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Pediatric osteomyelitis

Olugbenga Akinkugbe, Charles Stewart, Caoimhe McKenna
OBJECTIVE: The objective of this study was to evaluate the presenting features of bone and joint infections with a view to identify distinguishing trends that will be useful for pediatric emergency departments. METHODS: We performed a retrospective review of patient records over a 12-year period in the pediatric emergency department of a large regional pediatric teaching center serving a diverse population. RESULTS: There were 88 cases of osteoarticular infections during the study period...
March 5, 2018: Pediatric Emergency Care
William T Davis, Shawn R Gilbert
BACKGROUND: The incidence of methicillin-resistant Staphylococcus aureus (MRSA) pediatric osteomyelitis has risen and been associated with a more severe clinical course than methicillin-susceptible Staphylococcus aureus (MSSA) infections. National databases have been underutilized to describe these trends. We compared demographics, clinical course, and outcomes for patients with MRSA versus MSSA osteomyelitis. METHODS: We queried the 2009 and 2012 Healthcare Cost and Utilization Project Kids Inpatient Database for discharge records with diagnosis codes for osteomyelitis and S...
February 16, 2018: Journal of Pediatric Orthopedics
Marguerite T Parisi, Jeffrey P Otjen, A Luana Stanescu, Barry L Shulkin
With the exception of radiolabeled monoclonal antibodies, antibody fragments and radiolabeled peptides which have seen little application in the pediatric population, the nuclear medicine imaging procedures used in the evaluation of infection and inflammation are the same for both adults and children. These procedures include (1) either a two- or a three-phase bone scan using technetium-99m methylene diphosphonate; (2) Gallium 67-citrate; (3) in vitro radiolabeled white blood cell imaging (using111 Indium-oxine or99m Technetium hexamethyl-propylene-amine-oxime-labeled white blood cells); and (4) hybrid imaging with18 F-FDG...
March 2018: Seminars in Nuclear Medicine
Marguerite T Parisi, Ramesh S Iyer, A Luana Stanescu
The introduction of diphosphonates in the 1970s revolutionized not only nuclear medicine but musculoskeletal imaging as well, providing functional assessment of entities such as osteomyelitis, trauma, and osseous metastatic disease. Although rarely the first-line imaging modality used today, nuclear medicine procedures continue to play a pivotal role in the evaluation of musculoskeletal diseases in children, providing whole-body assessment of disease involvement. More recently, the introduction of technologies such as single-photon emission computed tomography/computed tomography (SPECT/CT), as well as newer positron-emitting tracers such as 18 fluorine-fluorodeoxyglucose and sodium 18 F-fluorine, particularly when combined with CT (positron emission tomography/CT), have injected new life into the older established techniques and expanded the application of nuclear medicine imaging into new arenas...
February 2018: Seminars in Musculoskeletal Radiology
Benjamin D Welling, Lee S Haruno, Scott B Rosenfeld
BACKGROUND: Septic arthritis is frequently associated with adjacent infections including osteomyelitis and subperiosteal and intramuscular abscesses. While often clinically indiscernible from isolated septic arthritis, the diagnosis of adjacent infections is important in determining the need for additional surgical intervention. MRI has been used as the diagnostic gold standard for assessing adjacent infection. Routine MRI, however, can be resource-intensive and delay surgical treatment...
January 2018: Clinical Orthopaedics and related Research
Ángela Gentile, Julia Bakir, Gabriela Ensinck, Aldo Cancellara, Enrique V Casanueva, Verónica Firpo, Martín Caruso, María F Lución, Alejandro Santillán Iturres, Fabiana Molina, Héctor J Abate, Andrea Gajo Gane, Santiago López Papucci
INTRODUCTION: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are prevalent both in Argentina and worldwide, and they may have a severe clinical course. OBJECTIVES: To estimate the hospitalization rate and case fatality risk factors of CA-MRSA infection. METHODS: Cross-sectional, analytical study. All patients < 15 years old with community-acquired Staphylococcus aureus (CA-SA) infections admitted to 10 pediatric facilities between January 2012 and December 2014 were included...
February 1, 2018: Archivos Argentinos de Pediatría
Chetan Sharma, Brian Chow
Synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome is considered after exclusion of infection and arthritis; however, microbial infection may be present in osteoarticular lesions of these patients. Chronic osteomyelitis and associated bacterial infection were detected in a recurrent osteoarticular lesion in an adolescent patient with a history of clavicle pain, who complained of recurrent swelling in the left clavicle. Most pediatric case reports of SAPHO syndrome describe patients with associated skin conditions...
June 2017: WMJ: Official Publication of the State Medical Society of Wisconsin
M Lorrot, Y Gillet, C Gras Le Guen, E Launay, R Cohen, E Grimprel
Acute hematogenous bone and joint infections (osteomyelitis, septic arthritis, osteoarthritis, and spondylodiscitis) affect more frequently children younger than 5 years of age. Early diagnosis and prompt treatment are needed to limit the risk of complications. Children with suspected bone and joint infections (BJI) should be hospitalized at the beginning of treatment. Surgical drainage is indicated in patients with septic arthritis and in those with periosteal abscess. Staphylococcus aureus is involved in BJIs in children at all ages; Kingella kingae is a very common causative pathogen in children under 4 years of age...
December 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Colen Cooper Gore Silier, Justina Greschik, Susanne Gesell, Veit Grote, Annette F Jansson
OBJECTIVE: Although chronic non-bacterial osteitis (CNO) is an ever-increasingly recognised illness in the paediatric community and the adult healthcare community, a study to assess diagnosing, treatment and the psychosocial aspect of CNO from a large population pool was not available. We aimed to investigate CNO from the patient perspective. DESIGN: Health services research, patient survey. SETTING: Ludwig-Maximilians-University (LMU) Pediatric Rheumatology Department CNO Conferences held in June 2013 and June 2015...
December 26, 2017: BMJ Open
Sigrun Ruth Hofmann, Fanny Böttger, Ursula Range, Christian Lück, Henner Morbach, Hermann Joseph Girschick, Meinolf Suttorp, Christian Michael Hedrich
Objectives: Chronic recurrent multifocal osteomyelitis (CRMO), the most severe form of chronic nonbacterial osteomyelitis (CNO), is an autoinflammatory bone disorder. In the absence of diagnostic criteria or biomarkers, CNO/CRMO remains a diagnosis of exclusion. The aim of this study was to identify biomarkers for diagnosing multifocal disease (CRMO). Study design: Sera from 71 pediatric CRMO patients, 11 patients with osteoarticular infections, 62 patients with juvenile idiopathic arthritis (JIA), 7 patients with para-infectious or reactive arthritis, and 43 patients with acute leukemia or lymphoma, as well as 59 healthy individuals were collected...
2017: Frontiers in Pediatrics
Divyaswathi Citla Sridhar, Ossama M Maher, Nidra I Rodriguez
Deep venous thrombosis (DVT) has been previously reported in children with methicillin-resistant Staphylococcus aureus (MRSA). This study reviews our institutional experience by evaluating characteristics and outcomes of children with DVT and staphylococcal infections. Retrospective clinical data from 16 pediatric patients with DVT and staphylococcal infections over a 5-year period was obtained via medical record abstraction. Sixteen patients with a median age at diagnosis of 8 years were included. The most common infection encountered was osteomyelitis (56%)...
March 2018: Journal of Pediatric Hematology/oncology
Patricia Barrios, Federica Badía, Valentina Misa, M Inés Mota, Arací Martínez, Hebert Mariño, Gabriela Algorta, Javier Prego, M Catalina Pírez
BACKGROUND: Salmonella can cause asymptomatic infections, diarrhea, bacteremia and focal infections such as meningitis and osteomyelitis. AIM: To describe clinical and microbiological aspects of infections by Salmonella spp. in children in a pediatric referral hospital: Centro Hospitalario Pereira Rossell, in Montevideo, Uruguay. MATERIALS AND METHODS: Descriptive and retrospective study of 46 patients, from which Salmonella spp was isolated between January 1, 2005 and December 31, 2010...
August 2017: Revista Chilena de Infectología: órgano Oficial de la Sociedad Chilena de Infectología
Y J Berkowitz, S J Greenwood, G Cribb, K Davies, V N Cassar-Pullicino
Chronic recurrent multifocal osteomyelitis (CRMO) is a rare condition thought to be under-diagnosed, with a true prevalence of more than the 1 in 10,000 estimated. It is a condition that is classically described as polyostotic with a relapsing and remitting course, preferentially affecting the metaphyses of tubular bones in the pediatric population. Lesions have characteristic appearances of cortical hyperostosis and mixed lytic/sclerotic medullary appearances radiographically, with active osteitis and periostitis best seen with fluid-sensitive sequences on magnetic resonance imaging (MRI)...
November 9, 2017: Skeletal Radiology
Yongdong Zhao, Eveline Y Wu, Melissa S Oliver, Ashley M Cooper, Matthew L Basiaga, Sheetal S Vora, Tzielan C Lee, Emily Fox, Gil Amarilyo, Sara M Stern, Jeffrey A Dvergsten, Kathleen A Haines, Kelly A Rouster-Stevens, Karen B Onel, Julie Cherian, Jonathan S Hausmann, Paivi Miettunen, Tania Cellucci, Farzana Nuruzzaman, Angela Taneja, Karyl S Barron, Matthew C Hollander, Sivia K Lapidus, Suzanne C Li, Seza Ozen, Hermann Girschick, Ronald M Laxer, Fatma Dedeoglu, Christian M Hedrich, Polly J Ferguson
OBJECTIVE: To develop standardized treatment regimens for chronic nonbacterial osteomyelitis (CNO), also known as chronic recurrent multifocal osteomyelitis (CRMO) to enable comparative effectiveness treatment studies. METHODS: Virtual and face-to-face discussions and meetings were held within the CNO subgroup of the Childhood Arthritis and Rheumatology Research Alliance (CARRA). A literature search was conducted, and CARRA membership was surveyed to evaluate available treatment data and identify current treatment practices...
November 7, 2017: Arthritis Care & Research
Chunmiao Cui, Muyong Fu, Boqian Gao
BACKGROUND High plasma levels of procalcitonin (PCT) are typically seen in children with severe bacterial infection, particularly in cases of septic shock or bacteremia. Similarly, pancreatic stone protein (PSP) is associated with inflammation, infection, and other disease-related stimuli. However, the prognostic value of PSP in critically ill pediatric patients is unknown. This study investigated the early diagnostic value of PCT and PSP in pediatric acute osteomyelitis. MATERIAL AND METHODS A total of 187 patients with suspected acute osteomyelitis and 80 healthy control children were enrolled...
November 1, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Delran Anandkumar, Ananthakrishnan Raghupathi, Ragai Gadelrab
INTRODUCTION: The current method in dealing with pediatric hip pathologies is to avoid joint replacement unless absolutely necessary. This decision is typically made on a scientific basis. However, this is not necessarily the correct approach in all cases as demonstrated in the following case report where social issues is an extremely important variable to be considered when deciding on surgical intervention. CASE REPORT: This case report is the first of its kind to highlight the pathology mentioned and the social determinants that were a causative agent in its development...
May 2017: Journal of Orthopaedic Case Reports
Charles Nathan Nessle, Allison K Black, Justin Farge, Victoria A Statler
A 5-month-old previously healthy female presented with a one-week history of fever and increased fussiness. Her presentation revealed an ill-appearing infant with an exam and cerebrospinal fluid (CSF) studies concerning bacterial meningitis; CSF cultures grew Pasteurella multocida. Additionally, brain magnetic resonance imaging (MRI) demonstrated cervical osteomyelitis. Despite multiple days of antibiotic therapy, she remained febrile with continued pain; MRI showed oligoarticular effusions, and aspiration of these joints yielded bloody aspirates...
October 16, 2017: Children
Nicolas V Vardiabasis, John A Schlechter
BACKGROUND: Children who present to the emergency department (ED) with complaint of fever and new-onset joint or extremity pain can be a diagnostic dilemma for many emergency and consulting physicians. OBJECTIVES: The purpose of our study was to identify the etiologies of pediatric fever and extremity pain presenting to a tertiary care pediatric ED and to define factors that were associated with advanced imaging, admission, and surgical intervention. METHODS: The electronic medical records of children presenting to our institution's pediatric ED with fever and extremity pain were retrospectively reviewed...
September 2017: Journal of Emergency Medicine
Joseph M Firriolo, Ingrid M Ganske, Carolyn M Pike, Catherine Caillouette, Heather R Faulkner, Joseph Upton, Brian I Labow
BACKGROUND: Pressure ulcers refractory to nonoperative management may undergo flap reconstruction. This study aims to evaluate the long-term outcomes and recurrence rates of flap reconstruction for pediatric pressure ulcers. METHODS: We reviewed the records of patients who underwent flap reconstruction for pressure ulcer(s) from 1995 to 2013. RESULTS: Twenty-four patients with 30 pressure ulcers, requiring 52 flaps were included. Ulcers were stages III and IV and mostly involved either the ischia (15/30) or sacrum (8/30)...
February 2018: Annals of Plastic Surgery
Derya Çayır, Mine Araz, Mustafa Filik, Mehmet Erdoğan
The appearance of a hot kidney on bone scintigraphy is rare and can be seen due to various factors. In our clinic, we observed hot kidney appearance in two patients to whom technetium-99m methylene diphosphonate (Tc-99m MDP) whole body scan has been performed: a young male adult at the age of 18 who was diagnosed with acute lymphocytic leukemia with a presumptive diagnosis of avascular necrosis, and a 9-year-old girl with cystitis for a pre-diagnosis of osteomyelitis. The first patient had a history of cyclosporine usage and the second patient was being treated with amikacin + vancomycin...
October 3, 2017: Molecular Imaging and Radionuclide Therapy
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