Asunto(s)
Artritis Infecciosa/veterinaria , Enfermedades de las Cabras/congénito , Transmisión Vertical de Enfermedad Infecciosa/veterinaria , Infecciones por Mycoplasma/veterinaria , Mycoplasma agalactiae , Animales , Animales Recién Nacidos , Artritis Infecciosa/congénito , Artritis Infecciosa/patología , Artritis Infecciosa/transmisión , Carpo Animal/microbiología , Carpo Animal/patología , Femenino , Enfermedades de las Cabras/microbiología , Enfermedades de las Cabras/patología , Enfermedades de las Cabras/transmisión , Cabras , Masculino , Infecciones por Mycoplasma/congénito , Infecciones por Mycoplasma/patología , Infecciones por Mycoplasma/transmisión , Embarazo , Tarso Animal/microbiología , Tarso Animal/patologíaRESUMEN
Acute hematogenous osteomyelitis most frequently occurs in children, generally around 6 to 9 years of age. If it occurs in early infancy, the infection usually involves both the bone and the joint, nearly simultaneously. Neonatal osteomyelitis is another presentation, with an osteomyelitic focus in the metaphysis. We report a case of septic arthritis following osteomyelitis of the hip joint in a neonate caused by a virulent pathogenic organism. Despite late diagnosis and treatment, outcome was very satisfactory with few sequelae for the joint and epiphysis. It should be emphasized that early diagnosis, with prompt and adequate treatment is essential to achieve good outcome. We discuss this case and present a review of the literature.
Asunto(s)
Artritis Infecciosa/congénito , Cabeza Femoral/microbiología , Enfermedades del Prematuro/microbiología , Recien Nacido Prematuro , Osteoartritis de la Cadera/congénito , Osteomielitis/congénito , Infecciones Estafilocócicas/congénito , Artritis Infecciosa/microbiología , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Diferencia de Longitud de las Piernas/etiología , Osteoartritis de la Cadera/microbiología , Osteomielitis/microbiología , Rango del Movimiento Articular/fisiologíaRESUMEN
INTRODUCTION: Septic arthritis represents an intra-articular infection caused by pyogenic bacteria. During the earliest childhood it is considered to be a systemic septic condition and demands early diagnosis and prompt surgical treatment. MATERIAL AND METHODS: This is a retrospective analysis of patients with septic arthritis treated at the Department of Orthopedics of the Pediatric Surgery Clinic in Novi Sad, over a 10-year period. We are also presenting a case of a 12-day-old newborn baby, with clear radiological signs of osteoarthritis of the right knee. RESULTS: A retrospective study included the period 1991-2000, and showed that 15 patients, aged 10 days--12 months were treated for osteoarthritis. The most common localization was the hip, in 60% of cases. In 11 patients the causative agent was Staphylococcus aureus, while in the 4 remaining patients the bacteriologic finding was negative. One patient died of generalized sepsis. DISCUSSION: In neonates and infants septic arthritis is characterized by atypical clinical picture, often causing delayed diagnosis. In the initial phases of the disease ultrasonographic findings were of greater use compared to radiological imaging, due to relatively late appearance of radiological signs of disease. CONCLUSIONS: Due to possible development of serious and irreversible damage, even lethal outcome, septic arthritis requires early diagnosis, prompt administration of antibiotics and early surgical treatment. It is a quite unique area in Pediatric Orthopedics where missed or delayed diagnosis may have serious consequences.
Asunto(s)
Artritis Infecciosa/congénito , Articulación de la Cadera , Articulación de la Rodilla , Infecciones Estafilocócicas/congénito , Artritis Infecciosa/diagnóstico , Humanos , Lactante , Recién Nacido , Estudios Retrospectivos , Infecciones Estafilocócicas/diagnósticoAsunto(s)
Antibacterianos , Profilaxis Antibiótica , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/tratamiento farmacológico , Quimioterapia Combinada/administración & dosificación , Gonorrea/transmisión , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Artritis Infecciosa/congénito , Artritis Infecciosa/microbiología , Femenino , Estudios de Seguimiento , Gonorrea/diagnóstico , Humanos , Recién Nacido , Oftalmía Neonatal/prevención & control , Embarazo , Atención Prenatal , Diagnóstico Prenatal , Resultado del TratamientoRESUMEN
The neonate is unable to relate specific complaints of pain and may not exhibit the usual signs of illness or infection. Septic arthritis of the hip is a surgical emergency in the neonate, and it should be considered in any irritable or ill child who has a high index of suspicion. Prompt diagnosis and immediate treatment are necessary. Nearly all babies undergo routine examination of the hip for dysplasia. It is recognized that limitation of abduction of the hip in the neonate may not represent developmental dysplasia of the hip but may represent other etiologies, such as fracture, infection, congenital anomaly, or tumor. The following case report illustrates the importance of careful clinical evaluation of an apparent asymptomatic neonate.
Asunto(s)
Artritis Infecciosa/congénito , Artritis Infecciosa/diagnóstico , Articulación de la Cadera , Ilion , Osteomielitis/congénito , Osteomielitis/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Humanos , Recién Nacido , Masculino , Infecciones Estreptocócicas/congénitoRESUMEN
A retrospective study was done to review the clinical experience of septic arthritis and osteomyelitis in the newborns in our centre. Case records of all the neonates born from January 1989 to August 1994 and those admitted to outborn nursery from 1985 to 1993 were reviewed. Diagnosis of septic arthritis/osteomyelitis was made in the presence of relevant clinical signs and supported by positive culture from blood or joint fluid and abnormal X-ray or ultrasound findings. The incidence of septic arthritis and osteomyelitis among inborn babies was 1 in 1500. There were 25 neonates with mean gestational age 34.5 (range 27-40) weeks and mean birth weight 2269 (range 990-4750) gms. Limitation of movement (64%) and local swelling (60%) were commonest presentations. A total of 33 joints were involved in 25 babies. Eight babies (32%) had multiple joint involvement. Hip and knee were the most commonly involved joints (48% each). In 19 babies (76%) joint involvement occurred in association with a generalized septicemic illness while 6 babies (24%) had localised signs and symptoms. Joint aspirate was positive for gram stain or culture in 12 (48%) and 10 babies (40%) had positive blood culture. Klebsiella pneumoniae and Staphylococcus aureus were commonest isolates. Radiological changes were seen in 13 (52%) babies. All were treated with appropriate antibiotics and open surgical drainage was done in 5 (20%) cases. Bone and joint infections are important complications in sick septicemic neonates and need early diagnosis, appropriate management with antibiotics, surgical drainage in selected cases to prevent long term morbidity.
Asunto(s)
Artritis Infecciosa/congénito , Enfermedades del Prematuro/diagnóstico , Osteomielitis/congénito , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/etiología , Femenino , Humanos , India , Recién Nacido , Enfermedades del Prematuro/etiología , Infecciones por Klebsiella/congénito , Infecciones por Klebsiella/diagnóstico , Infecciones por Klebsiella/etiología , Klebsiella pneumoniae , Masculino , Osteomielitis/diagnóstico , Osteomielitis/etiología , Infecciones Estafilocócicas/congénito , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/etiologíaRESUMEN
Bone and joint infections during the neonatal period differ from those in the older child. Neonates are relatively immunocompromised and their growth plate is pierced by blood vessels. Special characteristics of skeletal infection in the neonate are: (1) multiple foci of infection; (2) simultaneous involvement of the bone and the adjacent joint; and (3) limited systemic and local inflammatory response. The more common causative organisms are group B Streptococcus, Staphylococcus aureus, and gram-negative bacteria. Clinical findings can be minimal or absent. The more common findings include local swelling and limited motion in a joint or a limb. Early soft tissue radiographic changes are found in most cases and should be looked for. Every suspected bone or joint should be aspirated. Hip joint aspiration is recommended in the presence of other skeletal infection, even without local signs. Intravenous antibiotic treatment is started according to Gram's stain results or the best "educated guess." Surgical debridement is indicated for every site of pus in the extremities. Joint destruction and bone deformity and shortening are a common outcome. The only way to minimize early and late complications is high index of suspicion, aggressive workup, and adequate early treatment.
Asunto(s)
Artritis Infecciosa/congénito , Osteítis/congénito , Humanos , Recién Nacido , Factores de RiesgoRESUMEN
A fatally ending index case of septic osteoarthritis that was diagnosed retrospectively initiated this report. This patient had severe, asymmetrically distributed metaphyseal growth disturbances at many long bones. In order to determine the features of early radiologic diagnosis we report the findings of 7 further patients with neonatal septic osteoarthritis with clinical and radiological follow-up. The most important observation for early radiologic diagnosis of osteoarthritis is the displacement of fat layers along the metaphysis. Other findings of the soft tissues have the same diagnostic value as bone destruction and subperiosteal new bone formation found one to three weeks later on roentgenfilms. Detecting early signs of osteoarthritis helps in localizing the focus for bacteriologic diagnosis, which is said to be more successful than blood cultures. Diagnosing a joint empyema initiates surgical intervention for pressure relief in order to avoid necrosis of the epiphysis as seen in the femoral head in septic arthritis of the hip joint. Early diagnosis and treatment prior to destruction of the growing cartilage is necessary to avoid growth disturbances and length discrepancies of long bones. In cases of sepsis a so called "babygram" and a repeat examination 10 to 14 days later is mandatory.
Asunto(s)
Artritis Infecciosa/congénito , Enfermedades del Recién Nacido/diagnóstico por imagen , Osteoartritis/congénito , Infecciones Estafilocócicas/congénito , Artritis Infecciosa/diagnóstico por imagen , Preescolar , Femenino , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Humanos , Lactante , Recién Nacido , Enfermedades del Prematuro/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Masculino , Osteoartritis/diagnóstico por imagen , Radiografía , Infecciones Estafilocócicas/diagnóstico por imagenRESUMEN
The authors report a case of congenital syphilis with involvement of a joint space and adjacent bony surfaces in a newborn infant. Although similar findings have been reported in older children, this appears to be the first such case in a newborn.