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Pediatric Osteomyelitis Clinical Presentation

  • Author: Sabah Kalyoussef, DO; Chief Editor: Russell W Steele, MD  more...
Updated: May 02, 2016


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  • 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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  • Often, patients are able to localize the infected bone on examination, owing to pain.
  • Symptoms include focal swelling with cardinal signs of inflammation with or without fever and focal point tenderness over the affected bone. It is important to note whether the adjacent joint is involved by assessing the range of motion of the joint and signs of inflammation. Arthritis found on examination may be a reactive inflammatory response or a sign of an infected joint.
  • Draining sinus and bone deformity are both rare in acute disease. When present, these symptoms suggest subacute or chronic osteomyelitis.
  • 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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  • Staphylococcus aureus is the most common pathogen, followed by Streptococcus pneumoniae and Streptococcus pyogenes. Community-associated methicillin-resistant S aureus (CA-MRSA) continues to be a major and most common cause in many regions of the United States.[2, 5, 6, 7]
  • 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.
Contributor Information and Disclosures

Sabah Kalyoussef, DO Attending Physician, Pediatric Infectious Diseases and Hospital Medicine, The Children's Hospital at St Peter's University Hospital

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

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, Phi Beta Kappa

Disclosure: Received research grant from: Pfizer;GlaxoSmithKline;AstraZeneca;Merck;American Academy of Pediatrics<br/>Received income in an amount equal to or greater than $250 from: Sanofi Pasteur;Astra Zeneca;Novartis<br/>Consulting fees for: Sanofi Pasteur; Novartis; Merck; Astra Zeneca.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

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, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Gary J Noel, MD Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

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

Disclosure: Nothing to disclose.

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