Bacterial arthritis

The risk for infectious arthritis is high in patients with autoimmune diseases with compromised immunity. Acute bacterial arthritis mostly results from hematogenous spread in the elderly and in the less than 15 years. Acute monarthritis should raise a high index of suspicion of joint infection. 

Nongonococcal bacterial arthritis almost always involves only a single joint. The knee is the most commonly involved joint, but infections also may occur in the shoulder, wrist, hip, ankle, interpha-langeal joints, and elbow joints. Usually, the initial focus of infection that acted as the source for bacterial or microbial entrance can be identified. Common routes for bacterial entrance include infections of the respiratory tract, skin, and urinary tract. Blood cultures are important in these patients because they may be positive in 50% of patients. 

Cimmino MA. Recognition and management of bacterial arthritis. Drugs 1997 54 50-60. 

Newton PO, Ballock RT, Bradley JS. Oral antibiotic therapy of bacterial arthritis. Pediatr Infect J 1999 18 1102-1103. 

Kaandorp CJE, Kiijnen P, Bernelot Moens HJ, et al. The outcome of bacterial arthritis. Arthritis Rheum 1997 40 884-892. 

Although used as a simulant, it can cause acute bacterial meningitis, pneumonia, intraabdominal infections, enteric infections, urinary tract infections, septic arthritis, endophthalmitis, suppurative thyroiditis, sinusitis, osteomyelitis, endocarditis, and skin and soft tissue infections. There are also strains of E. coli (C17-A015) that produce lethal cytotoxins (C16-A052). ... 

The overall effect of Li+ on the hematopoietic system is of stimulation of the immune system. Not surprisingly then, Li+ is reported to exacerbate the activity of a number of autoimmune diseases, such as psoriasis [212] and rheumatoid arthritis [213], and to result in the production of autoantibodies in some patients [214]. However, there is no evidence that Li+ s stimulation of the immune system leads to any reduction in the occurrence of viral or bacterial infections in patients on Li+ therapy. 

Heavy Metals. Some heavy metals such as gold and platinum are used pharmacologically as immunomodulators to treat rheumatoid arthritis and as antineoplastic drugs, respectively. Most heavy metals inhibit mitogenicity, antibody responses, and host resistance to bacterial or viral challenge, and tumor growth. Platinum has been shown to suppress humoral immunity, lymphocyte proliferation, and macrophage function (Lawrence, 1985). Clinically, mild to moderate myelosuppression may also be evident with transient leukopenia and thrombocytopenia. 

Bacterial superficial skin infections including cellulitis and erysipelas, furunculosis and impetigo usually have a benign course. Infections of the subcutis often lead to necrosis of soft tissue. These infections are described in section 16 (surgical infections). Arthritis involves infection of the synovia and... 

Reactive arthritis (ReA) develops 1-3 weeks after a bacterial infection in the intestinal tract (diarrhea) and/or urethra (urethritis) or elsewhere due to immune responses. HLA-B27 positive individuals may develop ReA. ReA is an autoimmune disease and consists of sterile axial and/or peripheral articular inflammation, enthesitis and extra-articular manifestations. 

Infectious Arthritis comprises viral, bacterial, and fungal joint infection. Bacterial infectious arthritis should be considered an emergency for the patient... 

St. John s wort has been used to treat a wide range of ailments for more than 2000 years, and is said to have been prescribed by Hippocrates himself. Apart from depression, St. John s wort is being promoted or used as a treatment for attention-deficit hyperactivity disorder (ADHD), anxiety, stress, obsessive-compulsive disorder, sleep problems, nocturnal enuresis, bacterial and viral infections such as HIV-AIDS, respiratory conditions, peptic ulceration, inflammatory arthritis, cancer, and skin wounds (Rey and Walter, 1998 Walter et ah, 2000). It is also said to increase libido, an application dating from the Middle Ages (Fletcher, 1996). No empirical evidence is currently available to support any of these uses. 

It is an antisecretory drug. It is 5-ami-nosalicylic acid with linked sulfapyridine through azo bond. The drug is poorly absorbed from the intestine and the azo linkage is broken down by the bacterial flora in the distal ileum and colon to release 5-ami-nosalicylic acid (5-ASA) and sulfapyridine. 5-ASA inhibits locally prostaglandin synthesis, decreases mucosal secretion. It is used in rheumatoid arthritis and ulcerative colitis. Side effects include fever, rashes, blood dyscrasias, nausea, vomiting and headache. 

The introduction of the sulfa drugs was followed by the development of the penicillin antibiotics. Fleming s chance observation of the anti-bacterial action of the penicillin mold in 1928 and the subsequent isolation and identification of its active constituent by Florey and Chain in 1940 marked the beginning of the antibiotics era that still continues today. At roughly the same time, the steroid hormones found their way into medical practice. Cortisone was introduced by the pharmaceutical industry in 1944 as a drug for the treatment of arthritis and rheumatic fever. This was followed by the development of steroid hormones as the active constituents of the contraceptive pill. 

CO-RMs are generally effective at reducing inflammation. This is potentially of value for the treatment of arthritis [85], inflammatory responses following thermal injury [80-82], inflammatory responses following sepsis [83, 136], gastric ulcers [234], bacterial infection [134, 140] and neuro-inflammation [167],... 

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