Acute osteoarticular infections in children represent medical and surgical emergencies with potentially severe functional sequelae. 1 Hence, these infections require a rapid and sensitive diagnosis. Molecular diagnostic tools have dramatically improved the diagnostic yield of pediatric septic arthritis (SA). However, more than 20% of these infections remain unconfirmed because no microorganism is identified. 2 In such situations, the use of inflammatory markers may be helpful to quickly confirm the diagnosis. Serum C-reactive protein (CRP) level could be a useful tool, even if it is commonly lower during Kingella kingae infectionsthe leading causative agent in young children's arthritis. 2 Here we report a case of K. kingae knee arthritis with a high level of synovial calprotectin, an inflammatory biomarker recently successfully assessed in prosthetic joint infection (PJI). 3,4 | CASE REPORTAn otherwise healthy 14-month-old child was admitted to the pediatric emergency department after a 2-day history
Objectives. Extrapulmonary tuberculosis (EPTB) can be difficult to diagnose, especially in severe forms. The Xpert MTB/RIF Ultra test introduced an additional category called trace to reference very small amounts of Mycobacterium tuberculosis complex (MTBC) DNA. The objective of our multicenter study was to evaluate whether the trace result on an extrapulmonary (EP) sample is a sufficient argument to consider diagnosing tuberculosis and starting treatment, even in severe cases. Methods. A retrospective, multicenter cohort study was conducted from 2018 to 2022. Patients strongly suspected of EPTB with a trace result on an EP specimen were included. Hospital records were reviewed for clinical, treatment, and paraclinical data. Results. A total of 52 patients were included, with a severe form in 22/52 (42.3%) cases. Culture was positive for MTBC in 33/46 (71.7%) cases. Histological analysis showed granulomas in 36/45 (80.0%) cases. An Ultra trace result with a presumptive diagnosis of TB led to the decision to treat 41/52 (78.8%) patients. All patients were started on first-line anti-TB therapy (median duration of 6.1 months), with a favorable outcome in 31/35 (88.6%) patients. The presence of a small amount of MTBC genome in EPTB is a sufficient argument to treat patients across a large region of France.
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