Syrogiannopoulos G A, McCracken G H, Nelson J D
Pediatrics. 1986 Dec;78(6):1090-6.
Thirteen children with sickle cell disease were identified as having 14 episodes of osteoarticular infection in a review of 27 years' experience. There were eight episodes of osteomyelitis or osteoarthritis and six of suppurative arthritis alone. The etiologic agents in osteomyelitis or osteoarthritis were Salmonella sp in four cases, Escherichia coli in one, Enterobacter aerogenes in one, Staphylococcus aureus in one, and Haemophilus influenzae type b in one. Five of the cases with infection limited to the joint were caused by Streptococcus pneumoniae; the sixth was caused by H influenzae type b. Fever (greater than or equal to 38.3 degrees C) was present in all children and the temperature was in excess of 39 degrees C in 62%. The mean duration of pain before admission was 4.5 days. The initial total white blood cell count ranged from 5,200 to 29,700/microL (mean 19,436/microL) and the total band neutrophil count ranged from 0 to 5,103/microL (mean 1,660/microL). The ESR was greater than 20 mm/h in eight of the ten patients who were tested. Management consisted of antibiotic therapy in all. Needle aspiration was performed in two patients with osteomyelitis and in three with suppurative arthritis. Incision and drainage was performed in two cases of osteomyelitis and in four with suppurative arthritis. The outcome was satisfactory in all except one patient who had several complications as a consequence of femoral neck osteomyelitis. Recurrence was reported in only one patient.
在回顾27年的经验时，发现13名镰状细胞病患儿出现了14次骨关节炎感染。其中有8次骨髓炎或骨关节炎，仅6次为化脓性关节炎。骨髓炎或骨关节炎的病原体中，4例为沙门氏菌属，1例为大肠杆菌，1例为产气肠杆菌，1例为金黄色葡萄球菌，1例为b型流感嗜血杆菌。关节感染局限的5例由肺炎链球菌引起；第6例由b型流感嗜血杆菌引起。所有患儿均有发热（体温大于或等于38.3摄氏度），62%的患儿体温超过39摄氏度。入院前疼痛的平均持续时间为4.5天。初始白细胞总数为5200至29700/微升（平均19436/微升），中性杆状核粒细胞总数为0至5103/微升（平均1660/微升）。10例接受检测的患者中有8例血沉大于20毫米/小时。所有患者均采用抗生素治疗。2例骨髓炎患者和3例化脓性关节炎患者进行了穿刺抽吸。2例骨髓炎患者和4例化脓性关节炎患者进行了切开引流。除1例因股骨颈骨髓炎出现多种并发症的患者外，其他患者的治疗结果均令人满意。仅1例患者出现复发。
