Osteomielitis por Klebsiella pneumoniae BLEE. Reporte de un caso y revisión de la literatura. / OSTEOMYELITIS DUE TO KLEBSIELLA PNEUMONIAE ESBL. REPORT OF A CASE AND LITERATURE REVIEW

Las betalactamasas de espectro extendido (BLEE) son enzimas producidas por bacilos gram negativos capaces de hidrolizar las cefalosporinas de amplio espectro y los monobactámicos. La mayoría pertenece a la familia de Enterobacteriae, tales como Klebsiella pneumoniae y Escherichia coli: Sin embargo, se asocian también con otras bacterias como Proteus, Serratia, Salmonella, Pseudomonas aeruginosa y Acinetobacter. Las enterobacterias productoras de carbapenemasas no sólo han sido aisladas en el ambiente hospitalario, sino que también provienen de la comunidad. Se presenta una paciente de sexo femenino con antecedentes de sida y osteomielitis secundaria a artritis séptica producida por una Klebsiella pneumoniae BLEE de la comunidad. Un tratamiento oportuno y eficaz puede evitar la opción quirúrgica, disminuyendo la morbimortalidad asociada con esta afección

Extended-spectrum beta-lactamases (ESBL) are enzymes produced by gram-negative rods capable of hydrolyzing broad-spectrum cephalosporins and monobactams. Most belong to the Enterobacteriae family, such as Klebsiella pneumoniae and Escherichia coli. However, they are also associated with other bacteria such as Proteus, Serratia, Salmonella, Pseudomonas aeruginosa and Acinetobacter. Carbapenemase-producing Enterobacteriaceae have not only been isolated from the hospital environment, but also from the community. We present a female patient with a history of AIDS and secondary osteomyelitis to septic arthritis caused by a community Klebsiella pneumoniae ESBL. It is concluded that a timely and effective treatment can avoids the surgical option, reducing the morbidity and mortality of this condition.

Infecciones osteoarticulares en niños / Osteoarticular infections in children

Las infecciones osteorticulares (IOA) en el niño son una causa importante de morbilidad y secuelas. Su pesquisa oportuna y el tratamiento eficiente pueden lograr excelentes resultados. La mejoría en las condiciones de salud de la población, y el cambio de los agentes etiológicos han variado la forma de presentación y tratamiento. La existencia de gérmenes como Kingella kingae y Staphilococcus aureus multiresistente, contribuyen a la variabilidad de presentación de las infecciones osteoarticulares.El manejo de estas patologías requiere de un conocimiento del cuadro clínico, de los métodos de diagnóstico y las herramientas terapéuticas. Para obtener buenos resultados es requisito básico el enfrentamiento de estos pacientes en un equipo multidisciplinario de especialistas.En este manuscrito revisaremos los aspectos fundamentales de las infecciones osteoarticulares, según el enfoque que aplicamos en nuestros pacientes.

Osteoarticular infections are a substantial cause of morbidity and sequelae in children. Early diagnosis and efficient treatment can achieve excellent results. The improvement in the health conditions of the population and the change in the etiological agents have produced changes in their presentation and their required treatment. The existence of germs like Kingella kingae and Staphilococcus aureus multiresistant contribute to the variability of presentation of osteoarticular infections.The appropriate management of these pathologies requires knowledge of the clinical picture, diagnostic methods, and therapeutic tools. To obtain good results, it is a basic requirement that these patients be confronted by a multidisciplinary team of specialists.In this manuscript we will review the most fundamental aspects of osteoarticular infections according to the approach we apply to our patients

Streptococcus agalactiae: causa de artritis séptica inusual a partir de los 3 meses de edad. Caso clínico / Streptococcus agalactiae: an unusual cause of septic arthritis beyond 3 months of age. Case report

La artritis séptica es una patología poco frecuente, pero con una alta morbilidad, debido a las importantes secuelas que puede originar. La etiología varía según la edad, y Staphylococcus aureus es el microorganismo más frecuente en todas ellas. Streptococcus agalactiae odel grupo B es una causa infrecuente de infección fuera del período neonatal; se asocia, a partir de los 3 meses de edad, con infecciones graves en pacientes inmunocomprometidos. El tratamiento de elección es penicilina G o ampicilina.Aquí se describe el caso de un niño de cuatro meses y medio de edad que desarrolló una artritis séptica por Streptococcus agalactiae odel grupo B, con inicio insidioso de la clínica. El diagnóstico etiológico obligó a descartar meningitis y una inmunodeficiencia asociada. La frecuencia extremadamente baja de dicha artritis a esta edad y la importancia de descartar una enfermedad diseminada son importantes puntos de aprendizaje en este caso.

Septic arthritis is not a very frequent disease, but with a high morbidity due to the important sequelae that it can cause. The etiology is age-specific, with Staphylococcus aureus being the most frequent microorganism in all ages. Streptococcus agalactiae or group B Streptococcus is an uncommon cause of infection outside the neonatal period. Beyond 3 months of age, infections by this pathogen are associated with serious infections in immunocompromised patients. The treatment of choice is penicillin G or ampicillin. A 4.5-month-old child who developed a group B Streptococcus septic arthritis is reported. The onset was insidious, and the etiological diagnosis prompted us to rule out meningitis and associated immunodeficiency. The extremely low frequency of group B Streptococcus septic arthritis at this age and the importance of ruling out a disseminated disease are crucial learning points in this case

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.

Treatment of chikungunya chronic arthritis: A systematic review / Tratamento de artralgia crônica da chikungunya: uma revisão sistemática

Summary Introduction: Chikungunya (CHIK) is a tropical arbovirus, transmitted by the female mosquito Aedes aegypti and Aedes albopictus. In Brazil, there have been cases reported since 2014. The initial manifestations of this virus are sudden onset high fever, headache, chills, rashes, myalgia and intense joint pain. Usually, CHIK presents the acute and chronic phases, the latter characterized by bilateral polyarthralgia, which can last for months or even years. During this period, autoimmune diseases can be triggered, making the picture even more complicated. Method: A systematic review was performed on the PubMed and Scielo databases in January 2017. Clinical trials, cohorts, case-control and case reports were included in the study. Expert opinions, societal consensuses and literary reviews were exclusion criteria. Studies were conducted in English, Spanish and Portuguese. The studies were descriptively analyzed and the data was grouped according to methodological similarity. Results: Twenty-four (24) articles were selected and, in compliance with the inclusion and exclusion criteria, 18 were eliminated, with six studies remaining in the present review: five clinical trials and one case report. Conclusion: When the manifestations of CHIK become chronic and, the longer they last, more complications arise. Polyarthralgia can be immaterial, distancing individuals from their daily-life activities. Anti-inflammatory drugs (either steroid or not), in addition to immunosuppressants, homeopathy and physiotherapy are measures of treatment that, according to the literature, have been successful in relieving or extinguishing symptoms. However, it is fundamental that studies of CHIK treatment be further developed.

Resumo Introdução: A chikungunya é uma arbovirose tropical, transmitida pela fêmea dos mosquitos Aedes aegypti e Aedes albopictus. No Brasil, existem casos relatados desde 2014. As manifestações iniciais dessa virose são: febre alta de início súbito, cefaleia, calafrios, erupções cutâneas, mialgia e dor articular intensa. Normalmente, a chikungunya apresenta as fases aguda e crônica, sendo a última caracterizada pela poliartralgia bilateral, que pode durar meses e até anos. Durante esse período, doenças autoimunes podem ser desencadeadas, tornando o quadro ainda mais complicado. Método: Foi realizada uma revisão sistemática nos bancos de dados PubMed e Scielo em janeiro de 2017. Ensaios clínicos, coortes, casos-controle e relatos de caso foram incluídos na pesquisa. Opiniões de especialista, consensos de sociedades e revisões literárias foram critérios de exclusão. Foram avaliados estudos nas línguas inglesa, espanhola e portuguesa. Os estudos foram analisados descritivamente, e os dados agrupados, conforme semelhança metodológica. Resultados: Foram selecionados 24 artigos; em obediência aos critérios de inclusão e exclusão, 18 foram eliminados, restando seis estudos na presente revisão: cinco ensaios clínicos e um relato de caso. Conclusão: Quando as manifestações da chikungunya se tornam crônicas, quanto mais tempo duram, mais complicações surgem. A poliartralgia pode ser incapacitante, afastando os indivíduos das suas atividades de vida diária. Anti-inflamatórios (esteroides ou não), somados a imunossupressores, homeopatia e fisioterapia são medidas de tratamento que, conforme a literatura, têm alcançado êxito no alívio ou na extinção dos sintomas. Todavia, é fundamental que os estudos do tratamento da chikungunya sejam mais aprofundados.

Childhood pyogenic septic arthritis as seen in a teaching hospital South East Nigeria

Background: Childhood pyogenic septic arthritis and its associated musculoskeletal morbidity is an important health concern in developing countries. Its pattern of presentation that varies from and within subregions has implications on the early recognition, treatment, and outcome. The aim of this study was to determine the pattern and outcome of childhood septic arthritis in our environment. Materials and Methods: This was a retrospective study of all the children seen with pyogenic septic arthritis in Federal Teaching Hospital Abakaliki between January 2005 and December 2015. Results: Childhood septic arthritis accounted for 44 (83%) of the 53 patients seen with pyogenic septic arthritis. Female to male ratio was 1:1.75 and the mean age was 5.7 ± 0.73 years. Eight patients (18.2%) had polyarticular involvements. The right shoulder was significantly more involved than the left and the left hip more than right. Overall, there was a preponderance of onset of symptoms in the dry season. Children from the rural areas accounted for 85.7% of those with the onset of symptom in rainy season. Delayed presentation >6 days (in 68.2% of patients) was related to age (P < 0.042), and health seeking behavior (P < 0.036). Staphylococcus aureus was the commonest causative organism. Seventy-seven percent (77%) underwent open arthrotomy. Anemia, septic shock, and joint stiffness were three top complications observed. Mortality rate was 2.3%, and cause of death was overwhelming sepsis. Conclusion: In our setting, pyogenic septic arthritis is predominantly a childhood health problem and children under 5 years of age are the most vulnerable. Delayed presentation, an important factor in morbidity and mortality associated with septic arthritis was common among the patients, calls for a public enlightenment program on the importance of early presentation

Clinical and epidemiological characteristics of septic arthritis of the hip, 2006 to 2012, a seven-year review

OBJECTIVE: To epidemiologically characterize the population treated at our orthopedic clinic with a diagnosis of septic arthritic of the hip between 2006 and 2012. METHODS: Fifteen patients diagnosed with septic arthritis of the hip between 2006 and 2012 were retrospectively evaluated. The patients' clinical and epidemiological characteristics were surveyed; a sensitivity profile relating to the microorganisms that caused the infections and the complications relating to the patients' treatment and evolution were identified. RESULTS: Septic arthritis was more common among males. Most diagnoses were made through positive synovial fluid cultures, after joint drainage was performed using the Smith-Petersen route. Among the comorbidities found, the most prevalent were systemic arterial hypertension, diabetes mellitus, and human immunodeficiency virus. The pathological joint conditions diagnosed prior to joint infection were osteoarthrosis and developmental dysplasia of the hip. The infectious agent most frequently isolated was Staphylococcus aureus. From the clinical and laboratory data investigated, 53.33% of the cases presented with fever, and all except one patient presented with increased measures in inflammation tests. Gram staining was positive in only 26.66% of the synovial fluid samples analyzed. Six patients presented with joint complications after treatment was administered. CONCLUSION: S. aureus is the most common pathogen in acute infections of the hip in our setting. Factors such as clinical comorbidities are associated with septic arthritis of the hip. Because of the relatively small number of patients, given that this is a condition of low prevalence, there was no statistically significant correlation in relation to worse prognosis for the disease. .

Artritis séptica luego de la plástica artroscópica del ligamento cruzado anterior / Septic arthritis following ACL reconstruction

El objetivo de este trabajo es analizar nuestra experiencia en artritis séptica luego de la reconstrucción artroscópica del LCA. Nive! 4 de evidencia. Se realizó la revisión retrospectiva de las reconstrucciones de ligamento cruzado anterior (LCA) por via artroscópica realizadas en nuestros servicios. Se incluyeron todos los casos diagnosticados como artritis sépticas con un seguimiento mínimo de 1 año. Entre los años 1999 y 2008 se realizaron 1088 reconstrucciones artroscópicas de LCA. Se registraron 12 casos de artritis séptica, lo que implica una incidencia de 1,1 por ciento (IC95 0.6 por ciento - 2 por ciento), los pacientes eran todos de sexo masculino. La edad promedio fue de 27 años (rango entre 21-47). Luego de obtenido el material para cultivo por punción se realizó lavado artroscópico. Se comenzó con terapia antibiótica intravenosa empírica con vancomicina más ciprofloxacina. Al obtener la tipificación se rotó al antibiótico específico endovenoso durante 6 semanas. Se logró conservar el neoligamento en 11 casos (IC95 0,5 por ciento - 1,9 por ciento) y en 1 se perdió. En el seguimiento todos los pacientes presentaron rodillas estables a excepción de un caso. Es de fundamental importancia el trabajo interdisciplinario con el sector de infectología para determinar el tratamiento antibiótico definitivo. La artritis séptica post-reconstrucción de! LCA con diagnóstico precoz y tratamiento efectivo tiene resultados satisfactorios

Staphylococcus aureus sensible a la meticilina frente a Staphylococcus aureus resistente en la artritis septica aguda: estudio experimental, epidemiologico y clinico en niños / Methicillin-sensitive versus methicillin-resistant Staphylococcus aureus in acute septic arthritis: experimental, epidemiological and clinical study in children

Introducción: Los objetivos principales de este estudio fueron establecer la epidemiología de la artritis séptica en nuestra comunidad, determinar las diferencias entre la artritis séptica producida por Staphylococcus aureus sensible a la meticilina y las secundarias a Staphylococcus aureus resistente a la meticilina, y determinar las propiedades bactericidas del líquido sinovial. Materiales y métodos: Se utilizaron 28 conejos neozelandeses, divididos en cuatro grupos de 2 cada uno; en los de los grupos I y II se inocularon 0,3 mL de Staphylococcus aureus sensible a la meticilina y en los de los grupos III y IV, 0,3 mL de Staphylococcus aureus resistente a la meticilina. Se evaluó a 16 niños con artritis séptica, con un promedio de edad de 6 años. Se tomaron muestras de líquido sinovial de 10 rodillas, las cuales se colocaron en medios de cultivo inoculados con Staphylococcus aureus sensible a la meticilina y con Staphylococcus aureus resistente a la meticilina. Resultados: La resonancia magnética evidenció signos de artritis en todos los casos. Los hemocultivos fueron negativos. La anatomía patológica evidenció edema, infiltrado inflamatorio purulento con material fibrinoleucocitario, tejido de granulación y áreas con destrucción de la membrana sinovial. En la investigación clínica, la articulación más afectada fue la rodilla (10 casos); el agente causal no se pudo identificar en 9 casos. El estudio experimental para determinar la capacidad bactericida del líquido sinovial reveló 75 por ciento de inhibición de crecimiento de colonias de Staphylococcus aureus sensible a la meticilina y 0 por ciento de inhibición para colonias de Staphylococcus aureus resistente. Conclusiones: La elección de la antibioticoterapia para utilizar inicialmente en la artritis séptica debe variar de acuerdo con lo que muestren los estudios epidemiológicos de cada región...

Background: The main objectives of this paper were: to establish the epidemiology of septic arthritis in our community, determine the differences between methicillin-resistant and methicillin-sensitive Staphylococcus aureus septic arthritis, and determine the bactericidal properties of synovial fluid. Methods: Twenty-eight rabbits were used, divided into four groups of seven rabbits each; in groups I and II 0.3cc of methicillin-sensitive Staphylococcus aureus were inoculated, and in groups III and IV 0.3cc of methicillin-resistant Staphylococcus aureus were inoculated in the knee. We evaluated 16 children with septic arthritis, average age six years. Samples of synovial fluid were taken from 10 knees, placed in culture material and inoculated with methicillin-sensitive and methicillin-resistant staphylococcus. Results: The MRI showed signs of arthritis in all cases. Blood cultures were negative. The histological evaluation showed swelling, inflammation, granulation tissue, pus, and destroyed areas in the synovial membrane. In the 10 children evaluated the most affected joint was the knee; the causative agent could not be identified in nine cases. The study to assess the bactericidal activity of the synovial fluid revealed 75% of growth inhibition for methicillin-sensitive Staphylococcus aureus and no growth inhibition for the methicillin-resistant staphylococcus. Conclusions: The antibiotics used for the initial treatment in septic arthritis should vary according to the epidemiology of each region. Synovial fluid has important bactericidal properties against methicillin-sensitive Staphylococcus aureus, but not against methicillin-resistant staphylococcus. The MRI should be the imaging study of choice to diagnose and evaluate septic arthritis.

Artritis meningocócica primaria en pediatría: presentación de nueve casos / Primary meningococcal arthritis in pediatrics: report of nine cases

La artritis meningocócica primaria es una forma rara de presentación de la enfermedad invasiva por meningococo. Se define como la presencia de artritis séptica aguda sin asociación con meningitis, ni clínica de meningococemia, y con aislamiento de Neisseria meningitidis en líquido articular o sangre. La incidencia comunicada en pediatría es del 1,5 -1,8 por ciento de lasartritis piógenas. Generalmente presenta compromiso monoarticular y de grandes articulaciones. La respuesta es excelente con tratamiento antibiótico adecuado. Nuestro objetivo es comunicar 9 casos de artritis meningocócica primaria registrados en el Hospital de Niños Dr. R. Gutiérrez, en un período de 3 años y discutir los aspectos clínicos y epidemiológicos.

Primary meningococcal arthritis is an extremely uncommon type of invasive meningoccal disease, with an incidence of 1.5- 1.8% of all paediatric cases of pyogenic arthritis. It is defined as the presence of acute septic arthritis without association with meningitis or the classic meningococcaemia, and isolation of Neisseria meningitidis in synovial fluid and/or blood culture. Typically monoarticular, mostly affects large joints. Prognosis is excellent with appropriated treatment. The aim of this study is to report 9 cases of primary meningococcal arthritis, evaluated at Hospital de Niños "Dr. R. Gutiérrez" in a period of 3 years, and to discuss clinical and epidemiologic issues.

Avaliação do tratamento da artrite séptica do quadril / Treatment evaluation of septic arthritis of the hip

Objetivo: Revisão dos resultados do tratamento de 46 crianças, 47 quadris, com artrite séptica do quadril e a investigação da relação entre os fatores prognósticos e os resultados clínicos obtidos. Métodos: Foram classificados, do ponto de vista clínico e radiográfico, de acordo com as classificações de Hunka e a de Choi, e distribuídos em grupos para estudo estatístico. O grupo 1 foi formado por pacientes classificados como tipo IA, e o grupo 2 pelos pacientes tipos IB ao IVB. A doença acometeu 30 meninos, sendo o lado direito comprometido em 26 crianças e uma delas com acometimento bilateral. A média de idade na apresentação foi de 50 meses, sendo maior no grupo 1 (p = 0,023). A cultura do líquido sinovial foi positiva em 23 pacientes e, dentre elas, em 18 cresceram Staphylococcus aureus. O tempo de sintomas até o tratamento cirúrgico teve média de 3,5 dias, sendo a espera no grupo 1 menor (p = 0,03). Resultados: Quarenta e seis pacientes, 47 quadris, que compareceram ao Ambulatório da Ortopedia do HIJG, e responderam ao protocolo, submetidos a exame físico e radiografias da bacia, além da revisão de dados do prontuário. O resultado do tratamento foi satisfatório na grande maioria dos casos. Conclusão: Pacientes jovens, que, na apresentação, não claudicavam, com cultura do líquido sinovial positiva para Staphylococcus aureus e demora na instituição do tratamento cirúrgico constituíram fatores de pior prognóstico nos resultados.

Objective: Presenting a retrospective review of the results of treatment of children with septic arthritis of the hip and the investigation of the relationship between prognostic factors and the clinical results obtained. Methods: The patients evaluated (46) comprising 47 hips, who attended Orthopedics HIJG´s ambulatory clinic, answered a questionnaire, underwent physical examinations and radiographs of the pelvis, as well as the review of data from medical records. The patients were classified in terms of clinical and radiographic point of view according to both the classifications of Hunka and Choi, and were divided into groups for statistical comparison. Group 1 consisted of patients classified as Type IA and group 2 consisted of patients classified as Type IB to Type IVB. Results: The disease affected 30 boys, affecting the right hip in 26 children and both sides in one child. The average age at the presentation was 50 months, being higher in group 1 (p = 0.023). The synovial fluid culture was positive in 23 patients and Staphylococcus aureus grew in 18 of them. Symptoms lasted on average for 3.5 days before surgery, the wait being shorter in group 1 (p = 0.03). The treatment outcome was satisfactory in most cases. Conclusion: Young patients, who did not limp during the initial medical exam, with synovial fluid culture positive for Staphylococcus aureus and delay in undergoing surgical treatment, were associated with poor outcomes.

Tuberculosis como causas de osteomielitis en edad pediátrica: a proposito de un caso de osteomielitis en astrágalo / Tuberculosis as a cause of osteomyelitis in childhood: report of a case of osteomylitis of the talus

La osteomielitis hematógena es frecuente en la metáfisis de los huesos largos en la infancia; siendo esta misma afectación rara en otras localizaciones y más aun, extremadamente rara en el astrágalo, tanto así que se reportan solo unos pocos casos y de manera esporádica en la literatura mundial. En este trabajo presentamos un caso clínico, de una paciente preescolar que presento osteomielitis hematógena de astrágalo cuyo tratamiento médico y quirúrgico representaron y aun representan todo un reto para el ejercicio clínico debido a la dificultad del diagnostico etiológico y tórpida evolución.

Hematogenous osteomyelitis is frequent in the metaphysis of long bones in childhood, being the same affection rare in other locations and even more, extremely rare in the talus, so much so that only a few reported sporadic cases and literature world. We present a clinical case of a patient presenting preschool hematogenous osteomyelitis of the talus which medical and surgical treatment represented and still represent a challenge for clinical practice because of the difficulty of diagnostic and torpid evolution.

Approach to a child with monoarthritis.

Abstract Arthritis in childhood is common. The pattern, presentation and duration of arthritis help differentiate between the various possible diagnoses. When only one joint is involved, i.e., monoarthritis, it may be difficult to make a diagnosis as there are many possibilities both acute and chronic in nature. A detailed history and clinical examination is important to reach a correct diagnosis and the single most important investigation when a child presents acutely is a joint aspiration to rule out septic arthritis that may destroy the joint in hours. Inflammatory markers, antinuclear antibody testing, test for tuberculosis and imaging (in specific cases) play an important role in the diagnosis of a child that presents with a chronic monoarthritis. In this article we provide a clinical approach to the diagnosis of monoarthritis in a child.

Salmonella enterica enteritidis arthritis following trauma in a child with thalassemia major.

Osteoarticular infections caused by Non-typhi Salmonella are exceptionally encountered. We report a case of a bacteriologically documented knee joint infection due to Salmonella enterica serotype enteritidis, following trauma in a child with thalassemia major. Emergency arthrotomy combined with antimicrobial therapy was helpful in eradication of infection. Physicians should be aware of this rare manifestation of Non-typhi Salmonella infections in thalassemic patients.

Diagnóstico da monoartrite aguda na emergência / Diagnosis of acute monoarthritis in emergency

JUSTIFICATIVA E OBJETIVOS: A apresentação clínica B de artrite aguda na emergência é frequente e seu diagnóstico, etiológico é desafiador, tendo uma gama de possíveis diagnósticos. A correta avaliação da causa precipitante do sintoma é de extrema importância para orientar o tratamento adequado, minimizando as complicações. O objetivo deste estudo foi auxiliar o médico emergencista, no atendimento de pacientes adultos com quadro clínico de artrite aguda, em articulação nativa. CONTEÚDO: Artigos publicados entre 1970 e 2009, foram selecionados no banco de dados do MedLine através a das palavras-chave: monoartrite e emergência, assim como diretrizes internacionais foram buscadas no link http: sumsearch.uthsca.edu. Adicionalmente, referências destes a artigos, capítulos de livros e artigos históricos foram avaliados CONCLUSÃO: A artrite aguda é uma situação de emergência clínica, associada à fatores precipitantes e etiologias diversas. O correto atendimento, assim como o diagnóstico etiológico, assegura a recuperação e melhoria dos pacientes. Entre as etiologias de artrite aguda, deve-se salientar a importância da artrite infecciosa, devido suas complicações e sequelas, caso não seja instituído tratamento adequado.

Septic arthritis of the knee joint secondary to prevotella bivia

Prevotella bivia is an obligatory anaerobic, gram-negative rod, which often produces a detectable beta-lactamase. To date, there has been only 3 descriptions of septic arthritis secondary to this microorganism in a patients pre-existing sever joint disease like rheumatoid arthritis and osteoarthritis or after joint prosthesis. We are reporting the first case of septic arthritis due to Prevotella bivia in a patient with no pre-existing joint symptoms

Artritis septica luego de la reconstruccion artroscopica del ligamento cruzado anterior / Septic arthritis after anterior cruciate ligament arthroscopic reconstruction

El objetivo de este trabajo es analizar nuestra casuistica en relacion a la incidencia, prevalencia de germenes, tratamiento clinico y resultados clinicos luego del tratamiento. Se realizo la revision retrospectiva de las reconstrucciones de ligamento cruzado anterior (LCA) por via artroscopica realizadas en nuestro servicio. Se incluyeron todos los casos que fueron diagnosticados como artritis septicas con un seguimiento minimo de 2 años. Entre los años 1986 y 2006 se realizaron 2282 reconstrucciones artroscopicas de LCA. Se registraron 27 casos de artritis septica, lo que implica una incidencia de 1,18 por ciento, 25 pacientes eran de sexo masculino y 2 femenino. La edad promedio fue de 28 años (rango entre 21-47). En todos los casos la cirugia fue primaria. Para la evaluacion clinica se utilizo el score de Lysholm. Luego de obtenido el material para cultivo por puncion se realizo lavado artroscopico. Se comenzo con terapia antibiotica intravenosa empirica con vancomicina mas ciprofloxacina. Al obtener la tipificacion se rotó al antibiotico especifico IV durante 6 semanas. Se logro conservar el neoligamento en 25 casos y en 2 se perdio, siendo reimplantados. En el seguimiento todos los pacientes presentaron rodillas estables con un score de Lysholm de 97 puntos promedio. Es de fundamental importancia el trabajo interdisciplinario con el sector de infectologia para determinar el tratamiento definitivo. La artritis septica post-reconstruccion del LCA con diagnostico precoz y tratamiento efectivo tiene resultados satisfactorios. La mayoria de los pacientes conservo su plastica original luego de 2 años de minimo seguimiento

Criptococose articular: relato de caso / Articulate cryptococcosis: a case report

Objetivo: relatar um caso de criptococose articular no joelho esquerdo de um paciente residente no município de Benevides, Pará, 2007. Relato do caso: sexo masculino, 37 anos, desenvolveu artrite criptocócica na articulação do joelho, pelo agente etiológico Cryptococcus neoformans. Foi, inicialmente, atendido na Policlínica, em Santa Isabel, apresentando dor articular no joelho esquerdo, náuseas e cefaléia, como principais sintomas. Ao examefisico, verificou-se edema, calor, tumor,flutuação, choque patelar +++ do joelho esquerdo, tinnel-, adenopatia inguinal homolateral, além de palidez e desidratação de primeiro grau. O paciente submetido à punção do joelho e do LCR, na qualfoi diagnosticado o Cryptococcus neoformans. A terapêutica adotada foi a drenagem do joelho esquerdo. Feito isso, o paciente foi conduzido ao serviço público de saúde de referência, para dar continuidade ao tratamento específico. Considerações finais: o acometimento articular pela criptococose é raro. A descrição do caso é alertar uma maior atuação da vigilância sanitária frente à manipulação e manejo das aves nas granjas do estado.

Objective: report a case of articulate cryptococcosis of a lender in the city of Benevides, Pará, 2007. Case report: man, 37 years, developed artrite criptococose in the joint of the knee, by agent Cryptococcus neoformans. Initially he was taken care in clinical Policlinica, Santa Isabel presenting pain articulate in the left knee, nauseas, and chronic headache as main symptoms. To the physical examination edema, heat, tumor, fluctuation, patellar shock + + + of the left knee, tinnel -, homolateral inguinal adenopathy, beyond pallor and dehydration offirst degree were diagnosised. The patient was submitted to a punction of the knee and the lombar, in which Cryptococcus neoformans was diagnosised. The therapeutical adopted was the draining of the left knee. Made this, the patient was lead to the reference publicservice, to give continuity to the specific treatment. Final considerations: the articulate damage for cryptococcosis is rare. The description of the case is to alert to a bigger performance of the sanitary monitoring front the manipulation and handling of the birds in the chickens companies of the state.