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Staphylococcal infection we are treating is chronic?

Thank you for a very useful Q&A!

My seven-year-old complains with knee and leg pain and that she suddenly feels she cannot walk. She has CF. We do not listen to carefully, but then, I found this on the web (


2) Episodic (acute) arthritis

Hereby it deals in the first row with a typical so-called “CF-arthritis”. Hereby it deals in general with an acute illness. The joint problems occur asymmetrically and affect small or large joints. The complaints last mostly only for a limited time about 7-14 days. One assumes, that the reactions of the joints are caused by so-called immuno-reactions, which are based on the chronic bacterial inflammation of the lung.

For making the diagnosis, only few things can be found. On the x-ray, swelling of the soft tissues or effusions can be seen. In the laboratory, negative results for the rheumatic factors occur, in single cases so-called immuno-complexes (ANCA) can be positive.

As therapy, painkillers should be used. Of essential importance is an agressive antibiotic therapy.

Question: are we given a clue that the staphylococcal infection we are treating is cronic? are we given a clue that the x-ray and ultrasound from the last yearly check-up really show bacterial infection? might this speed up how and that we treat this?

Thank you for your question which I will try to answer in two parts.
The first part I think asks if Staphylococcal infection is chronic? Staphylococcal infection is sometimes transient in children and adults with Cystic Fibrosis but on some occasions can become a chronic infection. There are some different approaches to therapy. In some centres every positive isolate of S. aureus is treated with oral antibiotics, while in others long term antibiotics such as Flucloxicillin are used to prevent infection. There is not a huge amount of solid evidence to support long term therapy and a couple of studies have suggested that there is an increase in Pseudomonas infection when other long term antibiotics such as as Cephalexin are used (CF Trust Antibiotic Guidelines).

The second part asks about CF arthropy. With regard to CF arthrophothy this is quite hard to diagnose. Many young people have various aches and pains and in a 7 year old with CF, other causes outside of CF should be considered. Particularly with knee pain this can be caused by Osgood-Schlatter disease which is a well-recognised cause of knee pain in the first decade, usually in young people who are very active. I’m not clear from your question as to whether your daughter has had investigations including X-ray, Ultrasound or Immunology. These are all usually negative in CF arthrophothy. People can also get arthroid positive arthritis which may be better considered as rheumatoid arthritis rather than CF.

The role of infection is unproven in CF arthritis but it is generally very good advice that infection should be treated.

I hope this answers your question
Best wishes
Stuart Elborn

Antibiotic Treatment for Cystic Fibrosis. Third edition. May 2009.