The prognosis for the common forms of infectious arthritis encountered in infants and children is excellent. The major complications of neonatal, childhood, and gonococcal arthritis are loss of joint function resulting from damage to the articular surface. The highest incidence of these complications occurs with hip and shoulder infections, presumably resulting from avascular necrosis. The high incidence of concurrent suppurative arthritis with adjacent osteomyelitis in neonates places the epiphyseal growth plate at high risk for growth abnormalities. Neonates with osteomyelitis have an approximately 40% to 50% likelihood of growth disturbances with loss of longitudinal bone growth and ultimate limb shortening.
There are no effective means to prevent hematogenous
S. aureus arthritis. Universal immunization of infants with conjugate Hib vaccine has practically eliminated serious bacterial infections from this organism, including bone and joint infections.
Acute conjunctivitis is usually a bacterial or viral infection of the eye characterized by a rapid onset of symptoms that persist for a few days. Nontypable Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis account for approximately two thirds of bacterial causes (Table 1191). Other causes include Neisseria gonorrhoeae and Pseudomonas aeruginosa, which is associated with extended-wear soft contact lenses. Viral conjunctivitis most commonly is caused by adenoviruses, which cause epidemic keratoconjunctivitis, and less frequently by coxsackieviruses and other enteroviruses. Keratitis, or inflammation of the cornea, is not commonly associated with conjunctivitis but occurs with N. gonorrhoeae, herpes simplex virus (HSV), and adenovirus infections.
Neonatal conjunctivitis, or ophthalmia neonatorum, is purulent conjunctivitis during the first month of life, usually acquired during birth. The common causes of neonatal conjunctivitis, in order of decreasing prevalence, are chemical conjunctivitis secondary to silver nitrate gonococcal prophylaxis, Chlamydia trachomatis, common bacterial causes of conjunctivitis, Escherichia coli, other gram-negative enteric bacilli, HSV, and N. gonorrhoeae.
Conjunctivitis is common in young children, especially if they come in contact with other children with conjunctivitis. Predisposing factors for bacterial infection include nasolacrimal duct obstruction, sinus disease, ear infection, and allergic disease when children rub their eyes frequently. Conjunctivitis occurs in 1% to 12% of neonates. A mild to moderate chemical conjunctivitis commonly is present from 24 to 48 hours of age in most newborns who receive ophthalmic silver nitrate as gonococcal prophylaxis. Approximately 50% of infants born vaginally to infected mothers have neonatal acquisition of C. trachomatis, in which the risk of chlamydial conjunctivitis (inclusion conjunctivitis) is 25% to 50%.
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Symptoms include redness, discharge, matted eyelids, and mild photophobia. Physical examination findings include chemosis, injection of the conjunctiva, and edema of the eyelids. Corneal involvement suggests gonococcal or herpetic infection. Herpetic corneal lesions appear as dendritic or ameboid ulcers or, more commonly, in recurrent infection, as a deep keratitis. Unilateral conjunctivitis with ipsilateral otitis media is often caused by nontypable H. influenzae.