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Primary subacute haematogenous osteomyelitis in children
1University of Natal, Durban, South Africa.
Insights
Subacute osteomyelitis in children presents with prolonged symptoms but minimal impairment, often mimicking bone tumors. Prompt histological diagnosis and antibiotic treatment ensure complete healing.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Radiology
Background:
- Subacute hematogenous osteomyelitis (SHAO) is a bone infection in children.
- SHAO often presents with insidious onset, characterized by pain, swelling, and limp lasting weeks.
- Laboratory findings are typically non-contributory, complicating early diagnosis.
Purpose of the Study:
- To describe the clinical, radiological, and histological features of primary subacute hematogenous osteomyelitis in children.
- To highlight the diagnostic challenges and treatment outcomes of SHAO.
- To emphasize the importance of histological confirmation for accurate diagnosis and timely management.
Main Methods:
- Retrospective review of 21 children diagnosed with primary SHAO between 1990 and 1998.
- Classification of radiological lesions (metaphyseal, diaphyseal, epiphyseal, vertebral).
- Histological confirmation and microbiological culture (Staphylococcus aureus).
Main Results:
- Most common site was the tibia (20/24 lesions), predominantly in the diaphysis (17/24).
- Staphylococcus aureus was identified in 6 patients.
- All patients achieved complete healing with a 6-week antibiotic course, showing radiological improvement within 3-6 months.
Conclusions:
- SHAO can mimic bone tumors and infections, necessitating histological confirmation.
- Early diagnosis and appropriate antibiotic therapy lead to favorable outcomes.
- Understanding SHAO's presentation is crucial for pediatricians and orthopedic surgeons to avoid diagnostic delays.
Abstract:
Between 1990 and 1998 we saw 21 children with primary subacute haematogenous osteomyelitis. Pain, swelling and a limp had been present for two to 12 weeks with little functional impairment. Laboratory tests were non-contributory. The lesions were classified radiologically into metaphyseal, diaphyseal, epiphyseal and vertebral. There were 24 sites involved, with most (20) being in the tibia; 17 lesions were in the diaphysis, five in the metaphysis and two in the epiphysis. The diagnosis was confirmed histologically in all cases. Staphylococcus aureus was cultured in six patients. Healing occurred in all patients after treatment with antibiotics for six weeks and radiological improvement was seen after three to six months. Subacute osteomyelitis develops as a result of increased host resistance and decreased bacterial virulence. The radiological features can mimic various benign or malignant bone tumours and non-pyogenic infections. Histological confirmation is necessary to avoid a delay in diagnosis.