Distinguishing Kingella kingae from Pyogenic Acute Septic Arthritis in Young Portuguese Children

This article belongs to the Special Issue Kingella kingae: Virulence Factors, Clinical Disease, and Diagnostics.(1) Background: We aim to identify clinical and laboratorial parameters to distinguish Kingella kingae from pyogenic septic arthritis (SA). (2) Methods: A longitudinal, observational, single-centre study of children 6 months ≤ 2 years, apyrexy and CRP ≤ 100 mg/L were significative, with an overall predictive positive value of 86.5%, and 88.4% for K. kingae. For this model, ROC curves were capable of differentiating (AUC 0.861, 95% CI 0.767-0.955) K. kingae SA from typical pathogens. (4) Conclusions: Age > 6 months ≤ 2 years, apyrexy and PCR ≤ 100 mg/L were the main predictive factors to distinguish K. kingae from pyogenic SA < 5 years. These data need to be validated in a larger study.info:eu-repo/semantics/publishedVersio

asociación con miositis y artritis inesperadamente alta

okIntroduction: Despite the current trend towards less aggressive therapeutic approaches, acute haematogenous osteomyelitis (AHO) continues to be a challenge and is associated with significant morbidity worldwide. Our aim was to determine if 80% compliance with current protocol was achieved, identify complications and associated risk factors and analyse trends in aetiology and management of AHO in children. Methods: We conducted a longitudinal, observational, single-centre study in patients with AHO aged less than 18 years admitted to a paediatric hospital, between 2008 and 2018, divided into 2 cohorts (before and after 2014). Demographic, clinical data and disease progression were analysed. Results: The study included 71 children with AHO, 56% male, with a median age of 3 years (interquartile range, 1–11). We found a 1.8-fold increase of cases in the last 5 years. The causative agent was identified in 37% of cases: MSSA (54%), MRSA (4%), Streptococcus pyogenes (19%), Kingella kingae (12%), Streptococcus pneumoniae (8%), and Neisseria meningitidis (4%). Complications were identified in 45% of patients and sequelae in 3.6%. In recent years, there was an increase in myositis (30% vs. 7%; p = 0.02), septic arthritis (68% vs. 37.2%; p = 0.012) and in the proportion of patients treated for less than 4 weeks (37% vs. 3.5%; p = 0.012), with a similar sequelae rates. The risk factors for complications were age 3 or more years, CRP levels of 20 mg/l or higher, time elapsed between onset and admission of 5 or more days and positive culture, although on multivariate analysis only positive culture was significant. The presence of complications was a risk factor for sequelae at 6 months. Conclusions: Our study confirms that AHO can be aggressive. The identification of risk factors for complications may be fundamental for management.publishersversionpublishe

an unexpectedly high association with myositis and arthritis

Copyright © 2021. Published by Elsevier España, S.L.U.INTRODUCTION: Despite the current trend toward less aggressive therapeutic approaches, acute haematogenous osteomyelitis (AHO) continues to be a challenge and is associated with significant morbidity worldwide. Our aim was to assess whether compliance with the current protocol was achieved in 80% of cases, to identify complications and the associated risk factors, and to analyse trends in the aetiology and management of AHO in the paediatric population. METHODS: We conducted a longitudinal, observational, single-centre study in patients with AHO aged less than 18 years admitted to a paediatric hospital between 2008 and 2018 divided in 2 cohorts (before and after 2014). We analysed data concerning demographic and clinical characteristics and outcomes. RESULTS: The study included 71 children with AHO, 56% male, with a median age of 3 years (interquartile range, 1-11). We found a 1.8-fold increase of cases in the last 5 years. The causative agent was identified in 37% of cases: MSSA (54%), MRSA (4%), S. pyogenes (19%), K. kingae (12%), S. pneumoniae (8%), and N. meningitidis (4%). Complications were identified in 45% of patients and sequelae in 3.6%. In recent years, there was an increase in myositis (30% vs 7%; P=.02), septic arthritis (68 vs 37.2%; p=0.012) and in the proportion of patients treated for less than 4 weeks (37 vs 3.5%; p=0.012), with a similar sequelae rates. The risk factors associated with complications were age 3 or more years, C-reactive protein levels of 20mg/L or higher, time elapsed between onset and admission of 5 or more days and positive culture, although the only factor that continued to be significantly associated in the multivariate analysis was positive culture. The presence of complications was a risk factor for sequelae at 6 months. CONCLUSIONS: Our study confirms that AHO can be aggressive. The identification of risk factors for complications is essential for management.publishersversionpublishe

Artrite séptica por Haemophilus influenzae serotipo a – uma etiologia rara

Apresenta-se o caso de uma lactente do sexo feminino, 11 meses, com antecedentes pessoais e familiares irrelevantes, programa nacional de vacinação atualizado, desenvolve artrite séptica do cotovelo com isolamento de Haemophilus influenzae tipo a no líquido articular. A doente não apresentava quaisquer fatores de risco e o estudo imunológico realizado foi negativo. Existem poucos casos relatados a nível mundial de infeção a Haemophilus influenzae não-b, e de acordo com o nosso conhecimento este é o primeiro caso relatado na Europa. A importância da determinação da estirpe na era pós-vacinal, bem como a exclusão de fatores predisponentes de doença invasiva por H. Influenzae não-b em idade pediátrica serão aqui discutidos

Brachial plexus neuropathy - a rare manifestation of osteoarticular infection

Background: Brachial palsy is a rare condition beyond the neonatal period. Usually it is caused by physical mechanisms, but may be related with osteo-articular infections. There are few cases describing the association between these infections and true nerve paralysis. On the other hand, pseudo-paralysis or apparent weakness of a limb associated with septic arthritis or osteomyelitis is a well-documented phenomenon Case Report: We describe three cases of osteoarticular infection manifested by flaccid limb paralysis without the typical systemic signs of infection. The timing of rcognition differed among the cases, as well as the therapeutic interventions and the outcome. Discussion: Osteo-articular infections may go unrecognized in infancy. We highlight this rare manifestation of osteo-articular infection to avoid the delay in diagnosis and associated sequelae

Distinguishing Kingella kingae from Pyogenic Acute Septic Arthritis in Young Portuguese Children.

(1) Background: We aim to identify clinical and laboratorial parameters to distinguish Kingella kingae from pyogenic septic arthritis (SA). (2) Methods: A longitudinal, observational, single-centre study of children &lt; 5 years old with microbiological positive SA admitted to a paediatric hospital from 2013-2020 was performed. Clinical and laboratorial data at admission and at 48 h, as well as on treatment and evolution, were obtained. (3) Results: We found a total of 75 children, 44 with K. kingae and 31 with pyogenic infections (mostly MSSA, S. pneumoniae and S. pyogenes). K. kingae affected younger children with low or absent fever, low inflammatory markers and a favourable prognosis. In the univariate analyses, fever, septic look, CRP and ESR at admission and CRP at 48 h were significantly lower in K. kingae SA. In the multivariate analyses, age &gt; 6 months ≤ 2 years, apyrexy and CRP ≤ 100 mg/L were significative, with an overall predictive positive value of 86.5%, and 88.4% for K. kingae. For this model, ROC curves were capable of differentiating (AUC 0.861, 95% CI 0.767-0.955) K. kingae SA from typical pathogens. (4) Conclusions: Age &gt; 6 months ≤ 2 years, apyrexy and PCR ≤ 100 mg/L were the main predictive factors to distinguish K. kingae from pyogenic SA &lt; 5 years. These data need to be validated in a larger study.publishersversionpublishe

Resumos em andamento - Bioquímica

Resumos em andamento - Bioquímic