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Haemophilus influenzae type b osteomyelitis in infants and children
1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235.
Abstract:
Haemophilus influenzae type b has rarely been implicated as a pathogen of osteomyelitis in infants and children. Sixteen cases of Haemophilus osteomyelitis were identified in a 28-year review, representing 4.4% of all cases during that period. In the 1 to 24 months age group, H. influenzae type b caused 13.3% of all cases of osteomyelitis. The mean age was 15 months (range, 12 days to 34 months). All cases had fever, 75% had a history of a preceding respiratory tract infection, 75% had localized swelling, 69% had decreased range of motion of the affected or adjacent joint, 38% had local erythema and 13% had localized tenderness. The lower extremities were involved more often than the upper limbs. Concurrent adjacent suppurative arthritis was present in 75% and meningitis in 19% of patients. Clinical resolution was satisfactory in all but two of our patients, and both were associated with suppurative arthritis and inadequate surgical drainage.
Insights
Haemophilus influenzae type b is a rare cause of osteomyelitis in children, but significant in infants. This study reviewed 16 cases, highlighting clinical features and outcomes of this serious bone infection.
Area of Science:
- Pediatric Infectious Diseases
- Musculoskeletal Infections
- Bacterial Pathogenesis
Background:
- Haemophilus influenzae type b (Hib) is infrequently recognized as a cause of osteomyelitis in pediatric populations.
- Osteomyelitis is a serious bone infection that requires prompt diagnosis and treatment in children.
Purpose of the Study:
- To investigate the epidemiology, clinical presentation, and outcomes of osteomyelitis caused by Haemophilus influenzae type b in infants and children.
- To determine the incidence of Hib osteomyelitis within a pediatric cohort over a 28-year period.
Main Methods:
- Retrospective review of pediatric osteomyelitis cases over 28 years.
- Identification and analysis of cases specifically attributed to Haemophilus influenzae type b.
- Evaluation of patient demographics, clinical signs, symptoms, concurrent conditions, and treatment outcomes.
Main Results:
- Sixteen cases of Haemophilus osteomyelitis were identified, accounting for 4.4% of all osteomyelitis cases during the study period.
- In children aged 1-24 months, Hib was responsible for 13.3% of osteomyelitis cases, with a mean age of 15 months.
- Common presentations included fever, preceding respiratory infection, localized swelling, decreased joint range of motion, erythema, and tenderness. Concurrent suppurative arthritis (75%) and meningitis (19%) were frequent.
Conclusions:
- Haemophilus influenzae type b, while rare, is a notable cause of osteomyelitis in young children, particularly those under 24 months.
- Prompt recognition of clinical signs and appropriate management, including surgical drainage when indicated, are crucial for satisfactory outcomes.
- The high association with suppurative arthritis underscores the aggressive nature of Hib bone infections in this age group.