First case report of disseminated gonococcal arthritis in Newfoundland and Labrador
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Introduction. Disseminated gonococcal infections (DGIs) are a rare but often debilitating complication of Neisseria gonorrhoeae infections. Often presenting as arthritis–dermatitis syndrome, true suppurative joint infections are an even more rare form of DGI. Here, we present the first known case of DGI in Newfoundland and Labrador in over 10 years.
Case report. A 50-year-old man who is known to inject drugs with multiple housing and social challenges presented to the emergency department with a 2-day history of an isolated, painful, erythematous knee. After being assessed by orthopaedics and undergoing an operative debridement, intraoperative cultures grew N. gonorrhoeae . He was treated with intravenous ceftriaxone, and his course in hospital was complicated by inadequate pain control and a lack of stable housing.
Conclusion. Although rare, DGIs need to remain on every clinician’s differential for septic arthritis, given the increasing prevalence of gonorrhoeal infections in Canada, particularly in Newfoundland and Labrador. In addition, patients who are at risk of delaying accessing care, such as people who inject drugs and unhoused individuals, are at higher risk of complicated hospital stays.
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The work presented is clear and the arguments well formed.
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The reviewers have highlighted minor concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
Minor grammatical and spelling errors e.g. infectious diseases, not disease Excellent review of DGI and case presentation. Really good highlight of social and housing challenges and linking it to poor healthcare
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the …
Comments to Author
Minor grammatical and spelling errors e.g. infectious diseases, not disease Excellent review of DGI and case presentation. Really good highlight of social and housing challenges and linking it to poor healthcare
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
Interesting case. Well written. Suggest to use acronyms after initially using the full forms first time, like Intravenously (IV) and then in repitition can use (IV). Was a prolonged treatment, may be for another 2 weeks considered with oral antibiotics since the patient had septic arthritis? Was the patient later on at discharge offered post exposure prophylaxis for HIV. It is also interesting to see tetracycline resistance noted for the Neisseria in this patient specially when newer guidelines are promoting doxycycline to use as post exposure prophylaxis for STDs.
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns …
Comments to Author
Interesting case. Well written. Suggest to use acronyms after initially using the full forms first time, like Intravenously (IV) and then in repitition can use (IV). Was a prolonged treatment, may be for another 2 weeks considered with oral antibiotics since the patient had septic arthritis? Was the patient later on at discharge offered post exposure prophylaxis for HIV. It is also interesting to see tetracycline resistance noted for the Neisseria in this patient specially when newer guidelines are promoting doxycycline to use as post exposure prophylaxis for STDs.
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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