Diagnostic accuracy of point-of-care ultrasound (PoCUS) for the diagnosis of hip effusion in the pediatric emergency department.

PURPOSE: A new limp or refusal to weight-bear are common symptoms in children presenting to the pediatric emergency department (ED). This poses a diagnostic challenge, particularly among toddlers and nonverbal patients. Point-of-care ultrasound (PoCUS) used by pediatric emergency medicine physicians may detect hip effusion, which dramatically aids diagnostic workup and management. There is limited literature regarding the accuracy of hip PoCUS conducted by pediatric emergency medicine physicians. This study aims to assess the diagnostic performance of pediatric emergency medicine physician-performed PoCUS in identifying hip effusion. METHODS: This prospective study was conducted in a single-center pediatric ED. Children presenting with limb pain or new limp were evaluated by pediatric emergency medicine physicians who also performed hip PoCUS and categorized findings as either "effusion" or "no effusion" based on standard sonographic definitions. Patients also underwent radiology department ultrasound reviewed by a pediatric radiologist. Diagnostic test characteristics with corresponding 95% confidence intervals (CI) were calculated using radiology department ultrasound findings as the reference standard. RESULTS: A total of 95 patients were enrolled by 8 pediatric emergency medicine physicians. Excellent agreement was observed between PoCUS performed by pediatric emergency medicine physicians and radiology department ultrasound for the presence or absence of hip effusion (kappa = 0.81 [95% CI 0.70-0.93]). Hip effusion was identified by PoCUS in 44 out of 49 effusion-positive patients, with a sensitivity of 89.8% (95% CI 77.7-96.6%), specificity of 91.3% (95% CI 79.2%-97.5%), positive likelihood ratio of 10.33 (95% CI 4.03-26.47), and negative likelihood ratio of 0.11 (95% CI 0.05-0.26). CONCLUSION: PoCUS performed by pediatric emergency medicine physicians has reasonably high sensitivity and specificity for diagnosing hip effusion among pediatric patients presenting to the pediatric ED with a limp or leg pain. This practice may potentially expedite both diagnosis and treatment within this patient population.

RéSUMé: OBJECTIF: Un nouveau boiteux ou un refus de porter le poids sont des symptômes courants chez les enfants qui se présentent à l'urgence pédiatrique (DE). Cela pose un défi diagnostique, en particulier chez les enfants en bas âge et les patients non verbaux. Les échographies de point de soins (PUCU) utilisées par les médecins des urgences pédiatriques peuvent détecter un épanchement de la hanche, ce qui facilite considérablement le diagnostic et la gestion. Il existe une littérature limitée concernant la précision des PUC de la hanche effectuée par les médecins urgentistes pédiatriques. Cette étude vise à évaluer la performance diagnostique des PUCU réalisées par un médecin en médecine d'urgence pédiatrique pour identifier l'effusion de la hanche. MéTHODES: Cette étude prospective a été menée dans un seul centre de DE pédiatrique. Les enfants présentant une douleur aux membres ou une nouvelle boiterie ont été évalués par des médecins pédiatriques d'urgence qui ont également effectué un PUCU de la hanche et ont classé les résultats comme "épanchement" ou "aucun épanchement" selon les définitions échographiques standard. Les patients ont également subi une échographie du service de radiologie examinée par un radiologue pédiatrique. Les caractéristiques des tests diagnostiques avec leurs intervalles de confiance (IC) correspondants à 95 % ont été calculées en utilisant les résultats d'échographie du service de radiologie comme norme de référence. RéSULTATS: Un total de 95 patients a été inscrits par huit médecins urgentistes pédiatriques. Une excellente concordance a été observée entre les ultrasons réalisés par les médecins pédiatriques d'urgence et ceux du service de radiologie pour la présence ou l'absence d'effusion de la hanche (kappa = 0.81 [IC à 95% 0.70­0.93]). Le épanchement de la hanche a été identifié par PUCU chez 44 des 49 patients ayant un épanchement positif, avec une sensibilité de 89,8 % (IC à 95%, 77.7 ­96.6 %), une spécificité de 91,3 % (IC à 95%, 79.2­97.5%), un rapport de vraisemblance positif de 10,33 (IC à 95 %, 4.03­26.47) et un rapport de vraisemblance négatif de 0,11 (IC à 95% 0.05-0.26) CONCLUSIONS: Le PUCU réalisé par des médecins pédiatriques d'urgence a une sensibilité et une spécificité raisonnablement élevées pour diagnostiquer l'épanchement de la hanche chez les patients pédiatriques présentant une lésion ou une douleur aux jambes. Cette pratique pourrait accélérer le diagnostic et le traitement dans cette population de patients.

Increased Incidence and Clinical Features of Septic Arthritis in Patients Aged 80 Years and above: A Comparative Analysis with Younger Cohorts.

BACKGROUND: This study aimed to determine the incidence of septic arthritis across adult age groups in Västra Götaland Region (VGR) of Sweden, while also comparing disease characteristics among different age groups with hematogenous septic arthritis. METHODS: Using ICD-10 codes for septic arthritis from 2016 to 2019, we identified 955 patients in VGR. We reviewed the medical records of 216 adult patients with hematogenous septic arthritis and compared data across age groups. RESULTS: The overall incidence of septic arthritis in adults was 4 per 100,000 persons annually, rising to 14 per 100,000 in those ≥80 years. The median age of the 216 patients was 71. The comparison across age groups (18-64, 65-79, and ≥80) showed significantly longer hospital stays and higher mortality rate in the older groups. CRP levels were higher in the middle age group, SF-WBC counts were lower in the youngest age group, and synovial fluid crystals were more common in the oldest. No differences were found in joint involvement or the organisms isolated. CONCLUSION: The incidence of septic arthritis is 6.5 times higher in patients aged ≥ 80 compared to those under 65, highlighting the need to consider age-related differences in disease management.

Arthroscopic Debridement Enhanced by Intra-Articular Antibiotic-Loaded Calcium Sulphate Beads for Septic Arthritis of a Native Knee Following Iatrogenic Joint Injection: A Case Report.

Septic arthritis (SA) represents an orthopedics urgency and mainly affects the knee joint. Due to its devastating effects on cartilage, immediate management is crucial. SA is characterized by an annual incidence of 2 to 10 cases per 100,000 individuals, with mortality rates fluctuating between 0.5% and 15%, with a substantially higher mortality rate observed in older people (15%) in contrast to younger cohorts (4%). The etiology of septic arthritis is multifactorial: a spectrum of Gram-positive and Gram-negative bacteria can contribute to the development of this condition, especially Staphylococcus aureus. The treatment involves urgent (arthroscopic or arthrotomic) debridement associated with adequate antibiotic therapy. Intra-articular antibiotic carriers can also be used to increase their local concentration and effectiveness. The case of a 67-year-old woman affected by knee SA from methicillin-susceptible S. aureus is presented. She was treated with an arthroscopic debridement enhanced by intra-articular antibiotic-loaded calcium sulphate beads, together with antibiotic therapy. At 2-year follow up, the infection had been eradicated and the patient fully recovered. This is the first description, to our knowledge, in the English literature, of the use of antibiotic-loaded calcium sulphate beads as an adjuvant in the surgical treatment of SA of a native knee joint.

Hospitalisation cost for paediatric osteomyelitis and septic arthritis in New Zealand.

AIM: Hospitalisation rates for paediatric bone and joint infection (BJI) in New Zealand (NZ) are among the highest globally. This study aims to quantify hospitalisation costs of BJI in 2018-2019. METHODS: National hospitalisation data from the NZ Ministry of Health was used to describe costs associated with all paediatric hospitalisations coded for osteomyelitis or septic arthritis in those aged <16 years. Data included age, ethnic group, area level deprivation, diagnosis-related-group coding, admission length and cost-weight. Readmissions up to 24 months following the initial encounter were analysed for associated costs. RESULTS: More than ten million dollars was spent on hospitalisation for paediatric BJI over the study period (NZ$10 819 474). There were 869 primary hospitalisations and 229 related readmissions. Median length of stay was 7.4 days (95% confidence interval 6.8-7.9). Re-admission costs were NZ$1 196 640 within 24 months following diagnosis. Higher median hospitalisation costs occurred for children residing in the most deprived versus least deprived neighbourhoods (NZ$12 126 vs. NZ$9010, P < 0.01). NZ Maori compared with non-Maori children had longer length of stay (8.4 vs. 6.3 days, P = 0.04), more complex and severe illnesses (53% vs. 17%, P < 0.01), and higher median hospitalisation costs (NZ$11 796 vs. NZ$9581, P = 0.03). CONCLUSIONS: Direct BJI hospitalisation costs in 2018-2019 were NZ$10 819 474 with 11% of costs due to re-admission. Direct hospitalisation costs for paediatric BJI in NZ vary by deprivation and ethnic group. Illness complexity of paediatric BJI varies by ethnic group. Interventions are needed to reduce incidence and severity of these debilitating infections.

Management of Bone Loss After Multiple Metacarpal and Distal Row Carpal Resection Due to Osteomyelitis.

Atraumatic wrist pain can be due to a variety of causes including gout, pseudogout, cellulitis, arthritis flare, or infection of the joint. One important differential to rule out immediately is septic arthritis as it is considered an orthopedic emergency. Due to the rarity of septic arthritis in the wrist, there is limited data to guide diagnosis and treatment. Furthermore, delayed diagnosis of septic arthritis can progress to osteomyelitis and result in severe damage. The primary objective of this study is to present a case of atraumatic septic arthritis with a delayed diagnosis that developed into osteomyelitis in the left wrist and hand of an immunocompetent hand surgeon. In addition, we discuss the surgical treatment including reconstruction of the hand and wrist through a multidisciplinary approach.

Predictors of Methicillin-resistant Staphylococcus aureus infection in children with acute osteomyelitis.

BACKGROUND: This study aims to identify risk factors associated with Methicillin-resistant Staphylococcus aureus (MRSA) infection in children diagnosed with acute osteomyelitis (AO) and to elucidate the laboratory characteristics of these MRSA-infected children to enhance early targeted therapeutic interventions. METHODS: We conducted a retrospective analysis involving 123 children with acute osteomyelitis treated at our hospital. Upon admission, we measured white blood cell (WBC) counts, C-reactive protein (CRP) levels, erythrocyte sedimentation rates (ESR), and platelet counts. Patients were categorized into two groups: the non-MRSA group (n = 73) and the MRSA group (n = 50), with values assigned as follows (non-MRSA group = 0, MRSA group = 1). RESULTS: The MRSA group had a significantly higher average age compared to the non-MRSA group (P < 0.05). Notably, the incidence of suppurative arthritis was significantly lower in the MRSA group (P < 0.05). At the time of admission, CRP levels in the MRSA group were markedly elevated compared to those in the non-MRSA group (P < 0.01). After three days of empirical therapy, both WBC and CRP levels remained significantly higher in the MRSA group compared to the non-MRSA group (P < 0.05). CONCLUSIONS: In children newly admitted with acute osteomyelitis, a CRP level exceeding 73.23 µg/mL may indicate a high likelihood of MRSA infection. For children with AO who have been hospitalized for three days on empirical therapy, the presence of WBC > 10.95 × 10^9/L, CRP > 49.56 µg/mL, age > 3.5 years, and the absence of suppurative arthritis suggests a heightened risk of MRSA infection.

Facet joint septic arthritis: A review of cases.

Facet joint septic arthritis is a rare; yet, severe spinal infection often misdiagnosed due to its non-specific clinical presentation and radiological mimickers. This case series illustrates various clinical presentations, imaging features, and outcomes of patients with facet joint septic arthritis. We demonstrate different disease stages to aid clinicians and radiologists in recognizing this condition. Key diagnostic pitfalls are also discussed to enhance diagnostic accuracy in clinical practice.

Unraveling a Case of Uncommon Shoulder Septic Arthritis Attributed to Burkholderia pseudomallei: Investigating a Mysterious Organism.

Melioidosis is a serious infection caused by Burkholderia pseudomallei, typically found in tropical regions but now being increasingly recognized in areas outside its traditional endemic zones. This case report details the experience of a patient with type 2 diabetes mellitus who presented with unusual symptoms, complicating the diagnostic process. Initial treatment attempts were unsuccessful; however, the use of advanced microbiological methods allowed for the swift identification of the pathogen and led to effective treatment. The report showcases the critical need to include melioidosis in the differential diagnosis of severe infections, especially in patients with preexisting medical conditions or those in and around the endemic areas. It highlights the importance of timely and precise diagnosis, targeted antimicrobial therapy, and continuous monitoring to enhance patient outcomes.

Septic arthritis as breakthrough invasive fusariosis after cord blood transplantation.

A 63-year-old male received a third allogeneic hematopoietic stem cell transplantation with voriconazole prophylaxis for relapsed acute myeloid leukemia. He developed septic arthritis without any typical skin lesions due to fungal infection on day 42. Treatment with liposomal amphotericin B was initiated following surgical debridement; however, he died of progressive fungal infection. Ribosomal DNA sequencing identified Fusarium solani species complex (FSSC) harboring voriconazole resistance. This clinical course indicates that breakthrough invasive fusariosis (azole-resistant FSSC infection) needs to be considered as a pathogen when patients with hematological malignancies develop septic arthritis without typical skin lesions during voriconazole prophylaxis.

Synovial fluid D-lactate - a pathogen-specific biomarker for septic arthritis: a prospective multicenter study.

OBJECTIVES: The performance of synovial fluid biomarker D-lactate to diagnose septic arthritis (SA) and differentiate it from crystal-induced arthritis (CA), other non-infectious rheumatic joint diseases (RD) and osteoarthrosis (OA) was evaluated. METHODS: Consecutive adult patients undergoing synovial fluid aspiration due to joint pain were prospectively included in different German and Swiss centers. Synovial fluid was collected for culture, leukocyte count and differentiation, detection of crystals, and D-lactate concentration. Youden's J statistic was used to determine optimal D-lactate cut-off value on the receiver operating characteristic (ROC) curve by maximizing sensitivity and specificity. RESULTS: In total 231 patients were included. Thirty-nine patients had SA and 192 aseptic arthritis (56 patients with OA, 68 with CA, and 68 with RD). The median concentration of synovial fluid D-lactate was significantly higher in patients with SA than in those with OA, CA, and RD (p<0.0001, p<0.0001 and p<0.0001, respectively). The optimal cut-off of synovial fluid D-lactate to diagnose SA was 0.033 mmol/L with a sensitivity of 92.3 % and specificity of 85.4 % independent of previous antimicrobial treatment. Sensitivity and specificity of synovial fluid leukocyte count at a cut-off of 20,000 cells/µL was 81.1 % and 80.8 %, respectively. CONCLUSIONS: Synovial fluid D-lactate showed a high performance for diagnosing SA which was superior to synovial fluid leukocyte count. Given its high sensitivity and specificity, it serves as both an effective screening tool for SA and a differentiator between SA and RD, especially CA.

Synovial fluid analysis in healthy green turtles Chelonia mydas in Taiwan.

Septic arthritis is a frustrating disease in sea turtle rehabilitation because of its unclear pathogenesis, delayed onset during rehabilitation, long-term treatment requirements, and potentially poor prognosis. Radiography, blood cultures, and arthrocentesis have been used as diagnostic tools for suspected cases. However, there is currently a lack of data on the characteristics of synovial fluid in healthy sea turtles. To establish reference data for synovial fluid in sea turtles, we enrolled 14 green turtles Chelonia mydas rescued between 2019 and 2022 from 3 facilities using the following inclusion criteria: normal attitude and appetite, normal motor functions of the 4 limbs, no joint swelling, and no ongoing use of antibiotics for at least 1 mo. Bacterial cultures of blood and synovial fluid from the shoulder joints of these turtles were obtained and a qualitative analysis of the synovial fluid was performed. The results revealed bacterial culture-negative blood and synovial fluids at 37°C. Most characteristics of normal synovial fluid in green turtles, such as being transparent, colorless, and able to create a strand of over 2.5 cm by being pulled with a needle in viscosity trials, as well as the cytology of the normal synovial fluids being dominated by histiocytes and synovial lining cells, lymphocytes, and occasionally a few heterophils or erythrocytes were similar to those in mammals. This study provides information on the normal synovial fluid characteristics of green turtles in Taiwan, which may be beneficial for the diagnosis of joint diseases in sea turtles.

Serratia Sacroiliitis Secondary to Intravenous Drug Use: A Case Report.

Serratia spp. are ubiquitous, opportunistic, and infectious organisms that have historically been known to infect the upper respiratory, urinary, and circulatory systems. This manuscript presents the case of a 35-year-old White female with a past medical history of polysubstance abuse, intravenous drug use (IVDU), and poor dentition who was admitted to a community hospital with complaints of lower back pain for 10 days following the recent completion of treatment for a suspected epidural abscess. Per her report, her last IVDU with fentanyl was 11 days prior, and she admitted to using various sources of water to inject her drugs. Magnetic resonance imaging with contrast was significant for possible infectious sacroiliitis, and blood cultures grew Serratia marcescens. Due to this patient's extensive IVDU history, in-patient ceftriaxone was chosen over discharging the patient with a peripherally inserted central catheter line. Serratia spp.bacteremia with concomitant septic sacroiliitis in the setting of IVDU is an extremely rare presentation. Due to the nonspecific presentation of sacroiliitis, multidrug resistance profile of Serratia spp., and high mortality rate associated with S. marcescens sepsis, early detection and diagnosis is paramount in similar patients with extensive risk factors.

Protracted Course of Staphylococcus lugdunensis Septic Arthritis in Native Knee Joint.

Staphylococcus lugdunensis is a coagulase-negative bacteria of the Staphylococcus family. It is a highly invasive organism with similar virulence to Staphylococcus aureus. It is commonly associated with bacteremia and infections of the skin, soft tissues, joints, and bones. Those with indwelling medical devices are at the highest risk of infection due to biofilm formation. Instances of native joint infections are exceedingly rare. We describe a case of a 72-year-old female with multiple comorbidities presenting with native right knee joint septic arthritis from S. lugdunensis. Due to treatment noncompliance secondary to latent social determinants of health, she faced a complicated and protracted clinical course that was treated with inpatient intravenous antibiotics and outpatient oral doxycycline. Few cases of native joint infections with S. lugdunensis have been documented, and to our knowledge, the impact of treatment noncompliance on the sequelae of septic arthritis with this organism has not been reported. Socioeconomic factors and comorbidities have been shown to increase a patient's risk for an extended joint infection with S. lugdunensis.

Trained immunity of synovial macrophages is associated with exacerbated joint inflammation and damage after Staphylococcus aureus infection.

OBJECTIVES: Investigate whether and which synoviocytes would acquire trained immunity characteristics that could exacerbate joint inflammation following a secondary Staphylococcus aureus infection. METHODS: Lipopolysaccharide (LPS) and S. aureus were separately or double injected (21 days of interval) into the tibiofemoral joint cavity of male C57BL/6 mice. At different time points after these stimulations, mechanical nociception was analyzed followed by the analysis of signs of inflammation and damage in the affected joints. The trained immunity markers, including the glycolytic and mTOR pathway, were analyzed in whole tissue or isolated synoviocytes. A group of mice was treated with Rapamycin, an mTOR inhibitor before LPS or S. aureus stimulation. RESULTS: The double LPS - S. aureus hit promoted intense joint inflammation and damage compared to single joint stimulation, including markers in synoviocyte activation, production of proinflammatory cytokines, persistent nociception, and bone damage, despite not reducing the bacterial clearance. The double LPS - S. aureus hit joints increased the synovial macrophage population expressing CX3CR1 alongside triggering established epigenetic modifications associated with trained immunity events in these cells, such as the upregulation of the mTOR signaling pathway (p-mTOR and HIF1α) and the trimethylation of histone H3. Mice treated with Rapamycin presented reduced CX3CR1+ macrophage activation, joint inflammation, and bone damage. CONCLUSIONS: There is a trained immunity phenotype in CX3CR1+ synovial macrophages that contributes to the exacerbation of joint inflammation and damage during septic arthritis caused by S. aureus.

Paediatric Septic Arthritis of the Hip and the Efficacy of Kocher's Criteria: A Literature Review.

Pediatric septic arthritis (SA), an intra-articular infection in children, is considered a surgical emergency. The most commonly affected joints are the lower limb joints. It is more common in children below five years old and in males. Several scoring systems aid in the prediction of the disease and help differentiate it from similar differential diagnoses (such as transient synovitis (TS)). The first and most famous scoring system is Kocher's Criteria (KC), which utilizes a mixture of clinical signs, symptoms, and laboratory markers to predict the likelihood of the diagnosis. This review aims to assess the current literature to look at primary papers comparing the predicted probability of KC to the original probability described therefore evaluating its efficacy and usefulness in today's pediatric population. PubMed was searched using the terms "septic arthritis AND hip AND (Kocher OR Kocher's criteria)," 27 studies resulted, and each study was screened by reading the abstracts. Six studies were included in this review. Inclusion criteria were any study that looked at SA of the hip in the pediatric population prospectively or retrospectively, using KC to help make a diagnosis and looking at the predicted probability of KC. Exclusion criteria included studies looking at adults, joints other than the hip, and papers not assessing the predicted probability. The efficacy of KC for diagnosing SA is not well-supported by current literature. Studies indicate that KC have low specificity for SA, suggesting it should not replace arthrocentesis as the diagnostic gold standard. Clinicians should use this model cautiously, and more extensive, prospective studies are needed to validate its effectiveness.

Disseminated Gonococcal Infection Presenting as Isolated Septic Arthritis: A Case Report and Review of Literature.

Neisseria gonorrhoeae is a gram-negative diplococcus that passes from one person to another through sexual contact. On rare occasions, Neisseria gonorrhoeae may spread from the primary mucosal site to distant parts of the body and present with signs of systemic illness; this is commonly known as disseminated gonococcal infection (DGI). We present a case report of an 18-year-old patient who was diagnosed with septic arthritis of the right third metacarpophalangeal (MCP) joint without mucosal involvement or systemic symptoms and who was found to have gonococcal bacteremia. This case highlights the importance of clinician awareness of the many extragenital manifestations of DGI and a high index of suspicion in the setting of septic arthritis and high-risk sexual practices. Diagnosing DGI early and providing prompt treatment may prevent complications of sepsis, joint destruction, and a prolonged hospital stay.

The feasibility and safety of ultrasound-guided puncture for treatment of septic arthritis in children.

BACKGROUND: In septic arthritis, joint lavage can be performed using arthrocentesis (articular needle aspiration) or arthrotomy. The use of fluoroscopy to guide the puncture involves radiation. Ultrasound (US) guidance is still little recommended to guide the treatment of septic arthritis in children. We wanted to know whether treating septic arthritis in children was feasible and safe under ultrasound (US) guidance. METHODS: We retrospectively included 67 children (mean age, 3.0 years; range: 1 month-12 years) treated for septic arthritis of the hip, shoulder, or ankle using arthrocentesis or arthrotomy under US or fluoroscopic guidance (non-US group) with at least two years of follow-up. RESULTS: We found no significant difference between the groups. After arthrocentesis, patients in the US group remained in hospital for 0.8 days longer than those in the non-US group, but the difference was not significant. After arthrotomy, the arthrotomy-US group required 0.4 more days of hospitalization than the non-US group, but the difference was not significant. Patients in the US group exhibited higher initial CRP and WBC values than patients treated without US, although the differences were not significant. The WBC values of the arthrocentesis-US groups were higher than those of the non-US groups initially and at 72 h, but non significantly so; they became similar on day 5. Three puncture failures required arthrotomy (two under US guidance). Three patients required early revision surgery: one had undergone arthrocentesis with US, one arthrocentesis without US, and one arthrotomy without US. At the last follow-up, there were no clinical sequelae but two hip arthrotomies (one US and one non-US child) showed asymptomatic calcifications. CONCLUSIONS: US guidance is feasible and safe for treating septic arthritis in children, visualizing structures not shown by X-rays and avoiding radiation exposure during surgery. LEVEL OF EVIDENCE: IV (case series). TRIAL REGISTRATION: IRB-MTP_2021_05_202100781.

Sonographic findings associated with complications in pediatric patients with septic arthritis.

OBJECTIVES: Ultrasound is a valuable tool for diagnosing septic arthritis and guiding the development of treatment plans. This study aimed to identify sonographic findings associated with complications in septic arthritis. METHODS: Twelve patients aged <5 years diagnosed with septic arthritis were classified into two groups: those with and without complications. Complications were defined as the destruction of the epiphyseal bone head and metaphysis bone cortex. The following sonographic findings were compared between the two groups using Fisher's exact test: synovial membrane thickness, joint effusion, diminished hyperechoic foci within the epiphyseal bone head, and diminished smooth metaphyseal bone cortex. RESULTS: Overall, 4 of 12 patients developed complications. Joint effusion and synovial membrane thickening were detected in all patients with septic arthritis. The incidence of diminished hyperechoic foci within the epiphyseal bone head was significantly different between the two groups (presence/absence in patients with complications vs. without = 3/1 vs. 0/8, p = 0.018). The incidence of diminished smooth metaphyseal bone cortex was higher in patients with complications than in those without; however, this difference was not statistically significant (presence/absence in patients with complications vs. without = 4/0 vs. 3/5, p = 0.081). CONCLUSION: Ultrasound proved to be an effective diagnostic tool for septic arthritis and also demonstrated its potential in predicting complications of septic arthritis in the pediatric population.

Septic Arthritis Modeling Using Sonographic Fusion with Attention and Selective Transformation: a Preliminary Study.

Conventionally diagnosing septic arthritis relies on detecting the causal pathogens in samples of synovial fluid, synovium, or blood. However, isolating these pathogens through cultures takes several days, thus delaying both diagnosis and treatment. Establishing a quantitative classification model from ultrasound images for rapid septic arthritis diagnosis is mandatory. For the study, a database composed of 342 images of non-septic arthritis and 168 images of septic arthritis produced by grayscale (GS) and power Doppler (PD) ultrasound was constructed. In the proposed architecture of fusion with attention and selective transformation (FAST), both groups of images were combined in a vision transformer (ViT) with the convolutional block attention module, which incorporates spatial, modality, and channel features. Fivefold cross-validation was applied to evaluate the generalized ability. The FAST architecture achieved the accuracy, sensitivity, specificity, and area under the curve (AUC) of 86.33%, 80.66%, 90.25%, and 0.92, respectively. These performances were higher than using conventional ViT (82.14%) and significantly better than using one modality alone (GS 73.88%, PD 72.02%), with the p-value being less than 0.01. Through the integration of multi-modality and the extraction of multiple channel features, the established model provided promising accuracy and AUC in septic arthritis classification. The end-to-end learning of ultrasound features can provide both rapid and objective assessment suggestions for future clinic use.

Literature review and case report of septic arthritis and purpura fulminans leading to a child limb amputation as chickenpox complications.

Introduction and significance: Chickenpox, induced by the varicella-zoster virus (VZV), generally presents with an itchy rash and fluid-filled blisters. While complications such as pneumonia and sepsis are well-documented, occurrences of septic arthritis and purpura fulminans are exceedingly rare. Septic arthritis following varicella infection is infrequently reported and often attributed to Staphylococcus aureus. Purpura fulminans encompasses disorders characterized by rapidly progressing purpuric lesions, often fatal and associated with consumptive coagulopathy. Case presentation: The authors present the case of an 8-year-old boy diagnosed with chickenpox who concurrently developed severe left knee pain, erythema, and swelling indicative of septic arthritis, along with a single pustular lesion on his right foot that progressed to purpura fulminans. Laboratory investigations revealed elevated inflammatory markers. Knee ultrasound findings were consistent with septic arthritis, corroborated by synovial fluid analysis. Immediate initiation of empiric antibiotics was undertaken. Further investigation disclosed unusual coagulation parameters, positive autoantibodies, and reduced protein S levels. Treatment included anticoagulation, immunomodulation, and ultimately, amputation. Clinical discussion: This rare case underscores the complexity of varicella-related complications, representing the first documented instance of simultaneous septic arthritis and purpura fulminans in a pediatric patient. It highlights the necessity of a multidisciplinary approach for accurate diagnosis and management, emphasizing the importance of recognizing rare complications to improve patient outcomes. Conclusion: This case exemplifies the complexity of varicella-associated complications, showcasing a rare simultaneous occurrence of septic arthritis and purpura fulminans in a pediatric patient. It underscores the importance of a thorough understanding and collaborative management approaches for timely intervention and enhanced clinical outcomes.