Bona G, Cadario F, Benevenuta E, Sacco F, Garzoli E, Passaro R
Dipartimento di Scienze Mediche, Clinica Pediatrica di Novara, Università degli Studi, Torino.
Minerva Pediatr. 1998 May;50(5):193-6.
Septic arthritis is a serious pyogenic infection that may lead to permanent orthopedic sequelae. Infants represent the most of the cases. It usually develops as a result of bacterial seeding into the capillary-rich synovium in the course of a bacteremic episode. Etiology changes according to different ages; in children after the neonatal period but younger than 24 months, Haemophilus influenzae is the most frequent causative organism. A case of sepsis due to Haemophilus influenzae type b (Hib) with septic arthritis in a patient 3 months old, is reported. The child was admitted to the hospital with a very high temperature (39 degrees C) for five days. His right wrist and ankle appeared swelling and hyperemic. He was affected by congenital cardiopathy from birth. He was not immunizated against Hib. The blood colture was positive for Hib. The leukocyte count was 21,400 cell/mm3 with 55% of polymorphonuclear cells. During the second day of recovery, the patient was transfused, because of the very low value of hemoglobin (5.2 g/dl). The child was treated with netilmycina and ceftriaxone for 15 days. The temperature fell in two days. The articular pathology resolved in nearly ten days. The case reported confirms the importance of septic arthritis as a pathology that necessarily requires an early diagnosis and treatment. The Haemophilus influenzae vaccine, is recommended especially in immunocompromised or cardiopathic subjects and before the age of 2 years.
化脓性关节炎是一种严重的化脓性感染，可能导致永久性骨科后遗症。婴儿是最常见的病例群体。它通常是在菌血症发作过程中，细菌播散到富含毛细血管的滑膜所致。病因因年龄不同而变化；在新生儿期后但小于24个月的儿童中，流感嗜血杆菌是最常见的致病微生物。本文报道了1例3个月大的因b型流感嗜血杆菌（Hib）感染导致败血症并伴有化脓性关节炎的病例。该患儿因持续五天的高热（39摄氏度）入院。其右手腕和脚踝出现肿胀和充血。患儿自出生就患有先天性心脏病。他未接种Hib疫苗。血培养显示Hib阳性。白细胞计数为21,400个细胞/mm3，其中多形核细胞占55%。在恢复的第二天，由于血红蛋白值极低（5.2 g/dl），患儿接受了输血治疗。患儿接受了15天的奈替米星和头孢曲松治疗。两天内体温下降。关节病变在近十天内消退。该病例报告证实了化脓性关节炎作为一种疾病，早期诊断和治疗的必要性。尤其建议在免疫功能低下或患有心脏病的受试者以及2岁之前接种流感嗜血杆菌疫苗。
