A Neonatal Septic Arthritis Case Caused by Klebsiella Pneumoniae - A Case Report

DOI: 10.7860/JCDR/2016/17651.
7230
Case Report
A Neonatal Septic Arthritis Case

Paediatrics Section
Caused by Klebsiella pneumoniae:

A Case Report
Tamer Ozsarı1, Gülhan Bora2, Özmert M.A Ozdemir3, Ilknur Kılıç4
ABSTRACT
Septic arthritis is encountered very rarely during the neonatal period and its diagnosis can delay because of atypical symptoms, thus it
may lead to serious sequelae. The sequale can be prevented by early diagnosis and concomitant treatment. In neonates, pain can be
experienced as a result of pseudoparalysis and of movement of the effected joints. A 17-day-old neonatal patient was brought to our
hospital with complaint of unrest and then diagnosed with septic arthritis due to propagation of Klebsiella pneumoniae in joint fluid culture
was represented because of the rarity of such a case.
Keywords: Atypical symptoms, Newborn, Pseudoparalysis
case report The metaphysis and joint space are in relationship because of the
A female baby with birth weight of 2700 grams born via normal fact that within the first 12 months of the life, presence of capillaries
spontaneous vaginal delivery at the 37th week of pregnancy of a originated from metaphysis in long bones that pass the epiphysis
20-year-old mother’s third pregnancy was consulted to our hospital line vertically. Therefore, septic arthritis occurs frequently along with
with complaints of unrest, limitation and pain of motion in left leg. osteomyelitis during the neonatal period [4,5]. It was also reported
According to physical examination her general condition was good that in neonates with septic arthritis and osteomyletis, involvement
with a body temperature of 36.4°C, however, there was an increase in of lower extremities (70-80%) are observed more frequently than
temperature and limitation of motion in left hip joint. In the laboratory that of lower extremities (10-20%) [6,7]. In the formation of neonatal
examination following results were obtained: WBC 19,800/mm3, septic arthritis the risk factors which are connected to pregnancy
C-reactive-protein (CRP); 4.94 mg/L, erythrocyte sedimentation and labour such as prematurity, low birth infant weight, asphyxy,
rate (ESR); 100 mm/h 86% polymorphonuclear leukocytes in bacteraemia and intravenous or umbilical catheter are the leading
peripheral blood smear (PMNL). Effusion was detected in the left factors [8,9]. Among the described risk factors for the development
hip, by means of ultrasonograhic examination of the patient with of neonatal septic arthritis, case of prematurity and vitamin K
normal graphy of left hip joint. A 5 x 162 pieced leukocytes were injection, and heel prick test was performed in order to screen the
identified in the synovial fluid examination. In the gram staining, metabolic diseases. In the presented case report the involved joint
10-12 PMNL and a large number of gram negative bacteria with was left hip joint.
bacilli morphology. Because of the reason that the complaints of There may be a delay in the treatment because the diagnosis of
patient had been continuing for more than 4 days, irrigation with septic arthritis in the neonatal period [10]. It was exhibited with the
arthrotomy and debridement were performed by the department of conducted studies that the earliest detection of changes in the
orthopaedics and the joint was encased in the joint plaster splint. joints and bones in radiography is 7-16 days after the beginning of
Taking into consideration the fact that Staphlococcus aureus is the infection [11,12]. The most important clinical findings are swelling in
most common pathogen factor in childhood septic arthristis that soft tissue and pseudoparalysis [10,13].
occur in all age groups, the treatment was initiated with ampicillin- Clinically, soft tissue swelling, pseudoparalysis of the most important
sulbactam combination and parenteral cefotaxime at a dose of 100 clinical findings [10,13] have no fever and cannot seem half as sick
mg/kg/dose and 50 mg/kg/dose, respectively. Following isolation of newborns. No fever is experienced in the half of the neonates and no
Klebsiella pneumonia in joint fluid culture, in accordance with culture sign of disease might be observed, and also in these patients most
antibiogram results, transition to the treatment with parenteral of the laboratory and X-ray findings appear to be normal. There was
meropenem at a dose of 20 mg/kg/dose and amikacin at a dose 15 no fever in our patient but uneasiness and pain which occurred from
mg/kg/dose was performed. the movement of extremity were present. In order of frequency, S.
In the first week of treatment, a reduction in CRP and white blood Aureus, group B streptococcus and gram positive enterococcus are
cell count, then after observing a clinical improvement, the patient the most frequently determined significant pathogens in neonatal
was discharged from hospital 4 weeks later and was treated as an septic arthritis.
outpatient. In the physical examination, recovery of joint movements Before the world-wide immunization with conjugate vaccines,
was detected and the general condition of the patient fully improved Hemophilus influenza type b was responsible for over half of all
without sequelae. cases of bacterial arthritis in infants [10]. In recent years, Klebsiella
pneumoniae is reported to be the most common cause of the
DISCUSSION nosocomial infections in which the infection frequency with gram
Acute septic arthritis of the joints in the neonatal period was late negative bacteria has increased [14]. Length of hospitalization of
when microorganism haematogenously spread is considered in the patient was 2 days after the labour. During the hospitalization
rare treat infections cause morbidity mortality [1-4]. In acute septic duration of the patient, the performed invasive procedures are
arthritis of joints in the neonatal period, the infection is the main among the preventable risk factors, special care should be taken for
cause of the morbidty and mortality when getting late to treat the sterilization during the venesection and other invasive operations.
haematogenously spread of the rare microorganisms. The examination of purulent fluid is accepted as a gold standard
Journal of Clinical and Diagnostic Research. 2016 Feb, Vol-10(2): SD01-SD02 1
Tamer Ozsarı et al., Klebsiella Pneumoniae is Septic Arthritis of Neonatal Period; : Report of A Case www.jcdr.net
for detection of microorganism in gram staining and for definitive References

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PARTICULARS OF CONTRIBUTORS:
1. Department of Pediatrics, Igdır State Hospital, Igdır, Turkey.
2. Pharmacy, Department of Pharmaceutical Microbiology, YYU University, Turkey.
3. Faculity of Medicine, Department of Newborn, Pamukkale University, YYU University, Turkey.
4. Faculity of Medicine, Department of Newborn, Pamukkale University, YYU University, Turkey.
NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR:

Dr.Gulhan Bora,
Faculity of Pharmacy, Department of Pharmaceutical Microbiology, Gulhan Bora, YYU University, Turkey. Date of Submission: Nov 02, 2015
E-mail : [email protected] Date of Peer Review: Nov 17, 2015
Date of Acceptance: Dec 20, 2015
Financial OR OTHER COMPETING INTERESTS: None. Date of Publishing: Feb 01, 2016
2 Journal of Clinical and Diagnostic Research. 2016 Feb, Vol-10(2): SD01-SD02

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DOI: 10.7860/JCDR/2016/17651.

A Neonatal Septic Arthritis Case

Caused by Klebsiella pneumoniae:

Tamer Ozsarı1, Gülhan Bora2, Özmert M.A Ozdemir3, Ilknur Kılıç4

Keywords: Atypical symptoms, Newborn, Pseudoparalysis

for detection of microorganism in gram staining and for definitive References

NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR:

2 Journal of Clinical and Diagnostic Research. 2016 Feb, Vol-10(2): SD01-SD02

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