Gout Clinical Update, August 12, 2011

Staphylococcus Simulans as an Authentic Pathogenic Agent of Osteoarticular Infections

New data suggests that even though Staphylococcus simulans remains rarely observed in clinical pathology, its role in osteoarticular infections, especially in the case of infected orthopedic devices, is not exceptional. As for the antibiotic treatment, the combination of rifampicin and levofloxacin seems to be an effective strategy according to results from researchers at in the infectious disease department at Dron Hospital in Tourcoing, France.

According to the study, which was published online ahead of print in the journal Infection, the goal was to evaluate the role of S. simulans in bone and joint infections (BJI) and determine their main characteristics.

The researchers analyzed databases of the microbiology laboratories of Lille Hospital and Tourcoing Hospital and only considered results from blood, bone, and orthopedic device cultures taken for hospitalized patients between January 2004 and January 2009.

“We considered cases in which S. simulans was the only bacteria isolated in all of the patients’ biological samples with clinical and laboratory signs of infection. For patients with complete medical records, we recorded the clinical and epidemiological data,” the researchers wrote in the study abstract.

“Six cases of BJI due to S. simulans were recorded, with five cases related to orthopedic devices infections. Three patients lived in rural areas. In four out of six patients, S. simulans was isolated in intraoperative biopsy material,” the authors wrote.

“In one patient, S. simulans grew in synovial fluid and in another in blood cultures only. The latter patient had a spondylodiscitis, and chronic foot ulcers due to gout disease were suspected to be the origin of the infection. All patients were healed after a mean follow up of 9 ± 3 months. Orthopedic devices were removed in four of the five patients concerned. The combination of rifampicin plus levofloxacin was used in four patients.”

Space Occupying Lesions as Unusual Causes of Carpal Tunnel Syndrome

Researchers in the department of orthopedic surgery at the National Taiwan University & Hospital in Taipei, Taiwan, recently published results of an analysis of space occupying lesions found at surgery that caused or contributed to carpal tunnel syndrome.

They found 23 incidents of this in 779 patients who underwent surgery for carpal tunnel syndrome from January 1999 to December 2008. “The mean age of these 23 patients was 52.9 years, and in patients who had a local swelling or palpable mass, ultrasonography or magnetic resonance imaging was done. All had open release of the transverse carpal ligament and lesions were removed,” the authors wrote in the abstract for the study, which was published online ahead of print in the Journal of Hand Surgery-European Volume.

Histopathology conducted on the lesions showed tophaceous gout in 10 patients, tenosynovitis in seven patients and tumors in eight. “The tumors included ganglion cysts in two, lipoma in three, and fibroma of the tendon sheath in one. The neurological symptoms subsided after surgery in all,” the authors wrote.

“In patients with gout, one had an infected wound and another had recurrence of symptoms one year later. Carpal tunnel syndrome caused by a space occupying lesion is rare and more complicated than idiopathic carpal tunnel syndrome.”

SourcesStaphylococcus simulans as an authentic pathogenic agent of osteoarticular infections [Infection]Unusual causes of carpal tunnel syndrome: space occupying lesions [Journal of Hand Surgery-European Volume]