Salmonella septic arthritis of the shoulder in Zambian children

Nineteen children under the age of two with salmonella septic arthritis (SSA) of the shoulder presented to Mukinge Hospital between 1st January 1992 and 31st March 1993. There were 13 boys and six girls. All patients were below the 50th centile for weight. The most common presentation was swelling, pyrexia and non-use of the arm. Pain was not always present. All patients were anaemic but in many cases had both WBC and ESR in the normal range. All patients were treated with drainage and antibiotics. All made a good recovery and were discharged pain free, apyrexial and using the affected arm. One patient was re-admitted because of recurrent infection. Nine patients reviewed after one month had continued good function with no clinical sign of infection. We conclude that where intestinal salmonella are endemic, low nutritional status is likely to be a factor in the development of a bacteraemia, and that the intra-articular extension of the proximal humeral metaphysis and repetitive minor trauma to the joint are predisposing factors to the development of shoulder infection.