Artrocentesis en el tratamiento de artritis séptica en articulación temporomandibular: reporte de un caso / Arthrocentesis in the treatment of septic arthritis in the temporomandibular joint: a case report

Objetivo: El objetivo de este reporte de caso es presen- tar a la artrocentesis como una alternativa quirúrgica mínima- mente invasiva en el tratamiento de la artritis séptica tempo- romandibular. Caso clínico: Un paciente hombre de 26 años con an- tecedente de flegmón perimandibular derecho tratado, acude a la Unidad Hospitalaria de Cirugía Maxilofacial por dolor articular temporomandibular, impotencia funcional y trismus, a un mes de haber sido dado de alta de un primer cuadro infec- cioso. Luego de los exámenes clínicos y complementarios, se diagnostica artritis séptica de articulación temporomandibular derecha, la cual fue tratada quirúrgicamente mediante dos ar- trocentesis acompañadas de terapia farmacológica (AU)

Aim: The aim of this case report is to present arthrocen- tesis as a minimally invasive surgical alternative in the treat- ment of temporomandibular septic arthritis. Clinical case: A 26-year-old male patient, with a his- tory of treated right perimandibular phlegmon, came to the Maxillofacial Surgery Hospital Unit due to temporomandibu- lar joint pain, functional impairment and trismus, one month after having recovered from his first infectious process. After clinical and complementary examinations, septic arthritis of the right temporomandibular joint was diagnosed, which was treated surgically by means of two arthrocenteses and phar- macological therapy (AU)

Infecciones osteoarticulares en niños: experiencia de cinco años

Resumen Introducción: Las infecciones osteoarticulares (IOA) son consideradas una urgencia infectológica en niños. Los principales microorganismos causales son Staphylococcus aureus y Streptococcus pyogenes. Objetivo: Describir las características bio-demográficas y clínicas de pacientes de 2 meses a 15 años hospitalizados entre 2012 y 2017 con diagnóstico de IOA. Pacientes y Métodos: Estudio retrospectivo en un hospital pediátrico. Se revisaron fichas clínicas de pacientes internados con diagnóstico de IOA. Resultados: Se incluyó a 146 pacientes. Un 60,3% fueron de sexo masculino, mediana de edad 3 años 11 meses. El síntoma más frecuente al ingreso fue dolor articular (90%) y la mediana de PCR fue de 43 mg/L. Se obtuvo identificación microbiológica en 48%; de ellos, 67,8 % S. aureus (10,2% resistentes a meticilina). El 94,5% de los pacientes recibió de forma empírica β-lactámico anti-estafilocócico. Un 70,5% de los niños requirió procedimiento quirúrgico. A las 72 h se observó respuesta clínica y a los 4,7 días descenso de parámetros inflamatorios de laboratorio. El 88% de los pacientes cursó sin complicaciones. Conclusiones: Las IOA son más frecuentes en varones, el agente infeccioso más frecuentemente identificado fue S. aureus, por lo cual se sugiere inicio del esquema antimicrobiano con un β-lactámico anti-estafilocócico, ampliando cobertura en pacientes bajo 5 años de edad. A los 5 días del tratamiento antimicrobiano ya hay respuesta clínica y descenso de parámetros inflamatorios.

Abstract Background: Osteoarticular infections (IOA) are considered infectious emergencies. The main microorganisms isolated are Staphylococcus aureus and Streptococcus pyogenes. Aim: To describe demographic and clinical characteristics of patients from 2 months to 15 years old, hospitalized between the years 2012 and 2017 with IOA diagnosis. Methods: Retrospective study in a pediatric hospital. Clinical records of hospitalized patients with IOA were reviewed. Results: 146 met inclusion criteria. 60.3% of the patients were male, median age 3 years 11 months. The main symptom at admission was joint pain (90%) and the median CRP was 43 mg/L. 48% of the patients had microbiological identification; 67.8% were positive for Staphylococcus aureus (10.2% SAMR). 94.5% of the sample received empirical antistaphylococcal beta-lactam treatment and 70,5% had a surgical intervention. Clinical response was observed 72 hours of beginning of treatment, and a decreased in inflammatory laboratory markers was observed at 4.7 days. 88% of patients attended without complications. Conclusions: IOA infections are more common in boys, S. aureus is the main isolated pathogen, so we suggest to initiate the antimicrobial scheme with an antistaphylococcal beta-lactam, adding broad spectrum antimicrobial in children under 5 years. After 5 days of treatment, clinical resolution and decreased inflammatory laboratory parameters were observed.

Osteoarticular infections in pediatrics / Infecções osteoarticulares em pediatria

Abstract Objective To collect the most up-to-date information regarding pediatric osteoarticular infections, including the epidemiological and microbiological profiles, diagnosis, and treatment. Source of data A non-systematic review was performed on the search engines PubMed, SciELO, LILACS, and Google Scholar, using the keywords "bone and joint infection", "children", "pediatric", "osteomyelitis", "septic arthritis" and "spondylodiscitis" over the last ten years. The most relevant articles were selected by the authors to constitute the database. Synthesis of data Osteoarticular infections are still a major cause of morbidity in pediatrics. Their main etiology is Staphylococcus aureus, but there has been an increase in the detection of Kingella kingae, especially through molecular methods. Microbiological identification allows treatment direction, while evidence of inflammatory activity assists in treatment follow-up. Imaging tests are especially useful in the initial diagnosis of infections. Empirical treatment should include coverage for the main microorganisms according to the age and clinical conditions of the patient, while considering the local resistance profile. Surgical procedures can be indicated for diagnosis, focus control, and function preservation. Acute complications include sepsis, deep venous thrombosis, and pulmonary embolism. Deaths are rare. Late complications are uncommon but may lead to deformities that compromise motor development. Conclusion A correct and early diagnosis, prompt implementation of adequate antimicrobial therapy, and focus control, when indicated, are critical to a better prognosis.

Resumo Objetivo Compilar as informações mais atuais referentes às infecções ostoarticulares em pediatria, inclusive perfil epidemiológico e microbiológico, diagnóstico e tratamento. Fonte dos dados Feita revisão não sistemática nos mecanismos de busca Pubmed, Scielo, Lilacs e Google Scholar, com as palavras-chave bone and joint infection, children, pediatric, osteomyelitis, septic arthritis e espondylodiscitis nos últimos 10 anos. Os artigos mais relevantes foram selecionados pelos autores para compor a base de dados. Síntese dos dados As infecções osteoarticulares ainda são causa importante de morbidade na pediatria. A sua principal etiologia é o Staphylococcus aureus, porém há um aumento na detecção de Kingella kingae, especialmente através de métodos moleculares. A identificação microbiológica possibilita direcionamento de tratamento, enquanto que as provas de atividade inflamatória auxiliam no acompanhamento do tratamento. Exames de imagem são especialmente úteis no diagnóstico inicial das infecções. O tratamento empírico deve incluir cobertura para os principais microrganismos, de acordo com a faixa etária e as condições clínicas do paciente, considerando o perfil de resistência local. Procedimentos cirúrgicos podem ser indicados para diagnóstico, controle do foco e preservação da função. As complicações agudas incluem sepse, trombose venosa profunda e embolia pulmonar. Óbitos são raros. As complicações tardias são incomuns, mas podem levar a deformidades que comprometem o desenvolvimento motor. Conclusão O diagnóstico correto e precoce, com pronta instituição de terapia antimicrobiana adequada e controle do foco, quando indicado, é fundamental para um melhor prognóstico.

Daptomycin to bone and joint infections and prosthesis joint infections: a systematic review

ABSTRACT Backgroud: Daptomycin has been used in bone and joint infections (BJI) and prosthesis joint infections (PJI) considering spectrum of activity and biofilm penetration. However, the current experience is based on case reports, case series, cohorts, and international surveys. The aim of this systematic review was to evaluate studies about daptomycin treatment efficacy in BJI/PJI compared to other antibiotic regimens. Methods: PubMed, LILACS, Scielo and Web of Science databases were searched for articles about daptomycin and treatment of BJI and PJI from inception to March 2018. Inclusion criteria were any published researches that included patients with BJI treated with daptomycin. Diagnosis of BJI was based on clinical, laboratory and radiological findings according to IDSA guidelines. Results: From 5107 articles, 12 articles were included. Only three studies described the outcomes of patients with BJI treated with daptomycin with comparator regimen (vancomycin, teicoplanin and oxacillin). Studies presented large heterogeneity regarding device related infections, surgical procedures, and daptomycin regimens (varied from 4 mg/kg to 10 mg/kg). A total of 299 patients have been included in all studies (184 infections associated with orthopedic disposal and 115 osteomyelitis/septic arthritis). Two hundred and thirty-three patients were treated with daptomycin. The clinical cure rates on device related and non-device related infections (i.e. osteomyelitis) were 70% and 78%, respectively. Compared to all regimens evaluated, daptomycin group outcomes were non-inferior. Conclusion: Although a randomized clinical trial is needed, this systematic review tends to support daptomycin usage for bone and joint infections.

Septic arthritis caused by Salmonella enterica serotype Rubislaw: A case report

Abstract An eleven-year-old boy presented with fever and hip pain, with limited mobility of the right side of the hip. Computed tomography scan revealed an increased volume of the right coxo-femoral joint, requiring surgical drainage of purulent secretion, from which Salmonella enterica was isolated. After four weeks of treatment with third-generation cephalosporin, he was discharged with a favorable evolution. Invasive disease caused by Salmonella spp represents a small proportion of salmonellosis cases, although it is responsible for greater rates of hospitalization, morbidity and mortality. Children under 5 years, elders over 60 years and immunodeficient patients have greater risk for invasive salmonellosis.

Septic arthritis of native hip joint by Staphylococcus lugdunensis: a case report

Abstract Staphylococcus lugdunensis is a rare virulent coagulase-negative staphylococcus (CoNS) that behaves similarly to Staphylococcus aureus in causing deep abscesses, skin and soft tissue infections, and central nervous system infections. Additionally, there can be certain blood stream infections including sepsis, septic shock, toxic shock syndrome, and endocarditis complicated by embolic events. Reports of septic arthritis of a native joint associated with this organism have been infrequent, justifying the presentation and discussion of this case.

Escherichia vulneris como agente etiológico de artritis séptica en una niña / Escherichia vulneris etiologic agent of septic arthritis in a child

Resumen Escherichia vulneris es un bacilo gramnegativo, perteneciente a la familia Enterobacteriaceae, cuyo rol patógeno ha sido cuestionado. Sin embargo, se ha confirmado principalmente como causante de infecciones de heridas. Presentamos el caso de una niña de 12 años, previamente sana, con diagnóstico de una artritis séptica de rodilla derecha secundaria a una lesión con espina vegetal. En el estudio del líquido articular se aisló E. vulneris, una etiología poco habitual de artritis séptica en niños. Es uno de los primeros casos de artritis séptica por E. vulneris, secundaria a un cuerpo extraño vegetal en un niño, descritos en la literatura médica. Se enfatiza la importancia de realizar el estudio microbiológico del líquido articular en pacientes con artritis séptica originada por un cuerpo extraño de origen vegetal.

Escherichia vulneris is a gram-negative bacillus that belongs to the family Enterobacteriaceae, with a questioned pathogenic role. However, it has been confirmed as the cause of wound infections. We report the case of a 12-year-old girl, previously healthy, with a diagnosis of septic arthritis of the right knee, secondary to a spinal lesion. Escherichia vulneris, an unusual etiology of septic arthritis in children, was isolated in the joint fluid. This case is one of the first cases of septic arthritis due to E. vulneris, secondary to a plant-derived foreign body in a child, described in the medical literature. The importance of performing the microbiological study of joint fluid in patients with septic arthritis caused by a foreign body of plant-derived origin is emphasized.

Infecciones osteoarticulares en pacientes del Hospital del Instituto de Seguridad del Trabajador (IST) de Viña del Mar: periodo 2012-2013 / Osteoarticular infections in patients of the Hospital del Instituto de Seguridad del Trabajador in Viña del Mar (Chile): period 2012-2013

INTRODUCCIÓN: Las infecciones osteoarticulares son un desafío frecuente en la práctica traumatológica diaria. En Chile y en los distintos hospitales de la región de Valparaíso son escasos los trabajos con relación al tema, lo que es fundamental para optimizar el tratamiento, tanto quirúrgico como médico, de estas infecciones. OBJETIVOS: Describir las infecciones osteoarticulares del Hospital del IST de Viña del Mar durante el periodo 2012-2013. MATERIALES Y MÉTODO: Trabajo descriptivo retrospectivo de una serie de casos. Se revisaron las fichas clínicas de los pacientes que cursaron con alguna infección osteoarticular y se obtuvieron los datos demográficos y clínicos de cada paciente. RESULTADOS: Treinta pacientes fueron incluidos. Dieciséis (53,3%) fueron hombres con un promedio de edad de 38,5años. El 50% correspondieron a infecciones asociadas a la atención de salud. Las principales infecciones fueron asociadas a material de osteosíntesis. El agente más frecuente fue el Staphylococcus aureus meticilinosensible (SAMS). En la mayoría de los casos se realizó aseo quirúrgico, toma de cultivos e inicio de antibióticos con ceftriaxona más clindamicina. CONCLUSIONES: Las infecciones osteoarticulares ocurrieron principalmente en hombres jóvenes, fueron infecciones asociadas a material de osteosíntesis y producidas por SAMS.

INTRODUCTION: Osteoarticular infections are a common challenge in everyday trauma practice. In Chile, and in different hospitals in the region of Valparaiso, there are few studies on the issue, which is essential to optimise both surgical and medical treatment of these infections. OBJECTIVES: To describe the osteoarticular infections in the Hospital del Instituto de Seguridad del Trabajador (IST) of Viña del Mar during the 2012-2013 period. MATERIALS AND METHODS: A retrospective descriptive study was performed on a series of cases. A review was made of the medical records of patients with any osteoarticular infection. Demographic and clinical data were obtained from each patient. RESULTS: Of the total of 30 patients included, 16 (53.3%) were male with a mean age of 38.5 years. Half (50%) of the infections were associated with health care. Major infections were associated with osteosynthesis material. The most frequent agent was Methicillin Susceptible Staphylococcus aureus (MSSA). In most cases surgical cleanliness, taking of microbiological cultures, and antibiotic treatment with ceftriaxone plus clindamycin, was performed. CONCLUSIONS: Osteoarticular infections occurred mainly in young men, were infections associated to osteosynthesis material, and caused by MSSA.

Histoplasmosis diagnosed after arthroscopy of the knee: case report

ABSTRACTFungal arthritis is a rare complication of arthroscopic surgeries, but its possibility should always be considered due its deleterious effects on any joint. Infection caused by the fungus Histoplasma capsulatum is the most common cause of respiratory tract infections by fungi, meanwhile histoplasmosis arthritis is more rare than all other fungal infections. However, their atypical forms of arthritis and the importance of early diagnosis and treatment cannot be over-emphasized. Herein we report a case of knee monoarthritis in an immunocompetent patient with histoplasmosis arthritis following an arthroscopic meniscetomy, diagnosed by synovial biopsy and culture performed during a second arthroscopic procedure. The joint was debrided in this second intervention and the patient received itraconazole initially and fluconazole latter on. The arthritis subsided after 10 months of treatment.

Artritis infecciosa de la articulación temporomandibular consecutivo a otitis necrotizante: reporte de un caso / Septic arthritis of the temporomandibular joint: Report of one case

Septic arthritis of the temporomandibular joint (TMJ) is an uncommon condition, caused by hematic bacterial migration or direct migration of other head and neck infections. We report a 41 year old female who presented a right temporomandibular joint involvement, with bone destruction of the mandibular condyle and an infectious process spreading to the temporal space, following a necrotizing medial and external otitis with associated mastoiditis. A septic arthritis of the TMJ by continuity was diagnosed and treated with antimicrobials, TMJ arthrocentesis and occlusal stabilization, with a positive evolution. However, the patient remains in control due a secondary TMJ osteoarthritis caused by the septic arthritis.

Estudio descriptivo de infecciones osteo-articulares en niños en tiempos de Staphylococcus aureus resistente a meticilina de la comunidad (SARM-Co) / Descriptive study of bone and joint infections in children in times of community-acquired methicillin- resistant Staphylococcus aureus (CA-MRSA)

Background: Bone and joint infections (BJI) are relatively common in children, and community -acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is the leading cause in some countries. Aim: To evaluate epidemiological data, clinical and microbiological features and outcome of BJI. Methods: A prospective descriptive study was conducted. Results: 40 patients (p) completed the study. Bacterial cultures were positives in 30 p (75%): CA-MRSA was found in 19 p, methicillin-sensitive S. aureus in 6 p, and others in 5 p. Cultures were negatives in 10 p (25%). Median treatment duration was 28 days (r: 21-40 d); Analyzing patients with CA-MRSA positive cultures separately, initial CRP was higher (Md 76 vs 50 mg/L, p < 0.02), normalization occurred later (Md 14 days vs 7days, p < 0.03), and duration of treatment (Md 32 days vs 23, p < 0.004) as well as hospital stay (Md 9 days vs 7, p = 0.12) were longer. Sequelae were present in 3 p and 1 relapsed: All of them with CA-SAMR. Conclusion: CA-MRSA was the leading cause of BJI and was associated with higher CRP on admission, later normalization and longer treatment duration. Complications as drainage requirement, and sequelae were common in those p.

Introducción: Las infecciones osteo-articulares (IOA) son relativamente comunes en los niños, siendo la infección por Staphylococcus aureus resistente a meticilina de la comunidad (SARM-Co) una de las más frecuentes. Objetivo: Evaluar los datos epidemiológicos, características clínicas, microbiológicas y de evolución en niños con IOA. Métodos: Estudio descriptivo prospectivo. Resultados: Se incluyeron 40 pacientes (p). Los cultivos fueron positivos en 30 p (75%). Se aisló SARM-Co en 19 p; S. aureus sensible a meticilina en 6 p; otros microorganismos en 5 p. La duración del tratamiento fue de 28 días Md (r: 21-40 d). En los p con cultivos positivos para SARM-Co, la PCR inicial fue mayor (Md 76 vs 50 mg/L, p < 0,02), la normalización se produjo después (Md 14 días vs 7 días, p < 0,03) y la duración del tratamiento (Md 32 días vs 23, p < 0,004), así como la estancia hospitalaria (Md 9 días vs 7, p = 0,12) fueron más prolongados. En la evolución 1 p recayó y 3 tuvieron secuelas; en todos se aisló SARM-Co. Conclusión: SARM-Co fue la causa más frecuente de las IOA y se asoció con mayor valor de PCR al ingreso, normalización tardía, mayor duración del tratamiento, y complicaciones.

Artritis séptica en pacientes adultos en un hospital general de Chile / Septic arthritis in adult patients in a general hospital in Chile

Background: Septic arthritis is an infrequent condition of prolonged morbidity and there is no previous publications in Chile that allow orientate therapy. Aim: To characterize a group of adult patients with septic arthritis confirmed by culture. Material and Methods: Descriptive study of a case series. Results: From 2003 to august 2013, 24 patients with 25 events of septic arthritis were identified in a general hospital. Mean age was 68.3 years old (range 24-94). Predisposing conditions were harbored by 91.7%. Predominant clinical manifestations were pain (92%) and impaired joint movement (95.7%). Fever was present in 64%, hypotension in 28% of events, and C-reactive protein > 100 mg/L in 90.6%. Gram positive cocci were the most frequently isolated microorganisms (81.5%), predominating S. aureus (48.1%), and with 4 isolates methicillin resistant isolates (26.7%). Resistant isolates trend to be associated with previous surgery (p = 0.055) and all cases caused by non-fermentative Gram negative bacilli had recent hospitalization or surgery, a feature that did not reach a significant difference. Nine events were associated to bacteremia (36%). Outcome analysis indicated 32% of events with full recovery, 28% with a favorable evolution, 20% with therapy failure and 16.7% patients that died. A total of 24% of the series remained with significant sequels. Conclusions: Septic arthritis is an infrequent disease that affects in most cases patients with predisposing conditions. Associated symptoms include pain and impaired joint movement, sometimes fever, hypotension, positive blood cultures and frequently a C-reactive protein > 100 mg/L. Predominant agents are Gram positive cocci, specially S. aureus, including methicillin resistant isolates. Case-fatality ratio, treatment failure and sequels are important.

Antecedentes: Los cuadros de artritis séptica son esporádicos pero de elevada morbilidad y no hay publicaciones en Chile que permitan orientar el tratamiento de ellos. Objetivos: Caracterizar un grupo de pacientes con cuadros de artritis séptica confirmados microbiológicamente. Pacientes y Métodos: Serie de casos. Resultados: Un total de 24 pacientes con 25 eventos de artritis séptica fue identificado entre el 2003 y agosto de 2013. La edad promedio fue de 68,3 años (24-94) y 91,7% tuvo condiciones que predisponen. Las manifestaciones clínicas dominantes fueron dolor (92%) e impotencia funcional (95,7%), 64% presentó fiebre y 28% tuvo hipotensión arterial. Un 90,6% tuvo PCR > 100 mg/L. Las cocáceas grampositivas fueron los microorganismos más frecuentes (81,5%), predominando Staphylococcus aureus (48,1%) y cuatro cepas estafilocóccicas presentaron resistencia a cloxacilina (26,7%). Las cepas resistentes tendieron a estar asociadas a pacientes con cirugía articular previa (p: 0,055) y todos los casos asociados a bacilos gramnegativos no fermentadores tenían antecedentes de hospitalización reciente o cirugía articular previa. Nueve eventos (36%) se asociaron a bacteriemia. Un 32% de los pacientes tuvo curación, 28% un curso favorable, 20% fracaso y 16,7% falleció. Un 24% quedó con secuelas. Conclusiones: Los cuadros de artritis séptica son infrecuentes, afectan en su mayor parte a pacientes con factores que predisponen, se presentan con dolor e impotencia funcional, a veces fiebre, hipotensión arterial o bacteriemia y generalmente con PCR > 100 mg/L. Se asocian a cocáceas grampositivas, especialmente S. aureus, incluyendo aislados resistentes a cloxacilina. La letalidad, fracaso del tratamiento y secuelas no son despreciables.

Caracterización clínico - epidemiológica de pacientes con artritis séptica: año 2013: Instituto Traumatológico de Chile / Clinical - epidemiological characteristics of patients with septic arthritis: year 2013 Instituto Traumatologico of Chile

Artritis séptica (AS) es la reacción inflamatoria de una articulación desencadenada por microorganismos, provocando destrucción osteocondral y pérdida funcional irreversible si no es tratada a tiempo. El cuadro clínico de esta patología debe despertar sospecha del médico, obligando a realizar diagnóstico y manejo adecuado. OBJETIVOS: Caracterizar clínica y epidemiológicamente a pacientes con AS del InstitutoTraumatológico de Santiago, Chile (IT) y describir su manejo realizado. MATERIALES Y MÉTODOS: Estudio descriptivo retrospectivo de corte transversal, analizando fichas clínicas electrónicas de pacientes mayores de 15 años atendidos en elServicio de Urgencia del IT con diagnóstico de AS, durante el año 2013 (n=28). Los datos fueron tabulados en una planilla Microsoft® Excel® 2010. RESULTADOS: 68 por ciento fueron pacientes masculinos. Edad promedio de 54 años. Se realizaron 2 aseos quirúrgicos en promedio por paciente. 17 días fue el promedio de estadía hospitalaria. Principales comorbilidades fueron hipertensión arterial (29 por ciento) y diabetes mellitus 2 (21 por ciento). En síntomas predominó dolor (93 por ciento) y aumento de volumen (82 por ciento).La localización más frecuente fue rodilla (53,6 por ciento). Etiología más habitual fue Staphyloccocus aureus (60 por ciento). Las alteraciones de laboratorio fueron VHS elevada (90 por ciento), PCR elevada (80 por ciento) y leucocitosis(45 por ciento). Tratamiento antibiótico empírico más utilizado fue esquema tri asociado de cloxacilina, gentamicina y penicilinasódica (60 por ciento). Antibioticoterapia ambulatoria más indicada fuecloxacilina (60 por ciento). DISCUSIÓN: Recalcamos la importancia del diagnóstico y tratamiento oportuno de la AS, cuyo pronóstico y complicaciones dependen directamente de su pesquisa temprana. Las características clínico - epidemiológicas del presente estudio son consistentes con lo descrito en la literatura nacional e internacional...

Septic arthritis (SA) is the inflammatory reaction of an articular surface by the presence of microorganisms. It can cause joint destruction and rapid functional loss. Clinical manifestations of septic arthritis should be considered a medical emergency, therefore proper diagnosis and management is mandatory. OBJECTIVES: To characterize clinically and epidemiologically adult patients with SA from Instituto Traumatologico de Santiago de Chile (IT) and to describe its treatment. MATERIALS AND METHODS: A retrospective, cross-sectional, descriptive study analyzing electronic health records of patients over 15 years old, with diagnosis of SA, attended in the ER of the IT during 2013 (n=28). Data were tabulated in an Excel2010spreadsheet. RESULTS: 68 percent of patients were males. Average age was 54 years. An average of 2 surgical toilettes was performed per patient. The mean impatient stay was 17 days. Major comorbidities were hypertension (29 percent) and diabetes mellitus type 2(21 percent). The main symptoms were pain (93 percent) and swelling (82 percent).The most common location was the knee (53,6 percent). Most common etiology was Staphyloccocus aureus (60 percent). The laboratory abnormalities were high ESR (90 percent), elevated CRP (80 percent) and leukocytosis (45 percent). The most used empiric antibiotic the rap was the triassociated scheme of cloxacillin, gentamicin and sodium penicillin (60 percent). Most indicated outpatient antibiotic was cloxacillin (60 percent). DISCUSSION: We emphasize the importance of early diagnosis and treatment of SA, having direct consequences in complications and prognosis if not made quickly. Both clinical and epidemiological findings of our study were comparable to those found in national and international literature...

Repeated Serum Alkaline Phosphatase Measurements in the Treatment of Childhood Acute Bone and Joint Infections with High Doses of Antibiotics

No abstract available.

Artritis séptica y osteomielitis aguda en pediatría / Septic artritis and acute osteomielitis in pediatrics

Objective: To review the clinical presentation, the organisms responsible for arthritis and acute osteomyelitis and the intrahospitalary and ambulatorie management in childhood less than 16 years in the post Haemophilus influenza tipe B vaccine era. Methods: Retrospective review of clinic case account in the Hospital Clínico de la Pontificia Universidad Católica in the period from January 2004 to July 2008 with the diagnosis of acute infection oteomyelitis and septic arthritis. There were include all the cases, with or without surgical management and intra and extra hospitalary infection source. Results: There were 32 total cases, 22 acute osteomyelitis (AOM) and 16 septic arthritis (SA). Pain and functional impotence of lower limbs, were the 2 first sintoms. The agent was isolated in 25 percent of the SA and 54.5 percent of the AOM. The most frecuent isolated agent in AOM was the Staphilococcus aureus. In SA, there was no isolated this agent. Discussion: The clinical findings of the osteoarticular infections (OAI), presents with a loss florid illness than the classical presentation. To know the agent take time. For that reason, we thought that the empirical intravenosus antibiotical treatment is fundamental in this knew studies about this matter, that can propuose an universal empyric antibiotic therapy.

Objetivo: Revisar la presentación clínica, microorganismos responsables de artritis séptica (AS) y de osteomielitis aguda (OM), así como el manejo agudo y seguimiento en población pediátrica menor de 16 años en la era post vacuna anti Haemophilus influenzae tipo B (Hib). Métodos: Revisión retrospectiva de casos clínicos acontecidos en nuestro Hospital entre los años 2004 y 2008 con el diagnóstico de OM y AS de origen infeccioso. Se incluyeron todos los casos registrados, con o sin manejo quirúrgico, y con fuente infecciosa tanto intra como extra hospitalaria. Resultados: Se obtuvo ficha clínica completa en 38 casos, 22OMA y 16 AS. El dolor y la impotencia funcional de extremidades inferiores, fueron los principales motivos de consulta en ambos grupos. Se logró aislar el agente en un 25 por ciento de las AS y un 54,5 por ciento de las OMA. El microorganismo más frecuente en OMA fue el Staphilococcus aureus. No se aisló este mismo, en AS. Discusión: La presentación clínica inicial de las infecciones osteoarticulares (IOA), es menos evidente en la actualidad que en otros tiempos. Debido a que la identificación del microorganismo causante de la infección no es inmediata, pensamos que la terapia antibiótica (ATB) empírica inicial es fundamental en el manejo de estas patologías. Sugerimos nuevos estudios que propongan un determinado manejo ATB empírico inicial universal.

Tratamiento intravenoso inicial abreviado en 70 pacientes pediátricos con infecciones osteo-articulares / Short duration of initial intravenous treatment in 70 pediatric patients with osteoarticular infections

Osteoarticular infections (OAI) are infrequent in pediatrics and there is controversy on the need for prolonged use of intravenous antimicrobials. Objective: To characterize and describe evolution and complications of a regimen of 7 days initial intravenous antibiotic treatment for OAI in children, completing 4-6 weeks of total treatment. Patients and methods: In a large pediatric hospital, 70 children younger than 15 years of age were diagnosed with OAI between March 2003 and December 2004. Children received 7 days of intravenous antibiotics followed by 3 to 5 weeks of oral treatment. Results: Incidence of OAI in this hospital was 1.8:10000. Patients mean age was 6.4 ±4.4 years and 60 percent presented with septic arthritis, 36 percent osteomyelitis and 4 percent osteoarthritis. In 80 percent of cases, the infection was located in the lower extremity. Positive cultures were obtained in 59 percent predominating Staphylococcus aureus (46.5 percent). Seven patients had prolonged pain or persistantly high or increasing serum C reactive protein levels and were maintained on prolonged intravenous therapy. None of the 63 children with 7 day intravenous antimicrobials nor the 7 children with prolonged intravenous use developed a complication in the short-term follow up. Conclusions: Seven days of intravenous antibiotic for the initial phase of OAI treatment was effective in a majority of children and may be recommended.

Las infecciones osteoarticulares (IOA) son poco frecuentes en pediatría. Existe controversia acerca de la óptima duración y la vía de administración de la terapia antimicrobiana. Objetivo: Caracterizar y describir la evolución y complicaciones en niños con IOA que recibieron 7 días iniciales de terapia endovenosa, completando 4 a 6 semanas de terapia total. Pacientes y Métodos: Estudio descriptivo, que incluyó a 70 niños con diagnóstico de IOA, entre marzo de 2003 y diciembre de 2004 en un hospital pediátrico, quienes recibieron tratamiento endovenoso abreviado a 7 días, seguido de terapia oral por 3 a 5 semanas. Resultados: La incidencia de IOA fue de 1,8: 10.000 niños bajo 15 años de edad. El promedio de edad fue 6,4 ± 4,4 años. Sesenta por ciento presentaba artritis séptica, 36 por ciento osteomielitis y 4 por ciento osteoartritis. En 80 por ciento la infección se localizó en extremidades inferiores. Los cultivos fueron positivos en 59 por ciento. En 46,5 por ciento se aisló Staphylococcus aureus. Siete niños evolucionaron con dolor persistente o elevación significativa de PCR y requirieron prolongar la terapia endovenosa y/o total, sin presentar complicaciones a corto plazo. Conclusiones: Siete días de terapia antimicrobiana intravenosa parece ser efectivo y recomendable para el tratamiento, en su fase inicial, de las infecciones osteo-articulares.

Chronic knee monoarthritis caused by Mycobacterium chelonae.

Extrapulmonary tuberculosis occurs in 20% of all patients with tuberculosis and tubercular arthritis occurs in 10% of those with extrapulmonary tuberculosis. Arthritis caused by Mycobacterium tuberculosis is not uncommon in India. However, arthritis caused by Mycobacterium chelonae has not been reported to the best of our knowledge. We report a patient with arthritis caused by Mycobacterium chelonae in whom the diagnosis was confirmed by smear and culture of acid-fast bacilli. Polymerase chain reaction of the synovial fluid using IS6110 was negative.