Subacute Hematogenous Osteomyelitis in Children

Roberts, James A.; Drummond, Denis S.; Breed, Alan L.; Chesney, J.

doi:10.1097/01241398-198208000-00003

Cited by 118 publications

(83 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Gledhill 3 described four radiological types in long bones. Roberts et al 7 expanded and modified the classification into six forms to include the spine, the lesions being classified as metaphyseal, diaphyseal, epiphyseal and vertebral. Their classification is based on anatomical location, morphology and the similarity of the lesions to various neoplasms.…”

mentioning

confidence: 99%

“…It has an insidious onset, lacks a systemic reaction and may mimic various benign and malignant conditions, resulting in delay in diagnosis and treatment. [1][2][3][4][5][6][7] The condition has assumed importance in recent years and is becoming more common in the UK. [8][9][10] Although osteomyelitis is frequent in Northern Nigeria 11 and East Africa 1 it is only occasionally seen in the acute form.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Primary subacute haematogenous osteomyelitis in children

Rasool

2001

The Journal of Bone and Joint Surgery. British volume

View full text Add to dashboard Cite

Between 1990 and 1998 we saw 21 children with primary subacute haematogenous osteomyelitis. Pain, swelling and a limp had been present for two to 12 weeks with little functional impairment. Laboratory tests were non-contributory. The lesions were classified radiologically into metaphyseal, diaphyseal, epiphyseal and vertebral. There were 24 sites involved, with most (20) being in the tibia; 17 lesions were in the diaphysis, five in the metaphysis and two in the epiphysis. The diagnosis was confirmed histologically in all cases. Staphylococcus aureus was cultured in six patients. Healing occurred in all patients after treatment with antibiotics for six weeks and radiological improvement was seen after three to six months.Subacute osteomyelitis develops as a result of increased host resistance and decreased bacterial virulence. The radiological features can mimic various benign or malignant bone tumours and non-pyogenic infections. Histological confirmation is necessary to avoid a delay in diagnosis. J Bone Joint Surg [Br] 2001;83-B:93-8.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Primary subacute haematogenous osteomyelitis in children

Rasool

2001

The Journal of Bone and Joint Surgery. British volume

View full text Add to dashboard Cite

show abstract

“…6 Several classifications exist but Roberts et al's was the first to incorporate the subtype crossing the epiphysis. 5 Our subtype corresponds to type 3B in this classification.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Histopathological specimens generally contain fibrous connective tissue infiltration with lymphocytes, neutrophils, plasma cells, necrotic and new bone. 5 The abscess frequently occurs in the metaphysis of children and adolescents largely due to the metaphysis being highly vascular and bacterial clumping in hairpin-like metaphyseal end-loop arterioles. 6 Several classifications exist but Roberts et al's was the first to incorporate the subtype crossing the epiphysis.…”

Section: Discussionmentioning

confidence: 99%

Subacute physeal abscess: case report to illustrate treatment with a minimally invasive incision and drainage technique

Shah

Chin

Noorani

et al. 2012

annals

View full text Add to dashboard Cite

INTRODUCTION Brodie's abscess is a form of subacute osteomyelitis characterised by a low grade pyogenic abscess found most commonly in the metaphysis. One rare form found in children crosses the physeal growth plate and into the epiphysis. Due to the rarity of this subtype and apprehension associated with treatment of the transphyseal abscess, no clear guidance exists on its management. CASE HISTORY We present a case of delayed diagnosis of Brodie's abscess crossing the physis in a 14-year-old boy. He gave a one-year history of pain in the right knee and early x-rays had shown lucent areas in the tibia. However, these were only noted to be significant at presentation one year later. We also describe an improvised minimally invasive and atraumatic technique of modifying a laminar suction catheter for accessing and draining the abscess. CONCLUSIONS From our experience and reports in the literature it is clear that antibiotic treatment is generally advocated with varying degrees of surgical intervention. Outcomes are largely favourable. Nevertheless, initial drainage allows samples to be sent for microbiological and histological assessment to aid subsequent management and may prevent subsequent leg length discrepancy from failed conservative treatment. We believe that management of a transphyseal abscess must include early drainage and a prolonged course of antibiotics. The antibiotic choice and duration will be governed by culture results and local policy but is commonly given for up to six weeks in the literature and must include one antistaphylococcal drug.

show abstract

“…Some authors have suggested that antibiotics alone may be adequate and that surgery should be considered only for "aggressive According to King and Mayo, any bone infection lasting more than 2 weeks without acute symptomatology can be referred to as subacute osteomyelitis [18]. Subacute haematogenous osteomyelitis is most likely due to an atypical host-pathogen relationship that may comprise any combination of: increased host resistance; decreased virulence of the causative organism; and/or prior antibiotic exposure [13,14,20,27,28]. Since the 1980s, the number of K. kingae osteoarticular infections (OAI) has markedly increased [22,23,[29][30][31][32][33] and several current studies indicate that K. kingae is becoming a leading cause of bacterial osteoarticular infections in children aged from 6-48 months [23,30,31].…”

Section: Discussionmentioning

confidence: 99%

Patellar Subacute Hematogenous Osteomyelitis in Children Due To K. Kingae: A Report of Two Cases

Samara¹,

Steiger²,

Valaikaitė³

et al. 2017

J Infect Dis Preve

View full text Add to dashboard Cite

Isolated osteomyelitis of the patella is a rare condition mainly occurring in the pediatric population. Diagnosis is often delayed as clinical presentation manifests with vague anterior knee pain, sometimes with mild local signs of inflammation but frequently without any local signs at all. While falls on the knee can explain mild knee pain, erythema, swelling and persistent peripatellar pain should raise a high index of suspicion for local infection. We present two cases of subacute osteomyelitis of the patella in young children. In both cases bone lesions presented as an osteolytic lesion of the patella. After open biopsy of the lesion, bacteriological analysis confirmed infection with Kingella kingae.Keywords: Osteomyelitis; Kingella kingae; Trauma; Bone edema; Intravenous antibiotics; Radiographic; PCR Level of EvidenceCase reports, level IV. Case Report 1A 14-month-old Caucasian girl was admitted to the emergency department (ED) of our hospital due to persistent limping for more than 2 weeks. There was no history of trauma. A febrile episode (38.7°C) had occurred approximately 2 weeks before presentation at the ED, but as symptoms had decreased progressively no investigations into the cause of infection and no treatment had been undertaken. On admittance to our hospital, the child was afebrile and walked with a stiff knee. Clinical examination revealed right-sided knee pain, slight prepatellar edema, and a mild knee joint effusion. Laboratory results showed a white blood cell count of 17,000 cells/mm 3 , normal Creactive protein (2 mg/dL) and erythrocyte sedimentation rate (11 mm/h), but a high platelet count (520.000cells/mm 3 ). Conventional radiograph showed no significant abnormality. MRI demonstrated prepatellar soft tissue swelling, joint effusion, synovial enhancement and bone edema, all signs compatible with septic arthritis (Figure 1). Moreover, MRI revealed an osteolytic lesion located in the upper part of the right patella with anterior erosion of the cortical bone. The child underwent joint aspiration where a small quantity of mildly opaque liquid was extracted; the joint cavity was then thoroughly irrigated and the patient was immediately started on intravenous antibiotics (cefuroxime). A switch to oral antibiotics was undertaken after 3 days and treatment was continued for another 20 days. No pathogen was cultivated from the joint fluid, but K. kingae specific rtPCR gave a positive result. At the final clinical control, 12 months after surgery, the child did not complain about any pain and gait was normal. The clinical exam did not reveal any tenderness, swelling or erythema around the knee and the range of motion of the right knee joint was normal. Radiographs showed a normal patella without pathological findings.

show abstract

Subacute Hematogenous Osteomyelitis in Children

Cited by 118 publications

References 0 publications

Primary subacute haematogenous osteomyelitis in children

Primary subacute haematogenous osteomyelitis in children

Subacute physeal abscess: case report to illustrate treatment with a minimally invasive incision and drainage technique

Patellar Subacute Hematogenous Osteomyelitis in Children Due To K. Kingae: A Report of Two Cases

Contact Info

Product

Resources

About