name":"Revue du Rhumatisme Monographies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85956092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Infections rachidiennes de l’adulte autres que la spondylodiscite : l’envers des corps vertébraux","authors":"Simon Cadiou , Rachel Tuil , Géraldine Bart , Yann Breton","doi":"10.1016/j.monrhu.2021.11.003","DOIUrl":"10.1016/j.monrhu.2021.11.003","url":null,"abstract":"<div><p>Spinal infections other than vertebral osteomyelitis are mainly represented by facet joint septic arthritis (FJSA). The clinical presentation most often mimics vertebral osteomyelitis. The diagnosis is made by MRI, which sometimes shows abscesses of the adjacent soft tissues (muscular and epidural). Bacteriological documentation by blood cultures is usually sufficient, but a scan-guided puncture or even surgical management is sometimes necessary. Neurological deficit is the main complication of FJSA and requires urgent surgical management. Appropriate antibiotic therapy, most often against methicillin sensitive <em>Staphylococcus aureus</em>, is generally maintained for 6 to 12 weeks. The total duration of treatment is not recommended and depends on the presence or absence of a medically or surgically treated epidural abscess and the causative bacteria. Isolated and spontaneous epidural abscess is another spinal infection that can mimic the clinical presentation of spondylodiscitis and ASIA. Its management requires a surgical opinion, as it often leads to deficits.</p></div>","PeriodicalId":101125,"journal":{"name":"Revue du Rhumatisme Monographies","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82497972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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