Arthritis associated with Salmonella infections.

Infection should always be considered as a possible cause in a patient presenting with arthritis. The diagnosis can be difficult to make because the arthritis may appear without evidence of infection elsewhere , and it may mimic other arthritides. Moreover, aspiration of the joint may only reveal a sterile serous effusion. Many organisms can cause arthritis. One of the rarer causes of such an arthritis is salmonellosis. This paper presents seven cases of arthritis associated with Salmonella infections. Four of the patients were seen by the author and the other three had attended the same hospital in the previous 5 years. Six of the patients were adults. A woman aged 77 years was admitted to hospital on June 9, 1967, with a history of diarrhoea for 36 hours. She had ischaemic heart disease and osteo-arthritis of the knees and had been treated with steroids for giant cell arteritis for the previous year. Examination Both stool and blood cultures yielded Salmonella typhi-murium Type U 163. She was treated with ampicillin 500 mg. 6-hrly from June 15 to 25, but her condition remained poor and diarrhoea persisted. Her temperature occasionally rose to 990F. On July 13 the right knee became swollen and tender. At this time the haemoglobin was 10-3 g. sedimentation rate 45 mm/lst hr (Wintrobe). Treatment The knee was aspirated and 150 ml. cloudy fluid were removed. The fluid contained many polymorphs, and S. typhi-murium was cultured from it. Intra-articular ampicillin 500 mg. twice daily was given from July 14 to 28, and treatment was then continued with oral ampicillin 500 mg. 6-hrly until August 19. Result Her knee and general condition were much improved, and she was allowed home on September 19 with slight stiffness of the knee. She died of heart failure 3 months later and no post mortem examination was performed. There had been no recurrence of arthritis. A housewife aged 37 years was admitted to hospital on August 28, 1968, with painful swelling of both knees and conjunctivitis of the right eye. On August 18 she had had diarrhoea which had lasted until August 25. Examination The body temperature was 1010 F., and she had conjunctivitis and inflamed knees swollen with effusions. The haemoglobin was 14-5 g. per cent., W.B.C. 17,200 per cu.mm., neutrophil count 13,600 per cu.mm., and ery-throcyte sedimentation rate 35 mm./lst hr (Wintrobe). The latex-fixation test for rheumatoid factor and the Brucella complement …