Skeletal infections in children

Bacteremia is an almost daily occurrence in childhood. Fortunately, infections in children are usually easily controlled and seldom produce serious sequelae. The prompt diagnosis and treatment of osteomyelitis is especially important to prevent catastrophic complications. Recent articles have pointed out that fine-needle aspiration may be diagnostic in only about 60% of children with acute hematogenous osteomyelitis and have suggested that other diagnostic modalities, such as white-cell scintigraphy, ultrasound, and computed tomography, may be more sensitive. Recent recommendations about treatment of osteomyelitis included a comparison of antibiotic agents, a discussion of follow-up evaluation modalities, and a warning that the clinical effects of osteomyelitis may not be apparent until years after the infection has been successfully treated. Two articles noted the increase in the incidence of septic arthritis in children who are HIV-positive and another described a chlamydial-associated syndrome of arthritis and eye involvement. The increased incidence of HIV infections also was cited by three studies as a factor in the increased incidence of tuberculosis infections in children and in the increased risk of extrapulmonary involvement.