Culture-negative chronic hematogenous osteomyelitis in a two months old girl: a case report

Abstract Background Previous articles have focused on the diagnosis and treatment of acute hematogenous osteomyelitis. Here, we present a case of chronic hematogenous osteomyelitis in a 2-month-old girl. The diagnostic procedure was unusual and difficult due to negative culture results. Case presentation A girl aged 2 months and 23 days had fever and swelling in her right lower leg for 7 days. On the basis of her medical history, physical, and histological examination results; and radiologic and magnetic resonance imaging findings, a diagnosis of chronic osteomyelitis was made. The patient underwent surgical treatment and was discharged successfully. The patient showed good recovery and no sequelae at the 12-month follow-up. Conclusion Hematogenous osteomyelitis in babyhood is different from that at any other age. Hematogenous osteomyelitis-related bone destruction in babyhood is more serious and occurs faster. The transition from acute hematogenous osteomyelitis to chronic hematogenous osteomyelitis takes only 7 days. To the best of our knowledge, this chronic hematogenous osteomyelitis patient is the youngest ever reported.

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Epidemiologic, Bacteriologic, and Long-term Follow-up Data of Children With Acute Hematogenous Osteomyelitis and Septic Arthritis

Journal of Pediatric Orthopaedics B ◽

10.1097/01202412-199910000-00014 ◽

1999 ◽

Vol 8 (4) ◽

pp. 302-305

Author(s):

Peter Christiansen ◽

Birgitte Frederiksen ◽

Jens Glazowski ◽

Michael Scavenius ◽

Finn U. Knudsen

Keyword(s):

Septic Arthritis ◽

Hematogenous Osteomyelitis ◽

Acute Hematogenous Osteomyelitis ◽

Long Term Follow Up

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What Would Pediatric Infectious Disease Consultants Recommend for Management of Culture-Negative Acute Hematogenous Osteomyelitis?

Journal of Pediatric Orthopaedics ◽

10.1097/bpo/0b013e3181558981 ◽

2007 ◽

Vol 27 (7) ◽

pp. 805-809 ◽

Cited By ~ 17

Author(s):

Behnoosh Afghani ◽

Vivian Kong ◽

Fu L. Wu

Keyword(s):

Infectious Disease ◽

Pediatric Infectious Disease ◽

Hematogenous Osteomyelitis ◽

Acute Hematogenous Osteomyelitis ◽

Culture Negative

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391. Septic Arthritis and Acute Hematogenous Osteomyelitis in Children: Disease-Specific Antibiogram and Implications for Treatment

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.464 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S201-S202

Author(s):

Nisreen O Mobayed ◽

Kevin Schlidt ◽

Daniel Roadman ◽

Danita Hahn ◽

Anna R Huppler

Keyword(s):

Septic Arthritis ◽

Lyme Arthritis ◽

Older Children ◽

Free Standing ◽

Hematogenous Osteomyelitis ◽

Time Period ◽

Acute Hematogenous Osteomyelitis ◽

Empiric Antibiotic ◽

Culture Negative ◽

Disease Specific

Abstract Background Osteomyelitis and septic arthritis are common pediatric musculoskeletal infections with potential to cause significant morbidity. Empiric antibiotic selection is made prior to the availability of microbiologic data. The aim of this study was to compare the epidemiology of osteoarticular infections (OAI) to antibiotic regimens and local antibiograms. Methods A retrospective study was performed on patients aged 6 months to 18 years with a diagnosis of septic arthritis or acute hematogenous osteomyelitis in a large, free-standing children’s hospital between July 2012 and July 2017. Exclusion criteria were chronic osteomyelitis, prior trauma or surgery at the site, noninfectious arthritis, and Lyme arthritis. Data collected from the electronic medical record included demographics, initial and discharge antibiotic therapy, and microbiologic results. Data were compared with the local antibiogram during the same time period. Results A total of 207 patients were included: 66 patients <4 years (< 4Y) and 141 patients ≥4 years (≥4Y). Causative pathogens were identified in 70% of patients. Staphylococcus aureus comprised 55% of positive results in children < 4Y and 73% in children ≥4Y. Among S. aureus cultures, 70–76% were methicillin sensitive (MSSA). Overall clindamycin susceptibility was 97%, with all resistant strains detected in children ≥4Y with MSSA. This is strikingly different than the institutional antibiogram showing 79% overall clindamycin sensitivity in S. aureus [82% in MSSA, 72% in methicillin resistant (MRSA)]. Kingella kingae was exclusively identified in children <4Y (21% of positives), which was also the group with the highest rate of culture-negative infection (41%). Intravenous clindamycin alone was the most frequent initial antibiotic regimen, prescribed for 41% of all patients. Initial antibiotic regimens matched organism susceptibilities in 90% of MRSA and 100% of MSSA infections. Conclusion Our study revealed high rates of clindamycin-susceptible S. aureus in older children and K. kingae and culture-negative infection in children < 4 years with OAI. Antibiotic susceptibilities differing from our institutional antibiogram suggest that disease-specific antibiograms will aid with empiric treatment decisions. Disclosures All authors: No reported disclosures.

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ACUTE HEMATOGENOUS OSTEOMYELITIS

PEDIATRICS ◽

10.1542/peds.1.5.617 ◽

1948 ◽

Vol 1 (5) ◽

pp. 617-626

Author(s):

EDWARD B. SELF

Keyword(s):

Primary Closure ◽

Chronic Osteomyelitis ◽

Skin Grafts ◽

Acute Osteomyelitis ◽

Staph Aureus ◽

Bone Surgery ◽

Hematogenous Osteomyelitis ◽

Acute Hematogenous Osteomyelitis ◽

Radical Removal ◽

The Subject

One hundred and thirty-eight cases of acute osteomyelitis admitted to Babies Hospital between 1930 and 1946 are the subject of this report. An unexpected number of cases resulted from infection by hemolytic str. The behavior of hemolytic Staph. aureus is compared to hemolytic str. in osteomyelitis. Mortality is greatest with extreme youth, chronicity least with youth. Massive doses of penicillin in the earliest stages of the disease constitutes the treatment of choice and emphasis should be on the "treatment of the child," rather than treatment of the bone. Surgery should be postponed in the early stages and used later only to drain abscesses of the soft parts or abscesses of the bone which are well localized and not regressing. The treatment of chronic osteomyelitis is an entirely different problem. Radical removal of diseased bone and sinuses with primary closure of the wound is the treatment of choice. Immobilization, penicillin, and obliteration of dead spaces by the use of muscle and skin grafts are important adjuncts to success.

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The accuracy of different imaging techniques in diagnosis of acute hematogenous osteomyelitis

Medicina ◽

10.3390/medicina45080081 ◽

2009 ◽

Vol 45 (8) ◽

pp. 624 ◽

Cited By ~ 36

Author(s):

Dalius Malcius ◽

Martynas Jonkus ◽

Gintaras Kuprionis ◽

Almantas Maleckas ◽

Eglė Monastyreckienė ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Bone Scintigraphy ◽

Odds Ratio ◽

Diagnostic Odds Ratio ◽

X Rays ◽

Resonance Imaging ◽

X Ray ◽

Hematogenous Osteomyelitis ◽

Acute Hematogenous Osteomyelitis

Objective. The aim of this study was to establish and compare diagnostic accuracy (sensitivity, specificity, and diagnostic odds ratio) of plain x-ray, ultrasonography, bone scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI) in pediatric acute hematogenous osteomyelitis. Material and methods. Analysis of patients’ data, hospitalized at the Department of Pediatric Surgery with suspected acute hematogenous osteomyelitis in the period of 2002–2008, was carried out prospectively. Inclusion criteria were age of 1–18 years, pain in bone area, fever, functional disorder, and (or) signs of infection. Plain x-ray, ultrasonography, bone scintigraphy, computed tomography, and magnetic resonance imaging were performed. The recommendations of Standards for Reporting of Diagnostic Accuracy were used in study design. Results. A total of 183 patients were included into the study. Acute hematogenous osteomyelitis was diagnosed in 156 (85%) patients, and 27 (15%) had other diseases. A total of 169 early plain x-rays (median on the first day of hospital stay), 142 late x-rays (15th day of hospital stay), 82 ultrasonographies (second day), 76 bone scintigraphy (third day), 38 MRI scans (seventh day), and 17 CT (15th day) were performed. The sensitivity of ultrasonography was 0.55 (95% CI, 0.43–0.67); specificity, 0.47 (95% CI, 0.24–0.7); and diagnostic odds ratio, 1.08 (95% CI, 0.3–3.84). The sensitivity of CT was 0.67 (95% CI, 0.38–0.88); specificity, 0.5 (95% CI, 0.01– 0.98); and diagnostic odds ratio, 2.0 (95% CI, 0.02–172.4). The sensitivity of early x-ray was 0.16 (95% CI 0.1–0.23); specificity, 0.96 (95% CI, 0.78–1.0); and diagnostic odds ratio, 4.34 (95% CI, 0.63–186.3). The sensitivity of MRI was 0.81 (95% CI, 0.64–0.93); specificity, 0.67 (95% CI, 0.22–0.96); and diagnostic odds ratio, 8.67 (95% CI, 0.91–108.5). The sensitivity of late x-ray was 0.82 (95% CI, 0.75–0.88); specificity, 0.92 (95% CI, 0.62–1.0); and diagnostic odds ratio, 51.17 (95% CI, 6.61–2222.0). The sensitivity of bone scintigraphy was 0.81 (95% CI, 0.68–0.90); specificity, 0.84 (95% CI, 0.60–0.97); and diagnostic odds ratio, 22.30 (95% CI, 4.9–132.7). Conclusions. Our analysis showed that late x-ray is the most valuable radiologic method in the diagnosis of acute hematogenous osteomyelitis, but bone scintigraphy and magnetic resonance imaging are the most valuable tests at the onset of the disease.

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Tropheryma whipplei Endocarditis: Case Presentation and Review of the Literature

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy330 ◽

2018 ◽

Vol 6 (1) ◽

Cited By ~ 1

Author(s):

Michael McGee ◽

Stephen Brienesse ◽

Brian Chong ◽

Alexander Levendel ◽

Katy Lai

Keyword(s):

Heart Failure ◽

Rare Condition ◽

Tropheryma Whipplei ◽

Review Of The Literature ◽

Case Presentation ◽

Gastrointestinal Manifestations ◽

Presenting Symptoms ◽

Physician Awareness ◽

Culture Negative

Abstract Whipple’s disease is a rare infective condition, classically presenting with gastrointestinal manifestations. It is increasingly recognized as an important cause of culture-negative endocarditis. We present a case of Whipple’s endocarditis presenting with heart failure. A literature review identified 44 publications documenting 169 patients with Whipple’s endocarditis. The average age was 57.1 years. There is a clear sex predominance, with 85% of cases being male. Presenting symptoms were primarily articular involvement (52%) and heart failure (41%). In the majority of cases, the diagnosis was made on examination of valvular tissue. Preexisting valvular abnormalities were reported in 21%. The aortic valve was most commonly involved, and multiple valves were involved in 64% and 23% of cases, respectively. Antibiotic therapy was widely varied and included a ceftriaxone, trimethoprim, and sulfamethoxazole combination. The average follow-up was 20 months, and mortality was approximately 24%. Physician awareness is paramount in the diagnosis and management of this rare condition.

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Diagnostic value of radiography and ultrasound for suspected acute hematogenous osteomyelitis

Journal of radiology and nuclear medicine ◽

10.20862/0042-4676-2018-99-6-319-325 ◽

2019 ◽

Vol 99 (6) ◽

pp. 319-325

Author(s):

S. A. Polkovnikova ◽

V. D. Zavadovskaya ◽

V. M. Mashkov

Keyword(s):

Soft Tissues ◽

False Negative ◽

Bone Destruction ◽

Growth Zone ◽

Epiphyseal Cartilage ◽

X Rays ◽

Ultrasound Studies ◽

X Ray ◽

Hematogenous Osteomyelitis ◽

Acute Hematogenous Osteomyelitis

Objective:to evaluate the informativeness of ultrasonography and radiography in the early diagnosis of acute hematogenous osteomyelitis in children.Material and methods. Children (from 3 weeks to 1 year old) with suspected acute hematogenous osteomyelitis (n = 40) were examined and X-rays and ultrasound scan of the affected skeleton were performed. 39 (97.5%) of children underwent surgery.Results.Radiography in the first 3 days of the disease gave only false-negative results. On the 5th-7th day of the disease, the fuzziness of the outline of the growth zone, the uneven contour of the ossification core, was found, which resulted in 33% sensitivity. X-ray symptoms of bone destruction were obtained in the second week of the disease in 83% of the subjects.The resultsof ultrasound examination in the first 3 days of the disease exceeded the radiographic parameters and corresponded to 66.7% of sensitivity based on the definition of increased vascularization of edematous parasal soft tissues, epiphyseal cartilage. On the 5th-7th days of the disease, local hyperechoic areas were found in the epiphyseal cartilage, with additional color signals around it, an uneven contour of the ossification nucleus, which almost equalized the sensitivity parameters of X-ray and ultrasound studies (83.33% and 88.8%, respectively).The most sensitive, specific and accurate are the studies in the third week from the onset of the disease, in determining the sites of destruction in the metaphysis and the nucleus of ossification of the epiphysis, both in X-ray and ultrasound studies.Conclusion.X-ray and ultrasound studies should be considered complementary modalities for obtaining optimally complete information about the morphological substrate of the pathological inflammatory process.

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Semiotics of Proliferative Changes in Femur in Chronic Osteomyelitis Developed after Acute Hematogenous Osteomyelitis

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto201118460-64 ◽

2011 ◽

Vol 18 (4) ◽

pp. 60-64

Author(s):

Galina Viktorovna D'yachkova ◽

Yu L Mitina ◽

G V Diachkova ◽

Ju L Mitina

Keyword(s):

Computer Tomography ◽

Chronic Osteomyelitis ◽

Compact Bone ◽

Spongy Bone ◽

Hematogenous Osteomyelitis ◽

Acute Hematogenous Osteomyelitis

Semiotics of osteonecrosis and sequestration in femur has been studied on the basis of the data from roentgenography, linear tomography and computer tomography in 39 patients with transformation of acute hematogenous osteomyelitis into chronic one with the purpose of revealing the possible and most typical variants of proliferative changes in bone. It was established that during the process of assimilation the periosteal layers can convert into both compact bone and spongy bone. The average extent of periosteal layers in the shaft zone exceeded the size of destruction by 6.1±2.1 cm and the border of endosteal borders corresponded to that of periosteal layers. In metaphyseal zone the border of periosteal layers corresponded to the border of periosteal cambial layer and was not visualized by destruction spreading: the border of destruction could be located both proximally and distally to the periosteal layers' border.

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