osteomyelitis pediatric osteomyelitis presentation id osteomyelitis

1. Ranya H Albar
PGY3
Osteomyelitis

2. Outlines
INTRODUCTION ETIOLOGY CLASSIFICATION PRESENTATION DEFERENTIAL
DIAGNOSIS
LABORATORY RADIOLOGICAL MANAGEMENT

3. Introduction
Nelaton (1834): coined osteomyelitis
Osteon: bone myelo: marrow itis:
inflammation
Infection involves marrow spaces, haversian
canals, subperiosteal space
Bone involvement is secondary

4. Etiology
Common in pediatric age group
Sex : ♂>♀
Hx of trauma
Summer & rainy seasons
Metaphysis (60-70%) Most common: growth plates in long bone (lower femur, upper tibial)

5. Etiology
Category Organism
Neonate S. aureus, group B strept, gram -
Healthy child S. aureus, group A strept, H.
influenzae, kingella (<3yrs)
Immunocompromised S. Aureus
SCA Salmonella
Hospital acquired Gram -
Vertebral S. Aureus, Mycobacterium TB,
Bartonella

6. Classification
Duration: Acute, subacute, chronic
Mechanism: Heamatogenous: (tonsil, lungs, ears, GIT)
Exogenous: (direct, local invasion of infection)
Host
response:
Pyogenic, granulomatous

7. Presentation
Fever
Pain/tenderness
Inactivity
Swelling
Redness
Irritability

8. Differential
diagnosis
Acute Septic arthritis
Acute Rheumatic arthritis
Juvenile rheumatoid arthritis
Viral arthritis
SCA
Osteosarcoma
Ewing sarcoma
Scurvy
Acute poliomyelitis
Soft tissue sarcoma
Metastatic bone disease

9. Laboratory
ROUTINE
INVESTIGATION
INFLAMMATORY
MARKERS (CRP, ESR)
BLOOD C/S

10. Radiological
X-Ray
Bone scan
MRI

11. X-ray
• Specificity: 75%-83%
• Sensitivity: 43—75%
• Soft tissue swelling: 48H
• Periosteal reaction: 5-7D
• Osteolysis 10-14D (need 50% bone loss)

12. Bone scan
 Tc99
 24-48H +ve
 Bone aspiration dose not give
false +ve
 ↓ uptake in in early phase due
to ↑ pressure
 ‘Cold’ scan up to 100% PPV

13. MRI
Specificity: 75-100%
Sensitivity: 83-100%
PPV=Tc99
Marrow & soft tissue swelling
Good in spine & pelvis

14. Management
Medication
Analgesic Antibiotics
repeat
MRI
Repeat
Labs
Surgical

15. Antibiotics
 Antibiotics
 If < 3 month : vancomycin & cefotaxime
 If > 3 month : vancomycin or clindamycin
 Trace C/S & sensitivity & adjust Abx accordingly
 Duration:
 3-6 weeks
 6 month

16. Oral antibiotic
patient can be discharged on oral
Abx:
 Vitally & clinically stable
 Osteomyelitis improved
 ⇊ CRP
 ⇊ ESR

17. Thank you
MedStudy Upto date