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Mulla D, Levinsky Y, Marcus N, Kagan S, Goldberg L, Vardi Y, Brody Y, Rom E, Bar-Sever Z, Scheuerman O. Evolving Approach to Antibiotic Treatment of Pediatric Spondylodiscitis. J Pediatr 2024:114189. [PMID: 38992719 DOI: 10.1016/j.jpeds.2024.114189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 06/28/2024] [Accepted: 07/07/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE To describe for intervertebral spondylodiscitis (IS) its clinical characteristics, treatment approaches with intravenous (IV) antibiotics, and clinical implications of changes in treatment approach. STUDY DESIGN This retrospective study included all children aged 0 through18 years diagnosed with imaging-confirmed thoracic and lumbar IS from 2000 to 2022 at a tertiary pediatric hospital. Patients with longer intravenous (IV) treatment regimen were compared with those with a shorter clinically directed IV to oral regimen. RESULTS In all, 124 cases were included with median age 14.9 months (IQR 12.7-19.4) at diagnosis. Irritability and pain while changing diapers were common symptoms (52.4% and 49.2%, respectively). Elevated erythrocyte sedimentation rate (ESR) was the most common laboratory finding (95%, median 50 [IQR 34-64] mm/h). Elevated ESR was found in higher proportions (95%) compared with elevated CRP (76%, median 1.8 mg/dL; P< 0.001). Since implementing the shorter clinically directed IV treatment duration for patients with thoracic and lumbar IS, hospitalization duration was reduced from a median of 12 to 8 days (P =0.008) and IV treatment duration by a median of 14 to 8 days (P<0.001). Only 1(1.6%) patient in the clinically directed treatment group required re-hospitalization due to failure of therapy. Conversely, 9/124 children in the cohort suffered from IV treatment related complications; all had been treated IV for prolonged periods. CONCLUSION Early transition to oral treatment in pediatric spondylodiscitis appears to be appropriate clinically, and shortens hospital stay and intravenous treatment duration without major negative clinical impact.
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Affiliation(s)
- Doron Mulla
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Yoel Levinsky
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Nufar Marcus
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Shelly Kagan
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Lotem Goldberg
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Yoav Vardi
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Yael Brody
- Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Eran Rom
- Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Zvi Bar-Sever
- Institute of Nuclear Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Pediatric Infectious Disease Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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2
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Marin JR, Lyons TW, Claudius I, Fallat ME, Aquino M, Ruttan T, Daugherty RJ. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Technical Report. Pediatrics 2024; 154:e2024066855. [PMID: 38932719 DOI: 10.1542/peds.2024-066855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 06/28/2024] Open
Abstract
Advanced diagnostic imaging modalities, including ultrasonography, computed tomography, and magnetic resonance imaging, are key components in the evaluation and management of pediatric patients presenting to the emergency department. Advances in imaging technology have led to the availability of faster and more accurate tools to improve patient care. Notwithstanding these advances, it is important for physicians, physician assistants, and nurse practitioners to understand the risks and limitations associated with advanced imaging in children and to limit imaging studies that are considered low value, when possible. This technical report provides a summary of imaging strategies for specific conditions where advanced imaging is commonly considered in the emergency department. As an accompaniment to the policy statement, this document provides resources and strategies to optimize advanced imaging, including clinical decision support mechanisms, teleradiology, shared decision-making, and rationale for deferred imaging for patients who will be transferred for definitive care.
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Affiliation(s)
- Jennifer R Marin
- Departments of Pediatrics, Emergency Medicine, & Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Todd W Lyons
- Division of Emergency Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Ilene Claudius
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Mary E Fallat
- The Hiram C. Polk, Jr Department of Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky
| | - Michael Aquino
- Cleveland Clinic Imaging Institute, and Section of Pediatric Imaging, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Timothy Ruttan
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin; US Acute Care Solutions, Canton, Ohio
| | - Reza J Daugherty
- Departments of Radiology and Pediatrics, University of Virginia School of Medicine, UVA Health/UVA Children's, Charlottesville, Virginia
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3
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Marin JR, Lyons TW, Claudius I, Fallat ME, Aquino M, Ruttan T, Daugherty RJ. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Technical Report. J Am Coll Radiol 2024; 21:e37-e69. [PMID: 38944445 DOI: 10.1016/j.jacr.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Advanced diagnostic imaging modalities, including ultrasonography, computed tomography, and magnetic resonance imaging (MRI), are key components in the evaluation and management of pediatric patients presenting to the emergency department. Advances in imaging technology have led to the availability of faster and more accurate tools to improve patient care. Notwithstanding these advances, it is important for physicians, physician assistants, and nurse practitioners to understand the risks and limitations associated with advanced imaging in children and to limit imaging studies that are considered low value, when possible. This technical report provides a summary of imaging strategies for specific conditions where advanced imaging is commonly considered in the emergency department. As an accompaniment to the policy statement, this document provides resources and strategies to optimize advanced imaging, including clinical decision support mechanisms, teleradiology, shared decision-making, and rationale for deferred imaging for patients who will be transferred for definitive care.
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Affiliation(s)
- Jennifer R Marin
- Departments of Pediatrics, Emergency Medicine, & Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Todd W Lyons
- Division of Emergency Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Ilene Claudius
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Mary E Fallat
- The Hiram C. Polk, Jr Department of Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky
| | - Michael Aquino
- Cleveland Clinic Imaging Institute, and Section of Pediatric Imaging, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Timothy Ruttan
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin; US Acute Care Solutions, Canton, Ohio
| | - Reza J Daugherty
- Departments of Radiology and Pediatrics, University of Virginia School of Medicine, UVA Health/UVA Children's, Charlottesville, Virginia
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Polat M, Derinkuyu BE, Tapisiz A. Thoracic Spondylitis Caused by Panton-Valentine Leukocidin-positive Staphylococcus aureus Mimicking Pott Disease. Pediatr Infect Dis J 2024:00006454-990000000-00909. [PMID: 38900082 DOI: 10.1097/inf.0000000000004452] [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: 06/21/2024]
Affiliation(s)
- Meltem Polat
- Department of Pediatric Infectious Diseases, Gazi University School of Medicine, Ankara, Turkey
| | - Betül Emine Derinkuyu
- Department of Pediatric Radiology, Gazi University School of Medicine, Ankara, Turkey
| | - Anil Tapisiz
- Department of Pediatric Infectious Diseases, Gazi University School of Medicine, Ankara, Turkey
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5
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Soudack M, Shimoni HY, Plotkin S, Jacobson JM. Sonographic diagnosis of spondylodiscitis in a young child. Pediatr Radiol 2024; 54:1049-1052. [PMID: 38592502 PMCID: PMC11111475 DOI: 10.1007/s00247-024-05920-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
Sonographic diagnosis of spondylodiscitis is described in a 21-month-old girl who presented with altered gait. Spondylodiscitis, also referred to as discitis-osteomyelitis, is an infection of the intervertebral disc and adjacent vertebrae. The imaging modality of choice is spinal magnetic resonance imaging. Our case is the first description in the English language of the sonographic diagnosis of spondylodiscitis. Pediatric radiologists and sonographers should be acquainted with its features, for both incidental and intentional diagnosis.
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Affiliation(s)
- Michalle Soudack
- Division of Diagnostic Imaging, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Israel, 5266202.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel.
| | - Hadar-Yafit Shimoni
- Division of Diagnostic Imaging, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Israel, 5266202
| | - Simyon Plotkin
- Department of Pediatric Emergency Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Jeffrey M Jacobson
- Division of Diagnostic Imaging, Sheba Medical Center, Derech Sheba 2, Ramat Gan, Israel, 5266202
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Janahi SM, Ashoor WA, Alshaikh AA, Seroor RH. Early Diagnosis and Successful Empirical Treatment of L1-L2 Spondylodiscitis in a 21-Month-Old Girl: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943010. [PMID: 38669213 PMCID: PMC11060496 DOI: 10.12659/ajcr.943010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/16/2024] [Accepted: 02/26/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Infantile spondylodiscitis is a rare condition with a varied clinical presentation. Microbial infection may not always be identified, but early diagnosis and management are required to prevent long-term and irreversible complications, including spinal deformities and vertebral instability. CASE REPORT This report is of a 21-month-old girl with a 3-week history of difficulty in walking and constipation due to L1-L2 spondylodiscitis following a gluteal skin burn. The family had sought medical advice multiple times, but results of all investigations were unremarkable. Her initial spine X-ray was negative but her spine magnetic resonance imaging (MRI) showed a picture suggestive of spondylodiscitis, which then responded to empiric treatment with broad-spectrum antibiotics. The patient showed complete resolution of clinical symptoms and her bowel habits came back to normal after 6 months of complete antibiotics treatment. Her repeat spine MRI showed a significant improvement of her spondylodiscitis. CONCLUSIONS This report has highlighted the importance of rapid diagnosis and management of infantile spondylodiscitis and the challenging approach to treatment when no infectious organism can be identified, as well as the early initiation of antibiotics therapy when appropriate in pediatric patients to avoid serious neurological complications associated with spondylodiscitis. Thus, it is essential to assess children with refusal to walk, gait problems, or back discomfort, especially when they are associated with high inflammatory markers.
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Affiliation(s)
| | | | | | - Raafat Hammad Seroor
- Department of Pediatric Neurology, Bahrain Defense Force Hospital, Riffa, Bahrain
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Woods CR, Bradley JS, Chatterjee A, Kronman MP, Arnold SR, Robinson J, Copley LA, Arrieta AC, Fowler SL, Harrison C, Eppes SC, Creech CB, Stadler LP, Shah SS, Mazur LJ, Carrillo-Marquez MA, Allen CH, Lavergne V. Clinical Practice Guideline by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA): 2023 Guideline on Diagnosis and Management of Acute Bacterial Arthritis in Pediatrics. J Pediatric Infect Dis Soc 2024; 13:1-59. [PMID: 37941444 DOI: 10.1093/jpids/piad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
This clinical practice guideline for the diagnosis and treatment of acute bacterial arthritis (ABA) in children was developed by a multidisciplinary panel representing the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA). This guideline is intended for use by healthcare professionals who care for children with ABA, including specialists in pediatric infectious diseases and orthopedics. The panel's recommendations for the diagnosis and treatment of ABA are based upon evidence derived from topic-specific systematic literature reviews. Summarized below are the recommendations for the diagnosis and treatment of ABA in children. The panel followed a systematic process used in the development of other IDSA and PIDS clinical practice guidelines, which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) (see Figure 1). A detailed description of background, methods, evidence summary and rationale that support each recommendation, and knowledge gaps can be found online in the full text.
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Affiliation(s)
- Charles R Woods
- Department of Pediatrics, University of Tennessee Health Sciences Center College of Medicine Chattanooga, Chattanooga, Tennessee
| | - John S Bradley
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, School of Medicine, and Rady Children's Hospital, San Diego, California
| | - Archana Chatterjee
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Matthew P Kronman
- Division of Pediatric Infectious Diseases, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Sandra R Arnold
- Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lawson A Copley
- Departments of Orthopaedic Surgery and Pediatrics, University of Texas Southwestern, Dallas, Texas
| | - Antonio C Arrieta
- Division of Infectious Diseases, Children's Hospital of Orange County and University of California, Irvine, California
| | - Sandra L Fowler
- Division of Infectious Diseases, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | - C Buddy Creech
- Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Laura P Stadler
- Department of Pediatrics, Division of Infectious Diseases, University of Kentucky, Lexington, Kentucky
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lynnette J Mazur
- Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas
| | - Maria A Carrillo-Marquez
- Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Coburn H Allen
- Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, Texas
| | - Valéry Lavergne
- Department of Medical Microbiology and Infection Control, Vancouver General Hospital, Vancouver, British Columbia, Canada
- University of Montreal Research Center, Montreal, Quebec, Canada
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8
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Jasiewicz B, Helenius I. Tumors and infections of the growing spine. J Child Orthop 2023; 17:556-572. [PMID: 38050596 PMCID: PMC10693843 DOI: 10.1177/18632521231215857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
The growing spine differs from the adult spine in several ways. Although tumors and infections cause only a small percentage of pediatric back pain incidences, delayed proper diagnosis and treatment may be disastrous. Benign lesions, such as osteoid osteoma, osteoblastoma, and aneurysmal bone cyst in the spine, are predominant during the first two decades of life, whereas malignant bony spinal tumors are rare. In the pediatric population, malignant spine tumors include osteosarcoma, Ewing's sarcoma, lymphoma, and metastatic neuroblastoma. Infections of the growing spine are rare, with the incidence of discitis peaking in patients under the age of 5 years and that of vertebral osteomyelitis peaking in older children. Spondylodiscitis is often a benign, self-limiting condition with low potential for bone destruction. Conservative treatments, including bedrest, immobilization, and antibiotics, are usually sufficient. Spinal tuberculosis is a frequently observed form of skeletal tuberculosis, especially in developing countries. Indications for surgical treatment include neurologic deficit, spinal instability, progressive kyphosis, late-onset paraplegia, and advanced disease unresponsive to nonoperative treatment. Spinal tumors and infections should be considered potential diagnoses in cases with spinal pain unrelated to the child's activity, accompanied by fever, malaise, and weight loss. In spinal tumors, early diagnosis, fast and adequate multidisciplinary management, appropriate en bloc resection, and reconstruction improve local control, survival, and quality of life. Pyogenic, hematogenous spondylodiscitis is the most common spinal infection; however, tuberculosis-induced spondylodiscitis should also be considered. Level of evidence: level 4.
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Affiliation(s)
- Barbara Jasiewicz
- Department of Orthopaedics and Rehabilitation, Jagiellonian University Medical College, Zakopane, Poland
| | - Ilkka Helenius
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Paediatric Surgery, Orthopaedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland
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Lashkarbolouk N, Mazandarani M, Ilharreborde B, Nabian MH. Understanding the management of pediatric spondylodiscitis based on existing literature; a systematic review. BMC Pediatr 2023; 23:578. [PMID: 37980513 PMCID: PMC10656982 DOI: 10.1186/s12887-023-04395-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/28/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Spondylodiscitis (SD), a rare disease in children, poses diagnostic challenges due to non-specific presenting symptoms, scarcity in incidence, and difficulty expressing pain in non-verbal children. METHOD A comprehensive search was conducted on three databases, including PubMed/Medline, Web of Science, and Scopus until March 2023. The inclusion criteria were studies that investigated the clinical characteristics, treatment, and complications of children's spondylodiscitis. Full text of cross-sectional and cohort studies were added. The quality assessment of cohort studies was conducted using the Newcastle-Ottawa Quality Assessment Scale. The search, screening, and data extraction were performed by two researchers independently. RESULT Clinical manifestations of discitis in children are nonspecific, such as back pain, fever, reduced ability or inability to walk or sit, limping, and reduced range of movements. The mean delay in the time of diagnosis was 4.8 weeks. The most affected site of all the studies was the lumbar spine. 94% of studies reported increased inflammatory markers such as white blood cell count, C-reactive protein, and erythrocyte sedimentation rate. Less than 30% of patients had positive blood cultures and biopsy findings. The most common microbiological results (64%) were Staphylococcus Aureus and Kingella kingae. In radiographic evaluation, intervertebral disk narrowing, lumbar lordosis reduction, loss of disk height, and destruction of the vertebral body have been reported. In all studies, antibiotic therapy was initiated; in 52% immobilization was employed, and 29% of studies reported surgery was performed, and the follow-up period differed from 1.5 months to 156 months. 94% of studies reported complications such as vertebral body destruction, back pain, kyphosis, reduced range of movement, scoliosis, and neurological complications. CONCLUSION Spondylodiscitis is an uncommon, heterogeneous, multifactorial disease with resulting difficult and delayed diagnosis. Due to its morbidity, it is essential to investigate children with refusal to walk, gait disturbances, or back pain, particularly when associated with elevated inflammatory markers.
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Affiliation(s)
- Narges Lashkarbolouk
- Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahdi Mazandarani
- Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Golestan University of Medical Sciences, Gorgan, Iran
| | - Brice Ilharreborde
- Department of Pediatric Orthopedic Surgery, Robert Debré Hospital, AP-HP, Paris Diderot University, Paris, France
| | - Mohammad Hossein Nabian
- Department of Pediatric Orthopedic Surgery, Robert Debré Hospital, AP-HP, Paris Diderot University, Paris, France.
- Center for Orthopedic Trans- Disciplinary Applied Research (COTAR) Institute, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Al Shibli N, Al Ajmi E, Al Yazidi LS. Difficulty of Changing Diapers in a Toddler. Oman Med J 2023; 38:e539. [PMID: 37605773 PMCID: PMC10440022 DOI: 10.5001/omj.2023.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/16/2023] [Indexed: 08/23/2023] Open
Affiliation(s)
- Naema Al Shibli
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Eiman Al Ajmi
- Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
| | - Laila S. Al Yazidi
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
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A Systematic Review of the Diagnosis and Treatment of Non-Typhoid Salmonella Spondylodiscitis in Immunocompetent Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121852. [PMID: 36553297 PMCID: PMC9776940 DOI: 10.3390/children9121852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022]
Abstract
The aim of this systematic review is to distinguish the clinical features of immunocompetent children with non-typhoid Salmonella spondylodiscitis and summarize the diagnosis, diagnostic tools, and treatment methods to guide clinicians. The review was conducted according to the preferred PRISMA guidelines. We conducted a literature search in the PubMed, Embase, and Cochrane Library databases. Article screening, data extraction, and study evaluation were performed by two independent reviewers. A total of 20 articles, published between 1977 and 2020, were selected, which included 21 patients with average age of 12.76 years (range, 2-18) without comorbidities; in total, 19% of the patients had positive blood cultures for non-typhoid Salmonella, and 80.9% underwent either CT-guided or open biopsy, which were positive for NTS. All infections were monomicrobial, and 11 different serotypes of non-typhoid Salmonella were identified. Analyzing the reviewed cases, 52.4% of the patients presented with fever, 90.5% had localized pain, and only 19% had gastroenteritis. The most common level of discitis was the lumbar region, especially the L4/L5 level. Primarily, third-generation cephalosporin was administered, and antibiotic treatment was given for an average of 9.6 weeks. Non-typhoid Salmonella spondylodiscitis is a rare clinical entity in healthy and immunocompetent children. The identification of the responsible organism is essential to guide antibiotic therapy and define the treatment duration. A significant limiting factor in this systematic review was the lack of published research articles and case series due to the rarity of the disease.
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Al Yazidi LS, Hameed H, Kesson A, Isaacs D. Spondylodiscitis in children. J Paediatr Child Health 2022; 58:1731-1735. [PMID: 36000507 DOI: 10.1111/jpc.16175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/13/2022] [Accepted: 08/07/2022] [Indexed: 12/01/2022]
Abstract
Paediatric spondylodiscitis (SD) (discitis) is a rare bacterial infection involving the inter-vertebral disc space and adjacent vertebrae. The non-specific manifestations of SD can lead to delayed diagnosis, which may ultimately result in spinal deformities and even devastating neurological complications. The main purpose of this review is to discuss the epidemiology, clinical, laboratory and radiological features, management and outcome of paediatric SD to help paediatricians recognise and treat this important condition.
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Affiliation(s)
- Laila S Al Yazidi
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hina Hameed
- Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Alison Kesson
- Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
| | - David Isaacs
- Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
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13
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Beyer RS, Franklin AJ, Hatter MJ, Nguyen A, Brown NJ, Camino-Willhuber G, Davies NR, Hashmi S, Oh M, Bhatia N, Lee YP. Surgical treatment in primary spinal infections in a pediatric population: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22204. [PMID: 36046267 PMCID: PMC9329860 DOI: 10.3171/case22204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Primary spinal infections (PSIs) are a group of uncommon but serious infectious diseases that are characterized by inflammation of the endplate-disc unit. Pediatric spinal infection is rare and challenging to diagnose due to vague presenting symptoms. Most cases are conservatively managed with surgery rarely indicated. The authors performed a systematic review to study the baseline characteristics, clinical presentation, and outcomes of pediatric patients with PSIs who underwent surgical treatment. OBSERVATIONS PSI in pediatric patients might behave differently in terms of epidemiology, clinical presentation, and outcomes when compared with nonpediatric patients. Overall, PSI ultimately managed surgically in pediatric patients is associated with a high rate of localized pain, neurological compromise, and treatment failure when compared with nonsurgically managed pediatric spinal infections. LESSONS PSIs managed surgically in the pediatric population were found to be caused by Mycobacterium tuberculosis in 74.4% of cases and were associated with higher rates of localized pain, neurological compromise, and treatment failure than nonsurgically managed pediatric spinal infections. Thoracic involvement (71.8%) in the spinal infection was reported most commonly in our review. When omitting the cases involving M. tuberculosis infection, it was revealed that 50% of the pediatric cases involved infection in the cervical region, suggesting increased severity and disease course of cervical spinal infections in the pediatric population. Surgical treatment is indicated only in cases of severe neurological compromise and treatment failure.
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Affiliation(s)
| | | | | | - Andrew Nguyen
- Neurosurgery, University of California, Irvine, Irvine, California; and
| | - Nolan J. Brown
- Neurosurgery, University of California, Irvine, Irvine, California; and
| | | | - Nestor R. Davies
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Michael Oh
- Neurosurgery, University of California, Irvine, Irvine, California; and
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Yagdiran A, Meyer-Schwickerath C, Wolpers R, Otto-Lambertz C, Mehler K, Oberthür A, Kernich N, Eysel P, Jung N, Zarghooni K. What Do We Know about Spondylodiscitis in Children? A Retrospective Study. CHILDREN 2022; 9:children9081103. [PMID: 35892606 PMCID: PMC9331686 DOI: 10.3390/children9081103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/22/2022]
Abstract
Pediatric spondylodiscitis (PSD) is a rare disease with a major impact on mobility and functional status. Data concerning demographic and microbiological characteristics, clinical course, treatment, and outcome are scarce. Therefore, the aim of this study was to present clinical experiences of a third-level hospital (2009–2019) in PSD and compare these with adult spondylodiscitis (ASD). Of a total of 10 PSD patients, most of the infants presented with unspecific pain such as hip pain or a limping, misleading an adequate diagnosis of spine origin. Eight patients could be treated conservatively whereas surgery was performed in two cases with one case of tuberculous PSD (tPSD). The causative agent was detected in three of the patients. The diagnosis of PSD is often difficult since clinical symptoms are unspecific and causative pathogens often remain undetected. Nevertheless, empirical anti-infective therapy also seems to be effective. Based on recent studies, clinicians should be encouraged to keep the duration of anti-infective therapy in children short. Since comorbidities are not presented in PSD it is unclear which children suffer from PSD; thus, studies are necessary to identify predisposing factors for PSD. In our study, PSD differs from ASD in diagnostic and especially in therapeutic aspects. Therefore, specific guidelines for PSD would be desirable.
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Affiliation(s)
- Ayla Yagdiran
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (R.W.); (C.O.-L.); (N.K.); (P.E.); (K.Z.)
- Correspondence:
| | - Charlotte Meyer-Schwickerath
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, Center for Integrated Oncology, University of Cologne, 50937 Cologne, Germany; (C.M.-S.); (N.J.)
| | - Raphael Wolpers
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (R.W.); (C.O.-L.); (N.K.); (P.E.); (K.Z.)
| | - Christina Otto-Lambertz
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (R.W.); (C.O.-L.); (N.K.); (P.E.); (K.Z.)
| | - Katrin Mehler
- Department of Pediatrics, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (K.M.); (A.O.)
| | - Andre Oberthür
- Department of Pediatrics, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (K.M.); (A.O.)
| | - Nikolaus Kernich
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (R.W.); (C.O.-L.); (N.K.); (P.E.); (K.Z.)
| | - Peer Eysel
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (R.W.); (C.O.-L.); (N.K.); (P.E.); (K.Z.)
| | - Norma Jung
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, Center for Integrated Oncology, University of Cologne, 50937 Cologne, Germany; (C.M.-S.); (N.J.)
| | - Kourosh Zarghooni
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (R.W.); (C.O.-L.); (N.K.); (P.E.); (K.Z.)
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Cavalieri S, Pessina B, Indolfi G, Galli L, Trapani S. Spondylodiscitis in Pediatric Age: A Retrospective Cohort Study. Pediatr Infect Dis J 2022; 41:530-536. [PMID: 35675524 PMCID: PMC10826916 DOI: 10.1097/inf.0000000000003534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pediatric spondylodiscitis is rare, hardly diagnosed and treated due to the nonspecificity of clinical presentation and laboratory investigations, difficulty of etiologic identification and lack of management guidelines. METHODS A retrospective study was conducted on 29 children with spondylodiscitis. Clinical, hematic and radiologic data were collected and compared between 2 age-subgroups (below and from 4 years old on) to investigate age-related differences. Epidemiologic, management and follow-up data were also described. RESULTS Slight male predominance and a peak of incidence <2 years were observed. Symptoms were significantly differently distributed in the 2 age-subgroups: children <4 years showed mainly refusal/inability to sit or bear weight, irritability, limping and poor general conditions; children ≥4 years most frequently had back pain and fever, and pain upon palpation of the spine. The lumbar spine and more than 1 vertebra were most frequently involved. Median diagnostic delay of 12 days was observed, without significant difference between age-subgroups, and delay >2 months was always associated with multivertebral involvement and complications. All children were treated with broad-spectrum antibiotics for a median of 12 weeks. Only in 1 complicated case, surgical treatment was also required. CONCLUSIONS The clinical presentation of spondylodiscitis may be age-specific, with younger children often exhibiting subtle signs and symptoms. Broad-spectrum antibiotics covering for Staphylococcus aureus should be initiated as soon as possible and performed many weeks, being effective in treating the infection without clinical sequelae, even in patients with comorbidities. Surgical treatment should be reserved for complicated cases with neurologic involvement.
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Affiliation(s)
- Stefano Cavalieri
- From the Postgraduate School of Pediatrics, University of Florence, Meyer Children’s Hospital, Florence
- Department of Pediatrics, San Jacopo Hospital, Pistoia
| | - Benedetta Pessina
- From the Postgraduate School of Pediatrics, University of Florence, Meyer Children’s Hospital, Florence
| | - Giuseppe Indolfi
- Department NEUROFARBA, University of Florence
- Pediatric Unit, Department of Health Sciences, Meyer Children's University Hospital, Florence, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children’s University Hospital
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Sandra Trapani
- Pediatric Unit, Department of Health Sciences, Meyer Children's University Hospital, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
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Roversi M, Mirra G, Musolino A, Barbuti D, Lancella L, Deriu D, Iorio C, Villani A, Crostelli M, Mazza O, Krzysztofiak A. Spondylodiscitis in Children: A Retrospective Study and Comparison With Non-vertebral Osteomyelitis. Front Pediatr 2021; 9:727031. [PMID: 34746055 PMCID: PMC8567140 DOI: 10.3389/fped.2021.727031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/24/2021] [Indexed: 02/04/2023] Open
Abstract
Objectives: The aim of this study is to provide new data on pediatrics spondylodiscitis for an optimal clinical management of this site-specific osteomyelitis. Methods: We reported 48 cases of pediatric spondylodiscitis and made three comparisons between: (1) tubercular and non-tubercular cases; (2) patients aged more or less than 5 years; (3) children with spondylodiscitis and 62 controls with non-vertebral osteomyelitis. Results: A higher rate of sequelae was reported in patients with tubercular spondylodiscitis, but no significant differences were noted at the cut-off of 5 years of age. Compared to non-vertebral osteomyelitis, pediatric spondylodiscitis affects younger children of both genders, usually presenting with afebrile back pain, and requiring longer time to admission, hospitalization, and antibiotic therapy. Conclusion: Pediatric spondylodiscitis is an insidious disease with a non-specific presentation in childhood and peculiarities of its own. However, when clinical remission is obtained by an early start of broad-spectrum antibiotics, prolonging the therapy does not improve, nor worsens, the outcome. Surgical management is mandatory in case of vertebral instability and neurological signs but can be avoided when the infection is promptly treated with antibiotic therapy.
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Affiliation(s)
- Marco Roversi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Gianluca Mirra
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Antonio Musolino
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Domenico Barbuti
- Department of Imaging, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Daniele Deriu
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Carlo Iorio
- Spine Surgery Unit, Department of Surgery and Transplantations, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Marco Crostelli
- Spine Surgery Unit, Department of Surgery and Transplantations, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Osvaldo Mazza
- Spine Surgery Unit, Department of Surgery and Transplantations, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Andrzej Krzysztofiak
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
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