Non-axial osteoarticular tuberculosis in the paediatric age. / La tuberculosis osteoarticular no axial en la edad pediátrica.

INTRODUCTION AND OBJECTIVES: Osteoarticular tuberculosis, caused by a member of the Mycobacterium genus, represents approximately 10% of the total extrapulmonary tuberculosis in pediatric patients. Its low prevalence and nonspecific clinical presentation lead to a late diagnosis and elevated risk of sequelae. PATIENTS AND METHODS: This retrospective study included seven pediatric patients with non-vertebral osteoarticular tuberculosis diagnosed between 2006 and 2019. The patients were classified in accordance with the radiographic criteria of Kerri and Martini. RESULTS: The mean patient age was 7,4 years (median, 5 years; range, 2-16 years). The mean follow-up time was 18,5 months (range, 10-32 months). The mean diagnostic delay was 4,7 months (range, 1-8 months). The locations were femoral head osteoarthritis (two patients) and proximal humerus osteomyelitis, talus dome osteoarthritis, distal clavicle osteoarthritis, proximal ulna epiphysis osteoarthritis, and tibiotalar arthritis along with subtalar gland (one patient each). The clinical findings were lameness (four patients), localized pain (two patients), functional impotence, constitutional syndrome (asthenia, anorexia, and involuntary loss of>5% of total body weight) (two patients), local inflammatory signs (one patient), and fever (one patient). One patient was asymptomatic and received a diagnosis during pulmonary radiological analysis. Medical treatment with four drugs was performed in all patients; five patients required surgical treatment for abscess drainage, three of them open drainage, and two with laparoscopic drainage. CONCLUSIONS: The final results were satisfactory, such that 71% of patients recovered joint balance but with radiological sequelae in 57,1% patients. Good prognosis, according to our results, depends on younger age and early diagnosis with early medical or surgical treatments.

Osteoarticular infections: Blood as a determinant factor in the isolation of Kingella kingae.

We assessed the capacity of Kingella kingae to grow in blood culture bottles (BCB), taking into account the concentrations of the microorganism and blood in the culture medium. An initial suspension (McFarland 0.5) of 32 strains of K. kingae was serially diluted. One mL of the initial suspension and 1 mL of the subsequent dilutions were inoculated in two BCB, together with 1 mL of human blood in the 2nd BCB. Also, 1mL serial dilutions of human blood were added to BCBs previously inoculated with 1 mL of K. kingae dilution 1/104. In non-blood-supplemented BCB, 23 strains grew with the initial suspension and only one with the first processed dilution, as compared to all strains with the initial suspension and the 3 first dilutions, 22 with the 4th dilution, and one with the 5th dilution in blood-supplemented BCB. In BCB inoculated with K. kingae dilution 1/104 and decreasing concentrations of human blood, all strains grew with blood dilutions 1/2 and 1/4, 26 with dilution 1/8, 19 with dilution 1/16, 10 with dilution 1/32, and none with dilution 1/64. Increasing time to positivity was observed with both decreasing bacterial (p = .001) and blood concentrations (r = -0.632, p < .0001). The addition of human blood was essential to boost the growth of K. kingae in BCB. If replicated in vivo, these findings would increase the isolation of fastidious K. kingae organisms from pediatric osteoarticular exudates.

Pediatric Psoas Abscess, Early Diagnosis of a Challenging Condition.

INTRODUCTION: Psoas abscess is a rare entity at the pediatric stage of life. The clinical presentation of psoas abscess is insidious and not specifi c, and this usually causes diagnostic delay. Early diagnosis is relevant to prevent devastating consequences of this condition. AIMS: This study aimed to describe the natural history of psoas abscess, present our experience in a children's hospital, determine warning signs and symptoms that may lead to early diagnosis, and describe differential diagnoses. We also discuss the devastating consequences of misdiagnosing psoas abscess. METHODS: This retrospective study was performed at Sant Joan de Déu Children's Hospital (Barcelona, Spain) from 2008 to 2016. All patients younger than 18 years old (n = 12) with psoas abscess who were diagnosed by imaging tests were included. RESULTS: The initial clinical presentation of the patients was variable. Painful hip mobility at extension (7 cases), limping (5 cases), and fever (4 cases) were the most frequent presentations. Laboratory parameters were abnormal in nine patients. The main responsible bacteria was Staphylococcus aureus (9 cases). The mean hospital stay was 28 days (range, 10-71 days). Percutaneous drainage under ultrasound control was applied in two patients. Surgical debridement was performed in seven patients, and repeated procedures were required in three of them. CONCLUSIONS: Because of the erratic presentation of psoas abscess, its suspected diagnosis is essential for an early diagnosis, which will minimize the risk of diagnostic delay. One or more signs and symptoms at the same time might be considered as initiation of psoas abscess. Physicians should be aware of risk factors, such as previous traumatism and a known disturbed immunological system or temporal circumstances, which might lead to psoas abscess. Laboratory parameters may provide more confi dence in diagnosis, and early imaging tests provide a defi nitive diagnosis.