INTRODUCTION Septic arthritis (SA) is a devastating infection with a high rate of sequelae. The aim of this retrospective study was to determine the epidemiology, clinically significant sequelae and risk factors for developing these sequelae in children admitted to our hospital with SA. METHODS Patients with bacteriologically and/or radiologically confirmed SA from January 1999 to December 2014 were identified from discharge and laboratory records. Data was collected through a retrospective review of the case notes. RESULTS A total of 75 patients (62.7% male) met the inclusion criteria. The median age at presentation was six years (range two weeks to 15 years), and six patients were neonates. Microbiologic aetiology was determined in 40 (53.3%) patients, with Staphylococcus aureus being the most common organism. 68.0% of the patients underwent arthrotomy, and the average hospital stay was 15.3 days. Sequelae of SA were observed in nine patients on follow-up. Univariate and multivariate statistical analyses showed that young age, pyogenic bacterial isolation and concomitant osteomyelitis were significant risk factors for developing sequelae. CONCLUSION Our study demonstrated that young age, pyogenic bacterial isolation and concomitant osteomyelitis are associated with a high risk of sequelae. Timely microbiologic diagnosis by novel polymerase chain reaction methods and the use of magnetic resonance imaging in high-risk children to identify adjacent infection could possibly prevent lifelong disabling sequelae in SA.

Herpes simplex encephalitis (HSE) remains one of the most devastating infections of the central nervous system in children despite available antiviral therapy. Our aim was to determine the clinical epidemiology and long-term neuro-developmental outcome of neonates and children admitted to our hospital with proven HSE. Patients with HSE during November 1998 to December 2011 were identified from discharge and laboratory records and data collection was done by retrospective review of their case notes. HSE was proven by culture or polymerase chain reaction (PCR) or by a positive Herpes simplex virus (HSV)?specific intrathecal antibody. We identified 13 patients during the study period: nine neonates and four older children, all of whom were treated with intravenous acyclovir. In the neonatal cohort, three (33%) presented with seizures and only four (44%) had vesicles. The initial cerebrospinal fluid (CSF) HSV PCR was positive in seven (78%) and HSV type 2 was the most common. Repeat CSF study showed HSV positivity of 100%. Two (22%) neonates died and three (43%) had long-term neurodevelopmental sequelae. Developmental delay, focal neurological deficit, and cognitive deficit were among the most frequent neurological sequelae noted. In the pediatric cohort, three children (75%) had positive CSF HSV PCR and seizures. One (25%) died and two of the three survivors (67%) had neurodevelopmental sequelae. Early CSF studies may be negative in HSE, so a repeat CSF analysis should be considered, particularly in neonates. Early administration of acyclovir could prevent adverse outcomes in HSE.