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Abstract Objective: Signs and symptoms of osteomyelitis or septic arthritis in neonates and infants are often nonspecific and early-stage bone infections in infants may often go unnoticed. The objective of this study was to analyze the clinical characteristics of newborns and infants with osteomyelitis and septic arthritis to improve understanding of the disorder and to assist clinicians with diagnosis. Methods: A retrospective multicenter study was conducted on neonates (0-28 days old, n = 94) and infants (1-12 months old, n = 415) with osteoarticular infections. Data consisting of clinical characteristics, complications, laboratory outcomes, and the pathogenic microorganisms causing osteomyelitis were tabulated. The statistics were further broken down into two regions and the significant differences between neonates and infants were evaluated and compared to the literature. Results: Compared to infants, neonates had significantly lower incidences of fever (p < 0.0001), higher incidences of localized swelling (p = 0.0021), higher rate of infection at the humerus (p = 0.0016), higher percentage of Escherichia coli (p < 0.0001) and Klebsiella pneumoniae (p = 0.0039) infections, lower percentage of Staphylococcus aureus infections (p < 0.0001) and were more likely to develop septic arthritis (p < 0.0001). Conclusion: Distinct differences were found between neonatal and infants with osteoarticular infections. Future studies should focus on improving diagnosis and subsequent treatment regimens for younger age groups.

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BACKGROUND: Shewanella putrefaciens is a gram-negative, nonfermenting, oxidase-positive, hydrogen sulfide-producing bacillus and a halophilic bacterium, known for causing unusual infections in humans and often regarded as an opportunistic pathogen. Its diverse symptoms have a significant impact on human health, with 260 documented disorders reported in the literature over the last 40 years, highlighting its potential danger. CASE PRESENTATION: We present the case of a previously healthy 15-year-old male patient who sustained a self-inflicted sharp-object injury while working in the field, resulting in secondary septic monoarthritis due to Shewanella putrefaciens. CONCLUSIONS: This case highlights the bacteriological and clinical characteristics, as well as the antibiogram, of Shewanella spp. Given the recent increase in notifications of Shewanella infections, predominantly by S. algae and S. putrefaciens, it is essential to consider these pathogens in patients with a history of contact with bodies of water. Special attention must be paid to their resistance patterns in patient management to prevent the development of intrinsic antimicrobial resistance.

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OBJECTIVE: Signs and symptoms of osteomyelitis or septic arthritis in neonates and infants are often nonspecific and early-stage bone infections in infants may often go unnoticed. The objective of this study was to analyze the clinical characteristics of newborns and infants with osteomyelitis and septic arthritis to improve understanding of the disorder and to assist clinicians with diagnosis. METHODS: A retrospective multicenter study was conducted on neonates (0-28 days old, n = 94) and infants (1-12 months old, n = 415) with osteoarticular infections. Data consisting of clinical characteristics, complications, laboratory outcomes, and the pathogenic microorganisms causing osteomyelitis were tabulated. The statistics were further broken down into two regions and the significant differences between neonates and infants were evaluated and compared to the literature. RESULTS: Compared to infants, neonates had significantly lower incidences of fever (p < 0.0001), higher incidences of localized swelling (p = 0.0021), higher rate of infection at the humerus (p = 0.0016), higher percentage of Escherichia coli (p < 0.0001) and Klebsiella pneumoniae (p = 0.0039) infections, lower percentage of Staphylococcus aureus infections (p < 0.0001) and were more likely to develop septic arthritis (p < 0.0001). CONCLUSION: Distinct differences were found between neonatal and infants with osteoarticular infections. Future studies should focus on improving diagnosis and subsequent treatment regimens for younger age groups.

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Abstract Objective: Studies focusing on bone and joint infections (BJIs) in young infants are rare. Some cases of BJI are accompanied by sepsis. This study aimed to identify the clinical and bacteriological features of sepsis in neonates and young infants with BJIs. Methods: Neonates and infants younger than 3 months diagnosed with BJI in the present institution from 2014 to 2021 were retrospectively reviewed. Patient characteristics, clinical data, and outcomes were documented and compared between those with and without sepsis. Results: Twenty-five patients with a mean age of 34.8 days were included. Nine BJI cases had concomitant sepsis (group A), and 16 had BJI without sepsis (group B). Within group A, staphylococcus aureus was the major pathogenic germ (5 cases, of which 4 were of the methicillin-resistant staphylococcus aureus (MRSA) type). There was no statistical difference in male-to-female ratio, age, history of hospitalization, anemia, birth asphyxia, peripheral leukocyte counts, C-reactive protein on admission, and sequelae between groups. Univariate analyses indicated a significant difference in the incidence of septic arthritis (SA) combined with osteomyelitis (OM) (88.9% vs 37.5%), congenital deformities (44.4% vs 0%), and mean duration of symptoms (2.83 days vs 9.21 days) in comparisons between groups A and B. Conclusion: Staphylococcus aureus is the main pathogenic bacteria in BJI cases complicated with sepsis in neonates and young infants. Among infants younger than 3 months diagnosed with BJI, those with concurrent SA and OM, MRSA infection, or congenital deformities are more likely to develop sepsis.

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A 37-year-old immunocompetent man was admitted to the emergency department due to recurrent pain and oedema of his right knee. Two months earlier, he had undergone surgery to repair his meniscus. Arthroscopic joint lavage was performed and Candida dubliniensis was recovered in culture. The authors describe the first case of septic arthritis caused by Candida dubliniensis.

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OBJECTIVE: Studies focusing on bone and joint infections (BJIs) in young infants are rare. Some cases of BJI are accompanied by sepsis. This study aimed to identify the clinical and bacteriological features of sepsis in neonates and young infants with BJIs. METHODS: Neonates and infants younger than 3 months diagnosed with BJI in the present institution from 2014 to 2021 were retrospectively reviewed. Patient characteristics, clinical data, and outcomes were documented and compared between those with and without sepsis. RESULTS: Twenty-five patients with a mean age of 34.8 days were included. Nine BJI cases had concomitant sepsis (group A), and 16 had BJI without sepsis (group B). Within group A, staphylococcus aureus was the major pathogenic germ (5 cases, of which 4 were of the methicillin-resistant staphylococcus aureus (MRSA) type). There was no statistical difference in male-to-female ratio, age, history of hospitalization, anemia, birth asphyxia, peripheral leukocyte counts, C-reactive protein on admission, and sequelae between groups. Univariate analyses indicated a significant difference in the incidence of septic arthritis (SA) combined with osteomyelitis (OM) (88.9% vs 37.5%), congenital deformities (44.4% vs 0%), and mean duration of symptoms (2.83 days vs 9.21 days) in comparisons between groups A and B. CONCLUSION: Staphylococcus aureus is the main pathogenic bacteria in BJI cases complicated with sepsis in neonates and young infants. Among infants younger than 3 months diagnosed with BJI, those with concurrent SA and OM, MRSA infection, or congenital deformities are more likely to develop sepsis.

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RESUMEN La sacroileítis infecciosa (SII) es una afección poco común que, en ocasiones, se diagnostica tarde por la escasa especificidad de los síntomas. Además, se requiere de técnicas de imagen como la gammagrafía, tomografía y la resonancia magnética nuclear para valorar la extensión y gravedad de las lesiones. Si se hace un diagnóstico y tratamiento precoz, la evolución clínica es satisfactoria y no deja secuelas. Se presenta el caso de una paciente mujer de 83 años, con antecedentes de enfermedad cerebrovascular isquémico, hipertensión arterial, diabetes mellitus 2 e infección del tracto urinario que presentó dolor abdominal tipo cólico de moderada intensidad, afebril; manifestó que al momento de levantarse de su silla sintió debilidad en el hemicuerpo izquierdo. Al ingreso, hipertensa, febril con T° 38°C SatO2: 98 % con FiO2: 0.4. Al examen físico con edema en MMII con fóvea (+), abdomen distendido, doloroso en flanco derecho y hemiparesia izquierda. Al laboratorio: hemoglobina 14,8 g/dl, plaquetas 38.000 μl. leucocitos 18.000 μl. Posteriormente, confirmando el diagnóstico clínico sustentado en radio imágenes, se procedió al abordaje quirúrgico. La SII es una enfermedad rara con complicaciones graves, cuyo diagnóstico precoz e inicio de tratamiento rápido son fundamentales, basándose principalmente en el cuadro clínico, estudios de imágenes y la duración adecuada de la terapia antibiótica.

ABSTRACT Infectious sacroiliitis is a rare condition that is sometimes diagnosed late due to the poor specificity of the symptoms. In addition, imaging techniques such as scintigraphy, tomography, and nuclear magnetic resonance are required to assess the extent and severity of the lesions. If early diagnosis and treatment are made, the clinical evolution is satisfactory and leaves no sequelae. Clinical case: the case of an 83-year-old female patient is presented, with a history of ischemic cerebrovascular disease, high blood pressure, type 2 diabetes mellitus and urinary tract infection, who presented with moderately intense colic-like abdominal pain, afebrile, and reported that at the time After getting up from his chair he felt weakness in his left side. On admission, hypertensive, febrile with T°: 38°C SatO2: 98% with FiO2: 0.4. On physical examination, there was edema in MMII with pitting (+), distended abdomen, pain in the right flank and left hemiparesis. To the laboratory: hemoglobin 14.8 g/dl, platelets 38,000 μl, leukocytes 18,000 μl.

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OBJECTIVE: Microorganisms can cause acute infectious arthritis, chronic infectious arthritis, or reactive inflammatory arthritis. The aim of this study is to perform a narrative review of the pathophysiology, etiology, and diagnostic features of infectious arthritis and TMJ infectious arthritis. METHODS: A search of the literature was performed using Medline, Scielo, Embase, and Google Scholar databases. The terms employed for the search were "Temporomandibular Joint Disorders" and "Infectious Arthritis"; or "Septic Arthritis"; or "Bacterial, Fungal, or Viral Arthritis." Over three hundred articles were screened for eligibility. RESULTS: The selected articles were utilized to perform a narrative review of the general aspects of infectious arthritis and infectious arthritis affecting the TMJ. CONCLUSION: Infectious arthritis is a rare, yet very morbid, form of arthritis. Understanding general aspects of joint infections and specific features of TMJ infectious arthritis is imperative for an adequate diagnosis.

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INTRODUCCIÓN: El diagnóstico y tratamiento oportuno de las infecciones osteoarticulares (IOA) pediátricas son imperativos para evitar complicaciones y secuelas, siendo relevante conocer la microbiología local. OBJETIVO: Describir las características de las IOA pediátricas tratadas en nuestro centro. PACIENTES Y MÉTODOS: Estudio observacional descriptivo. Se analizaron pacientes bajo 15 años de edad tratados por IOA. entre los años 2004 y 2020. Se evaluaron características clínicas, de laboratorio, microbiología y tratamiento. RESULTADOS: Se incluyeron 126 pacientes (63,5% hombres), con una mediana de edad de 5,09 años (rango: 0,5-14,6 años); 61,1% artritis séptica (AS), 38,9% osteomielitis (OM). Un 92,9% presentó dolor y 68,3% fiebre. La localización más frecuente en AS fue rodilla (33,7%) y en OM tibia (30,6%) y fémur (30,6%). Se identificó agente en 77 pacientes (61,1%), siendo más frecuentes Staphylococcus aureus (n = 44), Kingella kingae (n = 13) y Streptococcuspyogenes (n = 8). Los cuatro pacientes con reacción de polimerasa en cadena (RPC) universal positiva para K. kingae no fueron detectados por otros métodos. CONCLUSIÓN: El agente más frecuente sigue siendo S. aureus, observándose un aumento en la resistencia de éste en comparación con series nacionales anteriores, y, por primera vez en nuestro medio, se comunica la detección de K. kingae, específicamente relacionada al uso de técnicas moleculares.

BACKGROUND: Timely diagnosis and treatment of pediatric osteoarticular infections (OAI) are imperative to avoid complications and sequelae, being relevant to know the local microbiology. AIM: To describe the characteristics of pediatric OAI treated in our center. METHODS: Descriptive observational study. Patients under 15 years of age treated for OAI between 2004 and 2020 were analyzed. Clinical, laboratory, microbiology and treatment characteristics were evaluated. RESULTS: 126 patients (63.5% men) were included, median age of 5.09 years (range: 0.5-14.6 years); 61.1% had septic arthritis (AS), 38.9% osteomyelitis (OM). Pain was present in 92.9% and fever in 68.3%. The most frequent location in AS was the knee (33.7%) and in OM the tibia (30.6%) and femur (30.6%). Agents were identified in 77 patients (61.1%), the most frequent being Staphylococcus aureus (n = 44), Kingella kingae (n = 13) and Streptococcus pyogenes (n = 8). The 4 patients with positive universal polymerase chain reaction (PCR) for K. kingae were not detected by other methods. CONCLUSION: The most frequent agent continues to be S. aureus, with an increase in its resistance, and this is the first report of K. kingae as a cause of OAI in Chile, specifically related to the use of molecular techniques.

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Bacteria of the genus Nocardia are implicated in several disease processes but are a rare cause of septic arthritis. Typically, the cause of Nocardia septic arthritis is dissemination from a pulmonary infection in an immunocompromised host. Herein we present a case of a 64-year-old male who had received a long course of prednisone for membranous nephropathy and developed a septic arthritis due to Nocardia brasiliensis. He was treated sequentially with trimethoprim-sulfamethoxazole and amoxicillin-clavulanate, linezolid and amoxicillin-clavulanate, tigecycline and amoxicillin-clavulanate, and omadacycline and amoxicillin-clavulanate. To our knowledge, only two prior cases of Nocardia brasiliensis septic arthritis without antecedent trauma to the joint or local skin breakdown have been reported. A review of the literature identified 19 other cases of Nocardia septic arthritis. This case reinforces the need to consider Nocardia infection in the differential diagnosis in the immunocompromised patient with concurrent pulmonary infection and septic arthritis.