Osteomyelitis in Immunocompromised children and neonates, a case series

Area of Science:

• Pediatric Infectious Diseases
• Immunocompromised Host Pathologies
• Skeletal System Infections

Background:

• Osteomyelitis in immunocompromised children differs from that in immunocompetent children.
• Inadequate treatment can lead to severe and lasting consequences.

Purpose of the Study:

• To review the etiology, clinical presentation, treatment strategies, and outcomes of osteomyelitis in immunocompromised children.
• To highlight the unique aspects of osteomyelitis in this vulnerable population.

Main Methods:

• Retrospective review of immunocompromised children (<16 years) and neonates with osteomyelitis.
• Data collected from January 2000 to January 2017, including referral to the Pediatric Infectious Disease Service.

Main Results:

• Fourteen patients were identified, with a median age of 70.5 months; 71% were male.
• Causal organisms included Staphylococcus aureus, Mycobacterium bovis (BCG), Mycobacterium tuberculosis, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Burkholderia pseudomallei, Rhizopus sp., Clostridium tertium, and Clostridium difficile.
• Treatment involved prolonged antimicrobials (6 weeks to 1 year) and surgery in 79% of cases. Only 21% achieved complete recovery; 36% experienced poor bone growth.

Conclusions:

• Osteomyelitis in immunocompromised children can be caused by rare pathogens and result in severe outcomes.
• Treatment necessitates extended antibiotic courses, surgical intervention, and management of the underlying immunodeficiency.
• Immune system recovery appears crucial for successful bone healing in these patients.