OSTEOMYELITIS
Overview
Osteomyelitis (OM), or inflammation of the bone, is usually caused by bacterial infection. Bone infections in children are primarily hematogenous, although incidents secondary to surgery, penetrating trauma, or infection in a contiguous site are reported (Kalyoussef, Windle, Domachowske, Steele, & Noel, 2016). OM is inflammation of the bone caused by a variety of infectious organisms (i.e., bacteria, fungi, or viruses) that results in tissue destruction of the affected bone. OM is a complex disease in its pathophysiology, clinical presentation, and management, making accurate diagnosis and treatment a challenging process. The symptoms of OM include the history of local inflammation, erythema, and/or swelling. In addition, patients with OM may present with a low-grade fever, malaise, and fatigue, along with nonspecific chronic pain at the site of infection (Malhotra, Schulz, & Kallail, 2015). OM may affect any bone, resulting in the progressive bone destruction leading to the formation of sequestra. OM can be acquired through contiguous spread from adjacent soft tissue, joint, and blood infections, or direct inoculation of microorganisms into the bone as a result of trauma or surgery (Malhotra et al., 2015). Other risk factors include diabetes, vascular insufficiency, dialysis treatment, intravenous drug use, and immunosuppression. If untreated, OM can become a life-threatening illness because of bacteremia and sepsis. Therefore, early diagnosis, identification of the causative organism, and prompt treatment can prevent recurrent infection, chronic disease, and complications.
Background
Approximately 50% of OM in children occurs in preschool-age children (Kalyoussef, 2016). Young children experience acute hematogenous osteomyelitis because of the rich vascular supply seen in developing bones. Circulating organisms tend to infect in the metaphyseal ends of the long bones because of the slower circulation in the loops of the metaphyseal capillary loops (Kalyoussef, 2016).
OM is an ancient disease and is one of the most difficult infectious diseases to diagnose and treat (Malhotra et al., 2015). OM can affect people of all ages, and in children, preponderance in males is observed in all age groups (Kalyoussef, 2016). Increased incidence in males may be related to increased trauma owing to risk-taking behavior or other physical activities that predispose to bone injury (Kalyoussef, 2016).
Major causative bacterial organisms include Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus pyogenes, and Streptococcus pneumoniae. Infection with drug-resistant organisms is of particular concern. For unknown reasons, Haemophilus influenza type B is shown to affect joints rather than bones 89alone. In addition, fungal or mixed bacteria are associated with skull, vertebrae, and/or long-bone OM. In fact, about 75% to 95% skull OM are reported to be of fungal origin (Johnson & Batra, 2014; Peltola & Pääkkönen, 2014).
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