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Viewers Choice) a Rare Case of Kingella Kingae Osteomyelitis of Left Femur in a Newborn

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Viewers Choice) a Rare Case of Kingella Kingae Osteomyelitis of Left Femur in a Newborn http://www.pediatriconcall.com collected from the infants and stored at -700 C. The H. gastric cancer. J Physiol Pharmacol. 2003; 54 Suppl 3: pylori antigen was detected by HPAT kit (Diagnostic 23-41 Bioprobes srI company, Italy). Maternal serum also was 2. Brown LM. Helicobacter pylori: epidemiology and routes studied for H.pylori IgG antibody by ELISA. The rate of of transmission. Epidemiol Rev. 2000; 22: 283-297 H.pylori infection in breast fed infants was 32% and in 3. Okuda M, Miyashiro E, Koike M, Okuda S, Minami K, formula fed infants was 60% (p=0.006). The rate of Yoshikawa N. Breast-feeding prevents Helicobacter pylori H. pylori antibody in mothers of both groups (breast infection in early childhood. Pediatr Int. 2001; 43: 714- milk and formula fed) was similar and 70%. 715 We found that the incidence of H.pylori infection is 4. Fujimura S, Kato S, Nagai K, Kawamura T, Iinuma K. significantly lower in the infants who are exclusively Detection of Helicobacter pylori in the stools of newborn breast fed. infants. Pediatr Infect Dis J. 2004; 23: 1055-1056 ACKNOWLEDGEMENT From: Department of Pediatrics, Gastroenterohepatology The authors would like to thank the office of Research Center, Nemazee Hospital Shiraz University Vice-Chancellor for Research of Shiraz University of of Medical Sciences, Shiraz, Iran. Medical Sciences for financial support and Dr. Davood Mehrabani at Center for Development of Clinical studies Address for Correspondence: Mohammad of Nemazee Hospital for editorial assistance. Ashkan Moslehi, MD, Pediatrician, Department of Pediatrics, Nemazee Hospital, Shiraz, Iran. REFERENCES Email: [email protected] 1. Konturek JW. Discovery by Jaworski of Helicobacter pylori and its pathogenetic role in peptic ulcer, gastritis and E-published: 1st August 2011. Art#52 LETTER TO EDITOR (VIEWERS CHOICE) A RARE CASE OF KINGELLA KINGAE OSTEOMYELITIS OF LEFT FEMUR IN A NEWBORN Rahul Sinha A 3.5kg term female neonate was delivered to 24 in a high risk of concomitant septic arthritis in these yrs old primigravida by emergency cesarean section joints (3). The most commonly affected joints are the (for breech with meconiun stained liquor). Baby was hip joints (31%), knee joints (25%), and ankle joints well till day 4 of life when she developed high grade (18%) (4). Affected neonates usually survive, but with fever, lethargy, poor feeding and swelling over left permanent skeletal deformities (5). Etiologically, the upper third of thigh. She was shifted to neonatal most common organisms affecting the joints in the intensive care unit (NICU) and detailed examination neonatal period are aerobes. The predominant aerobes revealed unhealthy umbilicus with marked swelling, causing osteomyelitis in children are Staphylococcus tenderness and fluctuation of left upper third of thigh aureus, Haemophilus influenzae type-b, Gram-negative with marked restriction of movements at left hip joint. enteric bacteria, beta-haemolytic Streptococci, Investigations revealed hemoglobin of 15gm%, white Streptococcus pneumoniae, Bartonella henselae and cell count of 34,000/cmm with polymorphs 76% and Borrelia burgdorferi. Anaerobes have rarely been platelets of 2,80,000/cmm. Peripheral smear showed reported as a cause of these infections in children. toxic granules, CRP was 24 mg/dl, ESR 40 mm at Many patients with osteomyelitis due to anaerobic end of 1hour. X ray of left femur showed a significant bacteria have evidence of anaerobic infection elsewhere periosteal reaction in the proximal humerus, along in the body, which is the source of the organisms with an irregularity at the proximal metaphysis. The involved in osteomyelitis (6,7). Kingella kingae often umbilical swab and local aspirate grew kingella kingae. colonizes the oropharyngeal and respiratory tracts of She was treated meropenem and vancomycin for 3 children but infrequently causes invasive disease (7). weeks and analgesics along with skin traction for 7 K. kingae is a slow-growing, fastidious, gram-negative days. microorganism that colonizes mucous membranes of Osteoarticular infections, although uncommon, the upper respiratory tract (8). To our knowledge this represent a severe condition in neonates. Infections in is the first reported case of Kingella osteomyelitis in newborns are largely of an acute nature, transmitted early neonatal period from India. by haematogenous means (1). The osteomyelitic focus is usually found in the metaphysis of a long REFERENCES bone, although infection may spread to the contiguous 1. Dessi A, Crisafulli M, Accossu S, Setzu V, Fanos V. Osteo- epiphysis and joint in neonates (1,2). The intracapsular articular infections in newborns: diagnosis and treatment. metaphysis of proximal femur and humerus, results J Chemother 2008; 20: 542-550 Pediatric Oncall July - September 2011. Volume 8 Issue 3 79 http://www.pediatriconcall.com 2. Haddad F, Sahyoun S, Maalouf G. [Neonatal osteomyelitis arthritis caused by Kingella kingae among child care center of the proximal femur: a case with ten-year follow-up attendees. Pediatrics. 2005; 116: e206. and review of the literature]. Rev Chir Orthop Reparatrice 8. Shelton MM, Nachtigal MP, Yngve DA, Herndon WA, Riley Appar Mot 2007; 93: 594-598 HD Jr. Kingella kingae osteomyelitis: report of two cases 3. Lamprecht E. Acute osteomyelitis in childhood. Orthopade. involving the epiphysis. Pediatr Infect Dis J. 1988; 7: 421- 1997; 26: 868-878 424. 4. Halder D, Seng QB, Malik AS, Choo KE. Neonatal septic arthritis. Southeast Asian J Trop Med Public Health. 1996; From: Department of Pediatrics, Military Hospital, 27: 600-605 Pathankot, Punjab, India. 5. Brook I. Joint and bone infections due to anaerobic bacteria Address for Correspondence: Dr Rahul Sinha, in children. Pediatr Rehabil. 2002; 5: 11-19 Department of Pediatrics, 167 Military Hospital, 6. Dich VQ, Nelson JD, Haltalin KC. Osteomyelitis in Infants and Children: A Review of 163 Cases. Am J Child. 1975; C/O 56 APO, Pathankot, Punjab 145001, India. 129: 1273-1278 Email: [email protected] 7. Kiang KM, Ogunmodede F, Juni BA, Boxrud DJ, Glennen E-published: 1st September 2011. Art#57 A, Bartkus JM, et al. Outbreak of osteomyelitis/septic LETTER TO EDITOR (VIEWERS CHOICE) CAN RETINA BE NORMAL IN AICARDI SYNDROME? Asok Kumar Datta, Indrajit Mondal A three and half years old muslim girl, born of syndrome though in some cases it may not be present a non-consanguineous marriage was admitted with (4) as was seen in our patient. uncontrolled recurrent infantile spasms since 4th day Acknowledgement: Dr. Shyamal Mitraneogi, of birth for which she was hospitalized 15 times and Professor and Head of the Department of Radio- had received anticonvulsive treatment initially with monotherapy and then gradually polytherapy. She was diagnosis for helping us in radiological investigations delivered by caesarean section and cried immediately and interpretation after birth. She had no other perinatal complications. Competing Interests: None There was gross developmental delay. She neither developed social smile nor could she sit or stand. She Authors contribution: AKD was responsible for was not able to hear or see. Her mother, 29 years old patient care and writing of manuscript, IM helped in had two successive abortions in early months, first one performing different investigations. All authors have at 4 months and second one at 2 months of gestation. read and approved the manuscript On examination the patient had spasticity. Examination of the fundus was normal. Other systems were normal. REFERENCES Investigations showed cortical dysrhythmia on EEG. 1. Hopkins IJ, Humphrey IK, Keith CG, Susman M, Webb GC, MRI of brain showed partial agenesis of corpus callosum Turner EK. The Aicardi syndrome in a 47 XXY male. Aust mainly in posterior portion of the body and splenum, Paediatr J. 15: 278-280 thalamus and periventricular region. Cross sectional 2. Hopkins B, Sutton VR, Lewis RA, Van den Veyver I, Clark MRI study revealed mild hyper intensities in bilateral G. Neuroimaging aspects of Aicardi syndrome. Am J Med putamen. Thus she was diagnosed as Aicardi syndrome Genet A. 2008; 146A: 2871-2878 without retinal involvement. 3. Sutton VR, Hopkins BJ, Eble TN, Gambhir N, Lewis RA, Aicardi syndrome is a severe neurodevelopment Van den Veyver IB. Facial and physical features of Aicardi disorder initially thought to be the triad of partial Syndrome: infants to teenagers. Am J Med Genet A. 2005; agenesis of corpus callosum, choroidoretinal lacunae 138A: 254-258 and infantile spasm. It is an X- linked dominant 4. Chevrie JJ, Aicardi J. The Aicardi syndrome. In: Pedley disorder affecting only females, usually males are TA and Meldrum BS, eds. Recent Advances in Epilepsy. not compatible with extrauterine life except some Edinburgh: Churchill Livingstone; 1986:3 47XXY (1). Infantile spasm usually starts in earlier and is very difficult to control. There is global mental From: Department of Pediatrics, Burdwan Medical retardation, visual defects and hearing defects. Other College, India. features present in subsets of affected individuals are costovertebral anomalies, facial dysmorphism, Address for Correspondence: Dr Asok Kumar Datta, hand abnormalities, hypopigmentary skin lesions, Ulhas, CRAV 01, Joteram, Burdwan-713101. India. multiple nevi, and an increased occurrence of rare Email: [email protected] vascular malformations and tumors along with other brain malformations (2,3). Chorioretinal lacunae are E-published: 1st September 2011. Art#58 considered one of the pathognomonic sign of Aicardi Pediatric Oncall July - September 2011. Volume 8 Issue 3 80.
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