Acute Osteomyelitis

Aka: Acute Osteomyelitis, Osteomyelitis in Children, Pediatric Osteomyelitis, Acute Hematogenous Osteomyelitis

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II. Epidemiology

  1. More common in boys

III. Pathophysiology

  1. Inflammatory bone changes associated with pathogenic Bacteria (often monomicrobial)
    1. Staphylococcus Aureus including MRSA is most common cause in Pediatric Osteomyelitis
    2. See causes below
  2. Typically acute hematogenous spread to Traumatized bone
    1. Most common in children under age 5 (50% of cases)
    2. Most commonly affects the highly vascular metaphyses of long bone

IV. Symptoms

  1. See Pediatric Limp
  2. Presentation within two weeks of symptom onset
  3. Fever
  4. Irritability or lethargy

V. Signs

  1. Systemic signs of infection
  2. Local signs of infection
    1. Tenderness on palpation over involved bone
    2. Localized inflammation with erythema and swelling
    3. Decreased range of motion of adjacent joints
  3. Distribution
    1. Femur, tibia or fibula
      1. Account for 50% of Osteomyelitis cases in prepubertal children
      2. May present with Pediatric Limp
    2. Vertebral Osteomyelitis
      1. Most common form of hematogenous Osteomyelitis, especially in older children or adults
      2. Presents with severe neck or back pain, Muscle tenderness and reduced range of motion
    3. Other sites
      1. Sternoclavicular Bone
      2. Pelvic Bone
      3. Other long bones

VI. Causes

  1. See Osteomyelitis Causes
  2. Staphylococcus Aureus including MRSA (most common)
  3. Kingella Kingae (esp. age <5 years, recent URI)
  4. Streptococcus Pyogenes
  5. Streptococcus Pneumoniae
  6. Pseudomonas Aeruginosa (Penetrating Trauma)
  7. Escherichia coli (newborns)
  8. Group B Streptococcus (newborns)

VII. Differential Diagnosis

  1. See Osteomyelitis

VIII. Labs

  1. See Osteomyelitis
  2. ESR and CRP may be early indicators of Osteomyelitis (albeit non-specific)
  3. Blood Cultures are positive in only 30 to 50% of cases

IX. Imaging

  1. See Osteomyelitis
  2. XRays are often normal for first 2-3 weeks
  3. MRI is sensitive and specific

X. Diagnosis

  1. See Osteomyelitis

XI. Management

  1. See Osteomyelitis Management

XII. References

  1. Jhun and Raam in Herbert (2016) EM:Rap 16(2):15-6
  2. Hatzenbuehler (2011) Am Fam Physician 84(9): 1027-33 [PubMed]
  3. Boutin (1998) Orthop Clin North Am 29:41-66 [PubMed]
  4. Bury (2021) Am Fam Physician 104(4): 395-402 [PubMed]
  5. Carek (2001) Am Fam Physician 63(12):2413-20 [PubMed]
  6. Dirschl (1993) Drugs 45:29-43 [PubMed]
  7. Eckman (1995) JAMA 273:712-20 [PubMed]
  8. Haas (1996) Am J Med 101:550-61 [PubMed]
  9. Lew (1997) N Engl J Med 336:999-1007 [PubMed]
  10. Lipsky (1997) Clin Infect Dis 25:1318-26 [PubMed]

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