[Pyogenic sacroiliitis: Lessons learned from an atypical case series]

Area of Science:

• Pediatric Infectious Diseases
• Musculoskeletal Infections
• Microbiology

Background:

• Pyogenic sacroiliitis (PSI) is a rare pediatric joint infection (1-2% of cases).
• Diagnosis is challenging due to nonspecific signs and symptoms.
• Identifying causative microorganisms is difficult due to negative blood cultures and risks of joint aspiration.

Purpose of the Study:

• To review cases of pediatric pyogenic sacroiliitis.
• To evaluate diagnostic challenges and causative agents.
• To assess treatment outcomes and identify optimal diagnostic strategies.

Main Methods:

• Retrospective review of pediatric patients (<18 years) with PSI.
• Analysis of medical records from 2008-2016.
• Inclusion of diagnostic methods used (blood cultures, joint aspiration, specific screening tests).

Main Results:

• Six pediatric PSI cases were identified.
• Blood cultures were consistently negative.
• Causative agents included Aggregatibacter aphrophilus, Kingella kingae, Brucella melitensis, and Bartonella henselae, requiring joint aspiration or specific screening.
• All patients achieved favorable outcomes with targeted antimicrobial therapy.

Conclusions:

• Blood cultures have low effectiveness for diagnosing pediatric PSI.
• A high index of suspicion for atypical agents is necessary.
• Early use of advanced diagnostics (imaging, serology, PCR) and appropriate antimicrobial therapy are essential for successful management.