- Access throughyour institution
Archives de Pédiatrie
Volume 26, Issue 1,
, Pages 38-43
Septic elbow arthritis is a rare disease, especially in children. The aim of this study was to report the functional outcome of our pediatric population with both demographic and microbiological features.
We retrospectively reviewed all our cases of pediatric septic elbow arthritis between 2007 and 2017. Demographic, microbiological, biological, and radiological features were analyzed. Functional outcome was evaluated according to the Morrey Elbow Performance Score (MEPS).
In total, 14 cases were reviewed. The mean age was 9 years. Microbiological findings revealed Staphylococcus aureus in 10 cases. The mean white blood cells count in synovial fluid was 101,306 cells per mm 3. The skin was the most frequently reported entry portal. The mean MEPS score was 86.13 points (excellent in eight cases, good in three cases, fair in two cases, and poor in two cases). Stiffness was observed in three cases. No growth disturbance was reported.
Septic elbow arthritis in children is rare. Biological inflammatory markers are sensitive but not specific. White blood cell count in the synovial fluid is specific. S.aureus is the most frequently cultured agent. Treatment is based on surgical debridement, antibiotics, and elbow immobilization. Concomitant osteomyelitis is frequent and should be diagnosed and treated simultaneously. Functional outcomes are usually satisfactory in contrast to osteomyelitis.
Pediatric septic elbow arthritis is rare. It may be primary or secondary to trauma and surgery of the elbow. Demographic, biological, and microbial features are similar to those reported for osteomyelitis; however, functional outcomes are better with a negligible rate of growth disturbance.
Septic elbow arthritis is a rare serious infectious disease, especially in children . This infection is dangerous because it may lead to fulminant sepsis , . In children, the risk of growth disturbance seems to be higher, explained by the cartilage damage and joint destruction. The elbow may be infected, similarly to the other joints, via three ways: (1) via hematogenous seeding of the joint space from a distant site of infection, (2) via a contiguous infected side, and (3) by direct inoculation after elbow trauma . The outcome depends on the delay of treatment and the effectiveness of antibiotic therapy. Furthermore, the earlier the treatment, the better the outcome , . As with the hip or knee, the diagnosis is suspected on the basis of preliminary symptoms such as stiffness, pain, edema, and erythema; laboratory findings may be unreliable given the lack of specificity of the symptoms. Hence, the diagnosis often relies on a heightened index of suspicion by the treating physician . In comparison with both hip and knee septic arthritis, there are few series reporting on the outcome after localization in the elbow, especially in children. Several studies have been found but they comprise mostly adults. The purpose of our study is to report the clinical, microbiological, and radiological features as well as the outcome of septic elbow arthritis in our pediatric population.
The cases of 15 children diagnosed with septic elbow arthritis at Sahloul University Hospital between January 2007 and December 2017 were reviewed retrospectively. After obtaining approval from our institutional review board, the study was undertaken. Inclusion criteria were: age younger than 17 years, confirmed septic elbow arthritis, positive microbial laboratory findings, and presence of patient at final follow-up. Exclusion criteria were: age older than 17 years, culture-negative synovial
This retrospective series included five female and 10 male patients (sex ratio: 2). The mean age of children at time of the infectious event was 9 years (range: 3–13 years). The mean time of symptom development was 4.2 days (range: 1–11 days). The right elbow was affected in eight cases (53%) whereas the left one was affected in seven cases (47%). Concerning the portal of entry, the skin was reported in nine cases (60%); infected granuloma around a K-wire after supracondylar fracture pinning
Septic elbow arthritis is a rare localization in children , . The number of cases in our series is important and may be considered to be one of the highest in the literature. Septic elbow arthritis has been reported in adults; however, pediatric series are fewer and have not sufficiently characterized the microbiological profile and utility of biological markers in the diagnosis . The aim of this study was to report the biological and microbiological profile as well as the outcomes of
Septic elbow arthritis in the pediatric population is a rare infectious disease. Demographic features in comparison with osteomyelitis are not different: The most commonly reported microbial agent is S.aureus. Reviewing the literature and according to our data, concomitant osteomyelitis is the most frequent situation explained by the high incidence of staphylococcal bone and joint infections in this age. The diagnosis is based on the clinical presentation and the results of physical
There was no financial support for the study.
Disclosure of interest
The authors declare that they have no competing interest.
We thank our colleagues in Sahloul orthopedics department, the participants, the coordinators, and the data reviewers who assisted in this study.
- B.W. Frazee et al.How common is MRSA in adult septic arthritis?
Ann Emerg Med
- B.W. Frazee et al.High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections
Ann Emerg Med
- G. Frank et al.Musculoskeletal infections in children
Pediatr Clin North Am
- T. Haas et al.
Septic arthritis of the elbow with Streptococcus pneumoniae in a 9-month-old girl
BMJ Case Rep
- J. Bowakim et al.
Elbow septic arthritis in children: clinical presentation management
J Pediatr Orthop B
- P. Mehta et al.
Septic arthritis of the shoulder, elbow, and wrist(Video) Swollen Joint in Children – Pediatrics | Lecturio
Clin Orthop Relat Res
- J.J. McCarthy et al.
Musculoskeletal infections in children: basic treatment principles and recent advancements
Instr Course Lect
- M.E. Margaretten et al.
Does this adult patient have septic arthritis?
- B.F. Morrey et al.
Functional evaluation of the elbow and its disorders
- O.A. Gafur et al.
The impact of the current epidemiology of pediatric musculoskeletal infection on evaluation and treatment guidelines
J Pediatr Orthop
Changing patterns of acute hematogenous osteomyelitis and septic arthritis: emergence of community-associated methicillin-resistant Staphylococcus aureus
J Pediatr Orthop
Infections due to Pseudomonas species and related organisms
Methicillin-resistant S.aureus infections among patients in the emergency department
N Engl J Med
- Acute osteomyelitis of the distal fibula in children: Treatment options and long-term follow-up
2020, Archives de Pediatrie
Acute osteomyelitis of the distal fibula is a rare disease in children and is characterized by special features compared with other sites. The objective of this study was to report the functional outcome at long-term follow-up.
We reviewed retrospectively, between January 2000 and December 2010, all cases of acute osteomyelitis of the distal fibula. Epidemiological and bacteriological data as well as therapy and outcome factors were analyzed. At the last follow-up, functional outcome was studied based on ankle motion, growth disturbance, and radiological sequelae.
Seven cases of acute osteomyelitis of the distal fibula were found. The mean age was patients was 7.71 years and the sex ratio was 2.5. The portal of entry of the pathogen was a skin injury in 57% of cases. Staphylococcus aureus was identified in 71% of cases. The mean duration of antibiotic therapy was 33.2 days. At a mean of 12.85 years of follow-up, no growth disturbance was found. The mean plantar and dorsal flexion was 41° and 27.7°, respectively. The mean postoperative American Orthopedics Foot and Ankle score (AOFAS) was 96.71 points.
Acute osteomyelitis of the distal fibula in children is scarce and rarely reported in the literature. It occurs more often in boys at an average age of 7 years. Local symptoms are usually more obvious than general symptoms. Surgical debridement of the subperiosteal abscess without bone trepanation seems to lead to a satisfactory outcome.
Level IV–case series.
Sahloul Hospital Human Research Ethics Committee.
Developments in diagnosis and treatment of paediatric septic arthritis
2022, World Journal of Orthopedics
Postoperative early measures and rehabilitation after surgical arthrolysis for elbow stiffness
2022, Obere Extremitat(Video) Approach to a child with arthritis
Current Variation in Joint Aspiration Practice for the Evaluation of Pediatric Septic Arthritis
2020, Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews
Research articleEpidemiological and clinical profile of intestinal parasitosis of children in rural areas in Central African Republic
Archives de Pédiatrie, Volume 26, Issue 1, 2019, pp. 34-37
To describe the epidemiological and clinical profile of intestinal parasites in children in rural Central African Republic.
We conducted a multicenter cross-sectional study in Central African Republic rural areas. Children seen as outpatients regardless of the reason for consultation were included in the study after parental consent. Each stool sample sent to the laboratory in a plastic pot was subjected to a direct co-examination with physiological water.
A total of 102 children were included in the study, of whom 53 were boys (51.96%), the median age was 4 years (3 months; 15 years old). They had a primary level of education in 31.37% of cases, 76.47% came from Health Region 1. Drilling was the source of drinking water in 61.76% of cases and the backwater was used for bathing by 26.47% of children. Abdominal pain was observed in 55 children (53.92%). The prevalence of intestinal parasitosis was 88.23%. Of 122 identified parasites, 96 were helminths (78.69%) and 26 were protozoa (21.31%). Of the three protozoan species isolated, Entamoeba histolytica was found in 15 cases (14.70%). The most common helminthiasis was Ascaris lumbricoides (40.19%). The frequency of parasitic infection was 92% in children aged from 5 to 9 years. Mono-parasitism was observed in 52.94% versus 33.33% for poly-parasitism.
Intestinal parasitosis is a public health problem in Central African Republic rural areas. Improving access to drinking water for populations could reduce the magnitude of these diseases.
Research articleAge at menarche and place of residence (Marrakesh, Morocco)
Archives de Pédiatrie, Volume 26, Issue 1, 2019, pp. 30-33
The aim of the study was to determine the age at menarche of Moroccan girls by place of residence (rural vs. urban).
The data were derived from a survey conducted between 2014 and 2016 in schools of the Marrakesh region. A total of 433 questionnaires were completed by 433 girls aged 9–18 years, with 245 (56.6%) living in urban areas and 188 (43.4%) in rural areas. The mean and median age at menarche of the girls were estimated by retrospective and status-quo methods, respectively. The sociodemographic variables used were the parents’ educational level, the parents’ socioeconomic status, and family size.(Video) Management of Bone and Joint Infections in Children - Charles R. Woods Jr., M.D., M.S.
Out of the 433 girls surveyed, 265 had attained menarche, and the mean was at 13.10 years. The median age at menarche was 13.46 years. According to the place of residence, the girls living in urban areas on average had their first menstruation earlier than girls from rural areas. The mean and median ages at menarche of urban girls were 12.96 years and 13.16 years, respectively, compared with 13.34 years and 13.94 years for their rural counterparts.
What can be inferred from this study is that the place of residence is a differential factor of age at menarche. This can be related to differences in the living conditions between the two environments.
Research articleCarbon monoxide poisoning from waterpipe (narghile) smoking in a child
Archives de Pédiatrie, Volume 26, Issue 1, 2019, pp. 44-47
Shisha smoking has spread to many countries since the 1990s and is now a global phenomenon among adolescents. Notwithstanding the connotations of conviviality of shisha smoking, it is in fact highly dangerous since the smoke inhaled contains toxic substances. Carbon monoxide (CO) poisoning carries a high risk of neurological and neuropsychological sequelae such as memory loss, impaired concentration, mood disorders, and various other symptoms. We report a case of severe CO poisoning in a 13-year-old boy after smoking shisha that caused loss of consciousness and seizure. To our knowledge, there have as yet been no reports of cases involving children. We present some epidemiological data on shisha smoking in adolescents as well as on CO intoxication.
Research articleAssessing assistive technology requirements in children with written language disorders. A decision tree to guide counseling
Archives de Pédiatrie, Volume 26, Issue 1, 2019, pp. 48-54
Children with a written language disorder are sometimes dependent upon help from others for their schoolwork. A computer can be a way to circumvent this difficulty. Various software programs and plug-in peripheral devices are available, some of which specifically target the needs of these young people. There is no consensus, however, with regard to how best to counsel parents and children with regard to these tools. Furthermore, written language disorders and existing technical supports are not always clearly understood. In many cases, healthcare and teaching professionals have only limited knowledge of the potentially specific advantages for patients with written language disorders. A child's full integration into daily activities and school life can be hampered by counseling that was inadequately tailored or by a lack of support in using this equipment. Joint consultations involving both an occupational and a speech therapist have been set up in our department to improve counseling with regard to technical supports. Using our daily practice as a basis, we have developed a decision tree that we see as a necessary tool for helping professionals make the most appropriate practical choices.
Research articleUnusual case of paediatric septic arthritis of the lumbar facet joints due to Kingella kingae
Orthopaedics & Traumatology: Surgery & Research, Volume 102, Issue 7, 2016, pp. 959-961
A 32-month-old boy presented with febrile limping that had developed over 6days, associated with right lumbosacral inflammatory swelling. Magnetic resonance imaging (MRI) showed joint effusion of the right L5–S1 zygapophyseal joint, complicated by destructive osteomyelitis of the L5 articular process and paraspinal abscess. Surgery was decided to evacuate the fluid accumulation and rule out differential diagnoses. The diagnosis of septic arthritis of the facet joint was confirmed intraoperatively; real-time quantitative PCR analysis identified Kingella kingae. This is the first substantiated paediatric case of zygapophyseal joint septic arthritis due to K.kingae. K.kingae is the most common pathogen responsible for invasive osteoarticular infection in children under 4years of age. Since empiric antibiotics are effective in early stages, physicians should consider the possibility of spinal infections due to K.kingae when a limping child under 4years of age presents with a fever.
Research articleAnalysis of aberrant splicing and nonsense-mediated decay of the stop codon mutations c.109G>T and c.504_505delCT in 7 patients with HMG-CoA lyase deficiency
Molecular Genetics and Metabolism, Volume 108, Issue 4, 2013, pp. 232-240
Eukaryotic cells can be protected against mutations that generate stop codons by nonsense-mediated mRNA decay (NMD) and/or nonsense-associated altered splicing (NAS). However, the processes are only partially understood and do not always occur. In this work, we study these phenomena in the stop codon mutations c.109G>T (p.Glu37*) and c.504_505delCT; the second and third most frequent mutations in HMG-CoA lyase deficiency (MIM #246450). The deficiency affects the synthesis of ketone bodies and produces severe disorders during early childhood. We used a minigene approach, real-time quantitative PCR and the inhibition of NMD by puromycin treatment, to study the effect of stop codons on splicing (NAS) and NMD in seven patients. Surprisingly, none of the stop codons studied appears to be the direct cause of aberrant splicing. In the mutation c.109G>T, the splicing is due to the base change G>T at position 109, which is critical and cannot be explained by disruption of exonic splicing enhancer (ESE) elements, by the appearance of exonic splicing silencer (ESS) elements which were predicted by bioinformatic tools or by the stop codons. Moreover, the mutation c.504_505delCT produces two mRNA transcripts both with stop codons that generate simultaneous NMD phenomena. The effects of the mutations studied on splicing seemed to be similar in all the patients. Furthermore, we report a Spanish patient with 3-hydroxy-3-methylglutaric aciduria and a novel missense mutation: c.825C>G (p.Asn275Lys).
© 2018 Elsevier Masson SAS. All rights reserved.
Conclusion: Pediatric septic elbow arthritis is rare. It may be primary or secondary to trauma and surgery of the elbow. Demographic, biological, and microbial features are similar to those reported for osteomyelitis; however, functional outcomes are better with a negligible rate of growth disturbance.
Which children are at risk for septic arthritis? Septic arthritis may occur without any known risk factors. But children who have an open skin wound and a weakened immune system may be at greater risk. A weakened immune system can be caused by diabetes, kidney disease, HIV infection, or cancer.
Septic arthritis is an infection in the joint (synovial) fluid and joint tissues. Different types of bacteria, viruses, and fungi can infect a joint. Symptoms include fever, joint pain, swelling, redness, and warmth. Quick treatment with antibiotics is needed to halt the risk of joint damage.
Bacterial infection with Staphylococcus aureus (staph) is the most common cause.
Septic arthritis is more common in males5 and the large joints are more often involved, of which the knee is the most commonly involved joint5. The risk is higher when the joint is traumatized. The causative organisms are diverse in septic arthritis, but Staphylococcus aureus infection is the most common6.
Approximately 20,000 cases of septic arthritis occur in the United States each year (7.8 cases per 100,000 person-years), with a similar incidence occurring in Europe. The incidence of arthritis due to disseminated gonococcal infection is 2.8 cases per 100,000 person-years.
- Chronic pain.
- Osteomyelitis (inflammation or swelling in the bone).
- Osteonecrosis (bone tissue dies due to lack of blood flow).
- A difference in leg length.
- Sepsis (widespread inflammation in the body).
These bacteria can enter a child's body in a variety of ways, including: Infection that spreads from another source inside the body, such as a skin or bone infection adjacent to a joint. Infected wounds. Open fractures, or bones that penetrate through the skin.
When evaluating a patient with suspected septic arthritis, also consider conditions such as primary rheumatologic disorders (eg, vasculitis, crystalline arthritides), drug-induced arthritis, and reactive arthritis (eg, postinfectious diarrhea syndrome, postmeningococcal and postgonococcal arthritis, arthritis of ...
How Is Septic Arthritis Diagnosed? A procedure called arthrocentesis is commonly used to make an accurate diagnosis of septic arthritis. This procedure involves a surgical puncture of the joint to draw a sample of the joint fluid, known as synovial fluid.
It is possible to prevent septic arthritis by avoiding infections, puncture wounds, and damage to the skin.
Septic arthritis medicine include intravenous vancomycin, ceftriaxone and ceftazidime. Treatment can then be changed to oral antibiotics such as cefixime or ciprofloxacin for at least one week.
Bacterial infections cause most cases of sepsis. Sepsis can also be a result of other infections, including viral infections, such as COVID-19 or influenza.
Most cases of infectious arthritis are caused by bacteria. The most common of these is Staphylococcus aureus (staph), a bacterium that lives on healthy skin. Infectious arthritis can also be caused by a virus or a fungus.
Infectious arthritis, also called septic arthritis, involves a sudden, severe infection of a joint. It is a type of inflammatory arthritis that can cause swelling, pain, and tissue damage. Infectious arthritis usually affects just one joint, but it can spread.
Acute nongonococcal septic arthritis is a medical emergency that can lead to significant morbidity and mortality. Therefore, prompt recognition, rapid and aggressive antimicrobial therapy, and surgical treatment are critical to ensuring a good prognosis.
ANSWER: Sepsis is a serious complication of an infection. It often triggers various symptoms, including high fever, elevated heart rate and fast breathing. If sepsis goes unchecked, it can progress to septic shock — a severe condition that occurs when the body's blood pressure falls and organs shut down.
Osteomyelitis is an infection of the bone that can include the periosteum, medullary cavity, and cortical bone. Septic arthritis is an infection of surface of the cartilage that lines the joint and the synovial fluid that lubricates the joint.
Septic arthritis can also cause many complications, including osteomyelitis, bony erosions, fibrous ankylosis, sepsis, and even death. Treatment consists of a combined medical and surgical approach.
In septic arthritis the joints are swollen, hot, sore, and pus-filled; the condition may occur following infection by such bacteria as Streptococcus, Staphylococcus, Pneumococcus, Gonococcus, or Meningococcus.
The incidence varies between studies, but septic arthritis has a predilection towards children under the age of 4 years. Septic arthritis occurs most commonly in the hip and knee joints. Other joints commonly affected include the shoulder and ankle, but septic arthritis can occur in any synovial joint in the body.
The average stay in hospital if you have septic arthritis is about 2 weeks. Most people start feeling better quickly once they are given antibiotics.
Patients will most commonly present with a single swollen joint causing severe pain. Pyrexia will be in around 60% of affected individuals (although its absence should not rule out septic arthritis).
Conventional radiograph is the initial screening imaging modality for the detection of septic arthritis, although it has low sensitivity and specificity for acute infection. In the early stage, the simple radiograph can appear normal, and this does not rule out infection.
Mortality rates can be significant, ranging from 3–25%. Despite the severity of illness, septic arthritis may be subtle, with many patients lacking the classic signs, symptoms, or laboratory findings. There are also a large number of conditions that may mimic septic arthritis, further confounding the diagnosis.
Septic arthritis is considered a surgical emergency. Diagnosis and prompt drainage is required to avoid continued joint damage, which can result in early onset arthritis. Septic arthritis typically occurs related to adjacent osteomyelitis (infection of the bone).
* Following joint drainage, the typical duration of antibiotic therapy for treatment of septic arthritis is three to four weeks; we typically administer parenteral antibiotics for at least 14 days followed by oral therapy for an additional 14 days.
Septic bursitis is a medical emergency that requires prompt treatment with broad-spectrum antibiotics (e.g., cephalosporins, clindamycin, or vancomycin).
Adults with suspected gonococcal arthritis are usually young, healthy and sexually active. On physical examination, they may have dermatitis, tenosynovitis, non-erosive arthritis and a migratory pattern of arthritis.
- feeling dizzy or faint.
- a change in mental state – like confusion or disorientation.
- nausea and vomiting.
- slurred speech.
- severe muscle pain.
- severe breathlessness.
- less urine production than normal – for example, not urinating for a day.
- Rapid breathing and heart rate.
- Shortness of breath.
- Confusion or disorientation.
- Extreme pain or discomfort.
- Fever, shivering, or feeling very cold.
- Clammy or sweaty skin.
- Sepsis. An infection gets into your bloodstream and causes inflammation in your body.
- Severe sepsis. The infection and inflammation is severe enough to start affecting organ function.
- Septic shock.
Antibiotics will not treat reactive arthritis itself but are sometimes prescribed if you have an ongoing infection – particularly if you have an STI. Your recent sexual partner(s) may also need treatment.
In children, an infection in the blood is a common cause of osteomyelitis. This is because a child's growing bones have an increased blood supply. That makes it easier for the bacteria to get into the bone. An infection from nearby soft tissue or from a wound may also lead to osteomyelitis.
Reactive arthritis occurs when the body's immune system reacts to a recent infection, usually within the past four to six weeks, with joint swelling and pain. The child has recovered from the infection and, several weeks later, develops the signs of reactive arthritis.
Juvenile rheumatoid arthritis (JRA), often referred to by doctors today as juvenile idiopathic arthritis (JIA), is a type of arthritis that causes joint inflammation and stiffness for more than six weeks in a child aged 16 or younger. It affects approximately 50,000 children in the United States.