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Pyogenic arthritis in infants and children: a review of 95 cases
Abstract:
The clinical and laboratory findings of 95 children with pyogenic arthritis were reviewed to assess etiologic agents, diagnostic tools and results of therapy. Despite obtaining specimens from multiple sites for culture and using antigen detection tests only 64% of patients had an etiologic agent determined. Haemophilus influenzae type b was the most common causative agent identified and 82% of such cases occurred in children between 6 and 24 months of age. Infection due to Staphylococcus aureus was not confined to any age group. Results of laboratory tests which measure inflammatory response were not always abnormal. Platelet count and sedimentation rate frequently rose as clinical improvement occurred. Roentgenograms and radionuclide studies were of little benefit. Therapy included immediate decompression of the joint space, articular rest and use of antibiotics delivered parenterally. Ninety percent of 70 patients who were followed for 1 month to 5 years (mean, 15.5 months) were cured. Eight children had clinically significant sequelae which affected length of extremity, stability of articulations and range of movement. Development of sequelae was significantly associated with infection at age less than 6 months, delay of 4 or more days in institution of medical or surgery treatment, infection due to S. aureus and most strikingly the involvement of the hip or shoulder with concomitant presence of osteomyelitis.
Insights
Pyogenic arthritis in children is often caused by Haemophilus influenzae type b, especially in infants. Prompt treatment improves outcomes, but complications can still occur, particularly with Staphylococcus aureus infections or hip/shoulder involvement.
Area of Science:
- Pediatrics
- Infectious Diseases
- Orthopedic Surgery
Background:
- Pyogenic arthritis is a serious joint infection in children.
- Identifying causative agents and optimizing treatment are crucial for patient outcomes.
Purpose of the Study:
- To review clinical and laboratory findings in children with pyogenic arthritis.
- To assess etiologic agents, diagnostic methods, and therapeutic outcomes.
- To identify factors associated with treatment success and sequelae.
Main Methods:
- Retrospective review of clinical and laboratory data from 95 children with pyogenic arthritis.
- Analysis of cultures, antigen detection tests, inflammatory markers, and imaging studies.
- Evaluation of treatment protocols including joint decompression, rest, and antibiotics.
Main Results:
- An etiologic agent was identified in 64% of cases; Haemophilus influenzae type b was most common in children aged 6-24 months.
- Staphylococcus aureus infections occurred across all age groups.
- Inflammatory markers (platelet count, sedimentation rate) often normalized with clinical improvement.
- Radiographs and radionuclide studies provided limited diagnostic value.
- 90% of treated patients achieved cure, but 8 children experienced significant sequelae.
Conclusions:
- Early diagnosis and parenteral antibiotic therapy are key to successful pyogenic arthritis treatment in children.
- Risk factors for sequelae include young age (<6 months), delayed treatment (>4 days), S. aureus infection, and hip/shoulder involvement with osteomyelitis.