Current Variation in Joint Aspiration Practice for the Evaluation of Pediatric Septic Arthritis

Pediatric septic arthritis is uncommon and has been traditionally treated by joint aspiration or open arthrotomy. There are some reports about arthroscopic surgery in pediatric septic arthritis of the knee, hip, and shoulder. However, there is no report for the case of elbow. We report a case of pediatric septic arthritis of elbow treated with arthroscopically with good clinical condition at 3-year follow-up. This paper is based on a report first published in Japanese (Tojo (2012)).

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Septic arthritis of ankle joint in the paediatric age group: a retrospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201016 ◽

2020 ◽

Vol 6 (3) ◽

pp. 442

Author(s):

Nasiur Rehman ◽

Marcin Zgoda ◽

Mohamed K. Osman

Keyword(s):

Retrospective Study ◽

Knee Joint ◽

Septic Arthritis ◽

Joint Infection ◽

Positive Culture ◽

Causative Organism ◽

Age Group ◽

Laboratory Findings ◽

Joint Aspiration ◽

Paediatric Age

Background: Septic arthritis in paediatric age group poses a significant clinical problem. Common sites are hip and knee joint. There are several orthopaedic literatures available on septic arthritis of the hip and knee joint, however, literature on epidemiology, causative organisms and outcome of septic arthritis of the ankle are very few.Methods: We conducted a retrospective study at a tertiary hospital with an aim to evaluate the incidence, causative pathogen, outcome and to identify differences, if any, between clinical features and laboratory findings of these patients when compared to those with hip and knee joint infection.Results: 47 children were diagnosed with septic arthritis, of which, 14 had septic arthritis of the ankle. Mean age was 5.2 years (8 months - 12 years). 13 children had undergone joint aspiration as a primary procedure. 50% (7) children had positive culture. Streptococcus pyogenes was the commonest causative organism in our cohort (29%) followed by Staphylococcus aureus. Mean follow-up was 36 months (16 - 56 months). 13 children (93%) had good clinical outcome. 1 child developed early arthritis.Conclusions: Septic arthritis of the ankle is a serious condition. Even-though the joint is superficial, diagnosing it clinically can be difficult due to less pronounced symptoms. This can lead to delay in establishing the diagnosis and commencing treatment, hence, it is imperative to have a high index of suspicion. We found early joint aspiration followed by a course of antibiotics to be an effective regimen in management of this devastating condition.

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Abklärung Monarthritis – Schritt für Schritt

DMW - Deutsche Medizinische Wochenschrift ◽

10.1055/a-0722-7254 ◽

2019 ◽

Vol 144 (22) ◽

pp. 1585-1589

Author(s):

Boris Ehrenstein

Keyword(s):

Septic Arthritis ◽

Leucocyte Count ◽

Joint Damage ◽

Inflammatory Rheumatic Diseases ◽

Fluid Sample ◽

Infectious Arthritis ◽

Joint Aspiration ◽

Gram Staining ◽

High Urgency ◽

Work Up

AbstractThe work-up of acute monoarthritis is challenging due to the abundance of differential diagnoses. In addition to a bacterial septic arthritis, which can, if not treated promptly, cause rapid irreversible joint damage, many diseases have to be considered: inflammatory rheumatic diseases, activated osteoarthritis, other infectious arthritis, cristal induced arthritis, and rare tumorous diseases. In cases with high urgency, and/or when medical history, physical examination and laboratory parameters remain without a specific etiologic clue, septic arthritis has to be excluded by immediate diagnostic joint aspiration. In many patients the cause of monoarthritis can already be determined by ordering a leucocyte count of the synovial fluid sample, a microscopy for crystals, and gram staining and culture for bacterial pathogens.

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Joint aspiration for suspected septic arthritis – are we requesting the right investigations?

International Journal of Surgery ◽

10.1016/j.ijsu.2018.05.376 ◽

2018 ◽

Vol 55 ◽

pp. S80

Author(s):

J. Baker ◽

G. Manoharan ◽

M. Hamadto ◽

D. Griffiths

Keyword(s):

Septic Arthritis ◽

Joint Aspiration ◽

The Right

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Arthritis in children: comparison of clinical and biological characteristics of septic arthritis and juvenile idiopathic arthritis

Archives of Disease in Childhood ◽

10.1136/archdischild-2016-310594 ◽

2016 ◽

Vol 102 (4) ◽

pp. 316-322 ◽

Cited By ~ 9

Author(s):

Camille Aupiais ◽

Romain Basmaci ◽

Brice Ilharreborde ◽

Audrey Blachier ◽

Marie Desmarest ◽

...

Keyword(s):

Juvenile Idiopathic Arthritis ◽

Septic Arthritis ◽

Tertiary Care ◽

Age At Onset ◽

First Episode ◽

Tertiary Care Centre ◽

Term Outcome ◽

Duration Of Symptoms ◽

Disease Evolution ◽

Joint Aspiration

AimChildhood arthritis arises from several causes. The aim of this observational study is to compare the clinical and biological features and short-term outcome of different types of arthritis because they have different treatment and prognoses.MethodsChildren <16 years of age hospitalised in a French tertiary care centre for a first episode of arthritis lasting for less than 6 weeks who underwent joint aspiration were retrospectively included. We performed non-parametrical tests to compare groups (septic arthritis (SA), juvenile idiopathic arthritis (JIA) and arthritis with no definitive diagnosis). The time before apyrexia or C reactive protein (CRP) <10 mg/L was analysed using the Kaplan-Meier method.ResultsWe studied 125 children with a sex ratio (M/F) of 1.1 and a median age of 2.2 years (range 0.3 to 14.6). SA was associated with a lower age at onset (1.5 years, IQR 1.2–3.0 vs 3.6 years, IQR 2.2–5.6), shorter duration of symptoms before diagnosis (2 days, IQR 1–4 vs 7 days, IQR 1–19) and higher synovial white blood cell count (147 cells ×103/mm3, IQR 71–227, vs 51 cells ×103/mm3, IQR 12–113), than JIA. Apyrexia occurred later in children with JIA (40% after 2 days, 95% CI 17% to 75%) than children with SA (82%, 95% CI 68% to 92%), as did CRP<10 mg/L (18% at 7 days, 95% CI 6.3% to 29.6% vs 82.1%, 95% CI 76.1% to 89.7%, p=0.01).ConclusionsThere were no sufficiently reliable predictors for differentiating between SA and JIA at onset. The outcomes were different; JIA should be considered in cases of poor disease evolution after antibiotic treatment and joint aspiration.

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Septic arthritis

10.1093/med/9780199550647.003.011005 ◽

2011 ◽

Author(s):

Peter Calder

Keyword(s):

Septic Arthritis ◽

Blood Cultures ◽

Joint Aspiration ◽

Significant Limitation ◽

Low Threshold ◽

Systemic Symptoms

♦ Painful swollen joint with significant limitation in movement♦ Systemic symptoms, fever, and malaise♦ Antibiotics following blood cultures, joint aspiration♦ Wash out and joint splintage in position of function♦ Low threshold to repeat washout if symptoms do not resolve.

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Septic Arthritis

10.1093/med/9780199976805.003.0046 ◽

2016 ◽

Author(s):

Hasan E. Baydoun ◽

Bachar Hamade ◽

Jamil D. Bayram

Keyword(s):

Septic Arthritis ◽

Joint Pain ◽

Nonsurgical Treatment ◽

Concomitant Infection ◽

Symptom Resolution ◽

Joint Aspiration

Septic arthritis is an infectious inflammation of a joint. It usually presents as acute, progressive pain that increases with motion and eventually leads to the inability to bear weight. The most common presenting features include joint pain, swelling, and fever. Pediatric cases are often associated with bacteremia. Gonococcal arthritis is migratory and associated with dermatitis and tenosynovitis. Optimal positioning of the joint to avoid future contractures is essential, and joint aspiration should be done as soon as possible. IV antibiotics should be given only after aspiration unless the patient is septic, in which case antibiotics should not be delayed. Orthopedic consultation is mandatory in cases of septic arthritis. In documented gonococcal arthritis with no suspicion for other concomitant infection, nonsurgical treatment may be considered if there is complete symptom resolution with IV antibiotics and joint aspiration.

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