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Follow-up of osteomyelitis of infants with systemic serum parameters and bone scintigraphy
R M Aigner1, G F Fueger, M Vejda
1Department of Radiology, University Hospital, Graz, Austria.
Insights
Early diagnosis and monitoring of infant osteomyelitis are crucial. Bone scintigraphy (BSC) combined with serum parameters like C-reactive protein (CRP) effectively track treatment response and detect recurrence in acute hematogenous pyogenic osteomyelitis (AHPO).
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Diagnostic Imaging
Background:
- Acute hematogenous pyogenic osteomyelitis (AHPO) in infants can lead to severe orthopedic complications.
- Early diagnosis, recurrence recognition, and effective therapy are vital for preventing long-term sequelae.
- Systemic serum parameters and bone scintigraphy (BSC) are used in managing AHPO.
Purpose of the Study:
- To evaluate the diagnostic value of systemic serum parameters in comparison to BSC for AHPO in infants.
- To analyze the effectiveness of these modalities in monitoring disease progression and treatment response.
- To identify reliable indicators for early detection of therapeutic failure or recurrence.
Main Methods:
- Retrospective analysis of 47 infants with bacteriologically confirmed AHPO.
- Characterization of AHPO using clinical findings, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, BSC, and plain radiography.
- Comparison of serum parameters and BSC findings for disease assessment and follow-up.
Main Results:
- C-reactive protein (CRP) demonstrated the highest efficacy among serum parameters for disease follow-up.
- A decrease or normalization of hyperperfusion on BSC indicated an adequate response to antibiotic treatment.
- Recurrence of focal hyperperfusion or persistent/increasing uptake ratios on BSC, despite normalized serum parameters, signaled therapeutic escape or poor prognosis.
Conclusions:
- Antibiotic therapy can mask clinical and radiographic findings, making laboratory results non-characteristic.
- BSC and specific serum parameters, when used together, are highly successful and efficient for AHPO follow-up.
- Antibiotic treatment should continue until BSC findings normalize to ensure complete recovery.
Aim:
To prevent orthopedic sequelae in acute hematogenous pyogenic osteomyelitis (AHPO) of infants early diagnosis, recognition of recurrence and effective therapy is needed. This retrospective study of 47 infants with bacteriologically confirmed AHPO concerned with an analysis of the diagnostic value of systemic serum parameters compared to bone scintigraphy (BSC).
Methods:
AHPO was characterized initially and during the course of disease by clinical findings, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total and differential white blood cell (WBC) count, BSC, and plain radiography.
Results:
CRP was the most effective serum parameter for follow-up of disease. The first sign of BSC to signal adequate response to antibiotic treatment was the decrease or normalization of hyperperfusion. Escape from therapy or poor prognosis, even when the serum parameters were normalized, was signaled by the recurrence of focal hyperperfusion and the persistent or increasing local uptake ratios on the 3-h-image over 6 weeks during a course of antibiotic treatment.
Conclusion:
Antibiotic treatment masks the clinical presentation, and the radiographic findings, causes non-characteristic laboratory findings, but do not prevent the scintigraphic visualization; BSC and serum parameters used in the right completion are the most successful and efficient modalities for follow-up of AHPO. Maintenance of antibiotic therapy should be done until BSC findings have reverted to normal.