Pediatric Osteomyelitis Clinical Presentation

  • Author: Sabah Kalyoussef, DO; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jul 27, 2010
 

History

  • Long bones, including the femur, tibia, and humerus, are most commonly affected.
  • Fever, bone pain, swelling, redness, and guarding the affected body part are common.
  • Inability to support weight and asymmetric movement of extremities are often early signs in newborns and young infants.
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Physical

  • Painful focal swelling with cardinal signs of inflammation is often present.
  • In a cooperative patient, the clinician may be able to elicit focal point tenderness over the affected bone.
  • Draining sinus and bone deformity are both rare in acute disease. When present, these symptoms suggest subacute or chronic infection.
  • Movements of the adjoining joint may be restricted due to joint involvement or associated soft tissue inflammation.
  • Cellulitis, subcutaneous abscess, fractures, and bone tumors should be considered in the differential diagnosis. In newborns and infants in whom osteomyelitis may present as a pseudoparalysis, also consider CNS disease (eg, poliomyelitis), cerebral hemorrhage, trauma, scurvy, and child abuse.
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Causes

  • Staphylococcus aureus is the most common pathogen, followed by Streptococcus pneumoniae and Streptococcus pyogenes. Community-associated methicillin-resistant S aureus (CA-MRSA) is also an increasing problem and is the most common cause in many regions.[2, 3, 4]
  • Gram-negative bacteria and group B streptococci are frequently seen in newborns.
  • Pseudomonas aeruginosa is often associated with osteomyelitis and osteochondritis following penetrating wounds of the foot through a tennis shoe.
  • Children who are immunocompromised are prone to infection with various fungi and bacteria, in addition to common pathogens.
  • Bony lesions due to Bartonella henselae (cause of catscratch disease) have also been reported.
  • Salmonella is an important cause of osteomyelitis in children with sickle cell disease and other hemoglobinopathies.
  • Kingella kingae, a fastidious gram-negative rod, is increasingly recognized as a cause of osteoarticular infections, particularly in the first 2 years of life and following a respiratory tract infection.
  • Anaerobes such as Bacteroides, Fusobacterium, Clostridium, and Peptostreptococcus rarely cause osteomyelitis.
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Contributor Information and Disclosures
Author

Sabah Kalyoussef, DO  Fellow in Pediatric Infectious Diseases, Children's Hospital at Montefiore

Sabah Kalyoussef, DO is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Specialty Editor Board

Gary J Noel, MD  Department of Pediatrics, Clinical Associate Professor, Weill Medical College of Cornell University

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Joseph Domachowske, MD  Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Daniel Rauch, MD, FAAP  Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine

Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine

Disclosure: Baxter Honoraria Consulting

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

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