March 15, 2010 (New Orleans, Louisiana) — Almost half of children with fluid in the knee in the Northeastern United States are likely to have Lyme arthritis, according to a new study presented here at the American Association of Orthopaedic Surgeons 2010 Annual Meeting.

“In a pediatric population, Lyme arthritis is probably the first diagnosis to consider if you are in an endemic area,” Matthew D. Milewski, MD, from Yale–New Haven Children’s Hospital in Connecticut, told meeting attendees.

Connecticut has the highest rate of Lyme disease, but other areas of the United States are considered endemic, including the northeast from Maine to the mid-Atlantic states, Minnesota, Wisconsin and other Midwestern states, and Northern California.

Lyme arthritis is on the rise, increasing almost 100% in the past 15 years, according to data from the Centers of Disease Control and Prevention.

Children are nearly twice as likely to develop arthritis with Lyme disease than adults, and also to have it as the initial manifestation. Distinguishing children who have Lyme arthritis from those who have septic arthritis can be a challenge in the emergency department (ED), but doing so is essential because their treatment is so different, Dr. Milewski said.

Excerpt:

Acupuncture, which is based on the theory that inserting and manipulating fine needles at specific acupuncture points located in a network of meridians will promote the harmonious flow of “Qi,” is one of the most widely practised modalities of alternative medicine. Because needles are inserted up to several centimetres beneath the skin, acupuncture may pose risks to patients. One of the most important complications is transmission of pathogenic micro-organisms, from environment to patient or from one patient to another.

In the 1970s and 1980s most infections associated with acupuncture were sporadic cases involving pyogenic bacteria.1 So far, more than 50 cases have been described globally. In most cases, pyogenic bacteria were transmitted from the patient’s skin flora or the environment because of inadequate skin disinfection before acupuncture. In localised infections, meridian specific and acupuncture point specific lesions were typical. About 70% of patients had musculoskeletal or skin infections, usually in the form of abscesses or septic arthritis, corresponding to the site of insertion of the acupuncture needles.1 2 A minority had infective endocarditis, meningitis, endophthalmitis, cervical spondylitis, retroperitoneal abscess, intra-abdominal abscess, or thoracic empyema.3 4

Full article: http://www.bmj.com/cgi/content/full/340/mar18_1/c1268

Excerpt:

Acupuncture, which is based on the theory that inserting and manipulating fine needles at specific acupuncture points located in a network of meridians will promote the harmonious flow of “Qi,” is one of the most widely practiced modalities of alternative medicine. Because needles are inserted up to several centimetres beneath the skin, acupuncture may pose risks to patients. One of the most important complications is transmission of pathogenic micro-organisms, from environment to patient or from one patient to another.

In the 1970s and 1980s most infections associated with acupuncture were sporadic cases involving pyogenic bacteria.1 So far, more than 50 cases have been described globally. In most cases, pyogenic bacteria were transmitted from the patient’s skin flora or the environment because of inadequate skin disinfection before acupuncture. In localised infections, meridian specific and acupuncture point specific lesions were typical. About 70% of patients had musculoskeletal or skin infections, usually in the form of abscesses or septic arthritis, corresponding to the site of insertion of the acupuncture needles.1 2 A minority had infective endocarditis, meningitis, endophthalmitis, cervical spondylitis, retroperitoneal abscess, intra-abdominal abscess, or thoracic empyema.3 4

November 13, 2009 (Washington, DC) — The odds that a child living in a Lyme-endemic area of the United States who presents with a joint effusion will be diagnosed as having Lyme arthritis is 29%. The odds are even higher (44%) if the affected joint is the knee. The leukocyte count is useful in distinguishing between septic and Lyme arthritis, researchers announced here.

“There was an increase in the number of cases in the United States by 101% over the past 15 years, possibly due to increased recognition of Lyme disease,” said Aristides I. Cruz Jr., MD, resident in the Department of Orthopedics and Rehabilitation at Yale University in New Haven, Connecticut. During his presentation, he noted that 93% of all Lyme disease cases arise from 10 states, most in the Northeast United States.

“There was an increase in the number of cases in the United States by 101% over the past 15 years, possibly due to increased recognition of Lyme disease,” said Aristides I. Cruz Jr., MD, resident in the Department of Orthopedics and Rehabilitation at Yale University in New Haven, Connecticut. During his presentation, he noted that 93% of all Lyme disease cases arise from 10 states, most in the Northeast United States.

“Children are more likely to present with arthritis as initial manifestation of Lyme disease,” Dr. Cruz told the audience.

“Children with Lyme arthritis presenting with a limp and a swollen joint will typically have a lower peripheral white blood cell count,” Dr. Cruz added. “They are less likely to have complete non-weight-bearing on the affected limb, less likely to have a fever, and [arthritis symptoms are] more likely to involve the knee joint compared with children with septic arthritis.”

The findings were reported here at the American Academy of Pediatrics 2009 National Conference & Exhibition.

Basic Diagnostic Tools Help Distinguish Lyme From Septic Arthritis

“In the Northeast, we see a lot of Lyme disease,” said Yi-Meng Yen, MD, PhD, instructor in orthopaedic surgery, Harvard Medical School, Children’s Hospital Boston in Massachusetts. “It is hard to distinguish whether [it] is Lyme disease or whether [it] is septic arthritis,” Dr. Yen agreed.

“Septic arthritis mandates that we take the patient to the operating room and do a surgery, whereas Lyme arthritis theoretically can be treated with antibiotics,” he told Medscape Pediatrics in an interview. For instance, he said, “Our institution has been looking at MRIs [magnetic resonance images] as a way to reliably distinguish between the two, because it takes several days sometimes for the lab tests to come back to definitely tell you whether you have Lyme disease or not. So, in those few days, if you have septic arthritis, that’s a bad thing.”

“To reliably, quickly diagnose what the patient has can help us determine the treatment quickly,” added Dr. Yen, who was not involved in this study.

“If you are clinically susceptible for septic arthritis, it pays to go to the operating room,” Dr. Cruz said in answer to a question from the audience. “In the past, almost all these patients automatically went to the operating room.”

However, if the clinical presentation is consistent with Lyme arthritis, treatment with antibiotics should suffice, he added. “The point of this study was to come up with some clinically useful criteria to arm ourselves with more tools to diagnose the disease.”

Dr. Cruz and his team sought to evaluate clinical parameters that could eventually be used to differentiate Lyme arthritis from septic arthritis in children and help with diagnosis and subsequent treatment.

In this retrospective analysis, the investigators reviewed data from children who underwent lower-extremity joint aspiration at Yale University Medical Center, a tertiary care children’s hospital in a Lyme disease endemic area.

Between August 2002 and August 2008, more than 200 children underwent a total of 212 aspirations for a joint effusion. Cell count, culture, hematologic inflammatory markers, and subsequent surgical intervention were available for 170 of the 212 aspirates.

Dr. Cruz’s team compared findings from 50 children with serologically confirmed Lyme disease with data from 21 patients with culture-positive septic arthritis.

They found statistically significant differences between the 2 cohorts. For instance, the peripheral white blood cell count was 9.5 x 1000/μL (range, 3.0 – 14.9 x 1000/μL) in the aspirates from children with Lyme disease vs 12.5 (range, 5.5 – 30.1) in children with septic arthritis (P = .002).

Other parameters, such as joint fluid cell count, erythrocyte sedimentation rate, and C-reactive protein levels, were not significantly different between the 2 groups and could not be used to differentiate between septic and Lyme arthritis.

Interestingly, said Dr. Cruz, of all the children presenting with a joint effusion at their hospital, 29% were likely to be diagnosed as having Lyme arthritis overall compared with 44% if the aspirate was a knee aspirate.

“Is it worthwhile to develop something that’s very reliable? Absolutely!” said Dr. Yen. “Especially in the Northeast centers. It is a growing healthcare problem and a lot more study should be put into it.”

Dr. Cruz and Dr. Yen have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2009 National Conference & Exhibition (NCE): Abstract 5806. Presented October 17, 2009.

Journalist

Crina Frincu-Mallos, PhD

Crina Frincu-Mallos is a freelance writer for Medscape Medical News.

• American Academy of Pediatrics (AAP) 2009 National Conference and Exhibition

This coverage is not sanctioned by, nor a part of, the American Academy of Pediatrics.

From Medscape Medical New

November 13, 2009 (Washington, DC) — The odds that a child living in a Lyme-endemic area of the United States who presents with a joint effusion will be diagnosed as having Lyme arthritis is 29%. The odds are even higher (44%) if the affected joint is the knee. The leukocyte count is useful in distinguishing between septic and Lyme arthritis, researchers announced here.

“There was an increase in the number of cases in the United States by 101% over the past 15 years, possibly due to increased recognition of Lyme disease,” said Aristides I. Cruz Jr., MD, resident in the Department of Orthopedics and Rehabilitation at Yale University in New Haven, Connecticut. During his presentation, he noted that 93% of all Lyme disease cases arise from 10 states, most in the Northeast United States.

“Children are more likely to present with arthritis as initial manifestation of Lyme disease,” Dr. Cruz told the audience.

“Children with Lyme arthritis presenting with a limp and a swollen joint will typically have a lower peripheral white blood cell count,” Dr. Cruz added. “They are less likely to have complete non–weight-bearing on the affected limb, less likely to have a fever, and [arthritis symptoms are] more likely to involve the knee joint compared with children with septic arthritis.”

The findings were reported here at the American Academy of Pediatrics 2009 National Conference & Exhibition.

Basic Diagnostic Tools Help Distinguish Lyme From Septic Arthritis

“In the Northeast, we see a lot of Lyme disease,” said Yi-Meng Yen, MD, PhD, instructor in orthopaedic surgery, Harvard Medical School, Children’s Hospital Boston in Massachusetts. “It is hard to distinguish whether [it] is Lyme disease or whether [it] is septic arthritis,” Dr. Yen agreed.

“Septic arthritis mandates that we take the patient to the operating room and do a surgery, whereas Lyme arthritis theoretically can be treated with antibiotics,” he told Medscape Pediatrics in an interview. For instance, he said, “Our institution has been looking at MRIs [magnetic resonance images] as a way to reliably distinguish between the two, because it takes several days sometimes for the lab tests to come back to definitely tell you whether you have Lyme disease or not. So, in those few days, if you have septic arthritis, that’s a bad thing.”

“To reliably, quickly diagnose what the patient has can help us determine the treatment quickly,” added Dr. Yen, who was not involved in this study.

“If you are clinically susceptible for septic arthritis, it pays to go to the operating room,” Dr. Cruz said in answer to a question from the audience. “In the past, almost all these patients automatically went to the operating room.”

However, if the clinical presentation is consistent with Lyme arthritis, treatment with antibiotics should suffice, he added. “The point of this study was to come up with some clinically useful criteria to arm ourselves with more tools to diagnose the disease.”

Dr. Cruz and his team sought to evaluate clinical parameters that could eventually be used to differentiate Lyme arthritis from septic arthritis in children and help with diagnosis and subsequent treatment.

In this retrospective analysis, the investigators reviewed data from children who underwent lower-extremity joint aspiration at Yale University Medical Center, a tertiary care children’s hospital in a Lyme disease endemic area.

Between August 2002 and August 2008, more than 200 children underwent a total of 212 aspirations for a joint effusion. Cell count, culture, hematologic inflammatory markers, and subsequent surgical intervention were available for 170 of the 212 aspirates.

Dr. Cruz’s team compared findings from 50 children with serologically confirmed Lyme disease with data from 21 patients with culture-positive septic arthritis.

They found statistically significant differences between the 2 cohorts. For instance, the peripheral white blood cell count was 9.5 x 1000/μL (range, 3.0 – 14.9 x 1000/μL) in the aspirates from children with Lyme disease vs 12.5 (range, 5.5 – 30.1) in children with septic arthritis (P = .002).

Other parameters, such as joint fluid cell count, erythrocyte sedimentation rate, and C-reactive protein levels, were not significantly different between the 2 groups and could not be used to differentiate between septic and Lyme arthritis.

Interestingly, said Dr. Cruz, of all the children presenting with a joint effusion at their hospital, 29% were likely to be diagnosed as having Lyme arthritis overall compared with 44% if the aspirate was a knee aspirate.

“Is it worthwhile to develop something that’s very reliable? Absolutely!” said Dr. Yen. “Especially in the Northeast centers. It is a growing healthcare problem and a lot more study should be put into it.”

Dr. Cruz and Dr. Yen have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2009 National Conference & Exhibition (NCE): Abstract 5806. Presented October 17, 2009.

Authors and Disclosures
Journalist
Crina Frincu-Mallos, PhD
Crina Frincu-Mallos is a freelance writer for Medscape Medical News.

From  http://www.medscape.com/news