Acute Osteomyelitis Research Articles

Bell's palsy with facial bone involvement: A rare presentation of chronic nonbacterial osteomyelitis with literature review.

Chronic nonbacterial osteomyelitis (CNO) is a chronic, sterile, inflammatory disease. It primarily presents with nonspecific bone pain and swelling but ultimately can cause bone destruction and deformities, if left untreated. The involvement of the cranial bones (apart from the mandible) is rare in CNO. In this report, we present a rare case of CNO affecting facial and cranial bones presenting as facial palsy with a review of the literature about similar affection. A 10-year-old, previously healthy female was initially evaluated for swelling of the left side of her face with slight tenderness on palpation, but no fever. Her complete blood count was unremarkable, her inflammatory markers were elevated (C-reactive protein 7.5 mg/dl and erythrocyte sedimentation rate 104 mm/h), and CT of facial and skull bones and MRI of brain showed a destructive osseous process involving the left maxillary, zygomatic, sphenoid bones and the clivus. Bone biopsy of the left maxilla showed fibrous dysplasia with abscess formation, most consistent with an infectious aetiology (acute osteomyelitis). She was started on oral clindamycin for a 3-month course. The facial swelling improved after starting clindamycin, but on her sixth week of treatment, she developed right-sided Bell's palsy. An MRI of the brain showed hyperenhancement of the right seventh cranial nerve. A month later, she was evaluated for right wrist and knee swelling, pain, and limitation of movement. Skeletal survey and MRI showed multifocal lesions with mixed sclerosis and lucency. Her inflammatory markers continued to be elevated. Another bone biopsy of the right radius showed similar findings of destruction with no evidence of malignancy. She was ultimately diagnosed with CNO. She was started on nonsteroidal anti-inflammatory drugs with gastric protection and regular follow-up. Over more than a year of follow-up, the patient's inflammatory markers remain normal, and joint swelling/limitation has remained in remission. We found five additional cases in the literature that presented with a similar presentation. To our knowledge, our patient is the first reported case in the USA involving the cranial/facial bones apart from the mandible presenting with facial palsy. The affection of the facial bones (apart from the mandible) in CNO is very rare, but the awareness of such a presentation by the clinician is an important aspect of reaching the diagnosis.

Osteomyelitis of the Acetabulum in a Child: A Case Report of an Unusual Localization

Introduction: Acute haematogenous osteomyelitis (AHO) of the acetabulum is a rare condition in children. Presentation of case: We report a rare case in a ten-year-old child who had an acute presentation with new-onset hip pain and fever evolving for one week. The standard radiograph was without abnormalities. Emergency MRI showed osteoarthritis of the hip, with a 15 mm internal acetabular subchondral lacuna. Therefore, the child had antibiotic therapy. Pain relief and radiological improvement was obtained after 3 months of antibiotic treatment. At a two-year follow-up, the X-ray was normal. Discussion: Diagnosis is delayed because of the deep-seated location. Staphylococcus aureus is the most common causative organism. In the event of strong clinical-radiological suspicion, empirical treatment must be started rapidly, in order to obtain satisfactory results. Conclusion: Because of the atypical location of acute osteomyelitis of the acetabulum, diagnosis can be delayed. In some cases, treatment may be based on antibiotics therapy alone.

Magnetic resonance imaging in the diagnosis of acute hematogenous osteomyelitis in children

Aim of the study: to show the possibilities of magnetic resonance imaging for the diagnosis of acute osteomyelitis. Materials and methods. One hundred thirty two children with hematogenous osteomyelitis (n = 112 - 84.8%), including BCG-osteomyelitis (n = 20 - 15.2%), aged 1 to 17 years, average age - 9.1 ± 4.9 years, were examined between 2011 and 2020. Out of 132 children, 77 were operated on (58.3%). Boys predominated - 70 (53%) patients, girls - 62 (47%). MRI was performed on a Philips Achieva dStream 3.0 T. Results. Over the first three days after onset of the disease, when radiography and CT did not reveal bone pathological changes, according to MRI acute osteomyelitis was detected in all patients (n = 51). The topical location of osteomyelitis foci was clearly established. Discussion. MRI is the most informative method for visualizing acute hematogenous osteomyelitis over first days of the disease. MRI clearly shows initial bone remodelling and bone marrow edema, including the such earliest sign as perifocal myositis. The most effective MRI sequences are STIR and T2WI, regardless of the pulse sequence, in which a pronounced hyperintense signal is visualized. Whole body MRI combined with clinical data is considered a promising method for distinguishing inflammatory processes from other specific diseases.

Magnetic resonance imaging protocols for pediatric acute hematogenous osteomyelitis.

Pediatric musculoskeletal infection can be a challenging clinical diagnosis. MRI protocols should be tailored appropriately to diagnose and localize sites of infection, to determine alternative pathologies that could explain the child's presentation, and to identify complications that could alter treatment or lead to devastating consequences in growing bones. In this review, we discuss MRI protocols tailored for suspected acute appendicular musculoskeletal infection in children. These protocols are based on patient age in order to generally reflect the developmental stage of the child, the corresponding relevant anatomy and physiology, and the skeletal maturity-dependent physiopathology of musculoskeletal infections.

Bioactive glass in the treatment of chronic osteomyelitis in children: Description of four consecutive cases and literature review

IntroductionChronic osteomyelitis in children is a rare condition. Debridement surgery, along with appropriate antibiotic therapy, is widely agreed to represent the best procedure in the treatment of chronic osteomyelitis but can result in an extensive dead space formation. In this study, we evaluated the use of bioactive glass to address dead space management. MethodsFour consecutive cases of chronic osteomyelitis treated with antibiotic therapy, one stage- surgical debridement and bioglass implantation between September 2016 and February 2017 were prospectively followed for a minimum of three years. Two cases followed acute hematogenous osteomyelitis, two cases followed fracture fixation. Clinical, histology, laboratory and radiographic findings were recorded. Primary endpoint was eradication of infection. Possible complication related to bioglass application were investigated. ResultsAll patients achieved healing at the latest follow-up of minimum three years. No successive surgical treatments were required at any time. No complications related to the bioglass were detected. Radiographic reconstruction of normal anatomy progressed through the years. ConclusionsBioglass for the treatment of dead space after surgical debridement appears a viable option in the treatment of chronic osteomyelitis in children.

Early Transition to Oral Antimicrobial Therapy Among Children With Staphylococcus aureus Bacteremia and Acute Hematogenous Osteomyelitis.

Staphylococcus aureus bacteremia (SAB) is a frequent complication of acute hematogenous osteomyelitis (AHO) in children, but data on the optimal duration of parenteral antibiotics prior to transition to oral antibiotics remains sparse. We examined clinical outcomes associated with early transition to oral antimicrobial therapy among children admitted to our institution with AHO and SAB, and evaluated the utility of a severity of illness score (SIS) to guide treatment decisions in this setting. Children with AHO and SAB admitted to our institution between January 1, 2009, and December 31, 2018, were retrospectively reviewed and stratified according to a previously validated SIS into mild (0-3), moderate (4-7) and severe (8-10) cohorts. Groups were assessed for differences in treatment (eg, parenteral and oral antibiotic durations, surgeries) and clinical response (eg, bacteremia duration, acute kidney injury, length of stay and treatment failure). Among 246 children identified with AHO and SAB, median parenteral antibiotic duration differed significantly between mild (n = 80), moderate (n = 98) and severe (n = 68) cohorts (3.6 vs. 6.5 vs. 14.3 days; P ≤ 0.001). SIS cohorts also differed with regard to number of surgeries (0.4 vs. 1.0 vs. 2.1; P ≤ 0.001), duration of bacteremia (1.0 vs. 2.0 vs. 4.0 days; P ≤ 0.001), acute kidney injury (0.0% vs. 3.0% vs. 20.5%; P ≤ 0.001), hospital length of stay (4.8 vs. 7.4 vs. 16.4 days; P ≤ 0.001) and total duration of antibiotics (34.5 vs. 44.7 vs. 60.7 days; P ≤ 0.001). Early transition to oral antimicrobial therapy among mild or moderate SIS cohorts was not associated with treatment failure despite SAB. SAB is associated with a wide range of illness among children with AHO, and classification of severity may be useful for guiding treatment decisions. Early transition to oral antimicrobial therapy appears safe in children with mild or moderate AHO despite the presence of SAB.

Delineating the Role of the msaABCR Operon in Staphylococcal Overflow Metabolism

Staphylococcus aureus is an important human pathogen that can infect almost every organ system, resulting in a high incidence of morbidity and mortality. The msaABCR operon is an important regulator of several staphylococcal phenotypes, including biofilm development, cell wall crosslinking, antibiotic resistance, oxidative stress, and acute and chronic implant-associated osteomyelitis. Our previous study showed that, by modulating murein hydrolase activity, the msaABCR operon negatively regulates the proteases that govern cell death. Here, we report further elucidation of the mechanism of cell death, which is regulated by the msaABCR operon at the molecular level in the USA300 LAC strain. We showed that deletion of msaABCR enhances weak-acid-dependent cell death, because, in the biofilm microenvironment, this mutant strain consumes glucose and produces acetate and acetoin at higher rates than wild-type USA300 LAC strain. We proposed the increased intracellular acidification leads to increased cell death. MsaB, a dual-function transcription factor and RNA chaperone, is a negative regulator of the cidR regulon, which has been shown to play an important role in overflow metabolism and programmed cell death during biofilm development in S. aureus. We found that MsaB binds directly to the cidR promoter, which represses expression of the cidR regulon and prevents transcription of the cidABC and alsSD operons. In addition, we observed that pyruvate induced expression of the msaABCR operon (MsaB). The results reported here have enabled us to decipher the role of the msaABCR operon in staphylococcal metabolic adaption during biofilm development.

Identifying predictors for source culture positivity in children with acute musculoskeletal infections.

Identifying the causative bacterial pathogen for children with acute hematogenous musculoskeletal infections (MSKIs) allows for improved care. The purpose of our study was to determine if clinical markers could predict which patients will have a causative pathogen found on source culture alone, thus being highest yield to undergo operative diagnostic procedures. A single-center, retrospective cohort study was performed. Medical records for patients between 6months and 18 years of age admitted between July 2014 and September 2018 with a discharge diagnosis of acute osteomyelitis, septic arthritis, or pyomyositis were reviewed. Patients were stratified based on results of blood and source cultures. Predictors of interest were screened on a univariable basis with significant predictors retained in a multivariate analysis. There were 170 patients included. No predictors were significantly associated with increased odds of having a causative pathogen found on source culture alone. Degree of C-reactive protein elevation and history of fever were associated with decreased odds of being source culture positive, OR (95% CI); 0.92 (0.87, 0.98) and 0.39 (0.19, 0.81), respectively. Predictive modeling failed to identify children with MSKIs whose causative pathogen was found by source culture alone. It is difficult to predict which MSKI patients will be highest yield for operative diagnostic procedures.

Fifteen-minute consultation: Recognition of sickle cell crises in the paediatric emergency department

Children with sickle cell disease can develop life-threatening and painful crises that require prompt assessment and efficient management by healthcare professionals in the emergency or acute care setting. Due to...

Early diagnosis and treatment of acute brucellosis knee arthritis complicated by acute osteomyelitis: two cases report

BackgroundBrucellosis is an endemic systemic infectious disease, the most common complication is bone and joint involvement. Sacroiliac joint and spinal joint are the most frequently involved sites in adults, but knee joint infection is rare, and acute infectious knee arthritis complicated by acute osteomyelitis is even extremely uncommon in adults. Here, we report two cases of acute septic knee arthritis complicated by acute osteomyelitis caused by Brucella melitensis (B. melitensis).Case presentationBoth patients had a history of traveling in animal husbandry areas within three months. On clinical examination, their right knee joint was tender, swollen, had limited movement and an effusion was present. Imaging examination showed effusion and synovial thickening of the right knee joint, as well as subchondral bone edema of the distal femur and proximal tibia. Laboratory examination showed that the serum agglutination test (SAT) in both patients were positive (1: 640 and 1: 320) without leukocytosis, although the proportion of lymphocytes, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) significantly increased. Both patients underwent knee joint aspiration. Real-time polymerase chain reaction (Real-time PCR) analysis of synovial fluid showed that there was B. melitensis, and blood bacterial culture was negative. We determined that two patients had acute brucellosis knee arthritis complicated by acute osteomyelitis. Antibiotic treatment was given during hospitalization consisting of doxycycline (0.1 g po bid) and rifampicin (0.6 g po qd) for six weeks, and the changes of inflammatory indexes were closely monitored. At discharge, the symptoms had completely resolved, imaging abnormalities disappeared, and inflammatory indexes returned to normal. There was no recurrence of the disease at 1-year follow-up.ConclusionAcute brucellosis knee arthritis complicated by acute osteomyelitis is a rare but serious complication of brucellosis in adults. There is no obvious specificity of clinical manifestation and imaging examination. Early diagnosis and treatment can prevent the occurrence of knee joint deformity and even pathological fracture. Clinicians should fully consider the possibility of brucellosis where the travel or occupational history is suggestive.

Clinical Scores Predict Acute and Chronic Complications in Pediatric Osteomyelitis: An External Validation.

Pediatric acute hematogenous osteomyelitis (AHO) outcomes are highly dependent on the disease severity. Recently, the A-SCORE and C-SCORE, were proposed as predictors of an acute complicated course and chronic morbidity, respectively. The purpose of this study was to externally validate the A-SCORE and C-SCORE at a single institution. This IRB-approved retrospective chart review included AHO patients admitted at a tertiary referral hospital between October 1, 2015 and December 31, 2019. The inclusion criteria were ages 0 to 18 and clinical response to treatment. The exclusion criteria were immunocompromised status or penetrating inoculation. The A-SCORE demonstrated an area under the receiver operator curve (ROC area) of >86% with regards to all acute complications. It also demonstrated sensitivities >85% and specificities >92% at the cut-off of 4 (Youden index) for all acute complications. The C-SCORE demonstrated an ROC area of 100% with regards to chronic osteomyelitis. It also demonstrated sensitivities >70% and specificities >93% for the chronic morbidity variables seen in our population at the cut-off of 3 (Youden index.). These novel composite clinical scores, in combination with clinical judgment, could help guide early care decisions. The A-SCORE and C-SCORE are useful risk stratification tools in the management of pediatric AHO and in predicting acute complicated courses or chronic sequelae of AHO, respectively. These scoring systems, if integrated into standardized pediatric AHO guidelines, can allow clinicians to stratify the AHO population and guide clinical decision making. Level III (prognostic study, retrospective chart review).

Is Early Surgical Intervention Necessary for Acute Neonatal Humeral Epiphyseal Osteomyelitis: A Retrospective Study of 31 Patients.

Objective: To review the treatment experience of neonatal humeral epiphyseal osteomyelitis retrospectively. Study design: Retrospective cohort study of infants with neonatal humeral epiphyseal osteomyelitis. Patients were divided into conservative group and surgical group, and the surgical group was subdivided into early and delayed surgical group. Results: In total, there were 7 patients in the conservative group and 24 in the surgical group. The length of hospital stay and intravenous course of antibiotic therapy were both significantly shorter in the surgical group (p < 0.001). The full recovery rate was also higher in the surgical group (83.3%) than the conservative group (14.3%) (p < 0.001). Early surgery group (n = 14) had an insignificantly higher positive rate of pus/aspirate culture and full recovery rate than delayed surgery group (n = 10). Conclusion: Surgical treatment for neonatal humeral epiphyseal osteomyelitis demonstrated significantly higher rates of positive culture for the pathogen, a shorter course of intravenous oral antibiotics, and lower incidence of growth abnormality than conservative treatment. In our institution, most of culture outcome Gram-positive bacteria, and early surgical treatment was recommended with better outcome than delayed surgical group. Empirical antibiotics should be tailored to the epidemiological characteristics of local virulent bacteria.

Paediatric Osteomyelitis and Septic Arthritis Pathogen Distribution and Antimicrobial Resistance in a Single Centre: A 15-Year Retrospective Analysis.

The epidemiological characteristics of the common pathogens underlying acute haematogenous osteoarticular infection (AHOI) and their resistance to drugs have temporal and regional differences. To determine the antimicrobial treatment most effective for culture-negative AHOI patients and those without bacterial cultures. Retrospective analysis of clinical data of children with AHOI who were culture positive from January 2007 to December 2021. And the distribution of the main pathogens and the drug resistance Staphylococcus aureus were analysed in different time periods, age groups and infection types. A total of 188 cases met the inclusion criteria, including 97 cases of acute haematogenous osteomyelitis (AHO), 75 cases of septic arthritis (SA) and 16 cases of AHO concomitant with SA. The commonest causative pathogen in local children was S. aureus of Gram-positive cocci, followed by Streptococcus, and occasionally Gram-negative bacilli. The distribution of S. aureus had no significant correlation with age or infection type. Staphylococcus aureus accounted for 81.82%, 90.91% and 96.15% of all pathogens, and methicillin-resistant S. aureus (MRSA) accounted for 24.22%, 53.33% and 76.00% of S. aureus in 2007-11, 2012-16 and 2017-21, respectively. The frequency of MRSA infection showed an increasing trend over time. Staphylococcus aureus is still the main pathogen of AHOI in local children. The proportion of MRSA in S. aureus has also increased over time to 76% in the last 5 years, and the increased proportion of MRSA can affect the choice of initial empirical medication.

Clinical Characteristics of Acute Hematogenous Osteomyelitis With and Without Subperiosteal Abscesses in the Acute Care Setting.

Acute hematogenous osteomyelitis (AHO) is a common pediatric disease that can progress to involve nearby structures leading to complications including subperiosteal abscesses (SPAs). Those with SPAs, in particular, often require surgical intervention for complete treatment. Staphylococcus aureus remains one of the most common causes of AHO. With the emergence of community-associated methicillin-resistant Ataphylococcus aureus and its propensity to form abscesses, there has been an observed increased frequency of AHO with SPAs in children. Although magnetic resonance imaging (MRI) remains the gold standard of imaging for AHO, it is not readily available on a 24/7 basis and often necessitates procedural sedation in children. Delay in MRI and surgical intervention in patients with SPAs may lead to increased complications. The goal of this study is to identify, using clinical features easily obtained in the acute care setting, patients at high risk for AHO with SPAs who may benefit from emergent MRI and/or surgical intervention. A retrospective chart review of patients aged birth to younger than 18 years diagnosed with AHO, who presented to a tertiary pediatric hospital from June 10, 2012, to November 1, 2017, were evaluated. Demographic, clinical, laboratory, and imaging data were collected. Patients were divided into 2 groups: AHO alone and AHO with SPAs. A final cohort of 110 subjects were included and analyzed. Of these, 73 (66%) were identified as having AHO alone and 37 (33.6%) as having AHO with SPAs. Patients had a higher risk of AHO with SPAs if they had a history of fever, decreased range of motion, edema, or elevated laboratory studies including white blood cell, absolute neutrophil count, erythrocyte sedimentation rate, and C-reactive protein. C-reactive protein was shown to have the highest correlation of AHO with SPAs, with an optimal cut point of 10.3 mg/dL, yielding a sensitivity of 67.7% and specificity of 77.6%. Patients with AHO with SPAs were at higher risk of having a positive blood culture for methicillin-resistant Staphylococcus aureus. Clinicians in acute care settings should have a high index of suspicion of AHO with SPAs in children with history of fever, decreased range of motion, or elevated laboratory values (white blood cell, absolute neutrophil count, erythrocyte sedimentation rate, and C-reactive protein). In particular, those with a significantly elevated CRP are at a higher risk for having AHO with SPAs in comparison with an uncomplicated AHO. However, with the significant overlap in historical and clinical variables in the initial presentations of children with AHO with and without SPAs, the clinical urgency in obtaining a magnetic resonance imaging must continue to be individualized based on overall clinical suspicion and availability of resources.

Atypical Kawasaki Disease with Polymyositis and Panniculitis

Background: Kawasaki disease (KD) is a medium-vessel vasculitis that commonly affects young children. Many atypical presentations that differ from the classical phenotype have been described. Clinical Description: A 3-year-old boy presented with acute onset refusal to walk due to severe pain in both lower limbs for 8 days. This was accompanied by fever for 7 days. Significant findings included diffuse tenderness of bilateral thighs and leg muscles, probable normal joints, and absence of rashes, edema, significant lymphadenopathy, organomegaly, or paralysis. He had a hemoglobin of 10.6 g/dL, neutrophilic leukocytosis, and normal platelet count (384 × 109/L). He was started on intravenous cloxacillin, assuming polymyositis or acute osteomyelitis. Radiographs, ultrasonography, and bone scan of the lower limbs revealed normal bones and joints. However, magnetic resonance imaging detected patchy hyperintensities in multiple muscles, though muscle-specific enzyme levels were normal. The fever and pain persisted and investigations for other differentials (including classical KD) were inconclusive. At the end of 2nd week of illness, atypical KD was suspected, when he developed periungual skin peeling with increasing erythrocyte sedimentation rate and platelet counts. Management: The diagnosis was confirmed by echocardiogram proven left main coronary artery dilatation. He was started on intravenous immunoglobulin. Since fever persisted, a second dose was administered, following which defervescence occurred and his symptoms subsided. Conclusions: Atypical KD should be considered in a fever of unknown origin when diagnostic criteria of classical KD are not satisfied. Polymyositis and panniculitis are uncommon atypical manifestations.

Osteomielitis

Osteomyelitis is the infection and destruction of bone tissue by microorganisms. The most common causative agent is Staphylococcus aureus, but many other infectious agents are involved. Microbiological diagnosis is fundamental for its optimal management, as it is crucial for treatment to be specifically target the microorganism responsible. In children, hematogenous acquisition is predominant whereas in adults, direct inoculation of microorganisms in the bone tissue occurs due to fractures or surgery. Acute osteomyelitis tends to respond to antibiotic treatment, but in chronic forms, there are two pathogenic elements: bony sequestrum and biofilm, which in the majority of cases make surgical treatment and prolonging antibiotic treatment necessary; even still, a cure is not always possible. Recently, various studies have demonstrated that less lengthy cycles of antibiotics have the same efficacy as classically recommended cycles.

Pelvic Osteomyelitis, about Four Observations and Review of the Literature

Acute pelvic osteomyelitis is rare (2 to 11% of osteomyelitis). The clinical picture is atypical making their diagnosis difficult. We report four cases of acute pelvic osteomyelitis in order to study the clinical and paraclinical features of this osteomyelitis location while specifying its different therapeutic modalities.

Pattern of orthopaedic case presentations at the rivers state university teaching hospital: a ten-year review

Background: Pattern of diseases help institutions and governments to know the dominant disease conditions and how to allocate scarce resources. Knowledge of the pattern of orthopedic disease conditions seen and treated in the Rivers State university teaching hospital will help in guiding the repositioning effort of the department/discipline, especially in the light of the new status of the institution as a teaching hospital for teaching, service delivery and research. The aim of this study therefore was to determine the pattern of orthopedic cases seen in the surgery department of the Rivers State university teaching hospital from January 2010 to January 2019.Methods: A descriptive retrospective cross-sectional study was carried out at the emergency room, clinic, operating theatre, and wards of the surgery department of the Rivers State university teaching hospital, using hospital registers. The study was analyzed using the Microsoft excel spreadsheet.Results: There were 2854 orthopedic emergency room cases seen, comprising 621 fractures, 463 lumbar spondylosis/ spondylolisthesis, 392-foot ulcer/sepsis, 375 dislocations, 310 acute osteomyelitis, and 864 osteoarthritis with other conditions. The common orthopedic cases seen in the out-patient clinics in descending order of occurrence were lumbar spondylitis / spondylolisthesis (881), osteoarthritis (655), fractures (560), dislocations (227), etc.Conclusions: Trauma-related disease care constituted the bulk of work of the orthopedic surgeon in our environment in the emergency room, operating theatre and ward admissions, and younger males were more affected.

The importance of Cone-Beam computed tomography in diagnosis of associated mandibular osteonecrosis: case report / A importância da TCFC no diagnóstico e prognóstico da osteonecrose mandibular associada aos bisfosfonatos: relato de caso clínico

The Cone-Beam Computed Tomography (CBCT) is very useful in diagnosis and treatment planning, as well as in the prognosis of osteonecrosis of the jaws. This study reports a clinical case of Bisphosphonate-Associated Mandibular Osteonecrosis from the perspective of CBCT. The patient, female, 83 years old, presented painful symptoms in the posterior region of the right mandible and reported Bisphosphonate medication for more than five years to treat osteoporosis and osteopenia. Based on clinical and CBCT imaging characteristics, the patient was diagnosed with Bisphosphonate-Associated Mandibular Osteonecrosis. Initially, the treatment consisted of oral antibiotic therapy, pain control, hyperbaric oxygenation and oral hygiene (mouthwashes). After 11 months of clinical therapy, CBCT revealed bone reconstruction of the buccal cortex, but also a hypodense imaging in the lingual cortex compatible with bone lysis and bone sequestration. The patient was referred for bone debridement and sequestrectomy. The histopathological diagnosis consisted of osteonecrosis with secondary acute osteomyelitis. After 60 days of the surgical procedure and hyperbaric sessions/systemic antibiotic therapy, an oral healthy mucosa in the region of the right mandibular body was evidenced in the intraoral examination. Cortical bone regeneration was observed on CBCT. Concluded that the use of CBCT, in this case report, makes it possible to estimate the extent of the lesion and the post-treatment outcome, assessing bone density, the presence of bone sequestration and the involvement of the involved areas. In fact, early diagnosis is essential for the success of the therapeutic approach.

The recent bacterial etiology of childhood osteoarticular infections focusing on the vaccine initiation for Streptococcus pneumoniae and Haemophilus influenzae: A single-center retrospective analysis in Japan

BackgroundPediatric acute osteomyelitis and septic arthritis can destroy growth plate cartilage and joint cartilage, causing permanent deformities and growth disorders. Preventing the contraction of osteoarticular infections is important. Various types of bacteria cause osteoarticular infections in children. Since 2013, when routine vaccination against Streptococcus pneumoniae and Haemophilus influenzae was initiated in Japan, diseases caused by these bacteria (other than osteoarticular infection) are reported to decrease. In this study, we aimed to re-confirm the actual situation including the presence of pathogenic bacteria of pediatric bone and joint infections. MethodsThe subjects were patients of 15 years old or younger who had been diagnosed with acute osteomyelitis or septic arthritis and received initial treatment in our hospital from April 1995 to March 2019. We obtained information from the medical records and analyzed them statistically. ResultsThere were 65 patients with 65 bones with acute osteomyelitis, and 120 patients with 124 joints with septic arthritis. The pathogenic bacteria were identified in 26 (40.0%) osteomyelitis patients and 59 (49.2%) septic arthritis patients. Staphylococcus aureus was the most common pathogenic bacterium, and S. pneumoniae and H. influenzae were identified in four and seven patients respectively, frequently in younger patients. After routine vaccination against S. pneumoniae and H. influenzae, these bacteria were no longer detected in patients under five years old. ConclusionsThe efficacy of the S. pneumoniae and H. influenzae vaccine against orthopedic infectious diseases in Japan was indicated.