eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Osteomyelitis
Updated: May 7, 2008
Introduction
Background
Osteomyelitis, or inflammation of the bone, is usually caused by bacterial infection. Bone infections in children are primarily hematogenous in origin, although cases secondary to penetrating trauma, surgery, or infection in a contiguous site are also reported.
Pathophysiology
Approximately 50% of cases occur in preschool-aged children. Young children primarily experience acute hematogenous osteomyelitis because of the rich vascular supply in their growing bones. Circulating organisms tend to start the infection in the metaphyseal ends of the long bones because of the sluggish circulation in the metaphyseal capillary loops. The presence of vascular connections between the metaphysis and the epiphysis makes infants particularly prone to arthritis of the adjacent joint. Involvement of the shoulder joint or hip joint is also noted when the intracapsular metaphyseal end of the humerus or femoral is infected. If untreated, infection can also spread to the subperiosteal space after traversing the cortex.
Frequency
United States
The exact frequency is not known because osteomyelitis is not a reportable disease.
International
Chronic osteomyelitis is frequently reported in developing countries where medical and surgical treatment modalities are not commonly accessible.
Mortality/Morbidity
As noted in recent studies, patients may develop deep vein thrombosis.1,2
Race
The disease is more common among black children.
Sex
A preponderance in males is observed in all age groups. Factors related to increased incidence in males may include increased trauma due to risk-taking behavior or other physical activities that predispose to bone injury.
Age
One half of cases occur in preschool-aged children.
Clinical
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.
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.
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.
- 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.
More on Osteomyelitis |
 Overview: Osteomyelitis |
| Differential Diagnoses & Workup: Osteomyelitis |
| Treatment & Medication: Osteomyelitis |
| Follow-up: Osteomyelitis |
| References |
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References
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Further Reading
Keywords
osteomyelitis, inflammation of the bone, bone infection, central osteitis, acute hematogenous osteomyelitis, chronic osteomyelitis, deep vein thrombosis, long bone infection, draining sinus, bone deformity, cellulitis, subcutaneous abscess, bone tumors, pseudoparalysis, CNS disease, polio, scurvy, cerebral hemorrhage, child abuse, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, community-associated methicillin-resistant S aureus, CA-MRSA, Pseudomonas aeruginosa, osteochondritis, Bartonella henselae, Salmonella, catscratch disease, sickle cell disease, Kingella kingae, respiratory tract infection, Bacteroides, Fusobacterium, Clostridium, Peptostreptococcus
