In developing countries, chronic osteomyelitis often results from untreated acute hematogenous osteomyelitis but may also be seen as sequelae of trauma war injuries. Acute osteomyelitis almost invariably occurs in children. Update on the management of pediatric acute osteomyelitis. Chronic recurrent multifocal osteomyelitis in children. Th e lack of normal disc signal at the circled segment black arrow represents infection.
Acute hematogenous osteomyelitis aho is particularly common in children 3 months old without medical comorbidities or penetrating trauma. Osteomyelitis is a bacterial infection of the bone associated with inflammation and bone destruction with an estimated incidence of approximately 8 per 100,000 children each year in highincome countries. Pathophysiology and pathogenesis of osteomyelitis 5 fig. They were mostly normal children with a single focus of infection. First, surgery makes it possible to obtain biological samples that are useful for identifying the etiologic agent and then guiding the selection of the correct antibiotic to use for treatment. Pdf acute bacterial osteomyelitis in children researchgate.
Paediatric bone and joint infection management childrens health. Children with sickle cell disease are at an increased risk for bacterial infections, and osteomyelitis is the second most common infection in these patients. The epidemiology, pathogenesis, and microbiology of hematogenous osteomyelitis in children will be discussed here. Records of 14 male and 10 female paediatric patients mean age, 9. In children, osteomyelitis most commonly occurs at the ends of the long bones of the arms and legs, affecting the hips, knees, shoulders, and wrists. In highincome countries, acute osteomyelitis occurs in about 8 of 100,000 children per year,2 but it is considerably more common in lowincome countries. To compare the age distribution, clinical manifestations, and radiographic findings, especially magnetic resonance imaging mri, in children. Twentynine children with pneumococcal osteomyelitis andor arthritis, 11 of whom had osteomyelitis, were treated at cook county hospital, chicago, ill, in the past 20 years. Chronic osteomyelitis may also be seen after traumatic injuries, especially in times of civil unrest or war, or as a complication of surgical procedures. The infection can be caused via the bloodstream or through an infected adjacent tissue. Update on the management of pediatric acute osteomyelitis and.
In infants and young children, the infection usually results from hematogenous spread and involves the metaphyses of long bones, most often the tibia or femur. Bone infections in children are primarily hematogenous in origin, although cases secondary to penetrating trauma, surgery, or infection in a contiguous site are also reported. Consider bone or joint infection in any child who has one or more of the following. The principal cause of osteomyelitis in children is staphylococcus aureus, and both the epidemiology and pathogenesis of s. Unless acute osteomyelitis in children is diagnosed promptly and treated appropriately, it can be a devastating or even fatal disease.
Pneumococcal osteomyelitis and arthritis in children. Chronic recurrent multifocal osteomyelitis crmo in children is an inflammatory disorder. Osteomyelitis is a common bacterial infection of the bone that accounts for about 1% of all pediatric hospitalizations. Together with antibiotics, surgery plays a key role in the treatment of acute osteomyelitis and septic arthritis in children. Acute haematogenous osteomyelitis om and septic arthritis sa are serious conditions, may be life. Osteomyelitis from a contiguous focus of infection e. Osteomyelitis in children and adults in children, osteomyelitis is usually acute. When adults are affected, it may be because of compromised host resistance due to debilitation, intravenous drug. Neonates are more likely to develop the multifocal disease while infants and children usually develop osteomyelitis of a single long bone. Acute haematogenous osteomyelitis in children the bmj. Clinical practice guidelines by the infectious diseases society of.
This condition is characterized by areas of devitalized bonesoft tissue sequestra, which serve as a nidus for recurrent episodes of infection. In adults, it is more common in the bones of the spine vertebral osteomyelitis, feet, or in the pelvis. Diagnosis and management of osteomyelitis of osteomyelitis. In majority of children, osteomyelitis affects the long bones of the body which are the legs and the upper arm whereas in the adult population osteomyelitis. The purpose of this study was to determine whether the use of fatsuppressed contrastenhanced mri, compared with unenhanced mri alone, increases reader confidence in the diagnosis of osteomyelitis and its complications in children. Meticillin resistant staphylococcus aureus osteomyelitis in particular is on the increase. In children, an acute bone infection is most often hematogenous in origin.
The pathogenesis of acute osteomyelitis and septic arthritis may occur with three different mechanisms. Acute osteomyelitis in children is an infection of the bone of less than two weeks duration. Current clinicalpractice guidelines of the in fectious diseases. The appendicular skeleton is the most common site of osteomyelitis. The clinical features, evaluation, diagnosis, and management of osteomyelitis in children are discussed separately. Acute hematogenous osteomyelitis american academy of. Antibiotic management of pediatric osteomyelitis sandra arnold, m. About half of the time, it happens in children under 5 years of age. The most common type of osteomyelitis, an infection of bone, that occurs in children is acute hematogenous osteomyelitis.
Some of them are growth disturbances, joint instability, chronic infection, misalignment and limb deformity. The incidence appears to be independent of the length of time from the injury to surgery. Kingella kingae in children children, osteomyelitis is more common in the long bones of the arms and legs. Management of acute hematogenous osteomyelitis in children. Children may present insidiously, hence careful history and clinical examination with a high index of suspicion are required. In developing countries, chronic osteomyelitis often results from untreated acute hematogenous osteomyelitis but may also be. Acute osteomyelitis in children is an infection of the bone of less than two weeks duration, which typically spreads haematogenously. Acute osteomyelitis in child 3 months old without medical comorbidities or penetrating trauma. The most common organisms involved in osteomyelitis in children with sickle cell anemia include salmonella species, s aureus, serratia species, and proteus mirabilis. Acute osteomyelitis in children new england journal. Acute osteomyelitis and septic arthritis are two infections whose frequencies are. This type of spinal infection is seen more commonly in children.
Osteomyelitis as stated is the name given to an infection of the bone. In children, the disease usually results from untreated acute hematogenous osteomyelitis. Discitis and vertebral osteomyelitis are uncommon entities, and diagnosis often is confounded by their similar clinical presentation, because characteristic radiographic findings are not evident until late in the course of illness. Acute osteomyelitis and septic arthritis in children. Acute osteomyelitis and septic arthritis in children european. Multiple osseous lesions and systemic infection were. Rare causes of osteomyelitis in pediatric patients are mycobacterium. Several points uncertainty exist regarding the antimicrobial management of acute hematogenous osteomyelitis, total duration of therapy and the use of oral stepdown to oral therapy following a period of parenteral therapy. In highincome countries, acute osteomyelitis occurs in about 8 of 100,000 children. Hematogenous osteomyelitis is much less common in adults than in children.
Acute hematogenous osteomyelitis aho is a bone infection resulting from the hematogenous spread of bacteria without direct inoculation and is an important cause of hospitalization and morbidity among children. Acute osteomyelitis comes on quickly, is easier to treat, and overall turns out better than chronic osteomyelitis. In children, osteomyelitis is more common in the long bones of the arms and legs. The first mechanism is the most frequently described in children. In neonates and infants, the clinical presentation may be barely appreciable or completely absent. Only 1 to 2 percent of prosthetic joints become infected. Acute hematogenous osteomyelitis in children ochsner journal. History of antibiotic treatment of osteomyelitis open. Osteomyelitis in pediatric patients is an important disease, because children are constantly growing and if the infection reaches the physis and epiphysis because of the delayed diagnosis, serious sequelae may appear. It typi cally involves the vertebrae, but can occur in the long bones, pelvis, or clavicle. Infection is more common in the long bones of the body, but it can affect any bone in the body. G19 osteomyelitis pathophysiology and treatment decisions. Osteomyelitis, or inflammation of the bone, is usually caused by bacterial infection.
1228 1121 952 687 694 535 1102 861 408 1486 829 657 874 234 170 356 897 1356 969 493 1337 971 1253 319 422 181 931 278 60 213 971 1284 143 140 1132 1144 539 1211 755 322 11 1179 912 688 427 77 487 134 943