PEDIATRIC BONE AND JOINT INFECTIONS: Diagnosis and Antimicrobial Management
Section snippets
OSTEOMYELITIS
Each year in the United States, 1 in 5000 children under the age of 13 years will be diagnosed with osteomyelitis. The disease occurs 2.5 times more commonly in males than in females and can affect any age group. Trauma may be a precipitating factor, especially in children.6,19 Unfortunately, permanent sequelae may occur.19 The pathologic origin of osteomyelitis in children can be broadly divided into three categories: (1) hematogenous seeding; (2) local invasion from contiguous infected
SEPTIC ARTHRITIS
Septic arthritis refers to microbial invasion of the synovial space. Bacterial pathogens are common in patients with acute septic arthritis, with fungal and mycobacterial pathogens isolated more commonly in patients with chronic septic arthritis.25 Acute septic arthritis is a medical emergency. Failure to diagnose and treat the disease properly results in permanent disability caused by destruction of the articular cartilage.
The synovial space may be invaded by one of three routes: (1)
SUMMARY
Bone and joint infections in children provide unique clinical challenges. When evaluating children with suspected bone and joint infection, the differential diagnosis is broad. Consideration must be given to possible neoplastic and traumatic causes. Appropriate imaging and diagnostic techniques should be initiated without delay. Orthopedic consultation for surgical evaluation should be made early. Prolonged use of antibiotics is often warranted. Treatment often is continued in the outpatient
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Address reprint requests to Nancy K. Henry, PhD, MD Associate Professor Division of Pediatric Infectious Diseases Department of Pediatric & Adolescent Medicine Mayo Clinic 200 1st Street, S.W. Rochester, MN 55905