Pediatric osteomyelitis

BACKGROUND: The detection and identification of pathogenic microorganisms are essential for the treatment of osteoarticular infection. However, obtaining a sufficient amount of specimen from pediatric patients is often difficult. Herein, we aimed to demonstrate the effectiveness of the blood culture bottle (BCB) system in pediatric osteoarticular infections. We hypothesized that our BCB culture method is superior to the conventional swab and tissue culture methods in terms of required specimen size, incubation time, and microbial identification rate...

Acute pediatric osteoarticular infection demonstrates variability in both presentation and response to treatment. Many respond to antibiotics ± single operation, while some require multiple surgeries. Currently, it is difficult to predict who may require additional procedures. Infections due to methicillin-resistant Staphylococcus aureus (MRSA) have been associated with more complications. The purpose of this study is to determine MRSA trends and degree of association with the occurrence of multiple procedures...

PURPOSE: Osteoid osteomas are benign and nonprogressive lesions. The clinical presentation of osteoid osteoma is typical with night pain responsive to nonsteroidal anti-inflammatory agents. The typical radiological appearance is lucent nidus and adjacent reactive sclerosis. The most traditional management of osteoid osteoma is surgical removal which is associated with significant morbidity. This article aims to demonstrate our single-center experience of 55 patients with osteoid osteoma treated with percutaneous radiofrequency ablation (RFA)...

BACKGROUND: The foot and ankle are uncommon sites of bone and joint infections (BJIs) in children. The objectives of the present study were to determine the clinical and bacteriologic features of BJIs and to assess any associated complications and orthopedic sequelae. METHODS: We performed a retrospective, single-center study of children treated for foot or ankle BJIs between 2008 and 2018 in a French university medical center. A total of 23 children were included...

We highlight 2 cases of immunocompetent pediatric patients diagnosed with osteomyelitis and cellulitis attributed to Aeromonas hydrophila. One case had a direct water source; however, the second case occurred following a wild hog bite. Both required fluoroquinolone treatment and demonstrated the need to consider A. hydrophila in patients with water exposure, animal bites and initial antibiotic failure.

INTRODUCTION: Langerhans` Cell Histiocytosis (LCH) is a rare disease involving proliferation of Langerhans-type cells, which shares immunophenotypic and ultrastructural similarities. In this article, we report a case of Langerhans cell histiocytosis in solitary involvement of clavicle of adult male. PRESENTATION OF CASE: A 21-year-old male visited outpatient department on account of solitary palpable tumorous lesion in right clavicle. The lesion was found 2 weeks before the visit, and it triggered pain but no tenderness...

Introduction: Pyogenic vertebral body osteomyelitis is rarer in children in comparison to adults. A rare case of pyogenic vertebral body osteomyelitis in a 10-year-old male is presented which was managed conservatively with antibiotics on the basis of antibiogram of blood culture. With 6 weeks of antibiotic therapy and at 12-month follow-up, the patient has no symptoms with no affection of any activity. This should be considered as a differential diagnosis in pediatric patients presenting with atypical symptoms related to spine and hip...

OBJECTIVE: The purpose of this study was 1) to assess the inter-reader reliability in detecting and scoring the inflammatory bone lesions in pediatric patients with chronic nonbacterial osteomyelitis (CNO) by using WB-MRI, and 2) to evaluate the responsiveness of the MRIdetected CNO lesions to pamidronate therapy. METHODS: Eighty-eight WB-MRI examinations were independently reviewed and scored by two radiologists blinded to clinical details in 32 retrospectively enrolled pediatric patients with CNO...

INTRODUCTION: Pediatric SAPHO syndrome is regarded as the equivalent of chronic recurrent multifocal osteomyelitis or chronic non-bacterial osteomyelitis. This study aimed to evaluate the clinical features and treatment options for Chinese pediatric patients with SAPHO syndrome. METHOD: We conducted a single-center, retrospective study on a sample of 24 pediatric patients with SAPHO syndrome who were diagnosed at Peking Union Medical College Hospital from April 2014 to August 2018...

OBJECTIVES: Osteoarticular infections are infrequent in pediatric patients, although their incidence seems to be increasing. They usually affect children younger than 5 years and tend to localize in the lower limbs. Because of their nonspecific symptoms, especially at onset, a timely diagnosis is difficult to achieve, with the subsequent risk of a delay in treatment. We hereby report the management of osteoarticular infections in our pediatric emergency department. METHODS: This is a retrospective descriptive study of patients diagnosed with osteoarticular upper limb infection in the pediatric emergency department of a tertiary hospital from January 2011 to December 2016...

Synovitis acne pustulosis hyperostosis osteitis (SAPHO) and chronic nonbacterial osteomyelitis (CNO) represent overlapping osteoarticular autoinflammatory syndromes, with a minority displaying neutrophilic skin features at the time of diagnosis. The pathophysiological link and chronological timeframe between skin and osteoarticular findings remain ambiguous, which in turn can manifest in diagnostic delay. We present a rare pediatric case of SAPHO-CNO with a clear association between cutaneous and osteoarticular symptoms, treated with nonsteroidal anti-inflammatory medications, corticosteroids, and intravenous pamidronate...

BACKGROUND: The causative pathogen of pediatric osteomyelitis is often unidentified despite culturing attempts. This study evaluated and compared the clinical characteristics, therapeutic approach, and outcomes of osteomyelitis caused by unknown pathogens and identified microorganisms. METHOD: This 17-year retrospective study was conducted at a tertiary hospital in central Taiwan. Medical records of children aged less than 18 years with a diagnosis of osteomyelitis between 2003 and 2019 were reviewed...

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...

Orbital osteomyelitis in the pediatric patient is a rare clinical entity with limited reports in the literature. Outcomes for orbital osteomyelitis can be potentially fatal, and effective diagnosis and treatment often requires an extensive differential and multidisciplinary team approach. As such, the authors systematically evaluated a pooled analysis of patients in published studies to better understand the clinical trends of this condition. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement guidelines, the authors queried the PubMed, Cochrane Library, and ISI Web of Science databases...

In the pediatric population, vascular access is often challenging to secure and to maintain, especially for long-term intravenous (IV) treatment. The traditional approach for patients who require long-term IV antibiotics is placement of a peripherally inserted central catheter (PICC). The challenge in the pediatric population is the high risk of dislodgement after PICC placement, as these patients tend to pull their line out accidentally or purposefully. Current bedside options to prevent catheter dislodgement include adhesive securement devices, subcutaneous securement devices, sutures, and wrapping the site in gauze...

BACKGROUND: While typical patterns of osteoid osteoma have been described on CT, MRI findings can overlap among different diseases, and atypical patterns exist. In this study, we assessed the presence of a novel dark rim sign and its utility in the MRI diagnosis of osteoid osteoma. OBJECTIVE: The purpose of this retrospective study was to assess the utility of the dark rim sign seen on MRI in children with osteoid osteoma. MATERIALS AND METHODS: MRI studies from 36 pediatric patients with osteoid osteoma and a control group of patients with either osteomyelitis or stress fracture were analyzed and then compared for the presence of the dark rim sign...

Objective: To investigate the clinical characteristics of pediatric methicillin-resistant Staphylococcus aureus (MRSA) infection and the antibiotic sensitivity of the isolates. Methods: The clinical data of children with MRSA infection and antibiotic sensitivity of the isolates from 11 children's hospitals in Infectious Diseases Surveillance of Paediatrics (ISPED) group of China between January 1, 2018 and December 31, 2018 were collected retrospectively. The children's general condition, high-risk factors, antimicrobial therapy and prognosis, differences in clinical disease and laboratory test results between different age groups, and differences of antibiotic sensitivity between community-acquired (CA)-MRSA and hospital-acquired (HA)-MRSA were analyzed...

Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disease of childhood and adolescence characterized by episodic bone pain. Diagnosis relies heavily on whole-body MRI and is made by excluding a wide variety of other disorders with overlapping imaging features, depending on location, marrow distribution, and the presence or absence of multifocality. We present an overview of the clinical and imaging features of CRMO and, through various clinical scenarios, provide tips for tailoring the differential diagnosis based on location and distribution of encountered abnormalities...

BACKGROUND: The detection and identification of pathogenic microorganisms are essential for the treatment of osteoarticular infection. However, obtaining a sufficient amount of specimen from pediatric patients is often difficult. Herein, we aimed to demonstrate the effectiveness of the blood culture bottle (BCB) system in pediatric osteoarticular infections. We hypothesized that our BCB culture method is superior to the conventional swab and tissue culture methods in terms of required specimen size, incubation time, and microbial identification rate...

According to the Guidelines of the European Society of Pediatric Infectious Diseases (ESPID), in low methicillin-resistant Staphylococcus aureus (MRSA) prevalence settings, short intravenous therapy is recommended in uncomplicated cases of acute haematogenous osteomyelitis (AHOM), followed by empirical oral therapy, preferentially with first/second-generation cephalosporin or dicloxacillin or flucloxacillin. However, several practical issues may arise using some of the first-line antibiotics such as poor palatability or adherence problems...