Septic arthritis of the shoulder in children in Malawi

Abstract

e undertook a prospective study of 61 children in Malawi with septic arthritis of the shoulder. They were randomised into two groups, treated by aspiration (group 1, 31 patients) or arthrotomy (group 2, 30 patients). Both received antibiotics for six weeks. We studied the results of blood tests, microbiology, and the clinical and radiological outcome one year after diagnosis. Only one patient was sickle-cell positive and three were HIV-positive. Non-typhoidal Salmonella species accounted for 86% (19/22) of the positive joint cultures in group 1 and 73% (16/22) in group 2. Of the 33 radiographs available for review at follow-up at six months, 23 (70%) showed evidence of glenohumeral damage. There was no statistical difference in radiological outcome for the two groups. We devised and validated a scoring system, the Blantyre Septic Joint Score, for the assessment of joints based upon swelling, tenderness, function and range of movement. Despite the radiological changes only one of the 24 joints examined at one year had any deficit in these parameters. There was no statistical difference in the clinical outcome for the two treatment groups at any stage during the period of follow-up.

Risk of repeated drainage in pediatric septic arthritis: patient or method?

“…In both papers, several patients have chronic debilitating diseases, some patients received intra-articular antibiotic and others have a continuous irrigation of the joint during 7 days [3]. Smith et al [9]. focused on shoulder arthritis, and also compared aspiration without drainage to At.…”

Shoulder Septic Arthritis

“…An alternative to arthrotomy is the single joint aspiration, which carries a minimal morbidity and may not require general anesthesia in older children, but it can provide a less satisfactory drainage of the joint. The arthroscopic wash is another option with some potential advantages and is increasingly used, particularly in the knee [6] . The majority of authors argue that in the septic hip deep, difficult to aspire and in which the consequences of sepsis can be devastating, the arthrotomy and flushing is the best method of treatment.…”

“…If it seems clear that antibiotics should be administered parenterally initially and then orally by once the signs and symptoms of infection begin to be resolved [6] . The recommended duration of the antibacterial treatment varies from two weeks to more than three months, although the majority of the authors use a six week treatment [6] .…”

“…If it seems clear that antibiotics should be administered parenterally initially and then orally by once the signs and symptoms of infection begin to be resolved [6] . The recommended duration of the antibacterial treatment varies from two weeks to more than three months, although the majority of the authors use a six week treatment [6] . Many authors argue that if the signs and symptoms subside in a few days, and the level of Creactive protein in the serum drops below 20 mg/l, the antibiotic can usually be safely suspended [10].…”

“…In recent years there has been an increase of Candida albicans due to prolonged intravenous catheterization in infants in critical condition [1] . In underdeveloped countries, it is frequently isolated non-typhoidal Salmonella, even being the most common pathogen in some regions [6] . In children older than 3 years, the germs are similar to adults: S. aureus, Streptococcus and N.gonorrheae.…”