Osteomyelitis In Pediatric Patients Research Articles

Effectiveness, safety, and cost-effectiveness of norvancomycin in the management of acute hematogenous osteomyelitis in pediatric patients: A retrospective case study.

This study was designed to investigate the effectiveness, safety, and cost-effectiveness of norvancomycin in the management of acute hematogenous osteomyelitis in pediatric patients. We conducted a retrospective study on cases of osteomyelitis in pediatric patients treated with norvancomycin or vancomycin at Hebei Children's Hospital from January 2015 to February 2023. The patients were categorized into the norvancomycin group and the vancomycin group. Clinical data regarding efficacy, safety, and cost-effectiveness before and after drug treatment were collected for comparative analysis. Each group contained 104 children. After 14 days of treatment, there were no statistically significant differences in the incidence of adverse events and efficacy indexes between the 2 groups. However, the total hospitalization cost of the norvancomycin group (¥28765.35 ± ¥11835.98) was significantly lower than that of the vancomycin group (¥43776.06 ± ¥33365.30) (P = .000). Additionally, compared to the vancomycin group, both the clinical efficacy cost ratio (290.44 vs 437.76) and bacteriological clearance cost ratio (356.14 vs 576.30) were lower in the norvancomycin group. Norvancomycin demonstrates comparable efficacy to the first-line drug vancomycin in treating acute hematogenous osteomyelitis in pediatric patients. Moreover, norvancomycin can significantly mitigate treatment expenses and exhibit favorable cost-effectiveness.

A transformer-based deep learning model for identifying the occurrence of acute hematogenous osteomyelitis and predicting blood culture results

BackgroundAcute hematogenous osteomyelitis is the most common form of osteomyelitis in children. In recent years, the incidence of osteomyelitis has been steadily increasing. For pediatric patients, clearly describing their symptoms can be quite challenging, which often necessitates the use of complex diagnostic methods, such as radiology. For those who have been diagnosed, the ability to culture the pathogenic bacteria significantly affects their treatment plan.MethodA total of 634 patients under the age of 18 were included, and the correlation between laboratory indicators and osteomyelitis, as well as several diagnoses often confused with osteomyelitis, was analyzed. Based on this, a Transformer-based deep learning model was developed to identify osteomyelitis patients. Subsequently, the correlation between laboratory indicators and the length of hospital stay for osteomyelitis patients was examined. Finally, the correlation between the successful cultivation of pathogenic bacteria and laboratory indicators in osteomyelitis patients was analyzed, and a deep learning model was established for prediction.ResultThe laboratory indicators of patients are correlated with the presence of acute hematogenous osteomyelitis, and the deep learning model developed based on this correlation can effectively identify patients with acute hematogenous osteomyelitis. The laboratory indicators of patients with acute hematogenous osteomyelitis can partially reflect their length of hospital stay. Although most laboratory indicators lack a direct correlation with the ability to culture pathogenic bacteria in patients with acute hematogenous osteomyelitis, our model can still predict whether the bacteria can be successfully cultured.ConclusionLaboratory indicators, as easily accessible medical information, can identify osteomyelitis in pediatric patients. They can also predict whether pathogenic bacteria can be successfully cultured, regardless of whether the patient has received antibiotics beforehand. This not only simplifies the diagnostic process for pediatricians but also provides a basis for deciding whether to use empirical antibiotic therapy or discontinue treatment for blood cultures.

Acute Hematogenous Osteomyelitis in Pediatric Patients.

This article focuses on the advancements made in diagnostic techniques and drug interventions of acute hematogenous osteomyelitis. A diagnosis necessitates a combination of factors, including inflammatory markers and imaging findings, as well as the collection of specimens for culture when feasible. Subsequently, treatment should be based on epidemiology, mechanisms of resistance, and susceptibility findings. A brief course of intravenous (IV) antibiotics, followed by oral antibiotics, may be employed for uncomplicated infections if there is improvement in the clinical condition and a decline in C-reactive protein levels. However, for complex infections caused by methicillin-resistant Staphylococcus aureus, prolonged administration of IV antibiotics is recommended, along with surgical intervention if necessary. [Pediatr Ann. 2024;53(10):e392-e395.].

Bacterial osteomyelitis in pediatric patients: a comprehensive review.

Bacterial osteomyelitis, an inflammatory response in the bone caused by microorganisms, typically affects the metaphysis in the skeletally immature. Bacterial osteomyelitis possesses a significant diagnostic challenge in pediatric patients due to its nonspecific clinical presentation. Because the metaphysis is the primary focus of infection in skeletally immature patients, understanding the normal physiologic, maturation process of bones throughout childhood allows to understand the pathophysiology of osteomyelitis.Timely and accurate diagnosis is crucial to initiate appropriate treatment, and prevent long-term sequelae and efforts must be made to isolate the causative organism. The potential causative organism changes according to the age of the patient and underlying medical conditions. Staphylococcus Aureus is the most common isolated bacteria in pediatric pyogenic osteomyelitis whereas Kingella Kingae is the most common causative agent in children aged 6months to 4years. Imaging plays a pivotal role in the diagnosis, characterization, evaluation of complications, and follow up of bacterial osteomyelitis. Imaging also plays a pivotal role in the evaluation of potential neoplastic and non-neoplastic mimickers of osteomyelitis. In children, MRI is currently the gold standard imaging modality when suspecting bacterial osteomyelitis, whereas surgical intervention may be required in order to isolate the microorganism, treat complications, and exclude mimickers.

Ultrasonography for the Detection of Osteomyelitis in Pediatric Patients With Soft Tissue Infection: A Pilot Study.

To demonstrate the usefulness of ultrasonography for differentiating soft tissue infections with or without osteomyelitis in pediatric patients who underwent ultrasonography and subsequent magnetic resonance imaging (MRI). Twenty-three patients were classified into 2 groups: 12 patients with and 11 patients without osteomyelitis based on MRI. Osteomyelitis using ultrasound is characterized by the presence of bone cortex irregularity and/or subperiosteal abscess formation. The diagnostic performance of ultrasonography for detecting osteomyelitis and subperiosteal abscess formation was compared with that of MRI. Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated with 95% confidence intervals (CIs). Of 12 osteomyelitis cases, 11 had abnormal bone marrow enhancement (one residual case did not undergo contrast enhancement study) and 5 had subperiosteal abscesses. The diagnostic accuracy of ultrasonography for osteomyelitis was 82.6% (number of correct diagnosis of osteomyelitis/total number = 19/23; 95% CI, 61.2-95.0) and for detecting periosteal abscess was 95.7% (number of correct diagnosis of periosteal abscess/total number = 22/23; 95% CI, 78.1-99.9), respectively. The sensitivity and specificity of ultrasonography for detecting osteomyelitis were 66.7% (95% CI, 34.9-90.1) and 100% (95% CI, 71.5-100), respectively. The sensitivity and specificity of ultrasonography for detecting periosteal abscess were 80% (95% CI, 28.4-99.5), and 100% (95% CI, 81.5-100), respectively. One-third of osteomyelitis cases could not be detected using ultrasonography. Ultrasonography may be useful for diagnosing osteomyelitis in pediatric patients; however, the technique appears limited by low sensitivity. However, it is more accurate for diagnosis of periosteal abscess in these patients.

1543. Validation of a Nitrocefin-based Rapid Test for the Detection of the Cefazolin Inoculum Effect in Pediatric Patients with Methicillin-Susceptible Staphylococcus aureus Acute Osteomyelitis

Abstract Background The cefazolin (Cz) inoculum effect (CzIE) defined as a Cz MIC ≥ 16 µg/mL at high inoculum (107 CFU/mL) in MSSA isolates has been associated with poor outcomes in adult patients with bacteremia. Recently, it was associated with higher rates of progression to chronic osteomyelitis in pediatric patients with acute MSSA osteomyelitis, independent of the treatment choice. Thus, its detection could be important for management of certain MSSA infections. Broth microdilution at high inoculum is the gold standard for the detection of the CzIE. Yet, this method is lengthy (3–5 days), cumbersome, and expensive. We developed a nitrocefin-based rapid test (∼3h) which can identify the CzIE among MSSA isolates and that can be incorporated in the laboratory workflow. Previously, this rapid test was validated in MSSA isolates from adult patients with bacteremia. Here, we aimed to validate it in isolates from pediatric patients with acute MSSA osteomyelitis Methods We included 206 MSSA isolates from the same number pediatric patients from Houston, TX (2011–2018). All patients were diagnosed with acute MSSA osteomyelitis. The CzIE was determined using broth microdilution at high inoculum with a cutoff of Cz MIC ≥ 16 µg/mL. Whole genome sequence analysis was performed using Illumina Hi-Seq. BlaZ type was determined according to predicted BlaZ residues at position 119 and 207. The nitrocefin rapid test was performed following the published protocol (Rincon et al., JCM, 2021). Performance metrics were calculated for the complete data set and for specific BlaZ types. Results The prevalence of the CzIE was 33%. Compared to the gold standard, the nitrocefin rapid test had a sensitivity of 81% and a specificity of 93% (Table 1). The false negative and false positive rate of 9.2% and 13.8%, respectively, with an overall accuracy of 89%. There were no false positive results among blaZ negative strains. Among type A BlaZ MSSA, the sensitivity was 96.7%, and the specificity was 80%, while in type C BlaZ, they were 70.5% and 92.8%, respectively. Performance metrics of the Nitrocefin-based Rapid Test in 206 MSSA isolates from pediatric patients with acute MSSA osteomyelitis compared to the Gold Standard of Broth Microdilution at high Inoculum. Conclusion The nitrocefin-based rapid test was able to correctly detect the CzIE in isolates from pediatric patients with MSSA acute osteomyelitis, with an overall accuracy of 89%. Implementation of this test may contribute to therapeutic decisions in deep-seated MSSA infections. Disclosures Sheldon L. Kaplan, MD, MeMed: Grant/Research Support|Pfizer: Grant/Research Support Jonathon C. McNeil, MD, Agency for Healthcare Research and Quality: Grant/Research Support|Allergan: Provided reagents for unrelated research|Nabriva: Site investigator for multicenter clinical trial Cesar A. Arias, MD, PhD, Entasis: Grant/Research Support|MeMed Diagnostics Ltd: Grant/Research Support|Merck: Grant/Research Support.

Acute hematogenous osteomyelitis in pediatric patients: epidemiology and risk factors of a poor outcome.

ObjectiveAcute hematogenous osteomyelitis (AHO) has declining incidence in developed countries. AHO can cause rapid destruction of bone that can lead to functional impairment or even death if misdiagnosed and not treated urgently. In this study, we aimed to identify the main factors that may lead to a poor outcome and to establish a profile of patients with AHO who might have a negative outcome.MethodsWe conducted a retrospective single-center study including 94 patients with AHO, over a 10-year interval. Complete medical history including age at diagnosis, sex, socioeconomic status, symptoms, entry portal, pathogenic agent, location of infection, radiological features, treatment, and outcome were recorded.ResultsMale predominance was observed, with boys from rural areas more prone to a poor outcome. This is likely because they are more exposed to trauma and do not have proper access to emergency medical care. Staphylococcus aureus was the most common etiologic agent, with 84 patients testing positive. Disease evolution was toward chronicity in patients diagnosed late. The most frequent complications were sepsis and pathological fractures.ConclusionsIn our study, patients with negative outcomes were characterized by young age, repeated negative cultures, delayed surgery, rural residence, and male sex.

Clinical Characteristics of Acne Fulminans Associated With Chronic Nonbacterial Osteomyelitis in Pediatric Patients.

Acne fulminans (AF) is a rare, explosive systemic form of acne. Chronic nonbacterial osteomyelitis (CNO) or chronic recurrent multifocal osteomyelitis (CRMO) is a primarily pediatric autoinflammatory disorder characterized by sterile osteolytic bone lesions. Concomitant occurrence of CNO/CRMO and AF is very rare, and little is known about the epidemiological and clinical particularities of this association. The aim of this retrospective observational study was to describe the characteristics of pediatric patients with CNO/CRMO associated to AF. Electronic mailing lists of French medical societies were used to call for patients with CNO/CRMO and AF. A search for published patients with CNO/CRMO and AF was performed by screening PubMed. We identified 5 original patients and 10 patients from the literature. All patients were adolescent boys. Mean age at disease onset was 14.8 years. Nine of 15 patients had received isotretinoin before the sudden onset of AF. Osteoarticular symptoms appeared within < 1-3 months after the onset of AF. The mean numbers of clinical and radiological bone lesions were 3.6 and 5.6, respectively. The percentages of patients with involvement of vertebrae, pelvis, chest, and cranial were 40%, 40%, 33.3%, and 6.6%, respectively. Arthritis was observed in 69.2% of patients and sacroiliac arthritis in 46.2%. CNO/CRMO associated to AF occurs predominantly in male adolescents and is characterized by frequent involvement of the axial skeleton and arthritis. Epidemiological and clinical features of these patients differ from general CNO/CRMO cohorts. Clinical management requires careful handling of isotretinoin doses.

Clinical and Magnetic Resonance Imaging (MRI) Decision Making Rules in Differentiating Vaso-Occlusive Crises (VOCs) from Osteomyelitis in Paediatric Sickle Cell Population: Is MRI Pathognomonic?

Objectives: Distinguishing between acute presentations of osteomyelitis (OM) and vaso-occlusive crisis (VOC) bone infarction in children with sickle cell disease (SCD) remains challenging for clinicians, particularly in culture-negative cases. VOC and osteomyelitis have a very similar presentation in the acute stage, and both are associated with a rise in C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR). The gold standard to diagnose osteomyelitis is obtaining a positive blood culture and bone/joint biopsy which is invasive and not frequently done. Standard magnetic resonance imaging (MRI) with fat suppression sequencing (subtraction technique) may help to confirm osteomyelitis in SCD patients; however, this is frequently not done in a timely manner and is associated with false positive and false negative results. The objective of this study is to assess the discriminative impact of baseline variable and build a score to assess the diagnosis of osteomyelitis in pediatric patients with SCD. Methods: A retrospective study of all patients with SCD, aged 1 to 18 years old with suspected osteomyelitis. The study covered a period of over 4 years (January 2015- June 2019) at Sultan Qaboos University Hospital, which is the main tertiary care and referral facility in Oman. All the patients were subjected to a complete clinical assessment, laboratory blood tests including, CBC, CRP, blood and aspirated fluid (if applicable) culture, and standard MRI with fat suppression sequencing of the affected bone. A clinical and laboratory score was designed to test whether it can help to prove or disprove the diagnosis in likely cases (Table 1). Results: A total of 43 patients fulfilled the inclusion criteria. Their mean age was 8.7 years +/-3.4. Male to female ratio was 1.87:1. All patients have been initiated on antibiotic therapy as osteomyelitis based on the clinical suspicion and MRI findings. The mean score in the 11 patients with confirmed osteomyelitis was 11/13. Thirteen patients were classified as likely osteomyelitis. Their mean score was 7.5/13. Seventeen patients were confirmed to have VOC by the clinical course (fast resolution of fever, local signs of inflammation and the drop in inflammatory markers). Their mean score was 5.7/13 (Table 2). Conclusion: Differentiating VOC from osteomyelitis in children with SCD who present with fever and bone pain is a difficult task. Our proposed score assigned different mean score to different clinical entity (confirmed OM vs. likely OM vs. VOC). This score may assist clinicians to differentiate these entities. A larger prospective study is needed to confirm and validate the score. Disclosures Tbaileh: Sultan Qaboos University Hospital: Other: Data Collection, Data Input , Discussion of data with my seniors. Al-Khabori:Roche: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Abbvie: Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; SOBI: Honoraria; AstraZeneca: Honoraria; NovoNardisk: Membership on an entity's Board of Directors or advisory committees; Servier: Membership on an entity's Board of Directors or advisory committees; Shire (Takeda): Membership on an entity's Board of Directors or advisory committees. Wali:Sultan Qaboos University Hospital: Employment.

Diagnostic errors in pediatric bacterial osteomyelitis.

Clinical evidence for improving diagnostic accuracy in pediatric medicine is still scarce. Septic osteomyelitis is sometimes challenging for physicians to diagnose. The aim of this study was to improve patient care through identifying the incidence and reasons for errors in the diagnosis of bacterial osteomyelitis in pediatric patients. We retrospectively identified patients younger than 16years with acute or chronic osteomyelitis at Tokyo Metropolitan Children's Medical Center between April 2010 and September 2017. We extracted data on patient demographics, clinical course, symptoms, locus of the lesions, and diagnosis at presentation and discharge. The patients were categorized into the misdiagnosis and non-misdiagnosis groups following a review by two pediatricians. Misdiagnosis was defined as a difference between the initial and discharge diagnosis. The factors in the two groups were compared, and the types of error in the misdiagnosis group were examined. In total 71 patients were enrolled. The median age and proportion of boys was 7.6years (IQR, 1.4-11.2years) and 66%, respectively. Misdiagnosis occurred in 27 patients (38.0%). Precedent antibiotic use was independently associated with misdiagnosis (P = 0.044). A cognitive error was observed in 88.3% of the misdiagnosis group. The median number of types of error per case was 2.0 (IQR, 2.0-3.0). The misdiagnosis of septic osteomyelitis in pediatric patients was common and chiefly caused by cognitive errors. Eliminating cognitive errors in diagnosis is highly likely to improve the care of patients with osteomyelitis.

Vertebral Fractures of Unknown Origin: Role of Computed Tomography-Guided Biopsy.

We performed a retrospective evaluation of histological and imaging results of patients submitted to computed tomography (CT)-guided biopsy for vertebral fractures (VFs) of unknown etiology to evaluate the pathological causes of fractures and also to observe the diagnostic results of imaging studies available. We retrospectively reviewed all the CT-guided vertebral biopsies performed in our institution in the last 2 years, selecting patients with VF of unknown etiology. We reviewed clinical records, imaging studies, and histological examination results. We compared diagnostic performance of the 2 most sensitive imaging modalities for detection of malignancy on the collapsed vertebral body: magnetic resonance imaging (MRI) and positron emission tomography-CT (PET-CT). Anatomopathological results have been considered the gold standard to assess the diagnostic performance of imaging studies. Age stratification has been performed to understand the distribution of different anatomopathological diagnoses in age groups. Among 282 CT-guided vertebral biopsies, 36 (12.8%) have been performed to diagnose the etiology of VF of unknown origin. In 26/32 (81.3%), the vertebral biopsy was diagnostic: 8 osteopenia, 6 multiple myelomas, 4 osteomyelitis, 2 eosinophilic granuloma, 3 metastases, 1 mastocytosis, 1 Paget's disease, and 1 dysmielopoiesis. In 6 cases, the anatomopathological diagnosis was normal bone structure, most likely excluding malignancy. There were no statistically significance differences between MRI and PET-CT results (P = 1.0000). Multiple myeloma and osteopenia represent the most frequent causes of this condition in adult patients, while eosinophilic granuloma and osteomyelitis in pediatric patients. Computed tomography-guided biopsy permits one to reach diagnosis in most of cases. Both PET and MRI could be insufficient to discriminate benign from malignant causes of fractures. Computed tomography-guided biopsy is needed when the etiology of fracture remains unclear.

Management of Pediatric Acute Hematogenous Osteomyelitis, Part I: Antimicrobial Stewardship Approach and Review of Therapies for Methicillin-Susceptible Staphylococcus aureus, Streptococcus pyogenes, and Kingella kingae.

Acute hematogenous osteomyelitis (AHO), often occurring in young children, is the most frequently diagnosed type of osteomyelitis in pediatric patients. Optimizing antibiotics is essential as delays to receipt of appropriate therapy can lead to chronic osteomyelitis, as well as impairments in bone growth and development. Antimicrobial stewardship programs (ASPs) are in a key position to help improve the care of patients with AHO as they contain a pharmacist with expertise in antibiotic drug selection, optimization of dosing, and microbiologic test review. A literature search of the MEDLINE database was conducted from initiation through January 2018. Articles selected for the review focus on pathogen identification, pharmacokinetics and pharmacodynamics, efficacy and safety in children, transition from intravenous to oral therapy, duration of treatment, and antimicrobial stewardship interventions. This review will highlight the potential roles ASPs can have in improving the management of AHO in pediatric patients. These roles include the creation of clinical pathways, improving testing algorithms, antibiotic choice and dosing, intravenous to oral transitions, duration of treatment, and therapy monitoring. Overall, patients are most effectively treated by focusing treatments on age, presentation, local sensitivities, and directed therapy with pathogen identification.

Methods of diagnosis of acute epiphyseal osteomyelitis in children

Summary. The article presents the analysis of different method for diagnosis of epiphyseal osteomyelitis, including radiography, ultrasonography, computed tomography, magnetic resonance tomography, and radioisotope bone scans. We address the advantages, disadvantages, and possibilities of each method from the standpoint of early diagnosis of osteomyelitis in children.&#x0D; Based upon the literature, the most effective and reliable methods for early diagnosis of epiphyseal osteomyelitis in pediatric patients are magnetic resonance and ultrasound. The present diagnostic methods involve no radiation exposure. Using an ultrasonic diagnostic method does not require complete immobility of the patient, can be used from the moment of birth, has widespread availability, and has a relative low cost to allow its use in any medical institution.

Role of MRI in the diagnosis and treatment of osteomyelitis in pediatric patients.

Osteomyelitis is a significant cause of morbidity in children throughout the world. Multiple imaging modalities can be used to evaluate for suspected osteomyelitis, however magnetic resonance imaging (MRI) has distinct advantages over other modalities given its ability to detect early changes related to osteomyelitis, evaluate the true extent of disease, depict extraosseous spread of infection, and help guide surgical management. MRI has assumed a greater role in the evaluation of osteomyelitis with the increase in musculoskeletal infections caused by methicillin-resistant Staphylococcus aureus which have unique imaging features that are well-demonstrated with MRI. This review focuses primarily on the use of MRI in the evaluation of osteomyelitis in children and will include a discussion of the clinically important and characteristic findings on MRI of acute bacterial osteomyelitis and related conditions.

Candida albicans osteomyelitis in an infant

Skeletal infections secondary to Candida albicans are uncommon and described primarily in adults. Nearly all 22 pediatric cases of C. albicans osteomyelitis described to date have occurred in neonates with specific risk factors or in children with a severe immunodeficiency. We report an unusual presentation of C. albicans osteomyelitis and arthritis in a 1-year-old boy without an immunodeficiency, which led to a delayed diagnosis. He most likely developed C. albicans arthritis and osteomyelitis during the neonatal period with a subsequent indolent and subacute presentation. Our literature search found no prior or recent reviews of C. albicans osteomyelitis in pediatric patients. On the basis of this patient and the case reports previously published, we discuss an approach to the evaluation and management of pediatric patients with Candida osteomyelitis.

Evidence for HLA class II susceptible and protective haplotypes for osteomyelitis in pediatric patients with sickle cell anemia

We investigated the association of human leukocyte antigen (HLA) class II alleles and haplotypes with the pathogenesis of sickle cell anemia (SCA) osteomyelitis. SCA patients comprised 42 patients with osteomyelitis and 150 patients without osteomyelitis; HLA-DRB1* and HLA-DQB1* genotyping was performed by polymerase chain reaction-sequence-specific priming (SSP). DRB1*100101 (P value corrected for the number of different alleles tested, Pc=0.003) was positively associated with osteomyelitis. At the haplotype level, DRB1*100101-DQB1*050101 (Pc=0.001) was more prevalent among patients, while DRB1*030101-DQB1*0201 (Pc=0.020) and DRB1*040101-DQB1*0302 (Pc=0.039) were more prevalent among SCA controls, thereby conferring disease susceptibility or protection to these haplotypes, respectively. These results show that specific HLA haplotypes influence SCA osteomyelitis risk and that specific HLA types may serve as markers for identifying SCA patients at high risk for osteomyelitis.

Evidence for HLA Class II Susceptible and Protective Haplotypes for Osteomyelitis in Pediatric Patients with Sickle Cell Anemia.

Background and Objective: Osteomyelitis (OM) is a common complication and significant cause of morbidity in patients with sickle cell anemia (SCA); however, its mechanisms are poorly understood. In view of their link to inflammatory diseases and autoimmune disorders, we investigated the association of HLA class II alleles and haplotypes with the pathogenesis of OM in Bahraini SCA patients.Patients and Methods. SCA patients comprised 42 with and 150 patients without OM; HLA-DRB1* and -DQB1* genotyping was done by PCR-SSP. HLA allele frequency was determined by the gene counting method, and haplotype frequency was determined by the maximum-likelihood method.Results. At the allele level, only DRB1*100101 (0.229 vs. 0.082, Pc = 0.003) was positively associated with OM after applying the Bonferrni correction factor. At the haplotype level, DRB1*070101-DQB1*0201 (Pc = 0.001), and DRB1*100101-DQB1*050101 (Pc = 0.001) were more prevalent among patients, while DRB1*030101-DQB1*0201 (Pc = 0.020) and DRB1*040101-DQB1*0302 (Pc = 0.039) was more prevalent among controls, thereby conferring disease susceptibility or protection to these DRB1*-DQB1* haplotypes, respectively.Conclusion. These results demonstrate that specific HLA halpotypes influence osteomyelitis risk in SCA, thereby suggesting that specific HLA types may serve as a marker for identifying SCA patients at high risk for osteomyelitis.HLA-DRB1* and DQB1* Haplotype FrequenciesHaplotypeOM PatientsControlsPPcORDRB1*030101-DQB1*02010.0150.1410.0020.0200.07DRB1*030201-DQB1*04010.0420.0160.2120.9082.95DRB1*040101-DQB1*03020.0160.1260.0040.0390.08DRB1*070101-DQB1*02010.2190.060<0.0010.0014.58DRB1*110101-DQB1*0301010.0560.1080.2780.9620.53DRB1*100101-DQB1*0501010.2080.063<0.0010.0014.03DRB1*130101-DQB1*0601010.0420.0340.7731.0001.45DRB1*150101-DQB1*0601010.0850.0680.7741.0001.27DRB1*160101-DQB1*02010.0640.0200.1210.7253.10DRB1*160101-DQB1*0501010.0110.0990.0160.1490.11

The Incidence of Joint Involvement with Adjacent Osteomyelitis in Pediatric Patients

Sixty-six patients admitted to our institution over an 8-year period with the diagnosis of osteomyelitis were analyzed to determine the incidence of adjacent joint involvement. Patients with osteomyelitis of the hand, foot, spine, and extraarticular pelvis were excluded from this study. The average age was 5.8 years (range, 1 month to 17 years). Forty-two percent of our patients who had osteomyelitis had evidence of adjacent joint involvement (either septic or nonseptic). One third of our patients had evidence of septic joint involvement. The most commonly involved joint was the knee. There was no difference in the incidence of adjacent joint involvement in those patients who were younger than 18 months compared with the incidence in older children. Our study suggests that the incidence of adjacent joint involvement in children who have osteomyelitis is higher than that suggested in the literature. We believe that careful evaluation of the adjacent joint should be an important part of the evaluation of any child who has osteomyelitis.

Cryptococcal rib osteomyelitis in a pediatric patient

A case of cryptococcal rib osteomyelitis in a pediatric patient is described. Isolated cryptococcal osteomyelitis in pediatric patients is a rare entity, and only 10 cases have been reported in the literature. The radiological findings are reviewed to include chest films, nuclear bone scan, and computed tomographic imaging scan. Because of its rarity, the management of isolated cryptococcal osteomyelitis is controversial. Although antifungal antibiotics and surgery are the two therapeutic options, the treatment of cryptococcal osteomyelitis has not been standardized yet. This patient was treated successfully with limited resection of the involved rib and antifungal chemotherapy. This article describes the second case in the literature of cryptococcal rib osteomyelitis in a pediatric patient, reviews the literature of similar cases, and evaluates the current role of surgery in its treatment.

Osteomyelitis in pediatric patients with leukemia.

An 11-year retrospective study showed that there were nine patients with osteomyelitis in our population of pediatric patients with leukemia. Six patients had acute lymphoblastic leukemia (ALL) and three had acute nonlymphoblastic leukemia (ANLL). Seven of nine patients were in remission at the time of diagnosis of osteomyelitis. The delay in diagnosis, which exceeded 2 weeks in seven patients, was typical. Surgical intervention was required for diagnostic or therapeutic purposes in five patients. Staphylococcus aureus was isolated from only three patients. Informative diagnostic studies included nuclear scans that yielded abnormal results in all patients and erythrocyte sedimentation rates (ESR) that were elevated to greater than 70 mm/h in seven patients. The recognition of features that differ from osteomyelitis in the normal population may facilitate earlier diagnosis.