Pediatric Tibial Osteomyelitis

Stone, Brad; Street, Matthew; Leigh, Warren; Crawford, Haemish

doi:10.1097/bpo.0000000000000472

Cited by 8 publications

(4 citation statements)

References 30 publications

(57 reference statements)

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“…A more specific antibiotic should be chosen according to bacteria culture and drug sensitivity results as soon as possible [20]. Initial antibiotic choice should cover Staphylococcus aureus which is the most common pathogen [21, 22]. Subsequent administration of antibiotics should be adjusted according to the results of drug sensitivity test, clinical manifestations, and laboratory tests.…”

Section: Discussionmentioning

confidence: 99%

Clinical experience of debridement combined with resorbable bone graft substitute mixed with antibiotic in the treatment for infants with osteomyelitis

Zhang¹,

Li²,

Li³

et al. 2018

J Orthop Surg Res

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BackgroundOsteomyelitis (OM) is an uncommon disease that originates from many different mechanisms in children. Treatment often involves a combination of surgical debridement combined and antibiotic therapy. The purpose of this article is to evaluate the effect of debridement combined with a new resorbable bone graft substitute (RBGS) mixed with antibiotics in the treatment of infants with OM.MethodsTwenty-two patients diagnosed with OM at our institution underwent debridement combined with implantation of RBGS mixed with vancomycin within 48 h after admission. Clinical and epidemiological factors, preoperative and postoperative radiographs, and laboratory parameters, including white blood cell (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil percentage (NEU%), were documented. The function of the involved extremity was evaluated at the final follow-up.ResultsThe mean age was 6.3 ± 4.8 months (range, 0.5 to 12 months). The mean duration of the symptoms was 14.5 ± 8.4 days (range, 2 to 30 days). The average length of hospitalization was 13.7 ± 6.2 days (range, 6 to 28 days). 13.64% (3/22) had positive results of purulent material obtained at the time of open biopsy and 18.18% (4/22) had positive blood cultures. The most common sites were located in the proximal femur (12), the distal femur (3), and the proximal humerus (3). Ten patients presented with concurrent pyogenic arthritis, while another 12 infants suffered from simple isolated hematogenous OM. The mean follow-up time was 3.0 ± 1.6 years (range, 1.0 to 6.0 years). Seven of 22 patients (31.82%) had complications such as limb length deformity (LLD), avascular necrosis (AVN), and pathologic subluxation of the hip. Fifteen out of 22 (68.18%) patients achieved good results. Additionally, patients who had concomitant pyogenic arthritis were more likely to develop complications than those with isolated OM (p = 0.02).ConclusionsEarly debridement combined with implantation of RBGS mixed with vancomycin in the treatment of infants with OM achieved acceptable results in this series. Compared to those with simple isolated OM, patients with secondary pyogenic arthritis had a more virulent course.

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Section: Discussionmentioning

confidence: 99%

Clinical experience of debridement combined with resorbable bone graft substitute mixed with antibiotic in the treatment for infants with osteomyelitis

Zhang¹,

Li²,

Li³

et al. 2018

J Orthop Surg Res

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“…A diagnosis of hematogenous osteomyelitis is more plausible. Pediatric hematogenous osteomyelitis commonly involves the long bones of the leg, with a single focus, and presents a bimodal distribution, usually affecting infants with less than two years and preadolescents between eight and twelve years (Stone et al, 2016;Yeo and Ramachandran, 2014). It is more common in individuals with compromised immunity, chronic disease, concomitant infectious diseases (parasites, Mycobacteria), anemia, malnutrition and substandard sanitary conditions (Macnicol and Watts, 2005;Spiegel and Penny, 2005).…”

Section: Discussionmentioning

confidence: 99%

“…Osteomyelitis is an inflammatory process of bone and bone marrow, usually caused by an infectious microorganism (Lew and Waldvogel, 2004;Macnicol and Watts, 2005). The major causative agent is Staphylococcus aureus, but other pathogens may be implicated, including Streptococcus spp., Haemophilus influenza type B, Kingella kingae, Salmonella spp., Pseudomonas aeruginosa, fungi (e.g., Aspergillus spp., Blastomyces dermatitidis), and multicellular parasites (Dormans and Drummond, 1994;Lew and Waldvogel, 2004;Stone et al, 2016). Osteomyelitic infections can be restricted to a single area of the bone or affect several regions, e.g., the marrow, cortex, periosteum and soft tissues (Lew and Waldvogel, 2004;Macnicol and Watts, 2005).…”

Section: Introductionmentioning

confidence: 99%

Pediatric chronic osteomyelitis in the outskirts of Al-Ushbuna (Carnide, Lisboa, Portugal)

Tavares¹,

Makhoul

Monteiro

et al. 2017

International Journal of Paleopathology

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The skeletal remains of seven individuals (five non-adults and two adults) were recovered during an archeological intervention in the township of Carnide (Lisbon, Portugal). Funerary anthropology strongly suggests that the sample is from the Medieval Islamic period (8th - 12th centuries AD). This report presents a case of chronic osteomyelitis in a non-adult individual. The diagnostic is substantiated by the presence of pathognomonic signs of osteomyelitis, including the presence of cloacae and a sequestrum in the left tibia. The bone infection is discussed in the context of inadequate socioeconomic conditions. This case from a relatively unfamiliar chronology and cultural context supplements the uncommon paleopathological descriptions of osteomyelitis in non-adults from historical populations.

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“…Where disease progression is rapid, accompanied by severe weight loss and systemic involvement, malignancy needs to be ruled out [ 68 ]. Chronic bacterial osteomyelitis may mimic it, but it is usually accompanied by fever and pain over affected sites unlike mycetoma except when superimposed by bacterial infection [ 69 , 70 ]. Fungal diseases such as botryomycosis, sporotrichosis, blastomycosis, chromoblastomycosis, coccidioidomycosis, phaeohyphomycosis, lobomycosis and paracoccidioidomycosis have close resemblance to mycetoma [ 71 ].…”

Section: Diagnosismentioning

confidence: 99%

Mycetoma: a clinical dilemma in resource limited settings

Pembi

Dumre

John

et al. 2018

Ann Clin Microbiol Antimicrob

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BackgroundMycetoma is a chronic mutilating disease of the skin and the underlying tissues caused by fungi or bacteria. Although recently included in the list of neglected tropical diseases by the World Health Organization, strategic control and preventive measures are yet to be outlined. Thus, it continues to pose huge public health threat in many tropical and sub-tropical countries. If not detected and managed early, it results into gruesome deformity of the limbs. Its low report and lack of familiarity may predispose patients to misdiagnosis and delayed treatment initiation. More so in situation where diagnostic tools are limited or unavailable, little or no option is left but to clinically diagnose these patients. Therefore, an overview of clinical course of mycetoma, a suggested diagnostic algorithm and proposed use of materials that cover the exposed susceptible parts of the body during labour may assist in the prevention and improvement of its management. Furthermore, early reporting which should be encouraged through formal and informal education and sensitization is strongly suggested.Main textAn overview of the clinical presentation of mycetoma in the early and late phases, clues to distinguish eumycetoma from actinomycetoma in the field and the laboratory, differential diagnosis and a suggested diagnostic algorithm that may be useful in making diagnosis amidst the differential diagnosis of mycetoma is given. Additionally, a proposed preventive measures which may be helpful in the community is also provided. Since treatment is currently based on expert opinion, we encourage active research to establish treatment guideline for it.ConclusionSince delay in visiting health facility results into gruesome complication, early presentation, recognition and initiation of appropriate choice of regimen is helpful in reducing complications. The clinical overview of mycetoma and the suggested algorithm may enhance suspicion and possibly increase recognition of mycetoma in the community and further guide in differentiation of eumycetoma from actinomycetoma. There is an urgent need for research funding for mycetoma, a disease plagued by severe physical disabilities and social stigma leading to isolation.Electronic supplementary materialThe online version of this article (10.1186/s12941-018-0287-4) contains supplementary material, which is available to authorized users.

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Pediatric Tibial Osteomyelitis

Abstract: Level IV-Prognostic study.

Cited by 8 publications

References 30 publications

Clinical experience of debridement combined with resorbable bone graft substitute mixed with antibiotic in the treatment for infants with osteomyelitis

Clinical experience of debridement combined with resorbable bone graft substitute mixed with antibiotic in the treatment for infants with osteomyelitis

Pediatric chronic osteomyelitis in the outskirts of Al-Ushbuna (Carnide, Lisboa, Portugal)

Mycetoma: a clinical dilemma in resource limited settings

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