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Reactive arthritis following an outbreak of Salmonella
Bovismorbificans infection.
J Infect. 1998 May;36(3):289-95.
Mattila L, Leirisalo-Repo M, Pelkonen P, Koskimies S, Granfors K, Siitonen A.
Laboratory of Enteric Pathogens, National Public Health Institute, Helsinki,
Finland.
A large, single-source Salmonella outbreak caused by a rare serovar
Bovismorbificans (6,8:r:1,5) occurred in southern
Finland in 1994.
The origin of the outbreak was sprouted alfalfa seeds. A questionnaire was
mailed to all 210 subjects with positive stool culture. Ninety-one percent
(191/210) returned the questionnaire. One hundred and fifty-three (80%) were
adults. One hundred and fifty-nine out of one hundred and ninety-one (83%)
reported diarrhoea, 109 (57%) fever, 104 (54%) abdominal pains, 83 (43%)
fatigue, 66 (35%) articular symptoms and 20 (10%) had no symptoms. The median
duration of diarrhoea was 5 days (range 1-35), that of other symptoms 4 days
(range 1-30). Those reporting articular symptoms were examined (51 patients) or
contacted by telephone (13 patients). Twelve percent (22/191) fulfilled the
criteria for reactive arthritis (ReA). The difference in the incidence of ReA
between children and adults was not significant (8%, vs. 12%). The median onset
of joint symptoms was 8.5 days; symptoms were oligoarticular in 14 (67%) and
polyarticular in four (19%) patients. Mostly ReA was mild, but in four patients
(18%) the joint symptoms lasted for more than 4 months. Ten (45%) ReA patients
had HLA-B27 tissue type. The duration and severity of ReA did not differ between
HLA-B27 positive and negative patients. Fourteen (64%) ReA patients had received
fluoroquinolone treatment before reactive joint or tendon symptoms manifested,
but this treatment did not prevent ReA symptoms.
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