Arthritis in children with bacterial meningitis
S. Likitnukul, G. H. McCracken Jr and J. D. Nelson
Forty-eight patients with arthritis and meningitis were identified by
hospital chart review among 2,089 cases of bacterial meningitis treated
between 1969 and 1984. The etiologic agents were Haemophilus influenzae in
38 cases (79%), Neisseria meningitidis in nine cases (19%), and
Staphylococcus aureus in one case (2%). Thirteen patients had more than one
joint affected: two affected joints, ten patients; three affected joints,
two patients; and four affected joints, one patient. The elbow (34%) and
knee (29%) were most frequently affected. Joint-fluid aspirations were done
in 44 patients; 22 cases (50%) had bacteria or bacterial antigen identified
in joint fluid by culture, Gram's stain, or counter-immunoelectrophoresis:
H influenzae (20 cases), N meningitidis (one case), and S aureus (one
case). Of the 48 patients, 14 patients were noted to have arthritis at the
time of diagnosis of meningitis, 16 patients on the first to sixth day, and
17 patients on the seventh day of treatment or later; one patient developed
arthritis 12 days after treatment of H influenzae meningitis had been
stopped. Fourteen cases with a culture-proved bacterial etiology of the
arthritis developed arthritis within four days of treatment; the exception
was a patient who developed arthritis after treatment of meningitis was
stopped. Of the 21 patients with culture-negative joint fluid and who
developed arthritis later in the course of treatment, 19 patients were
considered to have possible immune complex arthritis. Management consisted
of antibiotic therapy in all patients, open incision and drainage in 17
patients (36%), and multiple aspirations in 12 patients (25%). Of the
remaining 19 patients, 15 patients had a single arthrocentesis performed
and four patients had no aspiration. Early-onset arthritis appeared to be
related to bacteremia whereas late-onset arthritis may be immune complex
mediated.
