Unexpectedly high incidences of chronic non-bacterial as compared to bacterial osteomyelitis in children

Abstract

Historically, osteomyelitis was considered an infectious disorder. More recently, inflammatory mechanisms were recognized causing a significant proportion of pediatric osteomyelitis. This study was to compare characteristics of children with chronic non-bacterial (CNO) and bacterial osteomyelitis (BOM). A chart review of osteomyelitis patients from the departments of pediatrics, pediatric surgery, orthopedic surgery, and oral and maxillofacial surgery was conducted in a tertiary referral center, covering the years 2004-2014. Institutional incidences of CNO (n = 49) and BOM (n = 56) were comparable. Differentiation between CNO and BOM based on clinical or laboratory findings was mostly impossible. However, children with BOM more frequently presented with local inflammatory signs (47 vs. 68 %, p = 0.040), fever (12 vs. 38 %, p = 0.003), and abscesses (0 vs. 39 %, p < 0.001). Peripheral arthritis (14 vs. 0 %, p < 0.001), inflammatory bowel disease (10 vs. 2 %, p = ns), and hyperostosis (29 vs. 4 %, p = 0.001) were more common in CNO. Whole-body MRI was performed in 76 % of CNO patients, unveiling multifocal lesions in 80 % (CRMO). Though considered a rare disorder, institutional incidences of CNO were comparable to BOM, and the discrimination between CNO and BOM solely based on clinical aspects was mostly impossible. This is of special interest, since a correct and timely diagnosis is of utmost importance for long-term outcomes in both disorders. Whole-body MRIs should be considered in chronic osteomyelitis to (1) detect clinically inapparent lesions in CNO and (2) indirectly exclude (usually unifocal) chronic bacterial infections. Prospective studies are warranted to establish evidence-based diagnostic and therapeutic approaches to CNO.

Criteria for Differentiation of Non-Bacterial and Haematogenous Osteomyelitis: A Case-Control Study With Prospective Verification of the Outcomes

“…По нашему мнению, эффект монотерапии антибактериальными препаратами является 100% критерием того, что данное заболевание носило инфекционный (бактериальный) характер. Однако в аналогичном исследовании только у 63% больных с гематогенным остеомиелитом был идентифицирован возбудитель из костного биоптата, что совпадает с нашими данными -63% положительных культур [14].…”

“…В нашем исследовании не выявлено пациентов с гематогенным остеомиелитом с вовлечением ключицы и костей черепа, описанных в предыдущем исследовании, -локализациями, типичными, скорее, для небактериального остеомиелита и совершенно нетипичными для гематогенного [1,14,15].…”

“…Поскольку небактериальный остеомиелитотносительно новый термин, заболеваемость известна только для хронического рецидивирующего мультифокального остеомиелита и, согласно С. Chun, составляет всего от 2 до 5% всех случаев остеомиелита [15], что, вероятно, связано с отсутствием единых критериев диагностики заболевания [1,2], низким уровнем осведомленности врачей разных специальностей о заболевании [1] и в конечном итоге приводит к поздней диагностике заболевания и развитию инвалидизирующих осложнений [1,2]. В исследовании A. Schnabel показана примерно одинаковая частота встречаемости небактериального и бактериального остеомиелитов [14]. Аналогичную ситуацию мы видим и в клинике СПбГПМУ.…”

The molecular pathophysiology of chronic non-bacterial osteomyelitis (CNO)—a systematic review

“…Associations of CNO/CRMO with other autoinflammatory disorders, such as psoriasis or inflammatory bowel disease, and the occurrence of familial clusters further suggest a common genetic predisposition for sporadic CNO [1, 7, 33, 34]. Golla et al performed an association study in CNO patients identifying a potential susceptibility locus on chromosome 18q21.3-22 [35].…”

“…However, CNO can generally occur in all age groups. The clinical spectrum is variable and ranges from single asymptomatic bone lesions up to the most severe form of chronic recurrent multifocal osteomyelitis (CRMO) [1–7]. Due to this variable clinical presentation with sometimes rather mild and unspecific clinical symptoms, diagnosis is frequently delayed or even missed.…”