werner@aecom.UUCP (Craig Werner) (03/18/86)
<<<<>>>> > > A young woman comes into clinic several weeks after trying to > deposit a counterfeit $50 bill in net.jokes complaining of pain and swelling > in the left knee. In addition to her occupational history (see net.jokes.d or > net.women), she has a history of multiple episodes of venereal disease as well > as prior knee problems. There is no history of trauma and no other joints > are affected. She says that putting heat on it, which normally helps, has > been making it worse. During the exam, Cervical, Rectal, and Throat cultures > are taken and are negative for VD by microscopic inspection (and by culture). > > As if I hadn't told you enough already, what is the probable cause of > her knee pain, and what do you do to prove it, and to treat it? An aspiration of the Knee will reveal Gram-negative bacterial rods, you can bet on it. That is: GC, Gonnococcus, Neisseria gonnorheae, The Clap. But to consider a differential of arthritis of the knee. Certain clues come from the history. Rheumatoid arthritis is worse in the morning, Osteoarthritis gets worse with continued use. Osteoarthritis and arthritis due to injury are improved by heat. Septic (infectious) arthritis does just the opposite and gets worse with heat. Aspirin helps Rheumatoid arthritis but not arthritis due to Gout. [wts@burl and cramer@kontron suggested that she may be spending too much time on her knees, as it were. That may explain her previous history of knee problems, but as you can see, is totally irrelevant to this case.] OK, you say, if I'm so sure that the arthritis is due to a Gonorrhea infection of the knee, how do I explain the negative cultures. There are two alternative explanations: 1. The knee infection had to be proceeded by a systemic infection, the bacteria traveling to the knee from the blood and lodging there. It is also a fact that certain antibiotics do not penetrate into the joint space at typical dosages - Penicillin among these. Therefore, the bacteria was safely enscounced in the joint, while the inadequate self-treatment with antibiotics erradicated its traces elsewhere [I suppose another one of the reasons why antibiotics are by prescription only.] 2. An alternative explanation is "Looking for love in all the wrong places." -- Craig Werner !philabs!aecom!werner (1935-14E Eastchester Rd., Bronx NY 10461, 212-931-2517) "Well that's my story, not that it matters..."
dr@ski.UUCP (David Robins) (03/23/86)
Probably just a slip of the fingers, but: > An aspiration of the Knee will reveal Gram-negative bacterial rods, > you can bet on it. That is: GC, Gonnococcus, Neisseria gonnorheae, The Clap. N. gonorrheae is a gram-negative intracellular DIPLOCOCCUS, not a rod. As such, it would be found not in the fluid, but within the white blood cells (polymorphs) floating in the fluid. -- ==================================================================== David Robins, M.D. Smith-Kettlewell Institute of Visual Sciences 2232 Webster St; San Francisco CA 94115 415/561-1705 {ihnp4,qantel,dual}!ptsfa!ski!dr The opinions expressed herein do not reflect the opinion of the Institute!