Theory and Clinical Practice in Pediatrics

Abstract: Purpose The purpose of this study was to compare outcomes and reoperation rate between open and arthroscopic treatment of a suspected isolated septic hip in the pediatric population. Methods Retrospective review was performed on two cohorts of pediatric patients who underwent surgical intervention for suspected isolated septic hip arthritis at a single institution. Patients were subdivided into two cohorts based on whether they underwent an open versus arthroscopic approach. Patients were excluded if they received an initial surgery from an outside institution, did not have an acute, active infection at presentation, defined as a hip aspiration leukocyte count <50,000 cells with <75% neutrophils, had extracaspular pathology or osteomyelitis, or had septic arthritis of a joint other than the hip. Results Fifty-six hips were included [Open group (n = 36); Arthroscopic group (n = 20)]. Six percent (2/36) of hips in the open group and 26% (5/19) of hips in the arthroscopy group had a positive tissue culture (p = 0.041). Eleven hips (31%) underwent postoperative immobilization in the open group compared to one hip (5%) in the arthroscopic group (p = 0.039). Conclusions In the setting of isolated arthritis, arthroscopy is a reasonable treatment modality with no observed additional risk compared to open arthrotomy. However, with concomitant osteomyelitis or soft tissue abscess, open arthrotomy should remain the mainstay approach to address all elements of the infection.
Level of Evidence: Level III

Melioidosis and its germ are increasingly reported on the African continent and particularly in Central Africa, probably due to the increased awareness of clinicians and microbiologists and the growing recognition of the organism. It is called "Great Mimicker" because it produces a wide range of clinical characteristics such as would be found in patients living with sickle cell disease (SCD) in particular. However, to date, no publication presents this association between melioidosis and SCD. The authors describe here 3 clinical cases presenting this very rare association between melioidosis and SCD. These are 3 children with SCD (homozygous SS) residing in Lubumbashi in Haut-Katanga province in the Democratic Republic of Congo. One patient presented with sepsis as a clinical form of the disease. All 3 had presented a pulmonary form. Only one patient was treated specifically after the diagnosis of melioidosis; for the other two, this diagnosis was confirmed after their death. Thus the death rate is 66.67%. This article describes, through these 3 clinical cases, a very rare first association between melioidosis and SCD. This association requires research to establish whether, like Thalassemia, SCD can be considered a risk factor for melioidosis. A screening of cases of melioidosis in the general population should allow us to focus on this.