Osteomyelitis is a bacterial infection of the bone. The purpose of this study is to investigate if the commonly used criteria developed by kocher and colleagues for hip septic arthritis can be used for screening children with suspected septic knee. Acute septic arthritis in children is usually hematogenous. Septic arthritis is an infection in the joint fluid also known as synovial fluid and joint tissues. Septic arthritis and osteomyelitis in pediatric patients represent true emergencies, and can quickly threaten life and limb. How is pediatric septic arthritis sa differentiated from. The most common type of childhood arthritis is juvenile idiopathic arthritis jia, also known as juvenile rheumatoid arthritis. Fitytwo cases o nontuberculous purulent arthritis seen at the tobey hospital during a 16 year period.
Develop a broad differential diagnosis for arthritis in the pediatric population. Osteoarticular infections are complex con ditions, especially in paediatric patients, which unless treated. Pyogenic, or septic, arthritis refers to a bacterial infection of the joint space. Recognize and manage a patient with septic arthritis. Although a rare diagnosis, septic arthritis of the wrist should be considered in patients with pseudoparalysis of the upper extremity and. Pediatric septic arthritis request pdf researchgate. Septic arthritis in children is an orthopaedic emergency. Kingella kingae in children pediatric musculoskeletal infections page 4.
Pediatric septic arthritis of the hip sah remains an emergent condition with significant sequelae if missed in the acute setting. It is the most common septic joint condition during growth and may cause the most devastating complications without prompt and proper treatment. The pathological invasion of a joint and subsequent inflammation is known as septic arthritis. May 01, 2015 limping is a common chief complaint among children seeking medical attention. Early diagnosis and intervention are required to avoid irreversible complications. Update on the management of pediatric acute osteomyelitis and. Acute septic arthritis is a healthcare problem in growing children. The term septic arthritis usually refers to bacterial arthritis or fungal arthritis.
Septic arthritis is also known as infectious arthritis, bacterial, or fungal arthritis. Hip septic arthritis pediatric pediatrics orthobullets. Unfortunately, diagnosing septic arthritis is not always straightforward. Arthritis in children and adolescents american academy. Etiology of septic arthritis by age clues to the etiology of septic arthritis in children empiric parenteral rx for acute bacterial arthritis in children doses of iv abx for osteoarticular infections in children full hib and pneumococcal immunization status highrisk conditions for invasive pneumococcal disease specific treatment for osteoarticular infections in children. Septic arthritis of the wrist in pediatric patients is a rare diagnosis and is not well described in the literature. Septic arthritis of the hip is a surgical emergency which warrants prompt referral to a specialist.
Request pdf pediatric septic arthritis acute septic arthritis is a condition with the potential for joint destruction, physeal damage, and osteonecrosis, which warrants urgent. A weakened immune system can be caused by diabetes, kidney disease, hiv infection, or cancer. View the article pdf and any associated supplements. A differential diagnosis of septic arthritis in children can be difficult, but early treatment of joint infections avoids potentially disabling complications septic arthritis accounts for a small minority of the myriad musculoskeletal problems in childhood which primary care doctors will evaluate. Sep 15, 2011 septic arthritis is a key consideration in adults presenting with acute monoarticular arthritis. The most common pathogen responsible for septic arthritis in children remains. Typically, septic arthritis affects one large joint in the body, such as the knee or hip. Septic arthritis childrens hospital of philadelphia. Acute septic arthritis is a medical, and often surgical, emergency. But children who have an open skin wound and a weakened immune system may be at greater risk. Septic arthritis due to bacterial infection is often a destructive form of acute arthritis. The antibiotic is initially chosen on an empirical basis to cover the most frequent pathogens responsible for these conditions based on the age of the child and is then driven on the basis of the antibiograms obtained from the cultural investigations performed before.
Septic arthritis may occur without any known risk factors. Osteoarticular involvement in childhood brucellosis. Update on the management of pediatric acute osteomyelitis. Other forms of arthritis include reactive or postinfectious arthritis an immunologically induced inflammatory response to a distant infection and the arthritis associated with rheumatologic disorders eg, juvenile idiopathic arthritis jia. For example, total pediatric admissions rose by 32% from 1960 to 1970 while septic arthritis cases increased 46%. The behavioral objectives and examination for this program were prepared by jeanne f. It is more common in boys, and it most often affects the large joints of the lower limb. Septic arthritis is also known as infectious arthritis, and is usually caused by bacteria. Acute osteomyelitis and septic arthritis in children european.
In some cases, joints may become infected because of an injection, surgery, or injury. Epidemiology approximately half of all cases of septic arthritis occur in patients younger than 20 years old with a peak incidence in those under 3 years old. Surgical treatment options for septic arthritis of the hip. Mismanagement can lead to serious adverse outcomes, including systemic sepsis, cartilage destruction, growth plate damage and avascular necrosis of the femoral head figure 1. Professional nurses are invited to submit manuscripts for the home study program. Successful treatment of septic arthritis of the shoulder was accomplished in four cases without division of the biceps sheath, with an average followup of 8 months. Identify the common causes of arthritis in children. Among children with septic arthritis, does adding dexamethasone to antibiotic therapy. Septic arthritis is a bacterial infection of the joint.
Ullmann, rn, mhs, cnor, professional education specialist, center for perioperative education. Differentiating between septic arthritis and transient synovitis of the hip in children. Results of a thorough history and physical examination can narrow possible etiologies significantly. The early diagnosis of pediatric septic arthritis is paramount to the prevention of longterm sequela. Prompt diagnosis and treatment are critical in optimising patient outcomes. Bacteria were isolated from joint fluid of 75 patients and from blood, cerebrospinal fluid, cervix, bone, or wounds of 16. Pediatric septic arthritis salzbach 1999 aorn journal. Claudication and pain in the coxofemoral joint are frequent com plaints that lead children and adolescents to seek urgent medical care in pediatric orthopedics. Septic arthritis india pdf ppt case reports symptoms. The condition is an inflammation of a joint thats caused by infection. Bacteria and substances released by your immune system can be damaging to the joint cartlage if not removed from the joint quickly. Dermatitissa has dermatitis, migratory polyarthralgia and tenosynovitis fever, skin lesions, bacteremia in adolescent girls onset with mensus. As with all manuscripts sent to the journal, papers submitted for home study programs should not have been previously published or submitted simultaneously to any other publication.
Septic arthritis is an infection in the joint fluid synovial fluid and joint tissues. The condition is an inflammation of a joint thats caused by. Joint infections are best treated early to avoid potentially disabling complications. A high index of suspicion should be maintained, as these conditions often present with a subacute course of illness and vague signs and symptoms. The aim of the present study was to determine the demographic features, clinical presentation, diagnostic evaluation, treatment and outcome of children suffering from. Septic arthritis pediatric care online aap pointof. Knowledge of the following orthopedic emergencies can prevent further complications. View the article pdf and any associated supplements and figures for a period of 48 hours.
Arthritis in children and adolescents american academy of. Septic arthritis of the pediatric shoulder is a rare condition, with most reports citing a prevalence of 35% of all septic joints. Other forms of arthritis include reactive or postinfectious arthritis an immunologically induced inflammatory response to a distant infection and the arthritis associated with rheumatologic disorders eg, juvenile idiopathic arthritis. Septic arthritis in children is an orthopaedic emergency that has serious. Jan 11, 2007 the diagnosis of septic arthritis can be difficult to make even in the hands of experienced doctors. Once the diagnosis is made, the optimal management of septic arthritis is a subject of considerable debate. In contrast to children with septic arthritis sa, children with transient synovitis appear well and are usually. Staphylococcus aureus is the most common cause of septic arthritis in children. Septic arthritis in child 3 months old without medical comorbidities or. Septic arthritis in child 3 months old without medical comorbidities or penetrating trauma.
Acute osteomyelitis and septic arthritis need to be carefully assessed, diagnosed, and treated to avoid devastating sequelae. Medical records of 111 children discharged with the diagnosis of septic arthritis from 1973 through 1985 were examined. Acute osteomyelitis and septic arthritis are two infections whose frequencies are increasing in pediatric patients. Feb 28, 2019 diagnosis of septic arthritis sa is established by a combination of clinical findings and results of synovial fluid analysis. Nov 08, 2018 pediatric musculoskeletal infections page 4. Clinicians should have a low threshold for performing arthrocentesis, especially for children with a painful monoarthritis, significantly limited range of motion, and no plausible noninfectious explanation. In children younger than 18 months, septic arthritis is often secondary to osteomyelitis, which has eroded through the boney cortex. Distinguishing lyme arthritis from other etiologies. Osteomyelitis near a joint can mimic a septic arthritis or toxic synovitis by causing painful motion or. While many algorithms exist to assist in this clinical diagnosis, there is no single agreed upon set of predictive criteria.
Pdf acute septic arthritis in children nada bokhary. In a western setting, the annual incidence is around 4. Indications for joint aspirationdelayed management of septic arthritis. Childhood arthritis can cause permanent physical damage to joints. Approach to septic arthritis american family physician. The kocher criteria was derived to identify factors important in distinguishing. The infection usually reaches the joints though the bloodstream, although some joints may become infected after surgery or injury of an involved joint, which can expose the joint space to germs or infection. Pdf markus paakkonen1,2 1department of pediatric orthopaedic surgery, 2department of hand surgery, turku university hospital and the. Septic arthritis requires urgent recognition and treatment to avoid joint destruction. Septic arthritis is a key consideration in adults presenting with acute monoarticular arthritis. Septic arthritis is the result of bacterial infection of the hip joint and is often found in infants and toddlers. Held rigidly in flexion, external rotation, and abduction. Antibiotic therapy is the gold standard for treating acute osteomyelitis and septic arthritis. This damage can make it hard for the child to do everyday things like.
The septic arthritis clinical pathway outlines the appropriate care and steps necessary when treating a child with suspected septic arthritis in the emergency department. Accurate diagnosis can be particularly challenging in. Traditionally, the treatment of acute osteoarticular infection. Septic arthritis is a rheumatologic emergency as joint destruction occurs rapidly and can lead to significant morbidity and mortality.
Dexamethasone therapy for septic arthritis in children. Septic arthritis, suspected clinical pathway emergency. Orthopedic team, university of colorado hospital, denver. Hately, rn, msn, cnor, clinical editor, with consultation from eileen j. Bosilkovski m, kirovaurosevic v, cekovska z, et al. Septic arthritis infectious arthritis in children health. Definitive diagnosis requires an invasive procedure, thus making clinical evaluation and suspicion extremely important. We present a case of a 4month old patient with monoarticular septic arthritis of the wrist treated with surgical drainage and antibiotics. Haemophilus influenzae septic arthritis may occur in children who have not.
The differential diagnosis of a painful monoarthritis is rather extensive. Distinguishes septic arthritis from transient synovitis in a child with an inflamed hip. Recent advances in the management of septic arthritis of the hip in children include a better understanding of the effects of infection on articular cartilage. Manuscripts or queries should be sent to editor, aorn journal, 2170 s parker rd, suite 300, denver, co 80231. However, hot swollen joints frequently present to doctors unfamiliar with the assessment and management of joint disease. Pediatric acute septic arthritis is primarily hematogenous in origin aho. Infections of the joints known as septic arthritis, pyogenic arthritis, suppurative arthritis, purulent arthritis, or pyarthrosis may be caused by bacteria, fungi, mycobacteria, and viruses. Pediatric septic arthritis onstott 2000 aorn journal. It is the purulent invasion of a joint by an infectious agent which produces arthritis. The kocher criteria can be applied to all pediatric patients with an acutely irritable hip in whom septic arthritis and transient synovitis are in the differential diagnosis.