Haemophilus influenzae Type b Septic Arthritis in Children: Report of 23 Cases

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Abstract
Cases (23) of H. influenzae type b septic arthritis seen over a recent 5-yr period are reviewed. The natural history of the disease includes a mean 3 days of fever and joint symptoms prior to hospitalization, often accompanied or immediately preceded by a viral illness and/or otitis media. Concurrent H. influenzae type B meningitis was present in 30% of patients and concurrent osteomyelitis in 22%. Infants remained febrile in the hospital for a mean of 3.6 consecutive days. However, secondary and prolonged fevers were common. Clinical improvement in the joint examination was first seen at a mean of 2.5 days. Characteristic laboratory findings during recovery included a decline in total WBC [white blood cell] count, neutrophil count, ESR [erythrocyte sedimentation rate] and Ht, with a concomitant increase in lymphocyte and platelet counts. Outpatient follow-up for a mean duration of 20 mo. found only 2 of 21 infants with residual impairment. The time to total healing in the remaining 19 infants, however, varied widely.sbd.from 9 days to 17 mo. (mean of 4 mo.).