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Haemophilus influenzae type b septic arthritis in children: report of 23 cases
Insights
Haemophilus influenzae type b septic arthritis in infants often presents with fever and joint pain, sometimes alongside meningitis or osteomyelitis. Most infants recover fully within months, with few long-term impairments.
Area of Science:
- Pediatrics
- Infectious Diseases
- Rheumatology
Background:
- Septic arthritis caused by Haemophilus influenzae type b (Hib) was a significant concern in pediatric populations before widespread vaccination.
- Understanding the natural history and clinical course of Hib septic arthritis is crucial for effective management and prognosis.
Purpose of the Study:
- To review the clinical presentation, hospital course, laboratory findings, and long-term outcomes of infants diagnosed with Haemophilus influenzae type b septic arthritis.
- To describe the natural history of Hib septic arthritis, including associated conditions and recovery patterns.
Main Methods:
- Retrospective review of 23 cases of Haemophilus influenzae type b septic arthritis over a 5-year period.
- Analysis of clinical data, laboratory results, concurrent infections, treatment responses, and long-term follow-up.
Main Results:
- Patients presented with a mean of 3 days of fever and joint symptoms, often preceded by viral illness or otitis media.
- Concurrent meningitis occurred in 30% and osteomyelitis in 22% of cases. Infants averaged 3.6 febrile days in the hospital.
- Most infants showed clinical joint improvement by day 2.5, with laboratory markers indicating recovery. Long-term follow-up (mean 20 months) revealed residual impairment in only 2 of 21 infants, with total healing varying from 9 days to 17 months (mean 4 months).
Conclusions:
- Haemophilus influenzae type b septic arthritis requires prompt recognition and management, considering potential concurrent serious infections like meningitis and osteomyelitis.
- While the acute phase can involve prolonged fever, most infants achieve good functional recovery with minimal long-term sequelae, though healing times vary significantly.
Abstract:
Twenty-three cases of Haemophilus influenzae type b septic arthritis seen over a recent 5-year period are reviewed. The natural history of the disease includes a mean three days of fever and joint symptoms prior to hospitalization, often accompanied or immediately preceded by a viral illness and/or otitis media. Concurrent H influenzae type B meningitis was present in 30% of patients and concurrent osteomyelitis in 22%. Infants remained febrile in the hospital for a mean of 3.6 consecutive days. However, secondary and prolonged fevers were common. Clinical improvement in the joint examination was first seen at a mean of 2.5 days. Characteristic laboratory findings during recovery included a decline in total WBC count, neutrophil count, ESR, and hematocrit, with a concomitant increase in lymphocyte and platelet counts. Outpatient follow-up for a mean duration of 20 months found only two of 21 infants with residual impairment. The time to total healing in the remaining 19 infants, however, varied widely--from nine days to 17 months (mean of 4 months).