II. Epidemiology
- More common in boys
III. Pathophysiology
- Inflammatory bone changes associated with pathogenic Bacteria (often monomicrobial)
- Staphylococcus Aureus including MRSA is most common cause in Pediatric Osteomyelitis
- See causes below
- Typically acute hematogenous spread to Traumatized bone
- Most common in children under age 5 (50% of cases)
- Most commonly affects the highly vascular metaphyses of long bone
IV. Symptoms
- See Pediatric Limp
- Presentation within two weeks of symptom onset
- Fever
- Irritability or lethargy
V. Signs
- Systemic signs of infection
- Local signs of infection
- Tenderness on palpation over involved bone
- Localized inflammation with erythema and swelling
- Decreased range of motion of adjacent joints
- Distribution
- Femur, tibia or fibula
- Account for 50% of Osteomyelitis cases in prepubertal children
- May present with Pediatric Limp
- Vertebral Osteomyelitis
- Most common form of hematogenous Osteomyelitis, especially in older children or adults
- Presents with severe neck or back pain, Muscle tenderness and reduced range of motion
- Other sites
- Sternoclavicular Bone
- Pelvic Bone
- Other long bones
- Femur, tibia or fibula
VI. Causes
- See Osteomyelitis Causes
- Staphylococcus Aureus including MRSA (most common)
- Kingella Kingae (esp. age <5 years, recent URI)
- Streptococcus Pyogenes
- Streptococcus Pneumoniae
- Pseudomonas Aeruginosa (Penetrating Trauma)
- Escherichia coli (newborns)
- Group B Streptococcus (newborns)
VII. Differential Diagnosis
- See Osteomyelitis
VIII. Labs
- See Osteomyelitis
- ESR and CRP may be early indicators of Osteomyelitis (albeit non-specific)
- Blood Cultures are positive in only 30 to 50% of cases
IX. Imaging
- See Osteomyelitis
- XRays are often normal for first 2-3 weeks
- MRI is sensitive and specific
X. Diagnosis
- See Osteomyelitis
XI. Management
XII. References
- Jhun and Raam in Herbert (2016) EM:Rap 16(2):15-6
- Hatzenbuehler (2011) Am Fam Physician 84(9): 1027-33 [PubMed]
- Boutin (1998) Orthop Clin North Am 29:41-66 [PubMed]
- Bury (2021) Am Fam Physician 104(4): 395-402 [PubMed]
- Carek (2001) Am Fam Physician 63(12):2413-20 [PubMed]
- Dirschl (1993) Drugs 45:29-43 [PubMed]
- Eckman (1995) JAMA 273:712-20 [PubMed]
- Haas (1996) Am J Med 101:550-61 [PubMed]
- Lew (1997) N Engl J Med 336:999-1007 [PubMed]
- Lipsky (1997) Clin Infect Dis 25:1318-26 [PubMed]
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Related Studies
| Concepts | Disease or Syndrome (T047) |
| ICD9 | 730.00, 730.0 |
| SnomedCT | 203180000, 68231009, 156790002, 203146003, 203147007, 156781009, 409780002 |
| English | Acute osteomyelitis NOS, Acute osteomyelitis of unspecified site, Acute osteomyelitis, site unspecified, Acute osteomyelitis-site unsp., acute osteomyelitis (diagnosis), acute osteomyelitis, osteomyelitis acute, Osteomyelitis acute NOS, Ac osteomyelitis-unspec, bone abscess, Osteomyelitis;acute, abscess bone, Acute osteomyelitis, Acute osteomyelitis NOS (disorder), Acute osteomyelitis of unspecified site (disorder), Osteomyelitis acute, acute; osteomyelitis, osteomyelitis; acute, Acute osteomyelitis with or without periostitis, Acute osteomyelitis, NOS, Acute osteomyelitis (disorder), Acute or subacute osteomyelitis with or without mention of periostitis |
| Italian | Osteomielite acuta, Osteomielite acuta, sede non specificata, Osteomielite acuta NAS |
| Dutch | acute osteomyelitis, plaats niet-gespecificeerd, acute osteomyelitis, osteomyelitis acuut NAO, acuut; osteomyelitis, osteomyelitis; acuut, osteomyelitis acuut |
| French | Ostéomyélite aiguë, site non précisé, Ostéomyélite aiguë SAI, Ostéomyélite aiguë |
| German | akute Osteomyelitis, Stelle unspezifisch, Osteomyelitis akut NNB, akute Osteomyelitis |
| Portuguese | Osteomielite aguda NE, Osteomielite aguda de localização NE, Osteomielite aguda |
| Spanish | Osteomielitis aguda NEOM, Osteomielitis aguda, localización no especificada, osteomielitis aguda, de sitio no especificado, osteomielitis aguda, SAI (trastorno), Acute osteomyelitis NOS, osteomielitis aguda, de localización no especificada, osteomielitis aguda, SAI, osteomielitis aguda, de localización no especificada (trastorno), osteomielitis aguda, de sitio no especificado (trastorno), Osteomielitis aguda, osteomielitis aguda (trastorno), osteomielitis aguda |
| Japanese | 急性骨髄炎、部位不明, 急性骨髄炎, 急性骨髄炎ＮＯＳ, ｷｭｳｾｲｺﾂｽﾞｲｴﾝ, ｷｭｳｾｲｺﾂｽﾞｲｴﾝNOS, ｷｭｳｾｲｺﾂｽﾞｲｴﾝﾌﾞｲﾌﾒｲ |
| Czech | Akutní osteomyelitida, Akutní osteomyelitida NOS, Akutní osteomyelitida postihující blíže neurčenou část těla |
| Hungarian | acut osteomyelitis k.m.n., acut osteomyelitis, Acut osteomyelitis, Acut osteomyelitis, nem meghatározott helyen |
Ontology: Acute hematogenous osteomyelitis (C0600123)
| Concepts | Disease or Syndrome (T047) |
| ICD10 | M86.0 , M86.00, M86.09 |
| SnomedCT | 203179003 |
| English | Acute haematogen osteomyelitis, Acute hematogenous osteomyelitis, unspecified site, Acute haematogenous osteomyelitis, site unspecified, Acute hematogenous osteomyelitis, site unspecified, acute hematogenous osteomyelitis, osteomyelitis acute hematogenous, acute hematogenous osteomyelitis (diagnosis), Acute haematogenous osteomyelitis, Acute hematogenous osteomyelitis, Acute hematogenous osteomyelitis (disorder), osteomyelitis; acute, hematogenous |
| German | Akute haematogene Osteomyelitis |
| Korean | 급성 혈행성 골수염 |
| Spanish | osteomielitis hematógena aguda, osteomileitis hematógena aguda, osteomielitis hematógena aguda (trastorno), osteomileitis hematógena aguda (trastorno) |
| Dutch | osteomyelitis; acuut, hematogeen, Acute hematogene osteomyelitis |
