目的:淋球菌感染的外生殖器表现很少见(0.5-3%)。其中,淋球菌性关节炎(GA)是最常见的,占传播感染的30-90%。我们的研究旨在描述留尼汪岛的所有医院病例,法国海外领土。
方法:我们进行了回顾性研究,多中心,对某些病例的观察性研究,从2008年到2020年可能或可能的GA。
结果:我们确定了58例GA,大多数情况下(n=48)。性别比例是平衡的,但是男人比女人大(51岁比27岁,p<0.001)。在过去的三个月中,共有41%的人出国旅行,主要在马达加斯加或东南亚。最常感染的关节是膝盖,接着是脚踝,手腕和手指或腕关节。只有16%的病例有生殖器症状,但50%的人有另一种外生殖器表现,以皮损为主(40%)。关节穿刺阳性率为91%,带有脓性液体。只有58%的人有积极的文化,33%的人只有PCR阳性。没有3GC抗性菌株。与没有关节炎的淋球菌感染相比,患者年龄较大,生殖器较少,但生殖器外症状较多.出院时60%有持续性关节症状。2019年,GA占所有住院的脓毒性关节炎病例的18%,具有微生物鉴定。
结论:GA很少见,但早期诊断和及时治疗很重要。因为联合破坏可能很重要,导致出院后持续症状。在具有阴性培养物的情况下,在关节穿刺中使用PCR是有用的。
OBJECTIVE: Extra-genital manifestations of gonococcal infection are rare (0.5-3%). Among them, gonococcal arthritis (GA) is the most frequent, accounting for 30-90% of disseminated infections. Our study aimed to describe all hospital cases of GA in Reunion Island, a French overseas territory.
METHODS: We conducted a retrospective, multicentric, observational study of all cases of certain, probable or possible GA from 2008 to 2020.
RESULTS: We identified 58 cases of GA, mostly certain cases (n = 48). Sex ratio was balanced, but men were older than women (51 vs 27 years, p < 0.001). A total of 41% had travelled abroad during the previous 3 months, mostly in Madagascar or South-East Asia. The most frequently infected joint was the knee, followed by ankle, wrist and fingers or carpal joints. Only 16% of cases had genital symptoms, but 50% had another extra-genital manifestation, mainly skin lesions (40%). Positivity rate of joint puncture was 91%, with a purulent liquid. Only 58% had a positive culture, and 33% had only a positive PCR. There was no 3GC-resistant strain. In comparison with gonococcal infection without arthritis, patients were older and had fewer genital but more extra-genital symptoms. On discharge 60% had persistent articular symptoms. GA represented 18% of all hospitalised septic arthritis cases with microbial identification in 2019.
CONCLUSIONS: GA is rare but it is important to make an early diagnosis and treat promptly, as joint destruction may be important, leading to persistent symptoms after discharge. PCR use in joint puncture is useful in cases with negative culture.