Osteomyelitis in a General Pediatric Ward
INTRODUCTION: Pediatric acute osteomyelitis (AO) is a serious condition and a challenging diagnosis. It mainly affects previously healthy individuals and Staphylococcus aureus is the leading causative agent. The objective of this study was to characterize all pediatric AO cases admitted to a second-...
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| Format: | Article |
| Language: | English |
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José de Mello Saúde
2021-12-01
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| Series: | Gazeta Médica |
| Subjects: | |
| Online Access: | https://gazetamedica.pt/index.php/gazeta/article/view/497 |
| _version_ | 1818407628353568768 |
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| author | Mafalda Casinhas Santos Sara Limão Ana Sofia Vilardouro Clara Júlio Florbela Cunha |
| author_facet | Mafalda Casinhas Santos Sara Limão Ana Sofia Vilardouro Clara Júlio Florbela Cunha |
| author_sort | Mafalda Casinhas Santos |
| collection | DOAJ |
| description | INTRODUCTION: Pediatric acute osteomyelitis (AO) is a serious condition and a challenging diagnosis. It mainly affects previously healthy individuals and Staphylococcus aureus is the leading causative agent. The objective of this study was to characterize all pediatric AO cases admitted to a second-level hospital during a six-year period.
METHODS: Retrospective single-center study, including all children under 18 years-old with a primary diagnosis of AO. Descriptive statistics analysis was performed.
RESULTS: Ten cases were identified, 60% males. The median age was 6.7 years. Previous trauma was referred by five. Affected locations were foot (n=3), tibia (n=3), femur (n=2), sacrum (n=1) and hand (n=1). All presented with local pain and limping or inability to walk (except one case with hand involvement). Four patients had fever and inflammatory signs, namely erythema and edema, were reported by four. At admission, nine had elevated inflammatory markers and six out of eight had normal radiographs. Magnetic resonance imaging confirmed the diagnosis in seven. Blood cultures were positive for Staphylococcus aureus (n=3) and Streptococcus pyogenes (n=1). Salmonella enteritidis was isolated from pus (n=1) and there was one presumed Kingella kingae AO defined as a positive polymerase chain reaction test from an oropharyngeal swab. The average duration of parenteral and oral antibiotherapy was 14.7 days 3.9 weeks, respectively. The antibiotic of choice was flucloxacillin. Two patients developed local complications.
DISCUSSION: An unspecific and subacute clinical and radiological presentation together with low positive blood culture rates difficults timely diagnosis and management. An early empirical parenteral antibiotherapy is mandatory, followed by an oral regimen for at least four weeks. |
| first_indexed | 2024-12-14T09:30:51Z |
| format | Article |
| id | doaj.art-5f80a34ce79b495e959e1e666e88e78b |
| institution | Directory Open Access Journal |
| issn | 2183-8135 2184-0628 |
| language | English |
| last_indexed | 2024-12-14T09:30:51Z |
| publishDate | 2021-12-01 |
| publisher | José de Mello Saúde |
| record_format | Article |
| series | Gazeta Médica |
| spelling | doaj.art-5f80a34ce79b495e959e1e666e88e78b2022-12-21T23:08:04ZengJosé de Mello SaúdeGazeta Médica2183-81352184-06282021-12-0111Osteomyelitis in a General Pediatric WardMafalda Casinhas Santos0Sara Limão1Ana Sofia Vilardouro2Clara Júlio3Florbela Cunha4Pediatric Service, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal.Pediatric Service, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal.Department of Pediatrics, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.Orthopedic Service, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal.Pediatric Service, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal.INTRODUCTION: Pediatric acute osteomyelitis (AO) is a serious condition and a challenging diagnosis. It mainly affects previously healthy individuals and Staphylococcus aureus is the leading causative agent. The objective of this study was to characterize all pediatric AO cases admitted to a second-level hospital during a six-year period. METHODS: Retrospective single-center study, including all children under 18 years-old with a primary diagnosis of AO. Descriptive statistics analysis was performed. RESULTS: Ten cases were identified, 60% males. The median age was 6.7 years. Previous trauma was referred by five. Affected locations were foot (n=3), tibia (n=3), femur (n=2), sacrum (n=1) and hand (n=1). All presented with local pain and limping or inability to walk (except one case with hand involvement). Four patients had fever and inflammatory signs, namely erythema and edema, were reported by four. At admission, nine had elevated inflammatory markers and six out of eight had normal radiographs. Magnetic resonance imaging confirmed the diagnosis in seven. Blood cultures were positive for Staphylococcus aureus (n=3) and Streptococcus pyogenes (n=1). Salmonella enteritidis was isolated from pus (n=1) and there was one presumed Kingella kingae AO defined as a positive polymerase chain reaction test from an oropharyngeal swab. The average duration of parenteral and oral antibiotherapy was 14.7 days 3.9 weeks, respectively. The antibiotic of choice was flucloxacillin. Two patients developed local complications. DISCUSSION: An unspecific and subacute clinical and radiological presentation together with low positive blood culture rates difficults timely diagnosis and management. An early empirical parenteral antibiotherapy is mandatory, followed by an oral regimen for at least four weeks.https://gazetamedica.pt/index.php/gazeta/article/view/497ChildOsteomyelitis/diagnosisOsteomyelitis/therapy |
| spellingShingle | Mafalda Casinhas Santos Sara Limão Ana Sofia Vilardouro Clara Júlio Florbela Cunha Osteomyelitis in a General Pediatric Ward Gazeta Médica Child Osteomyelitis/diagnosis Osteomyelitis/therapy |
| title | Osteomyelitis in a General Pediatric Ward |
| title_full | Osteomyelitis in a General Pediatric Ward |
| title_fullStr | Osteomyelitis in a General Pediatric Ward |
| title_full_unstemmed | Osteomyelitis in a General Pediatric Ward |
| title_short | Osteomyelitis in a General Pediatric Ward |
| title_sort | osteomyelitis in a general pediatric ward |
| topic | Child Osteomyelitis/diagnosis Osteomyelitis/therapy |
| url | https://gazetamedica.pt/index.php/gazeta/article/view/497 |
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