Abstract: Introduction: Neonatal septic arthritis has a potential for disastrous sequels with long term disability, especially with joint destruction, instability and growth disturbances. But recent trend shows an increase in fungal septic arthritis. Fungal infections are not readily recognised, do not advertise their presence in a characteristic fashion, and the causative organism is generally not easy to demonstrate in tissue. The purpose of this study was to assess the incidence, identify the risk factors predisposing to fungal infection, its management and outcome.
Method: The study was conducted at paediatric hospital in Karnataka. All neonates diagnosed with septic arthritis were included. The neonates were assessed and managed as per our institutional protocol. All cases meeting the criteria underwent arthrocentesis followed by mini-approach arthrotomy of affected joint. The pus was sent for culture and sensitivity, fungal culture and gram staining. Data was collected with regards to organism grown, sensitivity pattern, antenatal, birth history and post-natal period to identify risk factor for infection.
Results: 26 of 132 children with septic arthritis had fungal septic arthritis. Candida species was noted to be the most common fungal infection followed by Malassezia furfur. The mean age of patients was 18 days and the mean age of presentation 18 days, 80% of them needed NICU care during first week of life. 65% of them had low birth weight. Hip joint was most commonly affected. 72% had no growth on initial culture and Six had concomitant infection with Klebsiella. 64% had delayed ossification of femur epiphysis and 5 had frank septic sequalae.
Conclusion: There is an increasing incidence of fungal septic arthritis and it should be kept in mind while treating a neonatal septic arthritis. Early diagnosis and aggressive line of treatment with a prolonged follow up is needed to reduce the morbidity of the disease.
