Artrite Séptica Meningocócica Primária em Lactente de Dois Meses

Abstract

(1):117-119 RESUMOA artrite meningocócica primária, isolada de contexto de sépsis meningocócica, é um fenómeno raro, em especial na idade pediátrica. O atingimento monoarticular é ainda menos frequente nas infecções a Neisseria spp. Apresentamos o caso de lactente de 2 meses de idade, sexo feminino, caucasiana, apresentando quadro de febre elevada com 4 dias de evolução e choro durante a manipulação do membro inferior esquerdo na muda de fralda. Sem sépsis clínica ou analiticamente. Sem vacinação anti-meningocócica prévia. A ecografia articular revelou presença de líquido intra-articular. O exame bacteriológico do drenado purulento por artrotomia foi positivo para Neisseira meningitidis. Apresentou boa resposta à antibioterapia e evolução favorável após a alta. A artrite séptica meningocócica, ainda que rara, constitui uma urgência pediátrica, e é diagnóstico diferencial perante uma criança com quadro febril e queixas articulares. Palavras-chave: Artrite Infecciosa; Infecções Meningocócicas; Lactente; Neisseria meningitidis. ABSTRACTMeningococcal septic arthritis, ocurring without signs of sepsis, is rare, including at pediatric age. The confinement of infection to a single articulation (monoarticular form) is even rarer in infections by Neisseria spp. We discuss the case of a two month-old caucasian girl, presenting with fever and persistent crying during nappy change. Absence of clinical sepsis was notable. She had had no previous anti-meningococcal immunizations. The ultrasound of the left hip revealed the presence of intra-articular fluid. Culture of the purulent sample after drainage by arthrotomy produced Neisseria meningitidis. She had a good clinical response to the antibiotics. Follow-up showed no sequels. Albeit a rare entity, primary meningococcal arthritis is a mandatory differential diagnosis concerning a feverish child with articular complaints.

Meningococcal Infection: A Brief Review and Personal Observations of the Generalized Form of the Disease in Three-Month-Old Twins

“…Infection and development of different clinical forms of the disease according to their severity is largely determined by the functionality of local defense mechanisms at the level of the mucous membrane in the upper respiratory tract, and the state of the patient's immune system. Under conditions of impaired systemic immune response, life-threatening generalized forms of MI are possible: meningitis and/or septicemia [4], pneumonia [12], septic arthritis [13,14], and pericarditis in children and adolescents [15].…”