ABSTRACT
Musculoskeletal infections in children present a diagnostic challenge because they are difficult to recognize in the early stages of the disease and can be confused with other pathology such as tumors or trauma. The severity of disease may be associated with the primary tissue of involvement with bone greater than joint, greater than muscle, greater than soft tissue. The incidence of musculoskeletal infection is higher in infants and young children, and risk factors include premature birth, umbilical catheterization, urinary tract infection, immunodeficiency, and other preexisting disease. Neonates are at greater risk for infection with less virulent organisms due to immaturity of the immune system. The epidemiology of musculoskeletal infection is evolving, and the incidence of musculoskeletal infections in children, especially gram-positive infections, are increasing. Staphylococcus aureus continues to be the leading cause of musculoskeletal infection in children, and the emergence of resistant bacteria such as methicillin-resistant S. aureus is associated with a higher rate of complications. Atypical infections such as tuberculosis have also shown resurgence in the last few decades, whereas other infections such as Haemophilus influenzae are much less prevalent due to widespread immunization. Recent advances in earlier diagnosis and treatment help to reduce complications. However, even when musculoskeletal infection is successfully treated, there may be significant long-term effects on growth.
KEYWORDS
Osteomyelitis - pediatric - musculoskeletal - infection
REFERENCES
-
1
Gafur O A, Copley L A, Hollmig S T, Browne R H, Thornton L A, Crawford S E.
The impact of the current epidemiology of pediatric musculoskeletal infection on evaluation and treatment guidelines.
J Pediatr Orthop.
2008;
28(7)
777-785
-
2
Offiah A C.
Acute osteomyelitis, septic arthritis and discitis: differences between neonates and older children.
Eur J Radiol.
2006;
60(2)
221-232
-
3
Frank G, Mahoney H M, Eppes S C.
Musculoskeletal infections in children.
Pediatr Clin North Am.
2005;
52(4)
1083-1106, ix
-
4
Robben S G.
Ultrasonography of musculoskeletal infections in children.
Eur Radiol.
2004;
14(suppl 4)
L65-L77
-
5
Jaramillo D, Treves S T, Kasser J R, Harper M, Sundel R, Laor T.
Osteomyelitis and septic arthritis in children: appropriate use of imaging to guide treatment.
AJR Am J Roentgenol.
1996;
166
725
-
6
Schmit P, Glorion C.
Osteomyelitis in infants and children.
Eur Radiol.
2004;
14(suppl 4)
L44-L54
-
7
Browne L P, Mason E O, Kaplan S L, Cassady C I, Krishnamurthy R, Guillerman R P.
Optimal imaging strategy for community-acquired Staphylococcus aureus musculoskeletal infections in children.
Pediatr Radiol.
2008;
38(8)
841-847
-
8
McCarthy J J, Dormans J P, Kozin S H, Pizzutillo P D.
Musculoskeletal infections in children: basic treatment principles and recent advancements.
Instr Course Lect.
2005;
54
515-528
-
9
Blickman J G, van Die C E, de Rooy J W.
Current imaging concepts in pediatric osteomyelitis.
Eur Radiol.
2004;
14(suppl 4)
L55-L64
-
10
Kleinman P K.
A regional approach to osteomyelitis of the lower extremities in children.
Radiol Clin North Am.
2002;
40(5)
1033-1059
-
11
Mandell G A.
Imaging in the diagnosis of musculoskeletal infections in children.
Curr Probl Pediatr.
1996;
26(7)
218-237
-
12
Pineda C, Vargas A, Rodríguez A V.
Imaging of osteomyelitis: current concepts.
Infect Dis Clin North Am.
2006;
20(4)
789-825
-
13
Santiago Restrepo C, Giménez C R, McCarthy K.
Imaging of osteomyelitis and musculoskeletal soft tissue infections: current concepts.
Rheum Dis Clin North Am.
2003;
29(1)
89-109
-
14
Christian S, Kraas J, Conway W F.
Musculoskeletal infections.
Semin Roentgenol.
2007;
42(2)
92-101
-
15
Gylys-Morin V M.
MR imaging of pediatric musculoskeletal inflammatory and infectious disorders.
Magn Reson Imaging Clin N Am.
1998;
6(3)
537-559
-
16
Oudjhane K, Azouz E M.
Imaging of osteomyelitis in children.
Radiol Clin North Am.
2001;
39(2)
251-266
-
17
Chau C L, Griffith J F.
Musculoskeletal infections: ultrasound appearances.
Clin Radiol.
2005;
60(2)
149-159
-
18
Thanni L O, Ogunfowora O B, Olanrewaju D M.
Hemoglobinopathy and pattern of musculoskeletal infection in children.
J Natl Med Assoc.
2004;
96(2)
224-228
-
19
Grogan D P, Love S M, Ogden J A, Millar E A, Johnson L O.
Chondro-osseous growth abnormalities after meningococcemia. A clinical and histopathological study.
J Bone Joint Surg Am.
1989;
71(6)
920-928
-
20
Clark P, Davidson D, Letts M, Lawton L, Jawadi A.
Necrotizing fasciitis secondary to chickenpox infection in children.
Can J Surg.
2003;
46(1)
9-14
-
21
De Vuyst D, Vanhoenacker F, Gielen J, Bernaerts A, De Schepper A M.
Imaging features of musculoskeletal tuberculosis.
Eur Radiol.
2003;
13(8)
1809-1819
-
22
Morris B S, Varma R, Garg A, Awasthi M, Maheshwari M.
Multifocal musculoskeletal tuberculosis in children: appearances on computed tomography.
Skeletal Radiol.
2002;
31(1)
1-8
-
23
Arkun R.
Parasitic and fungal disease of bones and joints.
Semin Musculoskelet Radiol.
2004;
8(3)
231-242
-
24
Letts M, Davidson D, Birdi N, Joseph M.
The SAPHO syndrome in children: a rare cause of hyperostosis and osteitis.
J Pediatr Orthop.
1999;
19(3)
297-300
Marilyn RansonM.D.
Department of Diagnostic Imaging, The Hospital for Sick Children
555 University Ave., Toronto, Ontario, Canada M5G 1X8
eMail: marilyn.ranson@sickkids.ca
