Primary Epiphyseal or Apophyseal Subacute Osteomyelitis in the Pediatric Population

Abstract

The use of organism-specific real-time PCR assays markedly improves the detection rate of the pathogen responsible for PEASAO, and K. kingae is the most commonly detected pathogen. The literature highlights a biphasic age distribution of PEASAO in children. The infantile form affects children from one to less than four years of age, accounting for approximately 75% of all PEASAO cases. The second form, in older children, is more likely to be associated with fever and systemic symptoms. The femur and the tibia are the most commonly affected long bones. Laboratory data are usually noncontributory for diagnosing PEASAO, and blood cultures are often sterile. Although K. kingae is the most commonly detected microorganism in children less than four years of age, S. aureus is responsible for most PEASAO in older children. Antibiotic treatment is usually sufficient to eradicate the pathogen.

Subacute metacarpal osteomyelitis in a child

“…Treatment of this aff ection is controversial (17). The recommended treatment for subacute osteomyelitis with a lucent lesion or nidus has been curettage, biopsy and culture, followed by immobilization and antibiotics (7,10,17).…”

“…The recommended treatment for subacute osteomyelitis with a lucent lesion or nidus has been curettage, biopsy and culture, followed by immobilization and antibiotics (7,10,17). In diaphyseal lesions with periosteal reaction, a core of the bone should be taken which includes periosteum, cortex and medullary contents (18).…”

“…In diaphyseal lesions with periosteal reaction, a core of the bone should be taken which includes periosteum, cortex and medullary contents (18). The diagnosis is usually confi rmed by histologic examination, which shows an infl ammatory component with scattered lymphocytes, plasma cells and granulation tissue (11,17,18). Staphylococcus aureus is regarded as the causative agent by most authors.…”

“…Staphylococcus aureus is regarded as the causative agent by most authors. It is, however, diffi cult to identify (17)(18)(19). Several studies have concluded that antibiotics alone may be adequate and surgery should be reserved for 'aggressive lesions' and those that do not respond to antibiotics (18,19).…”

<p>Systematic Review of <em>Kingella kingae</em> Musculoskeletal Infection in Children: Epidemiology, Impact and Management Strategies</p>

“…31 Twenty-nine articles were considered relevant with respect to identifying the number of confirmed infections with K. kingae in bacteriologically proven musculoskeletal infections in children (Table 1). 2,22,28,29,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][66][67][68][69][70] This was further studied to summarize the frequency of K. kingae infections among children under 48 months old ( Table 2). Additional epidemiological data extracted and collated included musculoskeletal infection sites, gender, age and seasonality.…”