OBJECTIVES: In this study, we aimed to contrast the bacteriologic epidemiology of osteoarticular infections (OAIs) between 2 patient groups in successive 10-year periods, before and after the extensive use of nucleic acid amplification assays in the diagnostic process. METHODS: Epidemiologic data and bacteriologic etiologies of all children presenting with OAIs on admission to our institution over 20 years (1997-2016) were assessed retrospectively. The population was divided into 2 cohorts, using the standardized use of polymerase chain reaction as the cutoff point (2007). The conventional cohort included children with OAIs mainly investigated by using classic cultures, whereas the molecular cohort referred to patients also investigated by using molecular assays. RESULTS: Kingella kingae was the most frequently isolated pathogen, responsible for 51% of OAIs, whereas other classic pathogens were responsible for 39.7% of cases in the molecular cohort. A statistically significant increase in the mean incidence of OAIs was observed, as was a decrease in the mean age at diagnosis after 2007. After 2007, the pathogen remained unidentified in 21.6% of OAIs in our pediatric population. CONCLUSIONS: Extensive use of nucleic acid amplification assays improved the detection of fastidious pathogens and has increased the observed incidence of OAI, especially in children aged between 6 and 48 months. We propose the incorporation of polymerase chain reaction assays into modern diagnostic algorithms for OAIs to better identify the bacteriologic etiology of OAIs.
Osteoarticular infections remain a significant cause of morbidity worldwide in young children. They can have a devastating impact with a high rate of serious and long-lasting sequelae, especially on remaining growth. Depending on the localisation of infection, they manifest as osteomyelitis, septic arthritis, a combination of both (i.e., osteomyelitis with adjacent septic arthritis) or spondylodiscitis. Osteoarticular infections can be divided into three types according to the source of infection: haematogenous; secondary to contiguous infection; or secondary to direct inoculation. During the last few years, many principles regarding diagnostic assays and the microbiological causes of these infections have evolved in a significant manner. In the present current-opinion review, we discuss recent concepts regarding epidemiology, physiopathology, and the microbiology of bone and joint infections in young children, as well as clinical presentations, diagnosis, and treatment of these infections. Clinicians caring for children need to be especially well versed in these newer concepts as they can be used to guide evaluation and treatment.
BackgroundThis study aimed to describe the spectrum of pediatric primary subacute hematogenous osteomyelitis (PSAHO) and to investigate its bacterial etiology.MethodsSixty-five consecutive cases of PSAHO admitted to our institution over a 16-year period (2000–2015) were retrospectively reviewed to assess their laboratory and radiographic imaging features, as well as their bacteriological etiology.ResultsOn evaluation, white blood cell count and C-reactive protein were normal in 53 (81.5 %) and 34 cases (52.3 %), respectively, whereas the erythrocyte sedimentation rate was superior to 20 mm/h in 44 cases (72.1 %). Blood cultures failed to identify the pathogen in all but one patient, and classic bone sample cultures only managed to isolate the pathogen in five cases (11.6 %). Use of polymerase chain reaction (PCR) assays on bone aspirates or blood allowed the causative microorganism to be isolated in a further 22 cases. Using classic cultures and PCR assays together resulted in pathogen detection in 27 cases (62.8 % of the children bacteriologically investigated), with Kingella kingae being the most frequently reported microorganism.ConclusionsTwo distinct forms of PSAHO should be distinguished on the basis of age of patients and bacteriological etiology. The infantile form affects children aged between 6 months and 4 years and is predominantly due to K. kingae. The juvenile form involves children aged >4 years and Staphylococcus aureus appears to be the main bacteriological etiology. Appropriate nucleic amplification assays drastically improve the detection rate of the microorganisms responsible for PSAHO.Level of evidence: Case series, level IV.
Background and Objective. Malocclusion, the body posture, and the breathing pat- tern may correlate, but this issue is still controversial. The aim of the study was to examine the relationship between the type of malocclusion, the body posture, and the nasopharyngeal obstruction in 12-14-year-old children. Material and Methods. The study group consisted of 76 orthodontic patients (35 boys, 41 girls) aged 12-14 years (mean age, 12.79 years {SD, 0.98J). All the patients were examined by the same orthodontist (study model and cephalometric radiograph analysis), the same orthopedic surgeon (body posture examined from the front, the side, and the back), and the same otorhinolaryngologist (anterior and posterior rhinoscopy and pharyngoscopy) in a blind manner. Results. The prevalence of a poor body posture and a nasopharyngeal pathology was high in the present study. In total, 48.7% of the orthodontic patients had a kyphotic posture and 55.3% a rib hump in the thoracic region. The nasopharyngeal pathology was diagnosed in 78.9% of the patients. The patients with the kyphotic posture had a higher mandibular plane angle (MP-SN) and a lower sagittal position of the mandible SNB angle. A deeper overbite correlated with shoulder and scapular asymmetry. The kyphotic posture was diagnosed in 55.0% of the patients with the naso- pharyngeal pathology. Conclusions. The sagittal body posture was related to the vertical craniofacial parameters and hypertrophy of the tonsils and/or the adenoids. The study showed no relationship between the degree of crowding, the presence of a posterior cross bite, orthopedic parameters, and a breathing pattern.
BACKGROUND Femoral fracture is a significant major trauma in children and adolescents, sometimes resulting in serious complications. This study aimed to determine the epidemiology of femoral fractures and to define associated injuries and mortality incidence in a pediatric population below 16 years old. METHODS The medical records of all patients with a femoral fracture treated in our hospital from 1997–2016 were reviewed retrospectively. Age, gender, mechanism of the trauma, month and season of fracture occurrence, fracture type, associated injuries, and mortality data were collected. Patients were divided into four age groups and compared. RESULTS The study included 348 children with 353 femoral fractures. The mean annual prevalence of femoral fracture during the study period was 22.7 per 100,000 children. Except for children less than 1 year old, most fractures occurred in male patients (69%), with a male-to-female ratio of 2.2:1. Road accidents were the most common mechanism at all ages. Femoral fractures were mainly due to low-energy trauma in neonates and infants, to road accidents and low-energy trauma in preschool children, to sports accidents in school-age children, and to road traffic accidents in teenagers. February was the month with the most occurrences of femoral fractures. Winter was the peak season for femoral fractures in children aged <1 year and 6–11 years (37.8% and 46.4% of fractures respectively), whereas autumn was the most common season (29.5%) for preschool children and spring (31.1%) the most common in the teenagers group. Diaphyseal fractures were the most commonly reported lesions in all four age groups, representing 72.3% of all fractures. Only 18 fractures were open (5.1%). Eighty-eight patients (25.3%) presented with associated injuries at admission, 12 presented with Waddell’s triad of injuries, and the mortality rate was calculated to be 1.1% (four cases). CONCLUSION The circumstances of injury and the seasonality of femoral fractures differed significantly depending on the children’s ages. Moreover, the morbidity of femoral fractures in children was closely correlated with associated injuries. (Level of evidence: Level III)
Isolated osteomyelitis of the patella is a rare condition mainly occurring in the pediatric population. Diagnosis is often delayed as clinical presentation manifests with vague anterior knee pain, sometimes with mild local signs of inflammation but frequently without any local signs at all. While falls on the knee can explain mild knee pain, erythema, swelling and persistent peripatellar pain should raise a high index of suspicion for local infection. We present two cases of subacute osteomyelitis of the patella in young children. In both cases bone lesions presented as an osteolytic lesion of the patella. After open biopsy of the lesion, bacteriological analysis confirmed infection with Kingella kingae.Keywords: Osteomyelitis; Kingella kingae; Trauma; Bone edema; Intravenous antibiotics; Radiographic; PCR Level of EvidenceCase reports, level IV. Case Report 1A 14-month-old Caucasian girl was admitted to the emergency department (ED) of our hospital due to persistent limping for more than 2 weeks. There was no history of trauma. A febrile episode (38.7°C) had occurred approximately 2 weeks before presentation at the ED, but as symptoms had decreased progressively no investigations into the cause of infection and no treatment had been undertaken. On admittance to our hospital, the child was afebrile and walked with a stiff knee. Clinical examination revealed right-sided knee pain, slight prepatellar edema, and a mild knee joint effusion. Laboratory results showed a white blood cell count of 17,000 cells/mm 3 , normal Creactive protein (2 mg/dL) and erythrocyte sedimentation rate (11 mm/h), but a high platelet count (520.000cells/mm 3 ). Conventional radiograph showed no significant abnormality. MRI demonstrated prepatellar soft tissue swelling, joint effusion, synovial enhancement and bone edema, all signs compatible with septic arthritis (Figure 1). Moreover, MRI revealed an osteolytic lesion located in the upper part of the right patella with anterior erosion of the cortical bone. The child underwent joint aspiration where a small quantity of mildly opaque liquid was extracted; the joint cavity was then thoroughly irrigated and the patient was immediately started on intravenous antibiotics (cefuroxime). A switch to oral antibiotics was undertaken after 3 days and treatment was continued for another 20 days. No pathogen was cultivated from the joint fluid, but K. kingae specific rtPCR gave a positive result. At the final clinical control, 12 months after surgery, the child did not complain about any pain and gait was normal. The clinical exam did not reveal any tenderness, swelling or erythema around the knee and the range of motion of the right knee joint was normal. Radiographs showed a normal patella without pathological findings.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.