Pediatric Osteomyelitis ICD-9
Pediatric Osteomyelitis Etiology / Epidemiology / Natural History
- 1/5,000 children
- Generally in children younger than 5 y/o.
- M:F = 2:1
- Most common organsism = S aureus. Others: group A beta-hemolytic streptococcus, Haemophilus influenzea, Kingella kingae( after URI), salmonella(sickle cell patients), bartonella henselae (cat-scratch disease), Pseudomonas aeruginosa (puncture wounds in feet).
Pediatric Osteomyelitis Anatomy
- Generally occurs at metaphyseal-epiphyseal junction of long bones (femur, tibia, humerus).
Pediatric Osteomyelitis Clinical Evaluation
- Fever and limb pain, limp
- Neonates: pseudoparalysis, pain with palpation, local swelling, decreased appetite, inconsolable crying.
- Infants/toddlers: fever, irritability, limp, inability to bear weight, swelling, warmth, erythema,
- Older children/adolescents: pain, fever
Pediatric Osteomyelitis Xray / Diagnositc Tests
- CBC with differential, ESR (rises within 2 days, continues to rise for 3-5 days even with treatment), CRP (rises witin 6 hours, peaks at 48 hrs, normal witin 1 week), blood cultures, gram stain, CXR. Consider Acid-fast staining, fungal cultures, prolonged incubation times (especially for infections after arthroscopic surgery).
- Xray: demonstrate soft-tissue swelling / loss of tissue planes early. Bone abnormalities require 30-40% bone losss.
- MRI: highest sensitivity and specificity for infection / osteomyelitis. low signal intensity in bone marrow on T1 images may indicated osteomyelits (bone marrow normally has high-signal intensity on T1 images).
- Bone scan: technetium 99m; gallium citrate Ga 67; indium-111 leukocyte-labeled etc.
- Fine needle aspiration.
Pediatric Osteomyelitis Classification / Treatment
- Acute: IV antibiotics for 4/6 weeks determined by culture and senstivities. Result of antibiotic treatment is best monitored with serial CRP levels. CRP should decline within 72hrs with appropriate treatment (Unkila-Kallio L, Pediatrics 1994;93:59).
- Chronic (any patient with subperiosteal abcess, soft-tissue abcess, sequestra, intrameduallar purulence): Operative debridement and IV antibiotics for 4/6 weeks determined by culture and senstivities.
Pediatric Osteomyelitis Associated Injuries / Differential Diagnosis
Pediatric Osteomyelitis Complications
Pediatric Osteomyelitis Follow-up Care
- Follow responce to treatment with serial ESR and CRP. CRP returns to normal in 1 week, ESR in 3 weeks with adequate treatment.
Pediatric Osteomyelitis Review References