A Artrite Séptica (AS) é a infecção duma articulação, geralmente por bactérias embora outros microorganismos a possam provocar também. Trata-se de um processo potencialmente devastador, uma verdadeira "tragédia articular" e…

A Tríada Séptica Infeliz da criança angolana
Acessos: 839
Piomiosite, Osteomielite e Artrite Séptica são processos infecciosos independentes. Quando aparecem concatenados numa mesma criança constituem o que denomino como a Tríada Séptica Infeliz do sistema musculoesquelético imaturo. A Tríada Séptica Infeliz (TSI) é das principais causas de sequelas musculoesqueléticas em crianças angolanas.

Piomiosite provocada por tratamento tradicional
A Tríada Séptica Infeliz (TSI)
A Piomiosite é a infecção bacteriana do músculo estriado, a Osteomielite é a infecção bacteriana do osso e a Artrite Séptica é a infecção bacteriana nas articulações. Todas elas partilham os mesmos agentes etiológicos, tem uma fisiopatogenia bastante similar e frequentemente aparecem de cascata num mesmo paciente.
A Piomiosite – com origem ate num furúnculo simples – origina uma bacteriemia que infecta ao osso. Em articulações com extremos ósseos intra-articulares, o abcesso formado como parte desta osteomielite drena na cavidade articular provocando uma Artrite Séptica.
Pelo frequente deste cenário no nosso meio e pelo nefasto das consequências, a TSI deve fazer parte do diagnostico diferencial sempre que temos uma criança com sinais de infecção musculosquelética.
O médico que observa uma criança com marcha antálgica e febre deve suspeitar infecção. Em media, a criança tem 3-4 dias de evolução antes de procurar assistência. A fase inflamatória inicial está no fim ou já passou. É na fase inflamatória onde os antibióticos tem total eficácia, de aí a importância de começar cedo o tratamento. Assim que houver pus fica mais complicado porque a cirurgia quase sempre é mandatória.
Crianças com claudicação antálgica e febre, nunca devem aguardar pelo ortopedista para iniciar tratamento antibiótico. Em causa pode estar a TSI, que coloca em risco a vida do paciente e que sempre deixa sequelas quando tratadas tardiamente.
Quer de forma isolada, quer como parte da tríada, qualquer destas infecções deve ser tratada de imediato, esperar pelo ortopedista é comprometer o prognostico. É augúrio de uma catástrofe.
Tenho observado que a má evolução nesta tríada deriva quase sempre do atraso no início do tratamento. De aguardar pela avaliação do ortopedista. Toda criança com claudicação antálgica e febre ou como sinais de miosite sem evidencias de trauma, tem uma TSI ate se demonstrar o contrario.
Se suspeita infecção comece de imediato tratamento com o antibiótico mais eficaz ao seu dispor, de preferência por via endovenosa. Saiba que qualquer dos “integrantes” da TSI tem uma evolução, “rápida e furiosa”, capaz de comprometer em poucas horas o futuro ou a vida da criança.
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