Osteomyelitis in Children: From Presentation, Diagnosis, and Pathogens to Management
Osteomyelitis, the most common musculoskeletal infection in children, typically presents with pain and limp. There is a male preponderance due to increase microtraumas in males. Infection reaches the bone either by direct inoculation or hematogenous spread. In children, most commonly affected bone is femur. The signs and symptoms of acute osteomyelitis in children as pain, tenderness, erythema, fever, and refusal to walk. Involvement of bone is confirmed by radiological imaging and laboratory investigations. Both CRP and ESR are raised, however, theses findings are non-specific if they alone are considered. The gold standard diagnostic modality for acute osteomyelitis is MRI. The radiological imaging may be unremarkable; however, it is done in order to rule out other differential diagnosis like malignancy and fractures. The most common causative agent of acute osteomyelitis in children in Staphylococcus aureus. Other organisms may include Streptococcus agalactiae and Gram-negative bacteria for children below 2 months. Causative agents in 2-5 years age bracket are Streptococcus pyogenes and Streptococcus pneumoniae. Fungal agents that can cause osteomyelitis in immunocompromised children are Candida spp., Histoplasma spp., and Cryptococcus spp. Other pathogens may include Bartonella henselae and Mycobacterium tuberculosis. For infants less than 3 months of age, IV 3rd generation cephalosporin along with oxacillin are administered. For vaccinated children more than 3 months old, belonging to a community with prevalent MSSA, first generation cephalosporin such as cefazolin and oxacillin are started empirically. For unvaccinated children more than 3 months of age, the drug of choice is ceftriaxone and oxacillin. Source Acute infectious osteomyelitis in children: new treatment strategies for an old enemy https://link.springer.com/article/10.1007/s12519-020-00359-z Image via https://pubs.rsna.org/doi/full/10.1148/radiol.2017151929