Sepsis and Macrophage Activation Syndrome: Two Successive Complications of Staphylococcus aureus Infection

The macrophage activation syndrome (MAS) and the sepsis are both a condition of hyperinflammation. The differential diagnosis can be difficult. The two pathologies can succeed with each other. The purpose of this literature review is to illustrate these diagnostic and therapeutic difficulties through a reported case of a macrophage activation syndrome secondary to infection (MASI). It was a 42- year- old diabetic man, hospitalized for an acute myositis due to an infection of Staphylococcus aureus. These germs caused a septic shock requiring antibiotic therapy. After an initial clinical improvement, the diagnosis of MASI post-Staphylococcus aureus was retained with a persistence of the inflammatory syndrome and appearance of fever with splenomegaly associated with hepatic cytolysis a 30% decrease in prothrombin time, a mild regenerative anemia without hemophagocytosis. An inflammatory syndrome may have several completely opposite etiologies and pathophysiology. Our case fulfilled both of the criteria of sepsis and MAS. Several signs were common for the two pathologies, but a detailed analysis of the clinical and biological elements lead to the diagnostic orientation

A Case of Haemophilic Arthropathy Seen in UTH Morafeno Toamasina

Introduction: Hemophilia is a hemorrhagic disease caused by congenital deficiency of factor VIII (hemophilia A) or factor IX (haemophilia B) coagulation. It is an inherited X-linked genetic inheritance disorder that affects mainly boys. Haemarthrosis is one of the common haemorrhagic signs of hemophilia, which could be complicated by advanced arthropathy that may affect the patient's functional prognosis. Our aim is to report through a case these rheumatologic complications of a haemophilia.Observation: A 15-year-old boy with severe haemophilia, presenting recurrent hemarthrosis since the age of 10 years. He was seen for arthritis of the right knee which has deteriorated progressively over two years, with knee joint swelling, patellofemoral syndrome, an axial valgus deviation and a flessum of the knee, accompagnied by an amyotrophy of the quadriceps. Radiological examination showed stage III hemophilic arthropathy. He received substitution treatment with symptomatic treatments and physiotherapy.Discussion and conclusion: Hemophilic arthropathy involves the functional prognosis of patients with severe hemophilia. Prophylactic replacement therapy has significantly decreased the frequency of advanced stages. However, in low-income countries, this prophylaxis is still limited because of the lack of accessibility and disponibility of replacement factor. There is a relatively broad therapeutic panel for the management of hemophilic arthropathy ranging from physiotherapy, to inflatrative procedures to surgery

GONARTHROSE ET SYNDROME MÉTABOLIQUE CHEZ LA POPULATION MALGACHE : ÉTUDE CAS TÉMOINS

Résumé-La gonarthrose est une des pathologies ostéoarticulaires les plus fréquentes, avec un risque de morbidité importante et un coût de prise en charge élevé.     Le syndrome métabolique est aussi un des problèmes de santé publique très répandus.Notre objectif principal était d’analyser l’association des syndromes métaboliques avec la gonarthrose primitive chez la population malgache. Nous avons réalisé une étude transversale, type « cas-témoins » sur une période de 7 mois allant de février 2020 à août 2020 dans les principaux CHU de Toamasina. Nous avons inclus les « cas » qui répondaient aux critères cliniques de gonarthrose de l’ACR en 1986, et les « témoins » ceux qui n’y répondaient pas, tout en éliminant les possibles causes secondaires. Nous avons recueilli les paramètres : IMC, périmètre abdominal, dyslipidémie, HTA.Cent-seize patients et individus étaient retenus, dont 58 pour le groupe « cas » et 58 pour le groupe « témoins ». L’IMC moyenne était plus élevée chez les cas que chez les témoins : 25.63 ± 4.65 kg\m2  versus 23.44 ± 4.82 kg\m2. Une association avec la gonarthrose  a été démontrée pour le surpoids/obésité selon l’IMC (OR 2.51, p 0.015), l’obésité abdominale isolée (OR 1; p1), le diabète (OR 0.80; p 0.67), l’HTA (OR 1.32; p 4.46), la dyslipidémie (OR 2.21; p 0.17).Le surpoids/obésité est le plus grand facteur de risque de gonarthrose, aussi bien dans le monde qu’à Madagascar. Son dépistage et sa prise en charge doivent être concomitants pour la prévention primaire et secondaire de la gonarthrose

Emerging Roles of Perivascular Mesenchymal Stem Cells in Synovial Joint Inflammation

International audienceIn contrast to the significant advances in our understanding of the mesenchymal stem cell (MSC) populations in bone marrow (BM), little is known about the MSCs that are resident in the synovial joint and their possible roles in the tissue homeostasis, chronic inflammation as well as in repair. Neural crest is a transient embryonic structure, generating multipotential MSC capable of migrating along peripheral nerves and blood vessels to colonize most tissue types. In adult, these MSC can provide functional stromal support as a stem cell niche for lymphocyte progenitors for instance in the BM and the thymus. Critically, MSC have major immunoregulatory activities to control adverse inflammation and infection. These MSC will remain associated to vessels (perivascular (p) MSC) and their unique expression of markers such as myelin P0 and transcription factors (e.g. Gli1 and FoxD1) has been instrumental to develop transgenic mice to trace the fate of these cells in health and disease conditions. Intriguingly, recent investigations of chronic inflammatory diseases argue for an emerging role of pMSC in several pathological processes. In response to tissue injuries and with the release of host cell debris (e.g. alarmins), pMSC can detach from vessels and proliferate to give rise to either lipofibroblasts, osteoblasts involved in the ossification of arteries and myofibroblasts contributing to fibrosis. This review will discuss currently available data that suggest a role of pMSC in tissue homeostasis and pathogenesis of the synovial tissue and joints