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Group A beta-hemolytic streptococcal osteomyelitis in children

Ekopimo O Ibia1, Menfo Imoisili, Andreas Pikis

  • 1Department of Infectious Diseases, Children's National Medical Center, Washington, DC, USA.

Pediatrics
|July 3, 2003
PubMed

Insights

Group A beta-hemolytic Streptococcus (GABHS) causes acute hematogenous osteomyelitis (AHO) in children, often presenting with high fever and leukocytosis. Consider GABHS in AHO cases linked to varicella infection.

Area of Science:

  • Pediatric Infectious Diseases
  • Musculoskeletal Infections
  • Microbiology

Background:

  • Acute hematogenous osteomyelitis (AHO) is a serious bone infection in children.
  • Group A beta-hemolytic Streptococcus (GABHS) is an underrecognized cause of AHO, accounting for up to 10% of cases.
  • Understanding GABHS AHO characteristics is crucial for timely diagnosis and treatment.

Purpose of the Study:

  • To define the clinical and laboratory features of AHO caused by GABHS.
  • To compare GABHS AHO with AHO caused by Streptococcus pneumoniae and Staphylococcus aureus.

Main Methods:

  • Retrospective study of 29 patients with GABHS AHO treated between 1983 and 1999.
  • Comparison with 28 patients with Streptococcus pneumoniae AHO and 45 patients with Staphylococcus aureus AHO.
  • Analysis of clinical data, laboratory results, and risk factors.

Main Results:

  • GABHS AHO patients were typically younger (median 36 months) than S. aureus AHO patients (median 96 months).
  • GABHS AHO presented with high fever and leukocytosis, similar to S. pneumoniae AHO but higher than S. aureus AHO.
  • Varicella infection was a significant risk factor for GABHS AHO (17% of cases).
  • Septic arthritis was less common in GABHS AHO (22%) compared to S. pneumoniae AHO (61%).
  • Erythrocyte sedimentation rate normalization was slower for GABHS and S. aureus AHO than for S. pneumoniae AHO.

Conclusions:

  • GABHS should be suspected in preschool and early school-aged children with AHO exhibiting high fever and leukocytosis.
  • AHO associated with varicella infection warrants high suspicion for GABHS.
  • Recognizing these patterns aids in differentiating GABHS AHO from other causative agents.
Abstract

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