Pyogenic arthritis in infants and children

Welkon, Celeste J.; Long, Sarah S.; Fisher, Margaret C.; Alburger, Philip D.

doi:10.1097/00006454-198611000-00014

Cited by 149 publications

(87 citation statements)

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“…However, the negative bacterial culture results are always found in clinical practice due to the method of sampling, methods of bacterial cultivation, the types of transport and culture media selected, and type of bacteria (Boon 1997). Furthermore, many studies also reported that attempts to obtain a bacteriologic diagnosis in the patients with suspected septic arthritis are frequently unsuccessful, and between onethird and two thirds of synovial fluid cultures do not detect the causative organisms (Barton et al 1987;Fink and Nelson 1986;Goldenberg and Cohen 1976;Welkon et al 1986). Examination of conventional plates seeded with synovial fluid specimens frequently shows that purulent exudates exert an inhibitory effect upon bacterial growth, which may explain the overall low sensitivity of synovial fluid cultures in the patients with joint infections.…”

Section: Discussionmentioning

confidence: 99%

Septic Arthritis in Dogs: A Retrospective Study of 20 Cases (2000-2002)

Soontornvipart¹,

Kohout²,

Proks³

2003

Acta Vet. Brno

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Soontornvipart K., P. Kohout, P. Proks: Septic Arthritis in Dogs: A Retrospective Study of 20 Cases (2000Cases ( -2002. Acta Vet. Brno 2003, 72: 405-413. Septic arthritis might be difficult to diagnose due to nonspecific clinical signs and radiological findings in early stage of the disease. An early diagnosis is important for achieving favorable prognosis. Diagnosis of septic arthritis was confirmed by physical and orthopedic examinations, evaluation of radiographs and synovial fluid analysis including leukocyte and neutrophil counts, cytological examination and bacterial culture. Sensitivity and specificity of these diagnostic methods were retrospectively evaluated from clinical records of 18 dogs with 20 septic joints treated in the Department of Surgery and Orthopaedics in Small Animal Clinic at University of Veterinary and Pharmaceutical Sciences Brno from January 2000 till the end of 2002.Our patients affected by septic arthritis belonged to medium to large breed dogs. Infection of 13 septic joints in 11 patients was spread by hematogenous route, whereas the other 7 joints (in 7 patients) were infected during surgical procedure or after joint injury. Recurrence of hematogenous joint infection was found in 2 patients. In all the patients, exercise intolerance and painful reaction in affected joint were detected. Cultures of synovial fluid samples were positive in only 8 cases. Staphylococcus intermedius, Streptococcus spp., Enterococcus Group 3, Pseudomonas aeruginosa, coagulase-negative staphylococcus and Bacillus spp. were isolated. Radiographic findings included joint effusion, osteoarticular destruction and new bone proliferation and these were not specific for septic arthritis.We found that diagnostic methods used in this study showed high sensitivity but low specificity. Complex diagnostic approach including physical, orthopaedic and radiographic examinations, and synovial fluid evaluation should be performed to achieve correct diagnosis and effective treatment.

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Section: Discussionmentioning

confidence: 99%

Septic Arthritis in Dogs: A Retrospective Study of 20 Cases (2000-2002)

Soontornvipart¹,

Kohout²,

Proks³

2003

Acta Vet. Brno

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“…1 Despite the use of antimicrobial treatment, the inflammatory process may be prolonged, leading to delayed recovery and residual joint damage. 2,3 Studies have shown that the host immune response is responsible for the ongoing inflammation, particularly activation of CD4 T lymphocytes induced by Staphylococcus exotoxins. 4,5 Sáez-Llorens et al 6 demonstrated that the synovial fluid of children with septic arthritis has high concentrations of tumor necrosis factor-a and interleukin (IL)-1b, which correlate with the severity of the inflammatory process.…”

Section: What This Study Addsmentioning

confidence: 99%

Dexamethasone Therapy for Septic Arthritis in Children

Fogel¹,

Amir²,

Bar‐On³

et al. 2015

PEDIATRICS

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BACKGROUND AND OBJECTIVE: Prospective studies of children with septic arthritis report that adding dexamethasone to antibiotic therapy contributes significantly to clinical and laboratory improvement. This study sought to evaluate the effect of this regimen outside of a randomized controlled trial. METHODS:The sample consisted of children with septic arthritis hospitalized at a tertiary pediatric medical center in 2008 to 2013. Disease course and outcome were compared between children treated with antibiotics alone or with adjuvant dexamethasone, according to the admitting department policy. RESULTS:The cohort included 116 patients, 90 treated with antibiotics alone and 26 treated with antibiotics+dexamethasone. The groups were similar for age, symptom duration before hospitalization, body temperature, acute-phase reactant levels, and rate of positive fluid cultures (21.6% total). Compared with monotherapy, antibiotics+dexamethasone treatment was associated with a shorter duration of fever (mean 2.3 vs 3.9 days, P = .002), more rapid clinical improvement (mean 6.3 vs 10.0 days to no pain/limitation, P , .001), more rapid decrease in C-reactive protein level to ,1 mg/dL (mean 5.3 vs 8.4 days, P = .002), shorter duration of parenteral antibiotic treatment (mean 7.1 vs 11.4 days, P , .001), and shorter hospital stay (mean 8.0 vs 10.7 days, P = .004). Recurrent symptoms of fever and joint pain occurred in 4 patients in the antibiotics+dexamethasone group after completion of the steroid course.CONCLUSIONS: Children with septic arthritis treated early with a short course of adjuvant dexamethasone show earlier improvement in clinical and laboratory parameters than children treated with antibiotics alone. WHAT'S KNOWN ON THIS SUBJECT:Two prospective studies of children with septic arthritis have shown that the addition of dexamethasone to antibiotic therapy contributes to clinical and laboratory improvement. Nevertheless, the mainstay of treatment remains antibiotics alone. WHAT THIS STUDY ADDS:This study, which was conducted outside a randomized controlled trial, demonstrates that children with septic arthritis treated early with a short course of adjuvant dexamethasone show earlier improvement in clinical and laboratory parameters than children treated with antibiotics alone.

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“…Clinical data suggest that the organism may gain access to the bloodstream in the course of an upper respiratory infection or stomatitis (191). In children older than 2 years, S. aureus, streptococci, H. influenzae, and N. gonorrhoea have usually been isolated (33,47,185), although H. influenzae may have also lost its predominance in patients in this age group (102).…”

Section: Microbiologymentioning

confidence: 99%

Acute Septic Arthritis

2002

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Acute septic arthritis may develop as a result of hematogenous seeding, direct introduction, or extension from a contiguous focus of infection. The pathogenesis of acute septic arthritis is multifactorial and depends on the interaction of the host immune response and the adherence factors, toxins, and immunoavoidance strategies of the invading pathogen. Neisseria gonorrhoeae and Staphylococcus aureus are used in discussing the host-pathogen interaction in the pathogenesis of acute septic arthritis. While diagnosis rests on isolation of the bacterial species from synovial fluid samples, patient history, clinical presentation, laboratory findings, and imaging studies are also important. Acute nongonococcal septic arthritis is a medical emergency that can lead to significant morbidity and mortality. Therefore, prompt recognition, rapid and aggressive antimicrobial therapy, and surgical treatment are critical to ensuring a good prognosis. Even with prompt diagnosis and treatment, high mortality and morbidity rates still occur. In contrast, gonococcal arthritis is often successfully treated with antimicrobial therapy alone and demonstrates a very low rate of complications and an excellent prognosis for full return of normal joint function. In the case of prosthetic joint infections, the hardware must be eventually removed by a two-stage revision in order to cure the infection

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Pyogenic arthritis in infants and children

Cited by 149 publications

References 0 publications

Septic Arthritis in Dogs: A Retrospective Study of 20 Cases (2000-2002)

Septic Arthritis in Dogs: A Retrospective Study of 20 Cases (2000-2002)

Dexamethasone Therapy for Septic Arthritis in Children

Acute Septic Arthritis

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