Bone and Joint Infections in Children
Section snippets
Osteomyelitis
Osteomyelitis is inflammation of the bone caused by infection with bacterial or fungal organisms. Osteomyelitis often is categorized into three different types: (1) acute hematogenous osteomyelitis; (2) osteomyelitis secondary to contiguous spread of infection after trauma, puncture wounds, surgery, or joint replacement; and (3) osteomyelitis secondary to vascular insufficiency [1]. Acute hematogenous osteomyelitis is seen most often in children. Osteomyelitis caused by contiguous spread of
Pyogenic arthritis
Infection of the joint space in children usually is a complication of bacteremia. Viruses, fungal organisms, and Mycobacterium tuberculosis are uncommon causes of joint space infection (see Table 2). Children also may develop reactive arthritis as a consequence of bacterial infection elsewhere in the body.
Summary
The numbers of bone and joint infections resulting from vaccine-preventable infections, such as Hib and S. pneumoniae, have decreased in recent years. S. aureus remains an important cause of pyogenic arthritis and osteomyelitis, and the prevalence of CA-MRSA is increasing. Transition from intravenous to oral antibiotic therapy remains the treatment of choice for uncomplicated pediatric bone and joint infections if the family is reliable and close follow-up can be ensured.
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