Tirta Maria, Ampelas Dimitris, Tsintavis Panagiotis, Pilichou Anastasia, Krallis Panayotis
Orthopaedics and Traumatology, Agia Sofia Children's Hospital, Athens, GRC.
Epidemiology and Public Health, National and Kapodistrian University of Athens, Athens, GRC.
Cureus. 2022 Aug 5;14(8):e27701. doi: 10.7759/cureus.27701. eCollection 2022 Aug.
Septic arthritis is an orthopaedic emergency, especially considering the pediatric population. Salmonella is a less common aetiologic factor for septic arthritis compared with other Gram-negative bacteria. Its isolation in immunocompetent children and infants is quite rare, with an estimated incidence of 0.1% to 0.2% of septic arthritis cases among children. We report three rare cases of hip septic arthritis with Salmonella as a confirmed pathogen in immunocompetent children, with two of them being infants. The main symptoms that occurred in all three cases were fever, hip pain/no bearing, and diarrhoea, as well as elevated levels of WBC, C-reactive protein and ESR. The duration of their hospitalization was 20, 26 and 52 days. One case was treated only with antibiotics, while the other two with surgical drainage with/without arthrotomy. All cases had a follow-up of at least one year, with only one of the infants having the femoral head in a subluxated position and early signs of osteonecrosis. Fluoroscopy-assisted closed reduction had to be performed and maintained by hip spica. A new femoral epiphysis was formed at the time of the last follow-up 2.5 years later. Our case series highlights the possibility of Salmonella typhi septic hip arthritis in immunocompetent individuals. Therefore, Salmonella species must always be kept in mind during the differential diagnosis of septic arthritis in a clinically relevant setting.
化脓性关节炎是一种骨科急症，尤其是对于儿童群体而言。与其他革兰氏阴性菌相比，沙门氏菌是化脓性关节炎中较不常见的病因。在免疫功能正常的儿童和婴儿中分离出该病菌的情况相当罕见，估计在儿童化脓性关节炎病例中占0.1%至0.2%。我们报告了3例罕见的髋部化脓性关节炎病例，确诊病原体为沙门氏菌，患儿免疫功能正常，其中2例为婴儿。所有3例出现的主要症状为发热、髋关节疼痛/不能负重、腹泻，以及白细胞、C反应蛋白和血沉水平升高。他们的住院时间分别为20天、26天和52天。1例仅接受抗生素治疗，另外2例接受了手术引流，伴或不伴关节切开术。所有病例均进行了至少一年的随访，只有1例婴儿的股骨头处于半脱位位置并有早期骨坏死迹象。必须通过髋人字石膏进行透视辅助闭合复位并维持。在2.5年后的最后一次随访时形成了新的股骨骨骺。我们的病例系列突出了免疫功能正常个体发生伤寒沙门氏菌化脓性髋关节炎的可能性。因此，在临床相关情况下对化脓性关节炎进行鉴别诊断时，必须始终考虑到沙门氏菌属。
