Septic_Arthritis_in_Children_Flashcards

Question 1

Why is it important to recognize septic arthritis in children promptly?

Answer 1

Recognizing septic arthritis in children promptly is important because prompt treatment can reduce the risk of permanent damage to the joint and systemic infection.

Question 2

What is the incidence of septic arthritis in children?

Answer 2

The incidence of septic arthritis in children is around 4-5 per 100,000.

Question 3

Is septic arthritis more common in boys or girls?

Answer 3

Septic arthritis is more common in boys, with a male to female ratio of 2:1.

Question 4

What are the most commonly affected joints in septic arthritis?

Answer 4

The most commonly affected joints in septic arthritis are the hip, knee, and ankle.

Question 5

What are the symptoms of septic arthritis in children?

Answer 5

Symptoms of septic arthritis in children include joint pain, limp, fever, and systemic unwellness such as lethargy.

Question 6

What are the signs of septic arthritis in children?

Answer 6

Signs of septic arthritis in children include a swollen, red joint and minimal movement of the affected joint.

Question 7

What investigations are used to diagnose septic arthritis?

Answer 7

Investigations used to diagnose septic arthritis include joint aspiration for culture, raised inflammatory markers, and blood cultures.

Question 8

What is the purpose of joint aspiration in the diagnosis of septic arthritis?

Answer 8

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.

Question 9

What will joint aspiration typically show in septic arthritis?

Answer 9

Joint aspiration will typically show a raised white blood cell (WBC) count in septic arthritis.

Question 10

What criteria are used to diagnose septic arthritis?

Answer 10

The Kocher criteria are used to diagnose septic arthritis.

Question 11

What are the components of the Kocher criteria for septic arthritis?

Answer 11

The components of the Kocher criteria for septic arthritis are fever >38.5 degrees C, non-weight bearing, raised ESR, and raised WCC.

Question 12

What is the initial antibiotic treatment course for septic arthritis?

Answer 12

A prolonged course of antibiotics, starting with 2 weeks of IV antibiotics followed by 4 weeks of oral antibiotics.

Question 13

What IV antibiotic is recommended for neonates to children under 3 months with septic arthritis?

Answer 13

IV cefotaxime.

Question 14

What IV antibiotic is recommended for children aged 3 months to 5 years with septic arthritis?

Answer 14

IV ceftriaxone.

Question 15

What IV antibiotic is recommended for children older than 6 years with septic arthritis?

Answer 15

IV flucloxacillin.

Question 16

What alternative IV antibiotic is recommended for penicillin-allergic patients with septic arthritis?

Answer 16

Clindamycin

Question 17

What are the options for oral step-down antibiotics in septic arthritis treatment?

Answer 17

Co-amoxiclav or flucloxacillin.

Question 18

What procedure should be performed on the affected joints in septic arthritis?

Answer 18

Joint aspiration to dryness, as often as required, through closed needle aspiration or arthroscopically.

Question 19

What additional procedures may be necessary for managing septic arthritis?

Answer 19

Washing out of the joint or surgical drainage.

Question 20

SUMMARISE SEPTIC ARTHRITIS

Answer 20

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

Question 21

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

Answer 21

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.