| Summary: | Don L Goldenberg1 in his helpful seminar on septic arthritis, does not mention septic arthritis in children from developing countries. Septic arthritis is rare in children from developed countries but is fairly common in sub-Saharan Africa.2, 3, 4 and 5During 15 months in 1981and#x2013;82, we prospectively studied 88 cases of septic arthritis seen in the paediatric department of the Queen Elizabeth Central Hospital (QECH) in Blantyre.2 Salmonella spp were the causative agents in 20 (23%) cases. Staphylococcus aureus, and#x3b2;-haemolytic streptococcus, and Haemophilus influenzae accounted for only nine (10%), ten (11%), and three (3%) cases, respectively. The salmonella arthritis occurred during the rainy season among children younger than 5 years who were often underweight and anaemic. The shoulder was the most frequently affected joint and we postulated that predeliction for this site may have been due to repeated minor trauma to the joint when a child was lifted by the upper arm on to his mother's back.In rural Zambia, during 14 months in 1992and#x2013;93, Lavy and Lavy5 found that 26 of 33 cases of septic arthritis in children aged under 3 years were due to Salmonella spp. They also reported that the shoulder joint was most commonly affected and the children were malnourished and anaemic. No child with sickle-cell disease was identified in either study. The study in Malawi was undertaken 3 years before the first case of HIV-1 was reported in the country. In the Zambian study, all ten children who were tested for HIV-1 antibodies were negative.In 1996and#x2013;97, salmonellae were isolated from 158 (45%) of 350 positive blood cultures taken in the paediatric department of the QECH, Blantyre. 62 joints were aspirated and 38% of the aspirates grew salmonellae on culture. 16 (73%) of 22 shoulder joints were infected with a salmonella of which 14 were S typhimurium. In our situation, salmonellae are sensitive to chloramphenicol and it is our first-choice antibiotic for septic arthritis. Cetriaxone, as advised by Goldenberg, would be effective but is too expensive and seldom available.
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