Osteomyelitis In Children: Symptoms, Diagnosis & Prevention

Osteomyelitis, a blood-borne fungal or bacterial infection, affects children and adults. The most common osteomyelitis in children is acute hematogenous osteomyelitis. The other two types, subacute and chronic osteomyelitis, are more frequently observed in adults.

Children of different age groups can be affected by acute hematogenous osteomyelitis. The infection usually affects the long bones of arms and legs in young children. Although osteomyelitis can be treated with antibiotics, the doctor rarely suggests surgical intervention.

The following post discusses the causes, symptoms, diagnoses, and treatments for osteomyelitis in children.

Who Is Susceptible To Osteomyelitis?

Osteomyelitis affects all age groups; however, it is more commonly seen in children. Whereas it causes an infection of the pelvic region and the vertebrae in adults, it primarily affects the long bones of the arms and legs in children. Acute osteomyelitis is the most common type and usually affects children under five years (1).

Underlying morbidities can influence the occurrence of osteomyelitis in both adults and children. Children who have had a premature birth or those with an underdeveloped immune system are at a higher risk. The following factors can make a child more susceptible to osteomyelitis (2) (3) (4).

• Premature delivery: This can compromise the child’s immune system and lead to different health complications. A child with low immunity is more susceptible to bacterial infections.

• Sickle cell anemia: Sickle cell anemia can cause decreased blood supply in the body and give rise to other health conditions, of which osteomyelitis is one of the most common ones.

• Diabetes: High blood sugar levels damage the blood vessels, making the child more prone to osteomyelitis.

What Are The Symptoms Of Osteomyelitis In A Child?

Children with osteomyelitis typically experience difficulty in moving the arms and legs or limping. The other common symptoms include (4) (5)

• Fever of around 104℃ or 38℉.
• Extreme pain in the bones of arms and legs, especially the femur.
• Swelling or redness of skin near the infected bones.
• Percolation of pus from the infected area.
• A feeling of laziness or lethargy.
• Refusal to eat or picky eating.
• Refusal to let anyone touch the affected area.

What Are The Causes Of Osteomyelitis In Children?

Acute osteomyelitis in children is generally caused by bacteria, and sometimes fungi. Staphylococcus aureus has been reported to be the primary causative agent for acute osteomyelitis (6) (7).

The germ can enter the body and cause infection in several ways (1) (4).

• Open wound: The bacteria can spread from an unattended and infected cut in the body or through the surrounding soft tissue infection to the bones.

• Blood infection: In children, the bones receive a substantial supply of blood for their growth, making it easier for the bacteria to reach the bones from other infected parts.

• Open fracture: The bone can also get infected through an open fracture. This can then get infected by bacteria and eventually spread to other bones in the body.

• Foreign object: In situations where a foreign object infiltrates the body, the risk of contracting osteomyelitis increases.

What Are The Complications Of Osteomyelitis?

In most cases, children recover from osteomyelitis via antibiotic therapy. However, delay in treatment can lead to the following complications.

• Damage to the blood vessels, muscles, and necrotic bone
• Blood clot
• Fractures
• Growth deformity

Under rare circumstances, surgery of the infected arms or legs may also be required to stop the spread of the infection and prevent its recurrence (3) (5) (8).

How Is Osteomyelitis Diagnosed In Children?

The doctor may start by taking a complete medical history of the child and do a physical examination. If these fail to provide the exact diagnosis, the doctor may order the following tests (2) (7).

1. X-rays: An X-ray helps detect any irregularity in the bone density. A lower bone density can indicate a bacterial infection and help determine the affected area of the bone.

2. Magnetic resonance imaging (MRI): It is an imaging test that helps detect the presence of fluid and determine the extent of the infection.

3. Blood tests: Blood tests are done to measure

• If the total white blood cell count has increased.
• A surge in the erythrocyte sedimentation rate (ESR).
• The elevation rate of C-Reactive Protein (CRP), which indicates inflammation in the body.

4. Needle aspiration: In this test, some cells or fluid from the area near the infected bone are drawn out and then placed in an environment conducive for the causative agent or the bacteria to grow. This test helps find the nature of the infection through the causative agent.

5. Biopsy: A sample of tissue from the infected bone is collected in this test and cultured. The culture from the bone biopsy is then examined for the presence of an infectious organism.

6. Blood culture: Blood samples from the child are collected and put in a condition favorable for the bacteria to grow. The bacteria is identified and tested against different antibiotics to find the right one.

7. Bone scan: For kids with osteomyelitis, a radioactive material called Technetium-99m Pyrophosphate is injected into the body. If the bones are infected, this material, instead of spreading uniformly, gets absorbed into the bones. In a bone scan test, an increased concentration of the radioactive material indicates an infected bone.

How Is Osteomyelitis Treated?

In most cases, the doctor may suggest antibiotic treatment. However, if the symptoms persist, surgery may be recommended (2) (4).

• Antibiotics: This is the first line of treatment for osteomyelitis in children. Antibiotics can be administered via the intravenous or oral route. The doses or type of antibiotic to be administered solely depends on the nature of the bacteria and the level of infection.

Antibiotics for osteomyelitis are typically given in the course of four to six weeks and are aimed at reducing the spread and recurrence rates.

• Surgery: It is recommended under extreme unavoidable circumstances. Surgery may be performed to remove the infected or dead tissue of the bone. To facilitate the formation of new bone tissues, bone grafting can be carried out. Sometimes, the packing material is used to fill in the space created by the removed tissues.

Is Osteomyelitis Contagious?

Given the fact it is a bone infection, osteomyelitis is not contagious. However, it is believed that the causative agents, bacteria and fungi, are transmissible (9).

Can Osteomyelitis In Children Be Prevented?

Osteomyelitis is a bacterial bone infection that spreads mostly through open cuts and wounds. Thus, a simple preventive measure could be to keep the wound or affected area clean. Thorough washing of the cut with clean water followed by application of an antiseptic cream can be done. You may keep the wound covered while cleaning it and apply an antiseptic cream regularly.

How Long Does Osteomyelitis Last?

Children generally feel better in a few days with antibiotic treatment. However, they would be required to take antibiotics for four to six weeks, which could increase to 12 weeks in severe cases (10).

References

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Reviewer

Dr. Dur Afshar AghaMS

   

Dr. Dur Afshar Agha is a consultant pediatrician with around 26 years of experience in various medical facilities both in Pakistan and Saudi Arabia. She has headed the Department of Preventive Pediatrics at the prestigious, Children’s Hospital and Institute of Child Health in Pakistan and is a life member of the Pakistan Paediatric Association.

Read full bio of Dr. Dur Afshar Agha