Skip to main content

Advertisement

SpringerLink
Log in

Bone and Joint Infections in Children: Acute Hematogenous Osteomyelitis

  • Review Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Acute hematogenous osteomyelitis (AHO) is one of the commonest bone infection in childhood. Staphylococcus aureus is the commonest organism causing AHO. With use of advanced diagnostic methods, fastidious Kingella kingae is increasingly becoming an important organism in etiology of osteoarticular infections in children under the age of 3 y. The diagnosis of AHO is primarily clinical. The main clinical symptom and sign in AHO is pain and tenderness over the affected bone especially in the metaphyseal region. However, in a neonate the clinical presentation may be subtle and misleading. Laboratory and radiological investigations supplement the clinical findings. The acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are frequently elevated. Ultrasonography and MRI are key imaging modalities for early detection of AHO. Determination of infecting organism in AHO is the key to the correct antibiotic choice, treatment duration and overall management and therefore, organism isolation using blood cultures and site aspiration should be attempted. Several effective antibiotics regimes are available for managing AHO in children. The choice of antibiotic and its duration and mode of delivery requires individualization depending upon severity of infection, causative organism, regional sensitivity patterns, time elapsed between onset of symptoms and child’s presentation and the clinical and laboratory response to the treatment. If pus has been evidenced in the soft tissues or bone region, surgical decompression of abscess is mandatory.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Arnold SR, Elias D, Buckingham SC, et al. Changing patterns of acute hematogenous osteomyelitis and septic arthritis: emergence of community-associated methicillin-resistant Staphylococcus aureus. J Pediatr Orthop. 2006;26:703–8.

    Article  PubMed  Google Scholar 

  2. Wald ER, Mirro R, Gartner JC. Pitfalls in the diagnosis of acute osteomyelitis by bone scan. Clin Pediatr. 1980;19:597–601.

    Article  CAS  Google Scholar 

  3. McCarthy JJ, Dormans JP, Kozin SH, Pizzutillo PD. Musculoskeletal infections in children. Instr Course Lect. 2005;54:515–28.

    PubMed  Google Scholar 

  4. Labbé JL, Peres O, Leclair O, et al. Acute osteomyelitis in children: the pathogenesis revisited? Orthop Traumatol Surg Res. 2010;96:268–75.

    Article  PubMed  Google Scholar 

  5. Karmazyn B. Imaging approach to acute hematogenous osteomyelitis in children: an update. Semin Ultrasound CT MR. 2010;31:100–6.

    Article  PubMed  Google Scholar 

  6. Harik NS, Smeltzer MS. Management of acute hematogenous osteomyelitis in children. Expert Rev Anti Infect Ther. 2010;8:175–81.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ceroni D, Cherkaoui A, Ferey S, Kaelin A, Schrenzel J. Kingella kingae osteoarticular infections in young children: clinical features and contribution of a new real time PCR assay to the diagnosis. J Pediatr Orthop. 2010;30:301–4.

    Article  PubMed  Google Scholar 

  8. Yaguspsky P, Porsch E, St Geme JW 3rd. Kingella kingae: an emerging new pathogen in young children. Pediatrics. 2011;127:557–65.

  9. Thomsen I, Creech CB. Advances in the diagnosis and management of pediatric osteomyelitis. Curr Infect Dis Rep. 2011;13:451–60.

    Article  PubMed  Google Scholar 

  10. Andrea Y, Manoj R. Acute haematogenous osteomyelitis in children. BMJ. 2014;348:g66.

    Article  Google Scholar 

  11. Syrogiannopoulos GA, Nelson JD. Duration of antimicrobial therapy for acute suppurative osteoarticular infections. Lancet. 1988;1:37–40.

    Article  CAS  PubMed  Google Scholar 

  12. Maraqa NF, Rathore MH. Pediatric outpatient parenteral antimicrobial therapy: an update. Adv Pediatr. 2010;57:219–45.

    Article  PubMed  Google Scholar 

  13. Floyed RL, Steele RW. Culture-negative osteomyelitis. Pediatr Infect Dis J. 2003;22:731–6.

    Article  PubMed  Google Scholar 

  14. Martinez-Aguilar G, Avalos-Mishaan A, Hulten K, Hammerman W, Mason EO Jr, Kaplan SL. Community-acquired, methicillin resistant and methicillin susceptible Staphylococcus aureus musculoskeletal infections in children. Pediatr Infect Dis J. 2004;23:701–6.

  15. Merali HS, Reisman J, Wang LT. Emergency department management of acute hematogenous osteomyelitis in children. Pediatr Emerg Med Pract. 2014;11:1–18.

    PubMed  Google Scholar 

  16. Offiah AC. Acute osteomyelitis, septic arthritis and discitis: differences between neonates and older children. Eur J Radiol. 2006;60:221–32.

    Article  CAS  PubMed  Google Scholar 

  17. Pääkkönen M, Kallio MJ, Lankinen P, Peltola H, Kallio PE. Preceding trauma in childhood hematogenous bone and joint infections. J Pediatr Orthop B. 2014;23:196–9.

    Article  PubMed  Google Scholar 

  18. Tuason DA, Gheen T, Sun D, Huang R, Copley L. Clinical and laboratory parameters associated with multiple surgeries in children with acute hematogenous osteomyelitis. J Pediatr Orthop. 2014;34:565–70.

    Article  PubMed  Google Scholar 

  19. Gaviria-Agudelo C, Carter K, Tareen N, Pascual V, Copley LA. Gene expression analysis of children with acute hematogenous osteomyelitis caused by Methicillin-resistant Staphylococcus aureus: correlation with clinical severity of illness. PLoS One. 2014;9:e103523.

  20. Bocchini CE, Hulten KG, Mason EO Jr, Gonzalez BE, Hammerman WA, Kaplan SL. Panton-Valentine leukocidin genes are associated with enhanced inflammatory response and local disease in acute hematogenous Staphylococcus aureus osteomyelitis in children. Pediatrics. 2006;117:433–40.

  21. Dohin B, Gillet Y, Kohler R, et al. Pediatric bone and joint infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus. Pediatr Infect Dis J. 2007;26:1042–8.

    Article  PubMed  Google Scholar 

  22. Ju KL, Zurakowski D, Kocher MS. Differentiating between methicillin-resistant and methicillin-sensitive Staphylococcus aureus osteomyelitis in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 2011;93:1693–701.

    Article  PubMed  Google Scholar 

  23. Weichert S, Sharland M, Clarke NM, Faust SN. Acute haematogenous osteomyelitis in children: is there any evidence for how long we should treat? Curr Opin Infect Dis. 2008;21:258–62.

    Article  PubMed  Google Scholar 

  24. Peltola H, Pääkkönen M, Kallio P, Kallio MJ; Osteomyelitis-Septic Arthritis Study Group. Short- versus long-term antimicrobial treatment for acute hematogenous osteomyelitis of childhood: prospective, randomized trial on 131 culture-positive cases. Pediatr Infect Dis J. 2010;29:1123–8.

  25. Unkila-Kallio L, Kallio MJ, Eskola J, Peltola H. Serum C-reactive protein, erythrocyte sedimentation rate, and white blood cell count in acute hematogenous osteomyelitis of children. Pediatrics. 1994;93:59–62.

    CAS  PubMed  Google Scholar 

  26. Peltola H, Unkila-Kallio L, Kallio MJ. Simplified treatment of acute staphylococcal osteomyelitis of childhood. The Finnish Study Group. Pediatrics. 1997;99:846–50.

    Article  CAS  PubMed  Google Scholar 

  27. Copley LA, Barton T, Garcia C, et al. A proposed scoring system for assessment of severity of illness in pediatric acute hematogenous osteomyelitis using objective clinical and laboratory findings. Pediatr Infect Dis J. 2014;33:35–41.

    Article  PubMed  Google Scholar 

  28. Pääkkönen M, Peltola H. Antibiotic treatment for acute haematogenous osteomyelitis of childhood: moving towards shorter courses and oral administration. Int J Antimicrob Agents. 2011;38:273–80.

    Article  PubMed  Google Scholar 

  29. Mok PM, Reilly BJ, Ash JM. Osteomyelitis in the neonates: clinical aspects and role of radiography and scintigraphy in diagnosis and management. Radiology. 1982;145:677–82.

    Article  CAS  PubMed  Google Scholar 

  30. Blickman JG, van Die CE, de Rooy JW. Current imaging concepts in pediatric osteomyelitis. Eur Radiol. 2004;14:L55–64.

    Article  PubMed  Google Scholar 

  31. Chau CL, Griffith JF. Musculoskeletal infections: ultrasound appearances. Clin Radiol. 2005;60:149–59.

    Article  CAS  PubMed  Google Scholar 

  32. Abiri MM, Kirpekar M, Ablow RC. Osteomyelitis: detection with US. Radiology. 1989;172:509–11.

    Article  CAS  PubMed  Google Scholar 

  33. Courtney PM, Flynn JM, Jaramillo D, Horn BD, Calabro K, Spiegel DA. Clinical indications for repeat MRI in children with acute hematogenous osteomyelitis. J Pediatr Orthop. 2010;30:883–7.

    Article  PubMed  Google Scholar 

  34. Gutierrez K. Bone and joint infections in children. Pediatr Clin North Am. 2005;52:779–94.

    Article  PubMed  Google Scholar 

  35. Chamroonrat W, Zhuang H. Early acute hematogenous osteomyelitis detected by bone scintigraphy but not MRI. Clin Nucl Med. 2013;38:285–8.

    Article  PubMed  Google Scholar 

  36. Jones DC, Cady RB. “Cold” bone scans in acute osteomyelitis. J Bone Joint Surg (Br). 1981;63:376–8.

    Google Scholar 

  37. Warmann SW, Dittmann H, Seitz G, Bares R, Fuchs J, Schäfer JF. Follow-up of acute osteomyelitis in children: the possible role of PET/CT in selected cases. J Pediatr Surg. 2011;46:1550–6.

    Article  PubMed  Google Scholar 

  38. Majewski J, Del Vecchio M, Aronoff S. Route and length of therapy of acute uncomplicated hematogenous osteomyelitis: do we have the answers yet? Hosp Pediatr. 2014;4:44–7.

    Article  PubMed  Google Scholar 

  39. Agarwal A, Aggarwal AN. Acute hematogenous osteomyelitis. In: Agarwal A, Aggarwal AN, editors. Pediatric osteoarticular infections. Delhi: Jaypee; 2014. p. 93–106.

    Google Scholar 

  40. Nelson JD. Towards simple but safe management of osteomyelitis. Pediatrics. 1997;99:883–4.

  41. Afghani B, Kong V, Wu FL. What would pediatric infectious disease consultants recommend for management of culture-negative acute hematogenous osteomyelitis? J Pediatr Orthop. 2007;27:805–9.

  42. Bouchoucha S, Gafsi K, Trifa M, et al. Intravenous antibiotic therapy for acute hematogenous osteomyelitis in children: short versus long course. Arch Pediatr. 2013;20:464–9.

  43. Jagodzinski NA, Kanwar R, Graham K, Bache CE. Prospective evaluation of a shortened regime of treatment for acute osteomyelitis and septic arthritis in children. J Pediatr Orthop. 2009;29:518–25.

  44. Belthur MV, Philips WA, Kaplan SL, Weinberg J. Prospective evaluation of a shortened regimen of treatment for acute osteomyelitis and septic arthritis in children. J Pediatr Orthop. 2010;30:942.

  45. Le Saux N, Howard A, Barrowman NJ, Gaboury I, Sampson M, Moher D. Shorter courses of parenteral antibiotic therapy do not appear to influence response rates for children with acute hematogenous osteomyelitis: a systematic review. BMC Infect Dis. 2002;2:16.

Download references

Conflict of Interest

None.

Source of Funding

None.

Author information

Authors and Affiliations

  1. Department of Pediatric Orthopedics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, Delhi, India

    Anil Agarwal

  2. Department of Orthopedics, UCMS and GTB Hospital, Shahdara, Delhi, India

    Aditya N. Aggarwal

Authors
  1. Anil Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aditya N. Aggarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anil Agarwal.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Agarwal, A., Aggarwal, A.N. Bone and Joint Infections in Children: Acute Hematogenous Osteomyelitis. Indian J Pediatr 83, 817–824 (2016). https://doi.org/10.1007/s12098-015-1806-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-015-1806-3

Keywords

Search

Navigation