Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Review article: Biomedical intelligence

Vol. 144 No. 2324 (2014)

Osteoarticular infections in young children: what has changed over the last years?

  • Dimitri Ceroni
  • Georgios Kampouroglou
  • Raimonda Valaikaite
  • Rebecca Anderson Della Llana
  • Davide Salvo
DOI
https://doi.org/10.4414/smw.2014.13971
Cite this as:
Swiss Med Wkly. 2014;144:w13971
Published
01.06.2014

Summary

Osteoarticular infections remain a significant cause of morbidity worldwide in young children. They can have a devastating impact with a high rate of serious and long-lasting sequelae, especially on remaining growth. Depending on the localisation of infection, they manifest as osteomyelitis, septic arthritis, a combination of both (i.e., osteomyelitis with adjacent septic arthritis) or spondylodiscitis. Osteoarticular infections can be divided into three types according to the source of infection: haematogenous; secondary to contiguous infection; or secondary to direct inoculation. During the last few years, many principles regarding diagnostic assays and the microbiological causes of these infections have evolved in a significant manner. In the present current-opinion review, we discuss recent concepts regarding epidemiology, physiopathology, and the microbiology of bone and joint infections in young children, as well as clinical presentations, diagnosis, and treatment of these infections. Clinicians caring for children need to be especially well versed in these newer concepts as they can be used to guide evaluation and treatment.

References

  1. Gutierrez K. Bone and joint infection. In: Long SS PL, Prober CG, eds Principles and Practice of Pediatric Infectious Disease 2nd ed Philadelphia, PA: Churchill Livingstone 2003:467–474.
  2. Ceroni D, Dubois-Ferriere V, Cherkaoui A, Lamah L, Renzi G, Lascombes P, et al. 30 years of study of Kingella kingae: post tenebras, lux. Future microbiology. 2013;8(2):233–45.
  3. Yagupsky P, Dagan R. Kingella kingae: an emerging cause of invasive infections in young children. Clin Infect Dis. 1997;24(5):860–6.
  4. Yagupsky P, Peled N, Katz O. Epidemiological features of invasive Kingella kingae infections and respiratory carriage of the organism. J Clin Microbiol. 2002;40(11):4180–4.
  5. Aniansson G, Alm B, Andersson B, Larsson P, Nylen O, Peterson H, et al. Nasopharyngeal colonization during the first year of life. J Infect Dis. 1992;165(Suppl 1):S38–42.
  6. Gray BM, Converse GM, 3rd, Dillon HC, Jr. Epidemiologic studies of Streptococcus pneumoniae in infants: acquisition, carriage, and infection during the first 24 months of life. J Infect Dis. 1980;142(6):923–33.
  7. Riordan T, Cartwright K, Andrews N, Stuart J, Burris A, Fox A, et al. Acquisition and carriage of meningococci in marine commando recruits. Epidemiol Infect. 1998;121(3):495–505.
  8. Ceroni D, Dubois-Ferriere V, Anderson R, Combescure C, Lamah L, Cherkaoui A, et al. Small Risk of Osteoarticular Infections in Children with Asymptomatic Oropharyngeal Carriage of Kingella kingae. The Pediatric infectious disease journal 2012.
  9. Yagupsky P. Kingella kingae: from medical rarity to an emerging paediatric pathogen. Lancet Infect Dis. 2004;4(6):358–67.
  10. Ceroni D, Cherkaoui A, Combescure C, Francois P, Kaelin A, Schrenzel J. Differentiating osteoarticular infections caused by Kingella kingae from those due to typical pathogens in young children. Pediatr Infect Dis J. 2011;30(10):906–9.
  11. Ceroni D, Cherkaoui A, Ferey S, Kaelin A, Schrenzel J. Kingella kingae osteoarticular infections in young children: clinical features and contribution of a new specific real-time PCR assay to the diagnosis. J Pediatr Orthop. 2010;30(3):301–4.
  12. Chometon S, Benito Y, Chaker M, Boisset S, Ploton C, Berard J, et al. Specific real-time polymerase chain reaction places Kingella kingae as the most common cause of osteoarticular infections in young children. Pediatr Infect Dis J. 2007;26(5):377–81.
  13. Ilharreborde B, Bidet P, Lorrot M, Even J, Mariani-Kurkdjian P, Liguori S, et al. New real-time PCR-based method for Kingella kingae DNA detection: application to samples collected from 89 children with acute arthritis. J Clin Microbiol. 2009;47(6):1837–41.
  14. Rosey AL, Abachin E, Quesnes G, Cadilhac C, Pejin Z, Glorion C, et al. Development of a broad-range 16S rDNA real-time PCR for the diagnosis of septic arthritis in children. J Microbiol Methods. 2007;68(1):88–93.
  15. Arnold SR, Elias D, Buckingham SC, Thomas ED, Novais E, Arkader A, et al. Changing patterns of acute hematogenous osteomyelitis and septic arthritis: emergence of community-associated methicillin-resistant Staphylococcus aureus. J Pediatr Orthop. 2006;26(6):703–8.
  16. Kaplan SL. Implications of methicillin-resistant Staphylococcus aureus as a community-acquired pathogen in pediatric patients. Infect Dis Clin North Am. 2005;19(3):747–57.
  17. Kaplan SL. Community-acquired methicillin-resistant Staphylococcus aureus infections in children. Semin Pediatr Infect Dis. 2006;17(3):113–9.
  18. Martinez-Aguilar G, Avalos-Mishaan A, Hulten K, Hammerman W, Mason EO, Jr., Kaplan SL. Community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus musculoskeletal infections in children. Pediatr Infect Dis J. 2004;23(8):701–6.
  19. Dohin B, Gillet Y, Kohler R, Lina G, Vandenesch F, Vanhems P, et al. Pediatric bone and joint infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus. Pediatr Infect Dis J. 2007;26(11):1042–8.
  20. Moumile K, Cadilhac C, Lina G, Berche P, Glorion C, Ferroni A. Severe osteoarticular infection associated with Panton-Valentine leukocidin-producing Staphylococcus aureus. Diag Microbiol Infect Dis. 2006;56(1):95–7.
  21. Bradley JS, Kaplan SL, Tan TQ, Barson WJ, Arditi M, Schutze GE, et al. Pediatric pneumococcal bone and joint infections. The Pediatric Multicenter Pneumococcal Surveillance Study Group (PMPSSG). Pediatrics. 1998;102(6):1376–82.
  22. Tan TQ, Mason EO, Jr., Barson WJ, Wald ER, Schutze GE, Bradley JS, et al: Clinical characteristics and outcome of children with pneumonia attributable to penicillin-susceptible and penicillin-nonsusceptible Streptococcus pneumoniae. Pediatrics. 1998;102(6):1369–75.
  23. Lew DP, Waldvogel FA. Osteomyelitis. Lancet. 2004;364(9431):369–79.
  24. Harik NS, Smeltzer MS. Management of acute hematogenous osteomyelitis in children. Expert Rev Anti Infect Ther. 2010;8(2):175–81.
  25. Gavilan MG, Lopez JB, Artola BS. Peculiarities of osteo-articular infections in children. Bailliere’s best practice & research. 1999;13(1):77–94.
  26. Krogstad P SA. Osteomyelitis and septic arthritis. In: Feigin RD, Cherry JD eds In Textbook of Pediatric Infectious Diseases 4th ed Philadelphia, PA: WB Saunders, 1998:683–704.
  27. Winters JL, Cahen I. Acute hematogenous osteomyelitis. A review of sixty-six cases. J Bone Joint Surg. 1960;42–A:691–704.
  28. Schenk RK, Wiener J, Spiro D. Fine structural aspects of vascular invasion of the tibial epiphyseal plate of growing rats. Acta anatomica. 1968;69(1):1–17.
  29. Ezra E, Cohen N, Segev E, Hayek S, Lokiec F, Keret D, Wientroub S. Primary subacute epiphyseal osteomyelitis: role of conservative treatment. J Pediatr Orthop. 2002;22(3):333–7.
  30. Ezra E, Wientroub S. Primary subacute haematogenous osteomyelitis of the tarsal bones in children. J Bone Joint Surg Br. 1997;79(6):983–6.
  31. Gillespie WJ, Moore TE, Mayo KM. Subacute pyogenic osteomyelitis. Orthopedics. 1986;9(11):1565–70.
  32. Gledhill RB. Subacute osteomyelitis in children. Clin Orthop Relat Res. 1973(96):57–69.
  33. Hamdy RC, Lawton L, Carey T, Wiley J, Marton D. Subacute hematogenous osteomyelitis: are biopsy and surgery always indicated? J Pediatr Orthop. 1996;16(2):220–3.
  34. Harris NH, Kirkaldy-Willis WH. Primary Subacute Pyogenic Osteomyelitis. J Bone Joint Surg Br. 1965;47:526–32.
  35. Jones NS, Anderson DJ, Stiles PJ. Osteomyelitis in a general hospital. A five-year study showing an increase in subacute osteomyelitis. J Bone Joint Surg Br. 1987;69(5):779–83.
  36. King DM, Mayo KM. Subacute haematogenous osteomyelitis. J Bone Joint Surg Br. 1969;51(3):458–63.
  37. Kozlowski K. Brodie’s abscess in the first decade of life. Report of eleven cases. Pediatr Radiol. 1980;10(1):33–7.
  38. Roberts JM, Drummond DS, Breed AL, Chesney J. Subacute hematogenous osteomyelitis in children: a retrospective study. J Pediatr Orthop. 1982;2(3):249–54.
  39. Season EH, Miller PR. Multifocal subacute pyogenic osteomyelitis in a child. A case report. Clin Orthop Relat Res. 1976(116):76–9.
  40. Dormans JP, Drummond DS. Pediatric Hematogenous Osteomyelitis: New Trends in Presentation, Diagnosis, and Treatment. J Am Acad Orthop Surg. 1994;2(6):333–41.
  41. Green NE, Beauchamp RD, Griffin PP. Primary subacute epiphyseal osteomyelitis. J Bone Joint Surg. 1981;63(1):107–14.
  42. Rasool MN. Primary subacute haematogenous osteomyelitis in children. J Bone Joint Surg Br. 2001;83(1):93–8.
  43. Wertheim HF, Melles DC, Vos MC, van Leeuwen W, van Belkum A, Verbrugh HA, et al. The role of nasal carriage in Staphylococcus aureus infections. The Lancet infectious diseases. 2005;5(12):751–62.
  44. Liu Y, Cui J, Wang R, Wang X, Drlica K, Zhao X. Selection of rifampicin-resistant Staphylococcus aureus during tuberculosis therapy: concurrent bacterial eradication and acquisition of resistance. J Antimicrob Chemother. 2005;56(6):1172–5.
  45. Wertheim HF, Vos MC, Ott A, van Belkum A, Voss A, Kluytmans JA, et al. Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers. Lancet. 2004;364(9435):703–5.
  46. Yagupsky P, Dagan R, Howard CW, Einhorn M, Kassis I, Simu A. High prevalence of Kingella kingae in joint fluid from children with septic arthritis revealed by the BACTEC blood culture system. J Clin Microbiol. 1992;30(5):1278–81.
  47. Ellington JK, Reilly SS, Ramp WK, Smeltzer MS, Kellam JF, Hudson MC. Mechanisms of Staphylococcus aureus invasion of cultured osteoblasts. Microb Pathog. 1999;26(6):317–23.
  48. Ellington JK, Harris M, Webb L, Smith B, Smith T, Tan K, et al. Intracellular Staphylococcus aureus. A mechanism for the indolence of osteomyelitis. J Bone Joint Surg Br. 2003;85(6):918–21.
  49. Roy S, Bhawan J. Ultrastructure of articular cartilage in pyogenic arthritis. Archives of pathology. 1975;99(1):44–7.
  50. Smith RL, Schurman DJ. Bacterial arthritis. A staphylococcal proteoglycan-releasing factor. Arthritis and rheumatism. 1986;29(11):1378–86.
  51. Smith RL, Schurman DJ, Kajiyama G, Mell M, Gilkerson E. The effect of antibiotics on the destruction of cartilage in experimental infectious arthritis. J Bone Joint Surg. 1987;69(7):1063–8.
  52. Trueta J, Morgan JD. The vascular contribution to osteogenesis. I. Studies by the injection method. J Bone Joint Surg Br. 1960;42–B:97–109.
  53. Ceroni D, Cherkaoui A, Kaelin A, Schrenzel J. Kingella kingae spondylodiscitis in young children: toward a new approach for bacteriological investigations? A preliminary report. J Child Orthop. 4(2):173–5.
  54. Early SD, Kay RM, Tolo VT. Childhood diskitis. J Am Acad Orthop Surg. 2003;11(6):413–20.
  55. Rocco HD, Eyring EJ. Intervertebral disk infections in children. Am J Dis Child. (1960) 1972;123(5):448–51.
  56. Bonfiglio M, Lange TA, Kim YM. The Classic: Pyogenic vertebral osteomyelitis: disk space infections. 1973. Clin Orthop Relat Res. 2006;444:4–8.
  57. Crawford AH, Kucharzyk DW, Ruda R, Smitherman HC, Jr. Diskitis in children. Clin Orthop Relat Res. 1991(266):70–9.
  58. Jansen BR, Hart W, Schreuder O. Discitis in childhood. 12–35–year follow-up of 35 patients. Acta Orthop Scand. 1993;64(1):33–6.
  59. Wenger DR, Bobechko WP, Gilday DL. The spectrum of intervertebral disc-space infection in children. J Bone Joint Surg. 1978;60(1):100–8.
  60. Brown R, Hussain M, McHugh K, Novelli V, Jones D. Discitis in young children. J Bone Joint Surg. 2001;83(1):106–11.
  61. Cushing AH. Diskitis in children. Clin Infect Dis. 1993;17(1):1–6.
  62. Hensey OJ, Coad N, Carty HM, Sills JM. Juvenile discitis. Arch Dis Child. 1983;58(12):983–7.
  63. Menelaus MB. Discitis. an Inflammation Affecting the Intervertebral Discs in Children. J Bone Joint Surg. 1964;46:16–23.
  64. Ryoppy S, Jaaskelainen J, Rapola J, Alberty A. Nonspecific diskitis in children. A nonmicrobial disease? Clin Orthop Relat Res. 1993(297):95–9.
  65. Spiegel PG, Kengla KW, Isaacson AS, Wilson JC, Jr. Intervertebral disc-space inflammation in children. J Bone Joint Surg. 1972;54(2):284–96.
  66. Eismont FJ, Bohlman HH, Soni PL, Goldberg VM, Freehafer AA. Vertebral osteomyelitis in infants. J Bone Joint Surg. 1982;64(1):32–5.
  67. Garron E, Viehweger E, Launay F, Guillaume JM, Jouve JL, Bollini G. Nontuberculous spondylodiscitis in children. J Pediatr Orthop. 2002;22(3):321–8.
  68. Tsirikos AI, Tome-Bermejo F. Spondylodiscitis in infancy: a potentially fatal condition that can lead to major spinal complications. J Bone Joint Surg. 94(10):1399–402.
  69. Chandrasenan J, Klezl Z, Bommireddy R, Calthorpe D. Spondylodiscitis in children: a retrospective series. J Bone Joint Surg. 93(8):1122–5.
  70. Fernandez M, Carrol CL, Baker CJ. Discitis and vertebral osteomyelitis in children: an 18–year review. Pediatrics. 2000;105(6):1299–304.
  71. Kayser R, Mahlfeld K, Greulich M, Grasshoff H. Spondylodiscitis in childhood: results of a long-term study. Spine. 2005;30(3):318–23.
  72. Rubio Gribble B, Calvo Rey C, Garcia-Consuegra J, Ciria Calabria L, Navarro Gomez ML, Ramos Amador JT. Spondylodiscitis in the autonomus community of Madrid (Spain). An Pediatr. (Barc) 2005;62(2):147–52.
  73. Spencer SJ, Wilson NI. Childhood discitis in a regional children’s hospital. J Pediatr Orthop B. 21(3):264–8.
  74. Tapia Moreno R, Espinosa Fernandez MG, Martinez Leon MI, Gonzalez Gomez JM, Moreno Pascual P. Spondylodiscitis: Diagnosis and medium-long term follow up of 18 cases. An Pediatr. (Barc) 2009;71(5):391–9.
  75. Ventura N, Gonzalez E, Terricabras L, Salvador A, Cabrera M. Intervertebral discitis in children: a review of 12 cases. Int Orthop. 1996;20(1):32–4.
  76. Enoch DA, Cargill JS, Laing R, Herbert S, Corrah TW, Brown NM. Value of CT-guided biopsy in the diagnosis of septic discitis. J Clinical Pathol. 2008;61(6):750–3.
  77. Sehn JK, Gilula LA. Percutaneous needle biopsy in diagnosis and identification of causative organisms in cases of suspected vertebral osteomyelitis. Eur J Radiol. 81(5):940–6.
  78. Newton SM, Brent AJ, Anderson S, Whittaker E, Kampmann B. Paediatric tuberculosis. The Lancet infectious diseases. 2008;8(8):498–510.
  79. Watts HG, Lifeso RM. Tuberculosis of bones and joints. J Bone Joint Surg. 1996;78(2):288–98.
  80. Host B, Schumacher H, Prag J, Arpi M. Isolation of Kingella kingae from synovial fluids using four commercial blood culture bottles. Eur J Clin Microbiol Infect Dis. 2000;19(8):608–11.
  81. Yagupsky P. Diagnosis of Kingella kingae arthritis by polymerase chain reaction analysis. Clin Infect Dis. 1999;29(3):704–5.
  82. Fenollar F, Roux V, Stein A, Drancourt M, Raoult D. Analysis of 525 samples to determine the usefulness of PCR amplification and sequencing of the 16S rRNA gene for diagnosis of bone and joint infections. J Clin Microbiol. 2006;44(3):1018–28.
  83. Yagupsky P, Porsch E, St Geme JW, 3rd. Kingella kingae: an emerging pathogen in young children. Pediatrics. 2011;127(3):557–65.
  84. Cherkaoui A, Ceroni D, Emonet S, Lefevre Y, Schrenzel J. Molecular diagnosis of Kingella kingae osteoarticular infections by specific real-time PCR assay. J Med Microbiol. 2009;58(Pt 1):65–8.
  85. Peltola H, Paakkonen M. Acute osteomyelitis in children. N Engl J Med. 2014;370(4):352–60.
  86. Walters R. Lumbar Intervertebral Disc Infection: Pathology, Prevention and Treatment. Adelaide: University of Adelaide; 2006.
  87. Boscardin JB, Ringus JC, Feingold DJ, Ruda SC. Human intradiscal levels with cefazolin. Spine. 1992;17(6 Suppl):S145–8.
  88. Fraser RD, Osti OL, Vernon-Roberts B. Iatrogenic discitis: the role of intravenous antibiotics in prevention and treatment. An experimental study. Spine. 1989;14(9):1025–32.
  89. Rhoten RL, Murphy MA, Kalfas IH, Hahn JF, Washington JA. Antibiotic penetration into cervical discs. Neurosurgery. 1995;37(3):418–21.
  90. Riley LH, 3rd, Banovac K, Martinez OV, Eismont FJ. Tissue distribution of antibiotics in the intervertebral disc. Spine. 1994;19(23):2619–25.
  91. Ceroni D, Dubois-Ferrière V, Cherkaoui A, et al. Detection of Kingella kingae Osteoarticular Infections in Children by Oropharyngeal Swab PCR. Pediatrics. 2013;131(January):1–6.
  92. Ceroni D, Cherkaoui A, Kaelin A, Schrenzel J. Kingella kingae spondylodiscitis in young children: toward a new approach for bacteriological investigations? A preliminary report. J Child Orthop. 2010;4(2):173–5.

Most read articles by the same author(s)