Pediatric musculoskeletal infections

Comparison Between Septic Arthritis Alone and Coexisting with Other Bone and Joint Infections in Pediatric Patients: A Retrospective Review

Background

It is unclear whether coexisting septic arthritis and osteomyelitis (CSAO) differs from septic arthritis (SA) alone in terms of susceptible age groups, clinical and paraclinical presentations, and prevalence. This study aimed to compare patients with isolated SA with those presenting with CSAO, determine the efficacy of different parameters used to distinguish those diagnoses, and investigate the prevalence of CSAO due to Kingella kingae.

Methods

The study retrospectively included all patients treated for SA over a 17-year period at Geneva University Hospitals. Clinical, biological, and bacteriological data were analyzed. Magnetic resonance imaging (MRI) was reviewed for all patients to identify those with coexisting osteomyelitis. Comparisons between patients with isolated SA and those with CSAO were performed using the unpaired Mann-Whitney U for continuous outcomes (reported with median [interquartile range]) and the Pearson χ2 tests for dichotomous outcomes (reported with n [%]).

Results

Of 247 patients with osteoarticular infections, 177 with SA fulfilled our inclusion criteria. Of these, 124 had SA alone, and 53 (29.9%) had a CSAO. There were no statistically significant differences between the 2 groups regarding sex, age, and clinical and paraclinical results. When coexisting osteomyelitis was present, 51% of cases were acute and 49% were subacute. Bone infection was found in the metaphyses of 21 patients (39.6%), the epiphyses of 11 (20.8%), and was transphyseal in 10 (18.9%). Whatever the infection location, K. kingae was the most common pathogen found in both groups (48% of SA, 43% of CSAO, p = 0.651).

Conclusions

This study showed that CSAO is common in children, especially among those younger than 4 years, with an unexpectedly high prevalence of subacute osteomyelitis. This should encourage caregivers to use MRI more extensively in diagnostic processes. Clinical and paraclinical data did not contribute to differentiate CSAO from SA. The widespread presence of K. kingae as a pathogen in both groups supports the advice to systematically use polymerase chain reaction techniques in children younger than 4 years of age.

Level of Evidence

Level III. See Instructions for Authors for a complete description of levels of evidence.

Leveraging core proteome data of Kingella kingae for multi-epitope vaccine design against TonB dependent receptor (TDR): an in silico approach

Kingella kingae is a Gram-negative bacterium that causes invasive infections in children and older or immunocompromised individuals, making it a significant public health concern. In this study, a pan-proteomic mediated vaccine target mining was attempted to identify potential vaccine targets in K. kingae. Currently, there is no vaccine available against this pathobiont. Therefore, we designed and validated an in silico vaccine construct by targeting the lactoferrin/transferrin-binding TonB-dependent receptor. Antigenic regions of the TonB receptor were mapped, and the predicted epitopes were anticipated to be effective in a broad range of the world population. Using their combinations with linkers and various adjuvants, 12 vaccine constructs were prepared. The best construct (C7) with no allergenicity and high antigenicity was subjected to molecular modeling, docking with important immune receptors of humans, and then molecular dynamics (MD) simulation. After binding validation and stability assessment, it was cloned into a pet-28a + plasmid vector. Immune response was also simulated, and the vaccine was observed to invoke B- and T-cell induction. These findings can help accelerate the development of a new vaccine against K. kingae or other pathogens targeting the homolog of TonB. Nevertheless, we propose additional testing of C7 construct for efficacy and safety in vitro and in vivo.

The use of the ratio of C-reactive protein to albumin for the diagnosis of pediatric septic arthritis

Purpose

This study aimed to investigate the relationship between the ratio of c-reactive protein to albumin (CAR) and pediatric septic arthritis (PSA).

Methods

Clinical and laboratory data were collected. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of CAR in identifying PSA. Multivariable logistic regression analyses was performed to calculate adjusted odds ratio (OR) with 95% confidence interval (CI).

Results

We included 305 patients with PSA (CAR ≤ 0.447, 182 patients; CAR > 0.447, 123 patients) between September 2013 and November 2022. ROC analysis showed that CAR performed best in diagnosing PSA, with an area under curve (AUC) value of 0.828. After adjusted for potential confounders, we found that high CAR was associated with PSA (OR = 6.85, 95% CI: 2.30-20.40, p = 0.001). In sensitivity analyses, subgroups analyses, and propensity score matching, the results remain stable.

Conclusions

The CAR (>0.447) at admission was an independent risk factor for PSA. It is worthy to further investigate this association.