Tehran University Medical Journal

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Background: Septic arthritis in neonates can be difficult to diagnose and may be associated with severe morbidity and even mortality. A majority of apparent septic arthritis cases may have a negative culture, thereby creating a dilemma regarding treatment. The present study investigates demographic, laboratory and clinical variables of septic arthritis in neonates hospitalized over a period of 17 years.
Methods: The medical files of all neonates hospitalized in Imam Khomeini and Vali-e-Asr Hospitals in Tehran, Iran, from 1989 to 2005 were assessed and the files of 59 neonates with a diagnosis of septic arthritis were further evaluated. Variables such as age, sex, gestational age, birth weight, history of hospitalization, body temperature, involved joints, blood and joint fluid cultures, ESR, CRP, and WBC count were evaluated in this group of hospitalized patients. Results: Of the 59 neonates, 39 cases were male and 20 cases were female. At the time of hospitalization, 45.8% of the neonates were 20-28 days old and 52.2% were 10-20 days old, and 67.7% and 35.6% of cases had been preterm and had low birth weight, respectively. Histories of hospital admission were found for 30.5% of patients. The two most common joints involved were hip (30.5%) and knee (23.72%). The mean body temperature was 36.6oC. ESR was elevated in all patients (mean 85 mm/h) and CRP was positive in all cases. The WBC count was >15,000/mm3 in 39% of the neonates and was in the range of 10,000-15,000/mm3 for 47.4%. Blood and joint fluid cultures were positive in 51% and 91.5% of cases, respectively. The organisms isolated from joint fluid culture were Klebsiella (54%), S. aureus (37%) and E. coli (9%). Conclusion: Due to the rarity of septic arthritis in neonates and paucity of signs and symptoms, all neonates with a high index of suspicion should be examined carefully with septic arthritis in mind.

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Background: Helicobacter pylori (Hp) infection often occurs in childhood and adolescence, with the frequency increasing with age. Hp infection is associated with insufficient hygiene, overcrowding and low socioeconomic status. Although declining in developed countries, children in the developing countries continue to have a high prevalence of Hp infection. As the association of Hp infection with chronic abdominal pain is not ubiquitously accepted, in this study we investigate the significance of endoscopic finding associated with Hp infection in children with abdominal tenderness.

Methods: This cross-sectional study included 1,665 healthy children, aged 6 to 12 years, in whom Hp infection was evaluated using the IgG anti-H. pylori test. Hp-positive children with epigastric tenderness underwent upper gastrointestinal (GI) endoscopy. Urease activity of gastric mucosal biopsies was measured. The presence and density of Hp organisms, the presence of follicular gastritis, and the nature of inflammation and gastritis activity were assessed by histologic examination.

Results: Of 1665 children, 429 (26%) subjects (51% girls, 49% boys) were seropositive for H. pylori. There was a significant association between Hp infection and older age (p<0.001) and male/female ratio (p<0.05). Epigastric tenderness was detected in 39 children (1%), 29 of whom underwent upper GI endoscopy. Nodular gastritis with antral erythema was the most common endoscopic finding (26/29 89.7%). Histological findings revealed that, in all cases with endoscopic nodularity, lymphoid follicles were present. Bacterial density was low in 13 (44.8%), moderate in 14 (48.2%) and high in 2 (7%) subjects.

Conclusion: The findings of the present study demonstrated that antral nodularity is the most common feature in children with Hp infection and epigastric tenderness was significantly associated with histological findings of lymphoid follicles.