Reflections on so-called culture-negative osteoarticular infections in pediatric populations

Area of Science:

• Pediatric infectious diseases
• Musculoskeletal infections
• Microbiology

Background:

• Osteoarticular infections (OAIs) in children pose significant risks to bone and joint health.
• A substantial number of OAIs are culture-negative, hindering epidemiological understanding.
• Subacute osteomyelitis, particularly subacute hematogenous osteomyelitis (SAHO), is increasingly recognized but often underdiagnosed due to subtle clinical and laboratory findings.

Purpose of the Study:

• To investigate the microbiological basis of culture-negative OAIs in children.
• To explore the parallels between culture-negative OAIs and subacute osteomyelitis (SAHO).
• To highlight the role of advanced diagnostic technologies in identifying causative agents.

Main Methods:

• Literature review focusing on culture-negative OAIs and SAHO.
• Analysis of microbiological data, including fastidious and atypical organisms.
• Discussion of diagnostic challenges and advancements.

Main Results:

• Culture-negative OAIs may be caused by fastidious or atypical microorganisms not routinely detected.
• SAHO presents with localized pain and positive imaging but negative routine tests, mimicking culture-negative OAI.
• Modern diagnostic tools offer improved detection rates for challenging pathogens.

Conclusions:

• Culture-negative OAIs represent a significant diagnostic challenge in pediatric infectious diseases.
• Recognizing the overlap with SAHO is crucial for accurate diagnosis and management.
• Technological advancements are vital for improving the etiological diagnosis of pediatric OAIs.