If your baby or toddler has purulent arthritis or infectious arthritis, we recommend that you read on. In this article, we want to introduce you to how children develop septic arthritis. In this article, we will introduce the causes of septic arthritis in children and discuss the manifestations and clinical signs of infectious arthritis in children.
How does a child get septic arthritis?
By reading more, you will find the answer to the above questions about infectious arthritis.
What does septic arthritis mean?
A joint infection that is associated with pain and reduced joint movement and occurs when, due to injury, the infectious agent enters the joint directly, is called arthritis.
It is said that the joint wall does not have enough strength to fight infection. With the infiltration of the infectious agent into the joint, the child’s immune system will react to the defense. The result of this immune system defense reaction is inflammation, which is accompanied by swelling, redness, and warmth of the joint when touched. So septic arthritis means inflammation and infection of the joint.
It is interesting to know that the two age groups are more at risk for septic arthritis
Septic arthritis in children
This is how doctors define septic arthritis:
Acute infection involving the joint space is more common in young children and infants and is a pediatric emergency.
Why is it considered an emergency?
Pediatric septic arthritis can potentially cause permanent mobility in infants and toddlers, so it should be diagnosed at an early stage so that the infection does not spread to the joint capsule, cartilage, and bone adjacent to the joint and cause complications.
The early signs and symptoms of septic arthritis in infants and young infants are very deceptive.
When a skin infection or urinary tract infection reaches the joint through the bloodstream, the joint covering layer called the synovial cannot prevent the infectious agent from entering the joint space because it has little resistance. The immune system’s reaction to the infectious agent, along with increasing pressure and decreasing articular blood flow, will worsen the damage process.
The following factors accelerate the process of joint infection in children:
- Damaged and injured skin or eczema or fragility of the skin
- Deep wounds on the skin caused by the teeth and claws of animals
- Immune deficiency or weakened immune system due to congenital causes or following the use of immunosuppressive drugs
Statistics and Epidemiology
Fifty percent of sufferers are said to be under two years old
Seventy-five percent of all children with septic arthritis are under the age of five.
The true prevalence of septic arthritis is unknown, but according to some credible research, 5/5 out of every 100,000 children develop septic arthritis.
Septic arthritis is 2-2/1 times more common in boys than in girls.
What is the infectious agent that causes septic arthritis or joint infection in children?
Doctors consider a bacterium called Staphylococcus aureus to be the most common pediatric septic arthritis.
In countries where the Haemophilus influenza vaccine (type b) is not part of the country’s routine vaccination program, the bacterium causes 50% of pediatric septic arthritis.
Streptococci also cause ten to twenty percent of pediatric septic arthritis.
What are the symptoms and manifestations of pediatric septic arthritis?
How do we know if our child has a joint infection?
Doctors say the symptoms of septic arthritis depend a lot on your child’s age.
In infants, the initial signs and symptoms of joint infection are very advanced, for example, due to the spread of infection from the joint space and reaching the bone, bone infection or osteomyelitis is caused.
In older infants, toddlers and children:
- Localized pain
- Localized inflation
- Redness of the localized skin around the joint
- And warmth when touched
A child who could walk until yesterday no longer avoids putting on a foot whose joint has purulent arthritis.
Limping can be caused by involvement of the pelvic, thigh, or knee and ankle joints.
Which joints are more prone to septic arthritis in children?
You may ask, in which joints is septic arthritis more common in children?
The highest prevalence of pediatric septic arthritis is related to the pelvic and lower pelvic joints.
Seventy-five percent of all cases of pediatric septic arthritis are said to be in the pelvic and lower pelvic joints.
- Knee Septic arthritis: forty percent
- Pelvic septic arthritis: twenty percent
- Ankle Septic arthritis: fourteen percent
Small joints are caused by penetrating traumas to the skin or fractures in which the bones protrude from the skin.
Laboratory findings and imaging
In a blood test:
- An increase in white blood cells is seen (leukocytosis)
- Inflammation-related parameters, (ESR or CRP) increase.
The point to note is that in the first few days of septic arthritis, the white blood cell count may not increase or the ESR may be elevated.
Therefore, if the above parameters are normal, it does not rule out the diagnosis of septic arthritis in a child.
In addition to septic arthritis, leukocytosis and an increase in ESR or CRP may be seen, so the presence or absence of these findings is not sufficient for a definitive diagnosis of septic arthritis.
Blood culture is required in all cases of suspected septic arthritis in children.
But it does not confirm the diagnosis
What will doctors do to make a definitive diagnosis of pediatric septic arthritis?
Extraction of joint fluid and study of its properties, (arthrosynthesis and analysis of joint fluid), is the diagnostic test of choice for the rapid diagnosis of joint infection.
Joint fluid is cultured and analyzed for white and red blood cell counts to determine the type of bacteria and infectious agent. Radiology modalities are also helpful; joint radiographs with X-rays, CT scans, and MRIs and radionuclide scans can help make a definitive diagnosis.
Joint ultrasound is the method to the follow-up of pelvic septic arthritis.
Depending on the age of the child and considering the common and infectious bacteria in that age range, the doctor will start the initial treatment by prescribing an appropriate antibiotic to prepare the joint fluid culture solution. If necessary, change the type of antibiotic will be applied.
Prescribed antibiotics must be able to reach the infected space inside the joint.
Antibiotic treatment lasts at least three weeks.
The duration of treatment depends on the speed with which the child develops clinical symptoms, fever, and decreased ESR.
In cases where there is a joint infection in the pelvis or shoulder, in addition to antibiotic treatment, surgery should be performed to clear and wash the joint of infectious and purulent secretions.
Doctors say the response to treatment for infectious arthritis in infants and children is excellent, and the worst results will be in cases where there has been involvement of the shoulder or pelvis.
We have said that in infants, a joint infection can spread to the bones adjacent to the joint and cause a bone infection or osteomyelitis. In these cases, if the baby’s bone growth plate becomes infected, it may lead to skeletal growth abnormalities.
In case of proper treatment, the recurrence of the infection will be less than ten percent, so despite the recovery of the children, do not forget the regular follow-up sessions.