Acute hematogenous osteomyelitis ahom is not uncommonly encountered in hospitalized pediatric patients, occurring in 1 in 5000 children per year or 1% of pediatric hospitalizations. Osteomyelitis is inflammation of the boneand bone marrow generally caused by a bacterial infection. Understand what predisposes children of different age groups to acute hematogenous osteoarticular infections oais, particularly the role of anatomy and differing pathogenic susceptibilities. A high index of suspicion is required as early treatment is essential for a good outcome. Pdf in children, osteomyelitis is primarily hematogenous in origin and acute in nature. After completing this article, readers should be able to. Management of pediatric acute hematogenous osteomyelitis. Acute hematogenous osteomyelitis is an infection that usually affects the growing skeleton, involving primarily the most vascularized regions of the bone. The most common organisms isolated in these cases include s aureus, streptococcus pneumoniae, and haemophilus influenza type b less common since the use of vaccine for h influenza type b. Acute hematogenous osteomyelitis aho remains an important and relatively common disease of infants and children. Worldwide incidence ranges between 1 to 120,000 population, with 50% of.
A penicillintreated series of cases of osteomyelitis in childhood. Staphylococ cus aureus is the most common cause of acute and chronic hematogenous osteomyelitis in adults and children. Early diagnosis decreases the risk of complications, including sepsis, chronic infection, growth arrest, and bone deformity. Infection in one part of the body may spread through the bloodstream into. The site of the infection may be made vulnerable by concurrent nonpenetrating trauma. Pediatric acute hematogenous osteomyelitis aho is a relatively common reason for hospitalization, but many variables require additional study, including the impact of antibiotic treatment on bone biopsy culture yield. Osteomyelitis can result from direct inoculation from a penetrating trauma or can spread from a contiguous site of infection, but the most common mechanism of infection in children is hematogenous inoculation of the bone during an episode of bacteremia. Acute hematogenous osteomyelitis in children springerlink. Emergency department management of acute hematogenous.
In developed countries, hematogenous osteomyelitis is. Use of a clinical care algorithm to improve care for. Acute hematogenous osteomyelitis may develop when a bloodborn bacteria enters the nutrient artery of a bone and lodges in the metaphysis. Acute hematogenous osteomyelitis, pediatric orthopedics, bone infection, outcome, patient profile, staphylococcus aureus date received. Management of acute hematogenous osteomyelitis in children. It is usually seen in children and is more common in boys. It is considered an acute process if the symptoms have lasted less than 2 weeks 2,3. Acute hematogenous osteomyelitis pubmed central pmc. Pdf management of acute hematogenous osteomyelitis in. Paediatric acute hematogenous osteomyelitis ahom is a serious disease requiring early diagnosis and treatment. Acute hematogenous osteomyelitis ahom is a rapid onset infection of the bone from bloodborn organisms. Epiphyseal osteomyelitis may present in acute or subacute forms. Correlate most common infectious causes of osteomyelitis with the age of the patient. The long bones of the arms and legs are most commonly involved in children, while the feet, spine, and hips are most commonly involved in adults.
Unless acute osteomyelitis in children is diagnosed promptly and treated appropriately, it can be a devastating or even fatal disease. Acute hematogenous osteomyelitis in children ochsner journal. The epidemiology, pathogenesis, and microbiology of hematogenous osteomyelitis in. Group a streptococ cus, streptococcus pneumoniae, and kingella kingae are the next most common pathogens in children. This increase in mrsa is due to the rise in community. The incidence of hematogenous osteomyelitis reflects the fact that the body is more susceptible to invasion by microorganisms when nutrition and hygiene are poor. Haemophilus influenzae type b hib is now rare in countries that routinely use the hib vaccine. In avian species, acute hematogenous osteomyelitis was experimentally induced in 29dayold broiler chickens by intravenous injection of s aureus, 25 this avian model closely mimicked human disease by affecting mainly the distal femur and proximal tibiotarsus. G19 osteomyelitis pathophysiology and treatment decisions. Hematogenous metaphysis of long bones most common in children vertebral osteomyelitis contiguous spread posttraumatic open fractures infections associated with deep implants prosthetic joint infections vascular insufficiency andor diabetes secondary to ulceration commonly affects the forefoot bones.
The clinical and roentgenologic features of aho have changed since. Hematogenous osteomyelitis is generally monomicrobiotic in nature, i. To describe occurrence, evolution, and out come of acute hematogenous osteomyelitis in children and adolescents. Septic arthritis of an adjacent joint may be an early complication of acute osteomyelitis in children.
Diagnosis and management of osteomyelitis of osteomyelitis. Osteomyelitis is an infection of the bone, a rare but serious condition. The most common type of osteomyelitis, an infection of bone, that occurs in children is acute hematogenous osteomyelitis. Acute hematogenous the authors 2020 osteomyelitis in. The most common form in childhood is acute hematogenous osteomyelitis aho, which is infection of the bone of less than two weeks duration spread hematogenously. Other risk factors for nonhematogenous osteomyelitis include open fractures that require surgical reduction, implanted orthopedic hardware such as pins or screws, and puncture wounds. In this study, the authors reported an unusual case of salmonella enteriditis osteomyelitis of the humerus complicated by methicillinresistant staphylococcus aureus superinfection and eventual chronic osteomyelitis in an immunocompetent host. Acute hematogenous osteomyelitis is characterized by an acute infection of the bone caused by the seeding of the bacteria within the bone from a remote source. Hematogenous osteomyelitis in infants and children. An update on diagnosis and treatment elena chiappini 1, greta mastrangelo 1 and simone lazzeri 2 1 infectious disease unit, meyer university hospital, university of florence, florence 50100, italy.
Infection initially is established in the metaphyseal region of tubular bones, beginning as a metaphysitis following seeding by bacteria. The acute form has been defined as rapid onset and progression with systemic symptoms. The principal cause of osteomyelitis in children is. Explain the appropriate use of ancillary information obtained by laboratory determinations and imaging studies to establish the diagnosis of acute hematogenous osteomyelitis. Epiphyseal osteomyelitis may present in either an acute or subacute form. Acute hematogenous osteomyelitis is an infection that usually affects the grow ing skeleton, involving primarily the most vascularized regions of the bone. The distinct entity to be considered in this paper is the acute stage of hematogenous osteomyelitis in children. In the acute setting, the duration of symptoms is less than two weeks. Acute hematogenous osteomyelitis aho causes significant morbidity in children and often requires prolonged and costly treatment1, 3 6 a recent large study from spain revealed that children with osteomyelitis were hospitalized for an average of 5 days. Acute hematogenous osteomyelitis is an infection that usually affects the grow ing skeleton, involving primarily the most vascularized regions of. Epidemiology and management of acute haematogenous. Acute osteomyelitis is an uncommon but important disease that affects previously healthy children. Antibiotic therapy and surgical drainage of the bone are the most commonly accepted forms of therapy for acute hematogenous osteomyelitis.
Dilemma in differentiating between acute osteomyelitis and bone infarction in children with sickle cell disease. Acute hematogenous osteomyelitis of a closed fracture with. In the past decade, rapid changes in the epidemiology of the condition, in particular of infections as a result of meticillin resistant staphylococcus aureus mrsa, and advances in diagnostics have. Acute hematogenous osteomyelitis usually occurs after an episode of bacteremia in which the organisms inoculate the bone. Acute hematogenous osteomyelitis american academy of. There would be a more general agreement if this principle were followed instead of considering the entire subject. Thus, hematogenous osteomyelitis is common in south america, asia, and africa. The etiology of acute hematogenous osteomyelitis aho remains unknown, and the disease has no laboratory model. A discussion of treatment should specify the type of osteomyelitis and the stage of the disease. The diagnosis of acute osteomyelitis can be established based on several specific clinical findings table 3. Acute hematogenous osteomyelitis of the foot and ankle in. We describe an aho model in the rabbit which resembles the human disease. Acute hematogenous osteomyelitis is most common in children and has the potential to cause lifelong musculoskeletal deformities.
Clinicians cannot reliably predict complications of acute hematogenous osteomyelitis aho. In acute hematogenous osteomyelitis, the joint is usually spared, unless the metaphysis is intracapsular, as is found at the proximal radius, humerus, or femur. Acute hematogenous osteomyelitis aho causes significant morbidity in children 1 3 and often requires prolonged and costly treatment. Hematogenous osteomyelitis an overview sciencedirect. Acute hematogenous salmonella osteomyelitis is rare among immunocompetent adults. Acute hematogenous bacterial osteoarticular infections in. Osteomyelitis is an infection of the bones that occurs either via hematogenous spread most common in children, bacterial spread from local contiguous infections cellulitis or septic arthritis, or traumatic inoculation.
Osteomyelitis is the inflammation of bone caused by pyogenic organisms. Acute hematogenous osteomyelitis aho is particularly common in children diagnosis. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. Acute hematogenous osteomyelitis is the most common type of bone infection. The major sources of infection are haematogenous spread, tracking from adjacent foci of infection, and direct inoculation from trauma or surgery. Therefore, it is important that clinicians are aware of the various and upcoming therapies that cover this bacterium.
Acute haematogenous osteomyelitis in children the bmj. Recognize the typical clinical manifestations of acute hematogenous osteomyelitis. N2 based on strong research evidence and clinical experience, most cases of acute hematogenous osteomyelitis begin as an infection in the metaphysis of a long bone that progresses by local extension and potentially can rupture into an adjacent joint or subperiosteal space. This study evaluated a strategy in which skeletal scintigraphy is the primary and mri a supplemental test. Hematogenous osteomyelitis in infants and children rsna. Imaging approach to acute hematogenous osteomyelitis in. Methods consecutive cases of aho from two pediatric centers in the united states were analyzed retrospectively to develop clinical tools from data obtained within 96 hours of hospitalization to predict acute and chronic complications of aho. Acute hematogenous osteomyelitis aho is inflammation of bone and bone marrow caused by an infectious organism that reaches the bone through the bloodstream. Historically, osteomyelitis has been cate gorized as acute, subacute or chronic, with the presentation of each type based on the time of disease onset i.
Acute primary hematogenous osteomyelitis of the epiphysis. Haematogenous osteomyelitis is an infection caused by bacterial seeding from the blood, involves a single species of microorganism typically a bacterium, occurs primarily in children, and is most common in the rapidly growing and highly vascular metaphysis of growing bones. The use of penicillin in the treatment of acute hematogenous osteomyelitis in children. Special populations are given consideration throughout the discussion, and. Hematogenous osteomyelitis definition of hematogenous. Evidencebased outcomes center acute hematogenous osteomyelitis aho evidencebased guideline definition. The epidemiology of acute hematogenous osteomyelitis aho in children has changed. Impact of antibiotic pretreatment on bone biopsy yield for.
Although magnetic resonance imaging is the preferred modality in localized disease, scintigraphy is often. The immature or compromised immune status of the host is the primary cause of initial infection and development into a persistent and chronic osteomyelitis. The most common site is the rapidly growing and highly vascular metaphysis of growing bones. The infection generally occurs in areas of high metabolic activity and commonly affects the distal femoral and proximal tibial metaphyses. In this issue, a systematic approach to the workup and treatment of a child who presents with possible acute hematogenous osteomyelitis is discussed.
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