Microbiology and radiographic features of osteomyelitis in children and adolescents with sickle cell disease

Abstract

Background Children with sickle cell disease (SCD) are at increased risk for bacterial infections including osteomyelitis (OM). Fever and bone pain, key presenting symptoms of OM, are common in SCD, thus complicating diagnosis. We reviewed presentation, imaging features, and microbiologic etiologies of children with SCD treated for OM. Methods The comprehensive SCD clinical database of children and adolescents with SCD followed at a single, large tertiary pediatric center were searched to identify all diagnostic coding for potential cases of osteomyelitis in children ages 6 months to 21 years from 2010 to 2019. Medical charts were reviewed to determine OM diagnostic probability based on radiographic and microbiologic findings and the duration of prescribed antibiotic treatment for OM. Results Review of 3553 patients (18 039 person‐years) identified 20 episodes of probable OM in 19 children. Magnetic resonance imaging (MRI) findings to support OM were definitive in 4/19 (21%), probable in 10/19 (53%), suspected in 5/19 (26%), based on blinded radiologist review. Blood and/or operative cultures from bone and tissue debridement isolated Salmonella species in seven (35%) cases and methicillin‐susceptible Staphylococcus aureus (MSSA) in two (10%). Six patients received antibiotic treatment prior to obtainment of cultures. Of culture‐positive cases, MRI findings for OM were definitive or probable in six of nine (67%), suspected in three of nine (33%). Conclusions Distinction between OM and sickle‐related bone infarct or vasoocclusion is difficult based on imaging findings alone. Early attainment of blood and operative cultures increases the likelihood of identifying and adequately treating OM.

Chronic humeral osteomyelitis in an adult with sickle-cell disease

“…Both clinical evaluations and microbiological analyses of blood cultures did not enable us to rule out any pathology, a common occurrence in this condition, as reported in studies such as the pediatric series of Kao et al (2020) [ 15 ]. They reported 20 OM cases among over 3000 SCD patients in a decade, with 6 of them presenting uni- or multifocal involvement in the humerus.…”

Multifocal osteomyelitis in a child with sickle cell disease and review of the literature regarding best diagnostic approach

“…Another large tertiary center queried their database to determine the diagnostic probability of imaging and microbiology for osteomyelitis. Out of 20 cases of osteomyelitis, imaging was obtained in 19 15 . Of these cases, four (21%) of them had imaging considered definitive for osteomyelitis 15 .…”

“…Out of 20 cases of osteomyelitis, imaging was obtained in 19. 15 Of these cases, four (21%) of them had imaging considered definitive for osteomyelitis. 15 Ten cases (53%) had imaging that was considered probable, and 5 cases (21%) were suspected osteomyelitis.…”

Salmonella Osteomyelitis in a Pediatric Patient with a Proximal Humerus Fracture

“…Salmonella species account for only 0.45% of cases of osteomyelitis, and only 0.8% of all Salmonella infections are osteomyelitis 2 . Bone infection because of Salmonella is associated most commonly with sickle cell disease or other immunodeficiencies, such as chronic granulomatous disease, diabetes, or immunosuppressant use 1,3,4 . There is a paucity of literature on pediatric fractures complicated by Salmonella .…”