A report of 12 cases. INTRODUCTION AND DEFINITION A bursa is a fluid-filled, saclike structure lined by synovial membrane that forms in clefts between mobile structures in the musculoskeletal system. Their cohort included all patients hospitalized between 2000 and 2004 in an orthopaedic surgery unit who had a deep sample positive for C. acnes from the pelvis (15% of cases), spine (40%), lower limb (12%), shoulder (22%), and other upper limb (11%) (the elbow was not specified). Trochanteric bursitis after total hip arthroplasty: incidence and evaluation of response to treatment. Septic arthritis can also occur when a penetrating injury, such as an animal bite or trauma, delivers germs directly into the joint. Zappe B, Graf S, Ochsner PE, Zimmerli W, Sendi P. Propionibacterium acnes in shoulder surgery: true infection, contamination, or commensal of the deep tissue? [QxMD MEDLINE Link]. A prospective study of 60 patients with trochanteric bursitis found that poor clinical outcomes correlated with obesity, smoking, emotional stress, fibromyalgia, and hypothyroidism. If you log out, you will be required to enter your username and password the next time you visit. Progression to septic shock raises the risk of death. ), Retrocalcaneal bursitis is generally caused by local trauma from poorly designed shoes. [QxMD MEDLINE Link]. Kim JY, Chung SW, Kim JH, Jung JH, Sung GY, Oh KS, et al. Skedros JG, Adondakis MG, Brown EM, Oliver MR. National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections. In the current episode reported here, he sustained a minor abrasion. The 2 commonly affected bursae are located superomedially between the serratus anterior and the chest wall. [QxMD MEDLINE Link]. Alcoholics have a higher incidence of septic olecranon bursitis due to their higher risk of trauma and immunosuppression [39,50,88]. Because C. acnes was the only organism grown in culture, the possibility that it was the causal organism of our patients olecranon bursitis/osteomyelitis warrants additional critical consideration in the context of other possible causal organisms. Chang Gung Med J. [QxMD MEDLINE Link]. 2013 Dec 23. Alves-Barroco C, Paquete-Ferreira J, Santos-Silva T, Fernandes AR. 8600 Rockville Pike 2016 Mar. 2011. Endoscopic Olecranon Bursal Resection for Olecranon Bursitis: A Comparative Study for Septic and Aseptic Olecranon Bursitis. Pearson M, Bent S. Post-vaccination Subacromial Bursitis. Less commonly, infection of deep bursae is due to contiguous septic arthritis or bacteremia (10% of cases). There are several explanations for this, including the administration of pre-culture antibiotics and inadequate culture media/conditions, especially for anaerobic biofilm-producing microorganisms [1,3,4]. Pitts TC, Kiser CJ, Skedros JG. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. 2009 Sep. 58(9):494-500. 2009 Sep. 84(9):831-6; quiz 837. Shiono Y, Ishii K, Nagai S, et al. Deep bursae (eg, subacromial and iliopsoas bursae) are located in the fascia. Hudek R, Sommer F, Kerwat M, Abdelkawi AF, Loos F, Gohlke F. Reply: Low-grade Cutibacterium acnes shoulder infections do exist! Koh IJ, Han SB, In Y, Oh KJ, Lee DH, Kim TK. Osteomyelitis resulting from chronic septic olecranon bursitis: report of two cases. [Full Text]. Cultures were obtained five separate times because of no growth and difficulty eradicating the infection. 1997 Nov 1. BMC Musculoskelet Disord. Morrey BF, Fitzgerald RH, Kelly PJ, Dobyns JH, Washington JA 2nd. Microscopic spread of the organisms might be caused by cell division and/or the intracellular invasion of marrow mesenchymal stem cells, which is a known behavior of C. acnes [71]. Severe bursitis is a very dangerous medical condition, so it's important to understand the symptoms, causes and treatment of this ailment. Can you get sepsis from bursitis? Injection-induced low-grade infection of the shoulder joint: preliminary results. 27(2):283-94. Comparison of high- and low-dose corticosteroid in subacromial injection for periarticular shoulder disorder: a randomized, triple-blind, placebo-controlled trial. Irrigation was then done with 3% hydrogen peroxide, followed by saline, and then packing with an iodine-containing gauze strip. J Clin Rheumatol. Our patient had prior surgery for an infection in the same location, which caused a subcutaneous adhesion at the upper aspect of the olecranon bursa region (Figure (Figure1).1). Khodaee M. Common Superficial Bursitis. Rhyou IH, Park KJ, Kim KC, Lee JH, Kim SY. For example, Weinstein et al. 9:CD007400. 1 Superficial bursae are. Byrd AL, Belkaid Y, Segre JA. Singh VR, Bain GI. Gram stain and culture are performed to identify any pathogens. Roschmann RA, Bell CL. By using our website, you consent to our use of cookies. Oral steroids for adhesive capsulitis. DeLee JC, Drez D, Miller MD, eds. In the ankle, two bursae are found at the level of insertion of the Achilles tendon. Furthermore, they did not provide details of the patients characteristics, potential cause, or treatment rendered. Ultrasound-guided shoulder injections in the treatment of subacromial bursitis. 7, they indicated it as no. A case ofmethicillin-resistantStaphylococcus aureus (MRSA)-caused septic bursitis was reported in aninjection drug user following an attempt to inject drugs into the soft tissue of the knee. Through two 1.5-centimeter incisions, one at the proximal and one at the distal aspect of the bursa, 10 milliliters of seropurulent/phlegmonous material was drained. [18, 19]. These results can guide the modification of antibiotics in cases of bacterial infection. [26]. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. All antibiotics were stopped on December 31, 2017, and the infection was considered eradicated. Among young, sexually active adults, neisseria gonorrhoeae is the most common pathogen for the condition. Ileopectineal bursitis following total hip replacement. The https:// ensures that you are connecting to the Bursae are small, fluid-filled sacs that cushion and lubricate joints, the areas where different tissues (e.g., muscles, tendons, and bone) rub against each other. The aspirate is considered infected in prepatellar bursitis if the WBC is >1,000/uL. The white blood cell (WBC) count in septic bursitis is typically lower than that in septic arthritis. Derry S, Moore RA, Rabbie R. Topical NSAIDs for chronic musculoskeletal pain in adults. It's likely that antibiotics will be administered immediately to avoid the spread of the infection. 94(13):1208-16. The most common causes of bursitis are injury or overuse, but it can also be caused by infection. 2007 Apr. This article will cover the symptoms of and risks for. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com. [QxMD MEDLINE Link]. [28]. 2004 Jun. [67] reviewed the literature and concluded that specimens should be cultured on multiple media, including aerobic, anaerobic, and broth, and should be observed for at least 17 days. 2009 Mar. in prosthetic joint infections: a diagnostic challenge. Bursitis. See the image below. Similar results in 60 patients treated with and without rifampicin. [QxMD MEDLINE Link]. Furustrand Tafin U, Corvec S, Betrisey B, Zimmerli W, Trampuz A. Propionibacterium acnes infection of the elbow. Orthopaedic surgeons and other healthcare providers who focus on musculoskeletal conditions are periodically faced with situations where there is clearly an infection, but the cultures fail to grow an organism or only show rare growth of an unlikely causal organism [1,2]. [10]. Imaging of the bursae. It is usually self-limiting and even if you ignore it, it may resolve in time. Canoso JJ, Sheckman PR. Prepatellar bursitis, also known as housemaids knee, is associated with trauma or with repetitive kneeling over an extended period. Leon Root, MD Professor of Clinical Surgery, Department of Orthopedics, Weill Medical College of Cornell University; Founder and Director, Pediatric Outreach Program; Emeritus Chief of Osteogenesis Imperfecta Clinic, Attending Orthopedic Surgeon, Medical Director of Rehabilitation, Emeritus Chief of Pediatric Orthopedics, The Hospital for Special Surgery 2014 Aug. 134 (8):1073-81. A history of noninfectious inflammation of the bursa also increases the risk of septic bursitis. Some investigators now advise that a C. acnes infection should be diagnosed only when there are multiple positive cultures [17]. HHS Vulnerability Disclosure, Help MRI is usually unnecessary but if needed is very sensitive for identification of bursitis, and can rule out suspected solid tumors and define pathology for possible surgical excision. Careers, Unable to load your collection due to an error. 58:371-3. Chronic bursitis leads to continual pain and can cause weakening of overlying ligaments and tendons and, ultimately, rupture of the tendons. [QxMD MEDLINE Link]. This ongoing friction can inflame and irritate bursae. Int Orthop. Consequently, daily oral levofloxacin 750mg and IV vancomycin were started (October 22, 2017) for broader coverage, as recommended by an infectious disease consultant [16]. Ultrasonography is useful for further imaging of the bursa when the diagnosis is uncertain, and can guide diagnostic aspiration or therapeutic injections. In the knee, bursae commonly affected by bursitis include the medial collateral ligament bursa, the anserine (pes anserinus) bursa (see the image below), the prepatellar bursa (located anteriorly over the patella, between patella and skin), the infrapatellar bursa (containing a superficial component lying between the patellar ligament and the skin and a deep component lying between the patellar ligament and the proximal anterior tibia), and the popliteal bursae, or Baker cysts (located in the posterior joint capsule of the knee). Mitchell WG, Kettwich SC, Sibbitt WL Jr, Sibbitt RR, Muruganandam M, Rolle NA, et al. 12:CD010071. What Is Septic Bursitis? | OrthoBethesda Esteban J, Garca-Coca M. Singularities of pyogenic Streptococcal biofilms - from formation to health implication. INTRODUCTION Bursitis is an inflammation of the sac-like structures that protect the soft tissues from underlying bony prominences [ 1 ]. Constant bursae have the following characteristics: Adventitial bursae (examples include those that develop over a bunion and osteochondroma) have the following characteristics: All of the approximately 160 bursae in the human body are potentially susceptible to injury. [25], Cases of post-vaccination subacromial bursitis have been reported resulting from injection into or near the subacromial bursa. Schneeberger AG, Yian E, Steens W. Antimicrobial susceptibility of Propionibacterium acnes isolates from shoulder surgery. Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital [QxMD MEDLINE Link]. 1995 Jun. Blood tests can also be taken to detect and monitor inflammation. The bacteria, most commonly group A streptococcal bacteria, enter the skin through an opening, such as cut, scrape, burn, or surgical incision, or even a bug bite or sting.. Cellulitis can cause sepsis in some people. Major change in mental status, such as extreme confusion. Magnetic resonance imaging (MRI) or ultrasonography can differentiate an isolated bursitis from intra-articular injury.
