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[Sepsis caused by Haemophilus influenzae type B with septic arthritis in an infant]
G Bona1, F Cadario, E Benevenuta
1Dipartimento di Scienze Mediche, Clinica Pediatrica di Novara, Università degli Studi, Torino.
Insights
Septic arthritis in infants, often caused by Haemophilus influenzae type b (Hib), requires prompt diagnosis and treatment to prevent lasting orthopedic damage. Vaccination against Hib is crucial, especially for vulnerable infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Orthopedics
Background:
- Septic arthritis is a severe bacterial infection of the joint synovium, potentially causing permanent orthopedic damage.
- Infants are the most commonly affected demographic, with etiology varying by age.
- Haemophilus influenzae is a frequent cause in children under 24 months.
Observation:
- A 3-month-old infant with congenital heart disease, unvaccinated against Hib, presented with sepsis and septic arthritis.
- Clinical signs included prolonged fever, swollen and hyperemic wrist and ankle joints.
- Blood cultures confirmed Haemophilus influenzae type b (Hib) bacteremia; anemia was also noted.
Findings:
- The infant received a 15-day course of netilmicin and ceftriaxone.
- Fever resolved within two days, and articular symptoms improved in approximately ten days.
- Early diagnosis and treatment of septic arthritis are critical for favorable outcomes.
Implications:
- This case underscores the importance of early intervention in pediatric septic arthritis.
- Recommends Haemophilus influenzae type b (Hib) vaccination, particularly for immunocompromised or cardiopathic infants before two years of age.
- Highlights the role of Hib in severe pediatric infections and the need for timely immunization.
Abstract:
Septic arthritis is a serious pyogenic infection that may lead to permanent orthopedic sequelae. Infants represent the most of the cases. It usually develops as a result of bacterial seeding into the capillary-rich synovium in the course of a bacteremic episode. Etiology changes according to different ages; in children after the neonatal period but younger than 24 months, Haemophilus influenzae is the most frequent causative organism. A case of sepsis due to Haemophilus influenzae type b (Hib) with septic arthritis in a patient 3 months old, is reported. The child was admitted to the hospital with a very high temperature (39 degrees C) for five days. His right wrist and ankle appeared swelling and hyperemic. He was affected by congenital cardiopathy from birth. He was not immunizated against Hib. The blood colture was positive for Hib. The leukocyte count was 21,400 cell/mm3 with 55% of polymorphonuclear cells. During the second day of recovery, the patient was transfused, because of the very low value of hemoglobin (5.2 g/dl). The child was treated with netilmycina and ceftriaxone for 15 days. The temperature fell in two days. The articular pathology resolved in nearly ten days. The case reported confirms the importance of septic arthritis as a pathology that necessarily requires an early diagnosis and treatment. The Haemophilus influenzae vaccine, is recommended especially in immunocompromised or cardiopathic subjects and before the age of 2 years.