Septic_Arthritis_in_Children_Flashcards
Why is it important to recognize septic arthritis in children promptly?
Recognizing septic arthritis in children promptly is important because prompt treatment can reduce the risk of permanent damage to the joint and systemic infection.
What is the incidence of septic arthritis in children?
The incidence of septic arthritis in children is around 4-5 per 100,000.
Is septic arthritis more common in boys or girls?
Septic arthritis is more common in boys, with a male to female ratio of 2:1.
What are the most commonly affected joints in septic arthritis?
The most commonly affected joints in septic arthritis are the hip, knee, and ankle.
What are the symptoms of septic arthritis in children?
Symptoms of septic arthritis in children include joint pain, limp, fever, and systemic unwellness such as lethargy.
What are the signs of septic arthritis in children?
Signs of septic arthritis in children include a swollen, red joint and minimal movement of the affected joint.
What investigations are used to diagnose septic arthritis?
Investigations used to diagnose septic arthritis include joint aspiration for culture, raised inflammatory markers, and blood cultures.
What is the purpose of joint aspiration in the diagnosis of septic arthritis?
The purpose of joint aspiration in the diagnosis of septic arthritis is to culture the joint fluid and it will show a raised white blood cell (WBC) count.
What will joint aspiration typically show in septic arthritis?
Joint aspiration will typically show a raised white blood cell (WBC) count in septic arthritis.
What criteria are used to diagnose septic arthritis?
The Kocher criteria are used to diagnose septic arthritis.
What are the components of the Kocher criteria for septic arthritis?
The components of the Kocher criteria for septic arthritis are fever >38.5 degrees C, non-weight bearing, raised ESR, and raised WCC.
What is the initial antibiotic treatment course for septic arthritis?
A prolonged course of antibiotics, starting with 2 weeks of IV antibiotics followed by 4 weeks of oral antibiotics.
What IV antibiotic is recommended for neonates to children under 3 months with septic arthritis?
IV cefotaxime.
What IV antibiotic is recommended for children aged 3 months to 5 years with septic arthritis?
IV ceftriaxone.
What IV antibiotic is recommended for children older than 6 years with septic arthritis?
IV flucloxacillin.
What alternative IV antibiotic is recommended for penicillin-allergic patients with septic arthritis?
Clindamycin
What are the options for oral step-down antibiotics in septic arthritis treatment?
Co-amoxiclav or flucloxacillin.
What procedure should be performed on the affected joints in septic arthritis?
Joint aspiration to dryness, as often as required, through closed needle aspiration or arthroscopically.
What additional procedures may be necessary for managing septic arthritis?
Washing out of the joint or surgical drainage.
SUMMARISE SEPTIC ARTHRITIS
Septic arthritis in children
Septic arthritis is important to recognise as prompt treatment can reduce the risk of permanent damage to the joint and systemic infection.
Epidemiology
has an incidence of around 4-5 per 100,000 children
more common in boys, M:F ratio = 2:1
The most commonly affected joints are the hip, knee and ankle.
Symptoms
joint pain
limp
fever
systemically unwell: lethargy
Signs
swollen, red joint
typically, only minimal movement of the affected joint is possible
Investigations
joint aspiration: for culture. Will show a raised WBC
raised inflammatory markers
blood cultures
The Kocher criteria for the diagnosis of septic arthritis:
fever >38.5 degrees C
non-weight bearing
raised ESR
raised WCC
Septic Arthritis
Prolonged course of antibiotics (initially IV for 2 weeks, followed by 4 weeks of oral antibiotics) o Neonate to <3 months:
IV cefotaxime
o 3 months to </=5 years:
IV ceftriaxone
If penicillin allergic, give clindamycin o >/=6 years
IV flucloxacillin
If penicillin allergic, give clindamycin o Oral stepdown:
Co-amoxiclav
Flucloxacillin
Joint aspiration - affected joints should be aspirated to dryness as often as required (through
closed needle aspiration or arthroscopically)
Washing out of the joint or surgical drainage may be required
A 2-year-old child comes to the emergency department with a 2 day history of right knee pain and irritability. She had recently recovered from a viral respiratory tract infection and is apyrexial and asymptomatic now.
On examination, the joint is painful to move but not hot or erythematous, and she is able to weight bear. Blood results show the following:
Haemoglobin (Hb) 140 g/L Male: (135 - 180)
Female: (115 - 160)
Platelets 450 * 109/L (150 - 400)
White cell count (WCC) 11.5 * 109/L (4.0 - 11.0)
C reactive protein (CRP) 29 mg/L (<5)
Erythrocyte sedimentation rate (ESR) 32 mm/hr (0 - 10)
What is the likely diagnosis?
Septic arthritis
Transient synovitis
Juvenile idiopathic arthritis
Psoriatic arthritis
Osteochondritis dissecans
Transient synovitis
Kocher’s criteria is used to assess the probability of septic arthritis in children
Kocher’s criteria is used to assess the probability of septic arthritis in children using 4 parameters:
Non-weight bearing - 1 point
Fever >38.5ºC - 1 point
WCC >12 * 109/L - 1 point
ESR >40mm/hr
The probabilities are calculated thus:
0 points = very low risk
1 point = 3% probability of septic arthritis
2 points = 40% probability of septic arthritis
3 points = 93% probability of septic arthritis
4 points = 99% probability of septic arthritis
This girl scores 0, and with a history of recent viral infection, the likely culprit is transient synovitis.
Juvenile idiopathic arthritis (JIA) is more likely to give a polyarticular presentation with systemic features, including fever and rashes.
There is no indication of psoriasis in the presentation, making psoriatic arthritis unlikely.
Osteochondritis dissecans occurs when small segments of articular cartilage and bone come loose into the joint due to reduced blood supply. It tends to present in older children with a more insidious onset.
