An unreported case of Streptococcus cristatus septic arthritis of wrist in a neonate

Abstract

Septic Arthritis of the wrist is rare in the paediatric population due to its extraarticular metaphysis. We report here a case of wrist septic arthritis in a neonate caused by an uncommon causative organism, Streptococcus cristatus.A 15 days old male child was referred with the complaint of swelling and decreased movement of the left wrist for 5 days. Local examination revealed warm, tender, erythematous and fluctuant swelling over the dorso-ulnar aspect of the left wrist. Ultrasonography of the affected region was suggestive of focal fluid collection in the wrist and periosteal elevation of the distal ulna. Aspiration followed by arthrotomy of the wrist joint was performed and multiple holes were made in the distal ulnar metaphysis using 0.8mm k-wire. The pus culture was positive for Streptococcus cristatus, sensitive to vancomycin, which was given for a total of 4 weeks. At one year follow up the child had a full, painless range of motion with no functional deficit. Final follow up x rays of the left wrist were normal.Streptococcus cristatus strains are described as Gram-positive, catalase-negative cocci, approximately 1 mm in diameter growing in chains and were originally isolated from the human throat and oral cavities.Its association with bone and joint infections has not been described in the literature. To our knowledge, this is the first case of isolated septic arthritis of wrist in a 15 days old child caused by Streptococcus cristatus.To conclude, wrist septic arthritis in a neonate is a rare entity. With the advanced diagnostics, specieslevel identification of rare organism like Streptococcus cristatus is possible along with antibiotic sensitivity for appropriate therapy. Early surgical decompression and intravenous culture-directed antibiotics are the mainstays of management.

Descriptive Epidemiology of Upper Extremity Septic Arthritis in Children—Review of a Retrospective Multicenter Database

“…Between the 5 case reports that we found8–11,13 and the 3 patients in our series, we are aware of only 8 cases of pediatric septic arthritis of the wrist described in the literature. Wrist septic arthritis in children may be more likely to be caused by an atypical organism, including Streptobacillus moniliformis from a rat bite,9 group A Streptococcus pyogenes,13 and Streptococcus cristatus 10. In our series, we had 1 case each of wrist septic arthritis caused by Streptococcus and Gram negative rods.…”

“…Wrist septic arthritis in children may be more likely to be caused by an atypical organism, including Streptobacillus moniliformis from a rat bite, 9 group A Streptococcus pyogenes, 13 and Streptococcus cristatus. 10 In our series, we had 1 case each of wrist septic arthritis caused by Streptococcus and Gram negative rods.…”

“…Only a few small single-center case series have been published on pediatric septic arthritis of the shoulder and elbow 1–7,11,12,14. We are aware of only 5 case reports on pediatric septic arthritis of the wrist 8–11,13…”

“…Upper extremity septic arthritis (UESA) is uncommon in children, and there is a lack of published data on the characteristics, diagnostic findings, and management. While there are numerous studies investigating pediatric septic hip and knee arthritis, only a few small single-center case series and case reports have been conducted on pediatric UESA 1–14. As UESA is much less common than septic hip and knee arthritis, it is important for treating clinicians to maintain a high index of suspicion and include septic arthritis in the differential when patients present with joint symptoms, such as pain with motion, decreased range of motion, swelling, and erythema.…”

Streptococcus cristatus, an infrequent cause of bacteremia and infective endocarditis. Case report and literature review

“…In fact, phylogenetic studies performed by Teng JL et al in 2014 have shown that S. oligofermentans is closely related to Streptococcus sinensis and a new phylogenetic clade, the "sinensis group", has been proposed to include Streptococcus sinensis, S. oligofermentans and S. cristatus [4]. Currently, only eight clinical cases of infections caused by this microorganism have been described: one case of bacteremia, six cases of infectious endocarditis, and another of septic arthritis (Table 1) [5][6][7][8][9]. This is the sixth confirmed case of endocarditis after the microorganism by sequencing the 16S ribosomal RNA gene when processing the surgical specimen of a replaced heart valve.…”