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2018, Number 2

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Rev Hosp Jua Mex 2018; 85 (2)

Primary meningococcal osteoarthritis of the hip. Presentation of a pediatric case

Casuriaga-Lamboglia AL, Cassanello-Pagani P, Barceló-Romero E, Giachetto-Larraz G

Language: Spanish
References: 19
Page: 110-113
PDF size: 146.98 Kb.


ABSTRACT

Introduction: Acute septic arthritis, without association to meningitis or sepsis, is an uncommon presentation of meningococcal disease. It is usually present in children less than 4 years-old as monoarticular form and its diagnosis and appropriate treatment are associated with a good evolution. The objective is to warn about an exceptional etiology as well as the importance of a systematic articular puncture for diagnosis. Clinical case: 14 months-old girl, healthy. Vaccine Certification Card updated. In addition of a high respiratory infection she presented painful limping which developed in functional impotence of her right hip. Leukocytosis 18.400/mm3, reactive C Protein 146 mg/L. Normal hip x-ray. Articular puncture: pus, empiric therapy was started with clindamycin and gentamicin. Articular liquid cultive Neisseria meningitidis B group, blood culture without development. Antibiotic was shifted to ceftriaxone during 10 days; evolution without complications, patient was discharged with a prescription of amoxicillin v/o for 21 days. Health Ministry was reported and chemoprophylaxis was indicated to contacts. Discussion: Staphylococcus aureus is the most frequent etiology of osteoarticular infections at all ages. In our environment, there is no previous communication of meningococcal arthritis in children. According to international data, meningococo causes 1.5% of septic arthritis in children. B serotype is the most prevalent in Uruguay. It is an invasive and primary form of the disease, with a commonly negative blood culture because of the short duration of bacteraemia. The systematic articular puncture is essential to confirm and identify the etiology. Appropriate diagnosis and surgical medical treatment are associated with excellent outcomes.


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