Primary subacute hematogenous osteomyelitis in children: A clearer bacteriological etiology

Abstract

BackgroundThis study aimed to describe the spectrum of pediatric primary subacute hematogenous osteomyelitis (PSAHO) and to investigate its bacterial etiology.MethodsSixty-five consecutive cases of PSAHO admitted to our institution over a 16-year period (2000–2015) were retrospectively reviewed to assess their laboratory and radiographic imaging features, as well as their bacteriological etiology.ResultsOn evaluation, white blood cell count and C-reactive protein were normal in 53 (81.5 %) and 34 cases (52.3 %), respectively, whereas the erythrocyte sedimentation rate was superior to 20 mm/h in 44 cases (72.1 %). Blood cultures failed to identify the pathogen in all but one patient, and classic bone sample cultures only managed to isolate the pathogen in five cases (11.6 %). Use of polymerase chain reaction (PCR) assays on bone aspirates or blood allowed the causative microorganism to be isolated in a further 22 cases. Using classic cultures and PCR assays together resulted in pathogen detection in 27 cases (62.8 % of the children bacteriologically investigated), with Kingella kingae being the most frequently reported microorganism.ConclusionsTwo distinct forms of PSAHO should be distinguished on the basis of age of patients and bacteriological etiology. The infantile form affects children aged between 6 months and 4 years and is predominantly due to K. kingae. The juvenile form involves children aged >4 years and Staphylococcus aureus appears to be the main bacteriological etiology. Appropriate nucleic amplification assays drastically improve the detection rate of the microorganisms responsible for PSAHO.Level of evidence: Case series, level IV.

<p>Systematic Review of <em>Kingella kingae</em> Musculoskeletal Infection in Children: Epidemiology, Impact and Management Strategies</p>

“…31 Twenty-nine articles were considered relevant with respect to identifying the number of confirmed infections with K. kingae in bacteriologically proven musculoskeletal infections in children (Table 1). 2,22,28,29,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][66][67][68][69][70] This was further studied to summarize the frequency of K. kingae infections among children under 48 months old ( Table 2). Additional epidemiological data extracted and collated included musculoskeletal infection sites, gender, age and seasonality.…”

Brodie abscess of the femoral capital epiphysis in a 2-year-old child caused byKingella kingae

“…The formation of a Brodie abscess is rarer still. Subacute osteomyelitis is, however, a growing problem according to some reports 5. Osteomyelitis accounts for around 1% of all hospital admissions in children 3.…”

“…Surgical drainage of these bone infections yields positive cultures in up to 75% of patients, and S. aureus is currently considered as the most common organism isolated 5. Other organisms that may be encountered include Streptococcus , Pseudomonas , Haemophilus influenzae , Mycobacterium tuberculosis and coagulase-negative S. aureus 5.…”

“…Other organisms that may be encountered include Streptococcus , Pseudomonas , Haemophilus influenzae , Mycobacterium tuberculosis and coagulase-negative S. aureus 5. Brodie abscesses in particular have traditionally been associated with staphylococcal infections, and these are considered more virulent than K. kingae infections 6 7.…”

Subacute knee pain and swelling in a healthy male: a case of Brodie’s abscess

“…It is typically seen in the metaphysis of long bones of young male patients 1. The most common causative organism is Staphylococcus aureus ,2 but other organisms may be encountered, such as Streptococcus, Pseudomonas, Haemophilus influenza and coagulase-negative S. aureus 3. In this report, we present a case of Brodie’s abscess in the tibial plateau of a middle-aged male.…”