[Septic osteoarthritis in children]. / Osteoartritis séptica en niños.

OBJECTIVE: Our objectives were to assess the clinical and microbiological aspects of septic osteoarthritis in children admitted to our center from 1987 until July 1997 and to determine the sensitivity of ultrasound in this age group. PATIENTS AND METHODS: The medical records of 36 children diagnosed as having septic osteoarthritis of the hip were reviewed retrospectively. The diagnosis had been based on clinical criteria, along with synovectomy and drainage of purulent material from the affected joint. An X-ray and/or ultrasound had been performed when the diagnosis was suspected. RESULTS: Nineteen children were diagnosed during the neonatal period, 8 between the ages of 1 and 12 months and 9 older than one year of age. Mean age at diagnosis was 16.8 +/- 6.2 months (median 29 days, range 6 days to 13 years). The hip was involved in 32 children, the ankle in 3 and the elbow in 1. A microbiological diagnosis was achieved in 22 cases (61%) by culture from blood, CSF, and/or synovial fluid. The most common isolates were Gram positive cocci (S. aureus in 9 cases and coagulase negative Staphylococcus in 3). The diagnostic value of the X-rays was very low (18%). The ultrasound was initially considered abnormal in 64.5% of the patients, with a lower sensitivity in the neonatal period. After a mean follow-up period of 36 months, the outcome was good in 86% of the cases, although three children continue with sequelae. Two preterm infants died due to sepsis associated with the osteoarthritis. CONCLUSIONS: At the time of diagnosis of septic arthritis of the hip, the ultrasound is frequently normal. Due to the poor outcome when there is a delay in surgery, we suggest immediate synovectomy and drainage when there is clinical suspicion of septic arthritis despite an apparently normal ultrasound.

Q fever in children.

OBJECTIVE: To describe clinical profiles of Q fever in children. DESIGN: Retrospective study. SETTING: Tertiary teaching hospital. PARTICIPANTS: Thirteen children aged 2 to 14 years, with a mean +/- SD age of 9.6 +/- 3.6 years. SELECTION PROCEDURES: Review of the medical records of all children with Q fever admitted from 1986 to 1990. The diagnosis was made by detection of phase II antibodies to Coxiella burnetii by the complement fixation test. MEASUREMENTS/MAIN RESULTS: Clinical profiles consisted of a self-limited illness characterized by high fever (mean +/- SD, 39.9 degrees C +/- 0.66 degrees C) of 5 to 10 days' duration (mean +/- SD, 7.4 +/- 1.6 days), constitutional symptoms, and mild liver dysfunction. Eleven patients had gastrointestinal manifestations (vomiting and/or abdominal pain). Respiratory symptoms were not prominent. Most patients had normal or low white blood cell counts, and seven showed a relative increase of band forms. Their erythrocyte sedimentation rates ranged from 8 to 23 mm/h. All patients did well without specific therapy for C burnetii. CONCLUSION: In children with the symptoms described above, tests to detect antibodies to C burnetii should be performed.

[Extrarespiratory manifestations of Mycoplasma pneumoniae infection]. / Manifestaciones extrarrespiratorias de la infección por Mycoplasma pneumoniae.

Three patients with Mycoplasma pneumoniae infection, documented by CF antibody titers greater than 128, developed severe extrapulmonary manifestations. Two of them had a Stevens-Johnson syndrome seven and two days after the beginning of respiratory symptoms and the third a demyelinating polyradicyloneuropathy three weeks later. One of the patients with Stevens-Johnson syndrome and serious respiratory involvement also had hemolytic anemia associated with a cold agglutinins titer of 128. Authors determined lymphocytes subpopulations in one of the cases of Stevens-Johnson syndrome and in the patient with polyradiculoneuropathy. In both of them they found a reduced number of T-helper lymphocytes, and in the patient with Guillain-Barré syndrome an increase in suppressor T cells was also demonstrated.

[Kawasaki disease: report of 6 cases]. / Enfermedad de Kawasaki: aportación de seis casos.

Six cases of children between 20 months and 6 years old, who suffer Kawasaki disease are presented. All of them had diagnostic parameters required by the Investigation Committee of this disease, with similar clinical symptoms as in other countries but with an upper average age (3 years old) to Japanese patients and nearer to that of the North American patients. It is important to emphasize the appearance of exanthema in one case, as well as a multiforme erythema exudative, a rare fact, and the observation, up to now not shown, of a positive rheumatoid factor in another two of the patients. All have undergone a good evolution without cardiovascular complications.

[Boutonneuse fever in childhood]. / La fiebre botonosa en la infancia.

35 cases of botonneuse Fever admitted in our hospital during the course of a year and a half are presented. They were all children between the age of 18 months and 11 years. The most common features were: fever, maculopapulous rush and "tache noir". Weil Felix test was not of diagnostic value in one third of the cases. 71 per cent of the children recieved etiological treatment (doxicicline or cloramfenicol); the remaining 29% only got simptomatic measures. A cure was achieved in every case. Nevertheless, the manifestatios lasted longer in those not treated with antibiotic therapy.