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Mulualem B, Belay G, Bogale EK. Magnitude of chronic osteomyelitis and its associated factors in children as diagnosed on X-ray visiting at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia: A cross-sectional study. SAGE Open Med 2023; 11:20503121231161191. [PMID: 36949827 PMCID: PMC10026118 DOI: 10.1177/20503121231161191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/15/2023] [Indexed: 03/19/2023] Open
Abstract
Objectives To assess the magnitude of chronic osteomyelitis and its associated factors in children at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia, in 2022. Methods A hospital-based cross-sectional study was done between April 15, 2022 and August 15, 2022, in children with an age of 18 years or below, who visited Felege Hiwot Comprehensive Specialized Hospital. A total sample size of 168 participants was involved in the study. The random sampling technique was applied to select the study participants. The data were collected from the patients, their charts, and X-ray requests. The data were cleaned, stored, checked for completeness, and entered into EpiData Version 3.1, which were then exported to SPSS Version 23 for analysis. Descriptive analysis was done, and bivariable and multivariable logistic regression were used for analysis. Results The prevalence of chronic osteomyelitis was found to be 86.3%. The tibia and femur were the most commonly involved bones, and metaphyseal involvement was very common. The most common radiological findings were sequestrum (56%) and involucrum (53%). Of the total patients with radiological evidence of chronic osteomyelitis, 16.6% had complications, the most common of which was a pathologic fracture (12.4%). Being male (adjusted odds ratio = 6.162, 95% confidence interval: 1.12-34.147), being over 10 years old (adjusted odds ratio = 4.048, 95% confidence interval: 1.032-15.886), living in a rural area (adjusted odds ratio = 4.046, 95% confidence interval: 1.236-13.364), having a discharging sinus (adjusted odds ratio = 5.237, 95% confidence interval: 1.393-19.693), having a clinical complaint lasting more than 1 year (adjusted odds ratio = 5.189, 95% confidence interval: 1.247-21.588), and a preceding event of trauma (adjusted odds ratio = =10.363, 95% confidence interval: 1.101-97.509) were the factors associated with chronic osteomyelitis. Conclusion The prevalence of chronic osteomyelitis is high. In this study, being male, being in the age group above 10 years, having rural residency, having a discharging sinus, having a clinical complaint duration of more than 1 year, and having a preceding event of trauma were the factors associated with chronic osteomyelitis. Therefore, healthcare providers should have a high index of suspicion of chronic osteomyelitis in older male children from rural areas with a chronic discharging sinus following trauma.
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Affiliation(s)
- Biruk Mulualem
- School of Medicine and Health Sciences,
Department of Dermatovenereology, Bahir Dar University, Bahir Dar, Amhara,
Ethiopia
| | - Genetu Belay
- School of Medicine and Health Sciences,
Department of Dermatovenereology, Bahir Dar University, Bahir Dar, Amhara,
Ethiopia
| | - Eyob Ketema Bogale
- Health Promotion and Behavioral
Sciences Department, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
- Eyob Ketema Bogale, Health Promotion and
Behavioral Sciences Department, Bahir Dar University, Bahir Dar, Amhara,
Ethiopia.
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Salman R, Mcgraw M, Naffaa L. Chronic Osteomyelitis of Long Bones: Imaging Pearls and Pitfalls in Pediatrics. Semin Ultrasound CT MR 2022; 43:88-96. [PMID: 35164913 DOI: 10.1053/j.sult.2021.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chronic bacterial osteomyelitis is characterized by progressive inflammatory bone destruction and apposition of new bone most often caused by pyogenic bacteria. Clinical findings are nonspecific, and serum inflammatory markers can be normal. Prompt diagnosis and treatment are essential. Left untreated, chronic infection can lead to high morbidity and mortality. Imaging's major role is to suggest the correct diagnosis, exclude other diagnoses that can mimic osteomyelitis, document extent of disease, and guide interventions such as image-guided biopsy or surgical debridement. Several conditions can mimic chronic osteomyelitis clinically and radiographically. The main differential diagnoses include an oncologic process, chronic nonbacterial or chronic recurrent multifocal osteomyelitis, bone infarct in sickle cell disease, osteoid osteoma, and stress reaction/fracture. The oncologic process to consider includes metastatic neuroblastoma and Langerhans cell histiocytosis in a child younger than five years or leukemia, Ewing sarcoma, and osteosarcoma in the older age group. However, these lesions can typically be excluded based on radiographs and magnetic resonance imaging findings. Therefore, radiologist familiarity with imaging findings and mimickers is essential. In this article, we briefly review the epidemiologic, clinical, and histopathologic features of chronic bacterial osteomyelitis and emphasize imaging pearls and pitfalls, with discussion of the most common differential diagnoses.
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Affiliation(s)
- Rida Salman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Marty Mcgraw
- Radiology Department, Nemours Children's Hospital, Orlando, FL
| | - Lena Naffaa
- University of Central Florida, Radiology Department, Nemours Children's Hospital, Orlando, FL.
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Stephan AM, Faino A, Caglar D, Klein EJ. Clinical Presentation of Acute Osteomyelitis in the Pediatric Emergency Department. Pediatr Emerg Care 2022; 38:e209-e213. [PMID: 32881826 DOI: 10.1097/pec.0000000000002217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Acute osteomyelitis is a challenging diagnosis to make in the pediatric emergency department (ED), in part because of variability in its presentation. There are limited data detailing the presenting features of pediatric osteomyelitis, factors that are essential to understand to inform diagnostic decision making. We sought to describe relevant clinical data that contributed to the diagnosis of acute osteomyelitis in children presenting to a pediatric ED. METHODS This was a 10-year retrospective cohort study of patients 18 years or younger diagnosed with acute osteomyelitis in the ED of a large tertiary care children's hospital. Collected data included demographics, clinical history, patient-reported symptoms, vital signs, physical examination findings, and results of basic laboratory, microbiologic, and imaging studies. Descriptive statistics were used to summarize key findings. RESULTS Two hundred eleven cases of acute osteomyelitis were identified during the study period. The median age was 8.4 years, with 61.1% male. One hundred twenty-seven patients (60.2%) presented to care more than once before being diagnosed. Common symptoms included pain (94.3%), functional limitation (83.9%), and fever (76.3%). Common examination findings included functional limitation (78.2%), focal tenderness (73.5%), and swelling (52.1%). One hundred seventeen patients (55.5%) were febrile during their ED evaluation. Elevated C-reactive protein (>0.8 mg/dL, 92.9%) and erythrocyte sedimentation rate (>10 mm/h, 94.3%) were the most sensitive laboratory markers. CONCLUSIONS Fever may be absent in up to a quarter of pediatric patients with acute osteomyelitis. Although highly sensitive, inflammatory marker elevations were more modest than those reported previously in cases of pediatric septic arthritis.
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Affiliation(s)
- Alexander M Stephan
- From the Division of Emergency Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine
| | - Anna Faino
- Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Washington
| | - Derya Caglar
- From the Division of Emergency Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine
| | - Eileen J Klein
- From the Division of Emergency Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine
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Diagnosis and Management of Osteomyelitis in Children. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00763-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lansell A, Vasili Y, Suchdev PS, Figueroa J, Kirpalani A. Impact of antibiotic pretreatment on cultures in children with osteomyelitis and septic arthritis: a retrospective review. BMC Pediatr 2021; 21:342. [PMID: 34389010 PMCID: PMC8361620 DOI: 10.1186/s12887-021-02806-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the management of pediatric osteomyelitis or septic arthritis, delay in treatment may affect outcome, while receipt of antibiotics prior to culture may affect culture results. We aimed to determine if pathogen identification decreased in cultures that were pretreated with antibiotics. METHODS We conducted a retrospective cohort study of 584 hospitalized children between 30 days and 18 years of age admitted to two tertiary children's hospitals. Logistic regression assessed the effect of antibiotic duration on blood, bone, joint aspirate, and "other" culture positivity. RESULTS Overall, 42% of blood cultures, 70% of bone cultures, 39% of joint cultures, and 70% of "other" cultures were positive. Compared with children who did not receive antibiotics prior to culture, there were no significant differences in odds of a positive culture in children whose cultures were pretreated with antibiotics for any of the culture types [OR (95% CI) 0.90 (0.56-1.44) for blood cultures, 0.77 (0.25-2.34) for bone cultures, 0.71 (0.39-1.28) for joint cultures, 1.18 (0.58-2.41) "for other" cultures; all p > 0.05]. Furthermore, the duration (hours) of antibiotics in the pretreated cultures was also not a significant predictor of culture positivity (OR ranged from 0.99-1.00 for all cultures, p > 0.05). CONCLUSIONS Culture positivity was not associated with antibiotic pretreatment in any of the samples, even for longer duration of antibiotics prior to culture, though the small sample size of subgroups is an important limitation. In pediatric patients hospitalized with osteomyelitis and/or septic arthritis, early initiation of antibiotics may not affect culture positivity.
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Affiliation(s)
- Amanda Lansell
- Children's Healthcare of Atlanta, Atlanta, Georgia. .,Emory University Department of Pediatrics, Atlanta, Georgia. .,Rainbow Babies and Children's Hospital, Cleveland, OH, USA. .,Present Address: Department of Pediatrics, Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Yasasvi Vasili
- Emory University Department of Pediatrics, Atlanta, Georgia
| | - Parminder S Suchdev
- Children's Healthcare of Atlanta, Atlanta, Georgia.,Emory University Department of Pediatrics, Atlanta, Georgia
| | - Janet Figueroa
- Emory University Department of Pediatrics, Atlanta, Georgia
| | - Anjali Kirpalani
- Children's Healthcare of Atlanta, Atlanta, Georgia.,Emory University Department of Pediatrics, Atlanta, Georgia
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Henry M, Lundy FH. Oral Antibiotic Management of Acute Osteomyelitis of the Hand: Outcomes and Cost Comparison to Standard Intravenous Regimen. Hand (N Y) 2021; 16:535-541. [PMID: 34260293 PMCID: PMC8283108 DOI: 10.1177/1558944719873145] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: Acute, direct inoculation osteomyelitis of the hand has traditionally been managed by intravenous antibiotics. With proven high levels of bone and joint penetration, specific oral antimicrobials may deliver clinical efficacy but at substantially lower cost. Methods: Sixty-nine adult patients with surgically proven acute, direct inoculation osteomyelitis of the hand were evaluated for clinical response on a 6-week postdebridement regimen of susceptibility-matched oral antibiotics. Inclusion required gross purulence and bone loss demonstrated at the initial debridement and radiographic evidence of bone loss. Excluded were 2 patients with extreme medical comorbidities. There were 53 men and 16 women with a mean age of 46 years. Mean follow-up was 16 weeks (±10). The cost model for the outpatient oral antibiotic treatment was intentionally maximized using Walgreen's undiscounted cash price. The cost model for the traditional intravenous treatment regimen was intentionally minimized using the fully discounted Medicare fee schedule. Results: All patients achieved resolution of osteomyelitis by clinical and radiographic criteria. In addition, 7 patients underwent successful subsequent osteosynthesis procedures at the previously affected site without reactivation. The mean postdebridement direct cost of care per patient in the study cohort was $482.85, the cost of the antibiotic alone. The postdebridement direct cost of care per patient on a regimen of vancomycin 1.5 g every 12 hours via peripherally inserted central catheter line was $21 646.90. Conclusions: Acute, direct inoculation osteomyelitis of the hand can be successfully managed on oral antibiotic agents with substantial direct and indirect cost savings.
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Affiliation(s)
- Mark Henry
- Hand & Wrist Center of Houston, TX, USA,Mark Henry, Hand & Wrist Center of Houston, 1200 Binz Street, 13th Floor, Houston, TX 77006, USA.
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Bartoloni A, Aparisi Gómez MP, Cirillo M, Allen G, Battista G, Guglielmi G, Tomà P, Bazzocchi A. Imaging of the limping child. Eur J Radiol 2018; 109:155-170. [PMID: 30527299 DOI: 10.1016/j.ejrad.2018.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/28/2018] [Accepted: 10/20/2018] [Indexed: 01/09/2023]
Abstract
Limping is a challenging symptom in the pediatric patient as the diagnosis can range from traumatic, malformative, infectious/inflammatory and neoplastic diseases. In this paper, we propose a schematic imaging algorithm to the limping child in three different age groups (Toddler: 1-3years, child: 4-10 years; adolescent: 11-16 years) based on presence of signs of infection, any specific localization of pain, and history of trauma. In this setting, the most common imaging pitfalls are also summarised. Finally, a literature review of the main differential causes of limping in the pediatric patient is reported.
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Affiliation(s)
- Alessandra Bartoloni
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Sant' Onofrio 4, 00165 Roma, Italy
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, 2 Park Road, Grafton, 1023 Auckland, New Zealand; Department of Radiology, Hospital Nueve de Octubre, Calle Valle de la Ballestera, 59, 46015 Valencia, Spain
| | - Marco Cirillo
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Sant' Onofrio 4, 00165 Roma, Italy
| | - Georgina Allen
- Department of Radiology, St Lukes Radiology Oxford Ltd, Oxford, UK
| | - Giuseppe Battista
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, 71100 Foggia, Italy; Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Foggia, Italy
| | - Paolo Tomà
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Sant' Onofrio 4, 00165 Roma, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136 Bologna, Italy.
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Wijesekara PNK, Kumbukgolla WW, Jayaweera JAAS, Rawat D. Review on Usage of Vancomycin in Livestock and Humans: Maintaining Its Efficacy, Prevention of Resistance and Alternative Therapy. Vet Sci 2017; 4:vetsci4010006. [PMID: 29056665 PMCID: PMC5606620 DOI: 10.3390/vetsci4010006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/05/2017] [Accepted: 01/22/2017] [Indexed: 12/27/2022] Open
Abstract
Vancomycin is one of the “last-line” classes of antibiotics used in the treatment of life-threatening infections caused by Gram-positive bacteria. Even though vancomycin was discovered in the 1950s, it was widely used after the 1980s for the treatment of infections caused by methicillin-resistant Staphylococci, as the prevalence of these strains were increased. However, it is currently evident that vancomycin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci have developed for various reasons, including the use of avaparcin—an analog of vancomycin—as a feed additive in livestock. Therefore, prophylactic and empiric use of antibiotics and their analogues need to be minimized. Herein we discuss the rational use of vancomycin in treating humans, horses, farm animals, and pet animals such as dogs, cats, and rabbits. In present day context, more attention should be paid to the prevention of the emergence of resistance to antibiotics in order to maintain their efficacy. In order to prevent emergence of resistance, proper guidance for the responsible use of antimicrobials is indispensable. Therefore, almost all stakeholders who use antibiotics should have an in-depth understanding of the antibiotic that they use. As such, it is imperative to be aware of the important aspects of vancomycin. In the present review, efforts have been made to discuss the pharmacokinetics and pharmacodynamics, indications, emergence of resistance, control of resistance, adverse effects, and alternative therapy for vancomycin.
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Affiliation(s)
| | - Wikum Widuranga Kumbukgolla
- Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University Mihintale, Mihintale 50008, Sri Lanka.
| | | | - Diwan Rawat
- Department of Chemistry, University of Delhi, Delhi 110007, India.
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Jødal L, Nielsen OL, Afzelius P, Alstrup AKO, Hansen SB. Blood perfusion in osteomyelitis studied with [ 15O]water PET in a juvenile porcine model. EJNMMI Res 2017; 7:4. [PMID: 28091979 PMCID: PMC5237436 DOI: 10.1186/s13550-016-0251-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/16/2016] [Indexed: 11/20/2022] Open
Abstract
Background Osteomyelitis is a serious disease which can be difficult to treat despite properly instituted antibiotic therapy. This appears to be related at least partly to degraded vascularisation in the osteomyelitic (OM) lesions. Studies of perfusion in OM bones are, however, few and not quantitative. Quantitative assessment of perfusion could aid in the selection of therapy. A non-invasive, quantitative way to study perfusion is dynamic [15O]water positron emission tomography (PET). We aim to demonstrate that the method can be used for measuring perfusion in OM lesions and hypothesize that perfusion will be less elevated in OM lesions than in soft tissue (ST) infection. The study comprised 11 juvenile pigs with haematogenous osteomyelitis induced by injection of Staphylococcus aureus into the right femoral artery 1 week before scanning (in one pig, 2 weeks). The pigs were dynamically PET scanned with [15O]water to quantify blood perfusion. OM lesions (N = 17) in long bones were studied, using the left limb as reference. ST lesions (N = 8) were studied similarly. Results Perfusion was quantitatively determined. Perfusion was elevated by a factor 1.5 in OM lesions and by a factor 6 in ST lesions. Conclusions Blood perfusion was successfully determined in pathological subacute OM lesions; average perfusion was increased compared to that in a healthy bone, but as hypothesized, the increase was less than in ST lesions, indicating that the infected bone has less perfusion reserve than the infected soft tissue. Electronic supplementary material The online version of this article (doi:10.1186/s13550-016-0251-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lars Jødal
- Department of Veterinary Disease Biology, University of Copenhagen, Copenhagen, Denmark. .,Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark. .,Department of Nuclear Medicine, Aalborg University Hospital, P.O. Box 365, 9100, Aalborg, Denmark.
| | - Ole L Nielsen
- Department of Veterinary Disease Biology, University of Copenhagen, Copenhagen, Denmark
| | - Pia Afzelius
- Department of Diagnostic Imaging, North Zealand Hospital, Hillerød, Copenhagen University Hospital, Copenhagen, Denmark
| | - Aage K O Alstrup
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Søren B Hansen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
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Thévenin-Lemoine C, Vial J, Labbé JL, Lepage B, Ilharreborde B, Accadbled F. MRI of acute osteomyelitis in long bones of children: Pathophysiology study. Orthop Traumatol Surg Res 2016; 102:831-837. [PMID: 27641643 DOI: 10.1016/j.otsr.2016.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/20/2016] [Accepted: 06/29/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The classic pathophysiology of acute osteomyelitis in children described by Trueta has a metaphyseal infection as the starting point. This hypothesis was recently brought into question by Labbé's study, which suggested a periosteal origin. Thus, we wanted to study this disease's pathophysiology through early MRI examinations and to look for prognostic factors based on abnormal findings. MATERIAL AND METHODS This was a prospective, multicentre study that included cases of long bone osteomyelitis in children who underwent an MRI examination within 7days of the start of symptoms and within 24hours of the initiation of antibiotic therapy. We also collected clinical, laboratory and treatment-related data. RESULTS Twenty patients were included, including one with a bifocal condition. The lower limb was involved in most cases (19/21). Staphylococcus aureus was found most frequently. Metaphyseal involvement was present in all cases. No isolated periosteal involvement was found in any of the cases. No prognostic factors were identified based on the various abnormal findings on MRI. CONCLUSION Our study supports the metaphyseal origin of acute osteomyelitis in children. LEVEL OF EVIDENCE II.
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Affiliation(s)
- C Thévenin-Lemoine
- Service d'orthopédie pédiatrique, hôpital des Enfants, Toulouse, France.
| | - J Vial
- Service d'imagerie médicale pédiatrique, hôpital des Enfants, Toulouse, France
| | - J L Labbé
- Service de chirurgie orthopédique, centre hospitalier térritorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - B Lepage
- Service d'épidémiologie médicale, hôpital Purpan, Toulouse, France
| | - B Ilharreborde
- Service d'orthopédie pédiatrique, hôpital Robert-Debré, Paris, France
| | - F Accadbled
- Service d'orthopédie pédiatrique, hôpital des Enfants, Toulouse, France
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Abstract
PURPOSE To review the records of 24 paediatric patients treated for acute bacterial osteomyelitis. METHODS Records of 14 male and 10 female paediatric patients (mean age, 9.4 years) who underwent medical treatment alone (n=3) or combined with surgery (n=21) for acute bacterial osteomyelitis were reviewed. Medical treatment included use of antibiotics and supportive care. Surgery was indicated when the largest dimension of fluid collection was >1 cm. RESULTS Of the 24 patients, Staphylococcus aureus was isolated in 18, group-D salmonella in 3, and no organism in 3. The mean time from admission to diagnosis was 1.87 days. For those treated surgically, the mean time from diagnosis to surgery was 1.19 days and the mean time from admission to surgery was 2.86 days. Four patients underwent multiple surgeries, 2 of whom developed chronic osteomyelitis and also had negative culture and delayed surgery by >10 days previously. No other patient had any complications. CONCLUSION Early surgical intervention for acute bacterial osteomyelitis in children increased diagnostic yield with cultures. For patients with fluid collection <1 cm in the largest dimension, medical treatment alone was effective. Patients with complications were characterised by negative culture, multiple surgeries, and delayed surgery.
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Affiliation(s)
- A Cc Chou
- Duke-NUS Graduate Medical School, Singapore Health Services, Singapore
| | - A Mahadev
- Duke-NUS Graduate Medical School, Singapore Health Services, Singapore & KK Women's and Children's Hospital, Singapore
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The Use of C-reactive Protein as a Guide for Transitioning to Oral Antibiotics in Pediatric Osteoarticular Infections. J Pediatr Orthop 2016; 36:173-7. [PMID: 25929777 DOI: 10.1097/bpo.0000000000000427] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In the treatment of pediatric osteoarticular infections, early transition to oral antibiotics is desirable to shorten hospital stays and complications of prolonged intravenous therapy. C-reactive protein (CRP) is an acute phase reactant with a short half-life and is utilized at our institution to monitor progress and determine the transition to oral antibiotics. We hypothesized that patients can be safely transitioned from parenteral antibiotics to oral antibiotics when patients improve clinically and CRP halves over a period of 4 days. MATERIALS AND METHODS A retrospective review was conducted of all pediatric patients between the ages of 1 month and 18 years admitted and treated for acute bacterial osteomyelitis and/or septic arthritis at the authors' institution. We recorded all relevant data, inpatient progress, and outpatient follow-up. RESULTS Thirty-seven patients fulfilled the selection criteria and were reviewed for this study. Patients were an average of 8.37±4.91 years old. Surgery was performed in 33 patients (89.2%). The average duration of intravenous antibiotics was 11.00±5.61 days and the average duration of oral antibiotics was 28.76±8.69 days, with an average total duration of antibiotics of 39.16±9.08 days. The average peak CRP was 156.91±97.81 mg/L and the average CRP at discharge was 24.94±22.36 mg/L. Thirty-four patients (91.89%) experienced a 50% decline in CRP over 4 days. Of these patients, only 1 (2.94%) went on develop complications in the follow-up period. The average hospitalization period was 11.50±6.55 days. The average duration of follow-up was 7.83±6.56 months. CONCLUSIONS We found that the combination of clinical improvement and a specific reduction of 50% in CRP levels over 4 days, or 5 CRP half lives, could be used to determine when to transition children with osteoarticular infections from parenteral to oral therapy. Complicated outcomes were associated with negative cultures, longer hospitalizations, and persistently elevated CRP levels.
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Brischetto A, Leung G, Marshall CS, Bowen AC. A Retrospective Case-Series of Children With Bone and Joint Infection From Northern Australia. Medicine (Baltimore) 2016; 95:e2885. [PMID: 26937926 PMCID: PMC4779023 DOI: 10.1097/md.0000000000002885] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Our clinical workload as infectious diseases pediatricians in northern Australia is dominated by complicated bone and joint infections in indigenous children. We reviewed the clinical presentation, microbiology, management, and outcomes of children presenting to Royal Darwin Hospital with bone and joint infections between 2010 and 2013, and aimed to compare severity and incidence with other populations worldwide.A retrospective audit was performed on children aged 0 to 18 years who were admitted to Royal Darwin Hospital between 1 January 2010 and 31 December 2013 with a bone and joint infection.Seventy-nine patients were identified, of whom 57 (72%) had osteomyelitis ± associated septic arthritis and 22 (28%) had septic arthritis alone. Sixty (76%) were indigenous Australians. The incidence rate of osteomyelitis for indigenous children was 82 per 100,000 children. Staphylococcus aureus was the confirmed pathogen in 43/79 (54%), of which 17/43 (40%) were methicillin resistant. Median length of stay was 17 days (interquartile range: 10-31 days) and median length of IV antibiotics was 15 days (interquartile range: 6-24 days). Fifty-six (71%) required at least 1 surgical procedure. Relapse within 12 months was documented in 12 (15%) patients.We report 3 key findings: osteomyelitis incidence in indigenous children of northern Australia is amongst the highest reported in the world; methicillin-resistant S aureus accounts for 36% of osteomyelitis with a positive microbiological diagnosis; and the severity of disease requires extended antibiotic therapy. Despite this, 15% of the cohort relapsed within 12 months and required readmission.
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Affiliation(s)
- Anna Brischetto
- From the Department of Infectious Diseases (AB, GL, CSM, ACB), Royal Darwin Hospital; Department of Infectious Diseases (ACB); Princess Margaret Hospital (ACB), Perth; Menzies School of Health Research (ACB), Darwin; and Telethon Kids Institute (ACB), University of Western Australia, Perth, Australia
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Epiphysial Separation of Femoral Head Due to Undiagnosed Hip Septic Arthritis. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2014. [DOI: 10.5812/rijm.17730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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van Schuppen J, van Doorn MMAC, van Rijn RR. Childhood osteomyelitis: imaging characteristics. Insights Imaging 2012; 3:519-33. [PMID: 22875760 PMCID: PMC3443272 DOI: 10.1007/s13244-012-0186-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 07/05/2012] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this review is to illustrate the imaging findings of childhood osteomyelitis. The diagnosis of childhood osteomyelitis can be challenging. Clinical presentation and laboratory results can differ and are relatively unreliable. To date, its role in the assessment of treatment efficacy is not yet clear. Methods This review article provides an overview of the different imaging modalities and imaging characteristics of childhood osteomyelitis. Levels of evidence for different modalities are presented. Results Paediatric radiology plays a pivotal role in the diagnosis of childhood osteomyelitis and can also be used to guide therapy and intervention. Conclusion Although imaging is essential in the diagnostic process, cooperation between the physician and radiologist remains the cornerstone in accurately diagnosing childhood osteomyelitis. Main Messages • Imaging plays a pivotal role in the diagnosis of childhood osteomyelitis. • Cooperation between the clinician and radiologist is a very important aspect of making the diagnosis. • The initial imaging modality in childhood osteomyelitis is conventional imaging. • Normal conventional imaging does not exclude osteomyelitis.
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Affiliation(s)
- Joost van Schuppen
- Department of Radiology, Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands,
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Johansen L, Koch J, Frees D, Aalbæk B, Nielsen O, Leifsson P, Iburg T, Svalastoga E, Buelund L, Bjarnsholt T, Høiby N, Jensen H. Pathology and Biofilm Formation in a Porcine Model of Staphylococcal Osteomyelitis. J Comp Pathol 2012; 147:343-53. [DOI: 10.1016/j.jcpa.2012.01.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/19/2011] [Accepted: 01/21/2012] [Indexed: 11/28/2022]
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Zaichick S, Zaichick V. Neutron activation analysis of Ca, Cl, Mg, Na, and P content in human bone affected by osteomyelitis or osteogenic sarcoma. J Radioanal Nucl Chem 2012. [DOI: 10.1007/s10967-012-1645-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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20
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Local osteogenic expression of cyclooxygenase-2 and systemic response in porcine models of osteomyelitis. Prostaglandins Other Lipid Mediat 2012; 97:103-8. [PMID: 22266364 DOI: 10.1016/j.prostaglandins.2012.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 12/19/2011] [Accepted: 01/06/2012] [Indexed: 01/23/2023]
Abstract
It is suggested that cyclooxygenase 2 (COX-2) derived prostaglandins contributes to the progressive bone loss seen in osteomyelitis lesions. In the present study we examined the expression of COX-2 in bones from 23 pigs with experimental osteomyelitis. Osteomyelitis was induced with Staphylococcus aureus and groups of animals were euthanized following 6 h, 12 h, 24 h, 2 days, 5 days, 11 days and 15 days, respectively. Expression of COX-2 was evaluated immunohistochemically and combined with characterization of morphological changes in bone tissue. Furthermore, the serum concentrations of alkaline phosphatase and haptoglobin were measured. Extensive COX-2 expression by osteoblasts was present 2 days after inoculation together with many activated osteoclasts. Simultaneously, the serum concentration of alkaline phosphatase decreased whereas the haptoglobin concentration increased. This is the first in vivo study showing an early wave of COX-2 mediated bone resorption during osteomyelitis. Therefore, treatment aiming to reduce the break down of bone tissue directed by the COX-2 pathway might be suggested early in the course of the disease.
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21
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Imaging Pediatric Musculoskeletal Infection. Tech Orthop 2011. [DOI: 10.1097/bto.0b013e31823a07df] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sreenivas T, Nataraj AR, Menon J, Patro DK. Acute multifocal haematogenous osteomyelitis in children. J Child Orthop 2011; 5:231-5. [PMID: 22654984 PMCID: PMC3100464 DOI: 10.1007/s11832-011-0347-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 04/25/2011] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Haematogenous multifocal osteomyelitis in children represents a dangerous form of osteomyelitis in which sepsis can develop quickly if it is not treated early. A retrospective analysis of 26 children with acute multifocal haematogenous osteomyelitis over a period of 5 years was undertaken in order to assess the clinical presentation, infective organism, laboratory investigations and risk factors involved. METHODS Children more than 1 year of age with two or more bones involvement presenting within one week from the onset of symptoms were included in this study. All of the children were evaluated by clinical examination, blood tests and local ultrasound. RESULTS The average age at presentation was 4.9 years and girls were affected more than boys, with a female to male ratio of 1.4. Lower limbs were affected in 92% of cases, and, specifically, the tibia in 73.1% of the patients. Blood culture was positive in 38.5% of our cases. The predominant microorganism isolated from surgical samples was Staphylococcus aureus, among which methicillin-resistant S. aureus (MRSA) was found in 50% of the patients. Surgical drainage of the pus was done in 24 cases, followed by appropriate antibiotics, and two cases were treated by conservative means. All of the children were successfully treated except for four, who developed chronic osteomyelitis and sequelae. CONCLUSION We conclude that acute multifocal haematogenous osteomyelitis in children needs early diagnosis by a high index of clinical suspicion and adequate treatment with timely intervention. The predominance of MRSA in our study shows the changing trend in its association with multiple bone involvement.
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Affiliation(s)
- T. Sreenivas
- Department of Orthopedics, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Pondicherry, 605006 India
| | - A. R. Nataraj
- Department of Orthopedics, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Pondicherry, 605006 India
| | - Jagdish Menon
- Department of Orthopedics, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Pondicherry, 605006 India
| | - D. K. Patro
- Department of Orthopedics, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Pondicherry, 605006 India
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Abstract
The imaging approach to osteomyelitis has evolved in the past two decades. Advances in MRI allow for whole body imaging, decreasing the need for scintigraphy when symptoms are not localized or the disease may be multifocal. There is an increasing clinical need for depiction of abscesses in the soft tissues and subperiosteal space, particularly because methicillin-resistant Staphylococcus aureus infections constitute more than one-third of all the infections. The increasing emphasis on radiation dose reduction has also led away from scintigraphy and computed tomography. MR imaging has become the advanced imaging modality of choice in osteomyelitis. There is an increasing understanding of the appropriate role for gadolinium enhancement, which is not indicated when the pre-gadolinium images are normal. Other related infections, including pyomyositis, are best imaged with MRI.
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Kim BN. Oral Agents for the Treatment of Orthopedic Infections Caused by Methicillin-resistant Staphylococci. Infect Chemother 2011. [DOI: 10.3947/ic.2011.43.4.322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Baek-Nam Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
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Vandoorne K, Magland J, Plaks V, Sharir A, Zelzer E, Wehrli F, Hemmings BA, Harmelin A, Neeman M. Bone vascularization and trabecular bone formation are mediated by PKB alpha/Akt1 in a gene-dosage-dependent manner: in vivo and ex vivo MRI. Magn Reson Med 2010; 64:54-64. [PMID: 20572141 DOI: 10.1002/mrm.22395] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PKBalpha/Akt1, a protein kinase, is a major mediator of angiogenic signaling. The purpose of this study was to determine the role of PKB alpha/Akt1 in bone vascularization and development. For that aim, macromolecular dynamic contrast enhanced MRI was applied to examine in vivo vascular changes in long bones of 40-day-old growing PKB alpha/Akt1-deficient, heterozygous, and wild-type mice. Ex vivo microMRI and microCT were applied to monitor the impact of PKB alpha/Akt1 gene dosage on trabecular bone formation during endochondral bone growth. PKB alpha/Akt1-deficient mice and, remarkably, also heterozygous mice showed significantly reduced blood volume fraction in the humerus compared to wild-type mice. Moreover, PKB alpha/Akt1-deficient mice showed a more severe vascular deficiency with reduced permeability. microCT and microMRI of trabeculae revealed impaired bone formation in both PKB alpha/Akt1-deficient and heterozygous mice, whereas cortical bone parameters were only reduced in PKB alpha/Akt1-deficient mice. Reduction of metaphyseal blood vessel invasion, concomitant with aberrant trabeculae and shorter long bones, demonstrates a gene-dose-dependent role for PKB alpha/Akt1 in regulation of overall size and endochondral bone growth. MRI proved to provide high sensitivity for in vivo detection of subtle gene dose effects leading to impaired bone vascularity and for uncovering changes in trabecular bone.
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Affiliation(s)
- Katrien Vandoorne
- Biological Regulation, The Weizmann Institute of Science, Rehovot, Israel
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Karmazyn B. Imaging Approach to Acute Hematogenous Osteomyelitis in Children: An Update. Semin Ultrasound CT MR 2010; 31:100-6. [DOI: 10.1053/j.sult.2009.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hematogenous infantile infection presenting as osteomyelitis and septic arthritis: a case report. CASES JOURNAL 2009; 2:8293. [PMID: 19830063 PMCID: PMC2740290 DOI: 10.4076/1757-1626-2-8293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 06/24/2009] [Indexed: 11/08/2022]
Abstract
The case of a 6-month old male infant presenting at the emergency department with fever and swelling at the left knee joint is discussed. Laboratory tests showed an inflammatory condition. Left knee plain radiograph demonstrated local soft tissue oedema. Percutaneous needle aspiration of articular fluid showed a positive culture for Staphylococcus aureus. The diagnosis of septic arthritis was confirmed. Because of inadequate response to treatment an MRI study was followed to evaluate possible abscesses. The presence of an abscess in the suprapatellar bursa was confirmed and an additional inflammatory process of the bone marrow was revealed, consistent with osteomyelitis. The pathophysiology, the imaging findings, the patient's management and a review of septic arthritis and osteomyelitis coexistence are presented in this paper.
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Knaap SF. Undiagnosed Brodie abscess in a gymnast after surgical fixation of a tibial fracture. J Chiropr Med 2007; 6:159-62. [PMID: 19674711 PMCID: PMC2647100 DOI: 10.1016/j.jcme.2007.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2007] [Revised: 06/24/2007] [Accepted: 08/08/2007] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study presents a case of a posttraumatic subacute osteomyelitis in a child with leg pain. CLINICAL FEATURES A 10-year-old female gymnast with leg pain presented to a chiropractic clinic after having been treated over the previous year for a leg fracture. The patient had leg pain associated with prolonged use of her right leg, restlessness at night, and tenderness over the right tibia. The history did not suggest a mechanical cause of the patient's pain. All available radiographs were reviewed by the chiropractor; a diffuse lytic lesion with bone thickening and sclerosis was clearly visible in the area of the patient's chief complaint, representing a Brodie abscess. INTERVENTION AND OUTCOME The doctor of chiropractic sent the patient back to the hospital. She was treated first with oral antibiotics, which were not successful. She underwent surgery and recovered well. CONCLUSION Subacute osteomyelitis may have a diagnostic delay; thus, it is possible for a chiropractor to see this condition in the office. A good case history, examination, and radiographs are important for the diagnosis and to make a proper referral.
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Rozmanic V, Banac S, Miletic D, Manestar K, Kamber S, Paparic S. Role of magnetic resonance imaging and scintigraphy in the diagnosis and follow-up of osteomyelitis in cat-scratch disease. J Paediatr Child Health 2007; 43:568-70. [PMID: 17635689 DOI: 10.1111/j.1440-1754.2007.01141.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cat-scratch disease (CSD) is a self-limiting infectious disease characterised with lymphadenopathy in a patient with a history of cat contact. Cases of bone involvement in patients with CSD are rare. We reported a case of 11-year-old boy with prolonged intermittent fever, inguinal lymphadenopathy and osteomyelitis. He had a history of exposure to kittens. The physical examination revealed a febrile boy without an apparent site of infection except an enlarged inguinal lymph node. Its histopathology demonstrated granulomatous lesion with no presence of acid-fast bacilli. Serum titers for Bartonella henselae were positive. Multiple bone lesions were detected by skeletal scintigraphy. Magnetic resonance imaging (MRI) confirmed and characterised osteolytic masses. The oral combination of azithromycin and rifampicin were given for 6 weeks with a good clinical response. At follow-up, the boy was without symptoms or signs of the disease. Successive MRI controls showed gradual regression of the bone lesions together with significant decrease of acute-phase reactants. In conclusion, CSD should be considered in the differential diagnosis of osteomyelitis. MRI is more reliable for the characterisation, evaluation of soft-tissue extension and follow-up of the bone lesions than scintigraphy. However, the later method permits an overview of the multiple osseous lesions. Therefore, standard MRI equipment may not exclude bone scintigraphy. Both methods are required until whole-body MRI units become routine.
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Affiliation(s)
- Vojko Rozmanic
- Department of Pediatrics, University of Rijeka, Rijeka, Croatia.
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&NA;. Treat children with acute haematogenous osteomyelitis with sequential intravenous/oral ??-lactamase-resistant penicillins. DRUGS & THERAPY PERSPECTIVES 2005. [DOI: 10.2165/00042310-200521100-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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