Musculoskeletal Infections in Children

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Introduction and epidemiology

Osteomyelitis is an infection of the bone and bone marrow generally of a bacterial origin. In the highly vascular bones of children, the most common form is acute hematogenous osteomyelitis (AHO). Approximately half of pediatric cases occur in children younger than 5 years of age [1], [2], [3], and boys are approximately twice as likely to be affected as girls [2], [4]. The incidence has not been found to be higher in any one race than another [2], [5]. Higher rates are seen in

Introduction and epidemiology

Septic arthritis refers to bacterial invasion of the joint space and the subsequent inflammatory response. Septic arthritis is commonly a disease of childhood, with approximately half of all cases occurring in patients younger than 20 years of age [37]. Rates of septic arthritis are estimated to be between 5.5 and 12 cases per 100,000 children [38]. The peak incidence is in children younger than 3 years, and boys are affected approximately twice as often as girls [37], [38], [39]. Septic

Introduction and epidemiology

Pyomyositis is a bacterial infection of skeletal muscle with a predilection for large muscle groups, and it often results in localized abscess formation. Although relatively uncommon in more temperate areas, such as North America [61], pyomyositis accounts for up to 4% of surgical admissions in some tropical areas [62]. This geographic distribution has led to the alternative name of pyomyositis tropicans. Within North America, the highest incidence of pyomyositis is in the southernmost regions.

Introduction and epidemiology

Necrotizing fasciitis (also known as hospital gangrene or hemolytic streptococcal gangrene) was described as early as the fifth century BC, when Hippocrates wrote, “flesh, sinews and bones fell away in large quantities. The flux which formed was not like pus but a different sort of putrefaction with a copious and varied flux… There were many deaths” [83]. Necrotizing fasciitis is a rapidly progressive, deep-seated bacterial infection of the subcutaneous soft tissue that may involve any area of

Summary

Musculoskeletal infections, including osteomyelitis, septic arthritis, necrotizing fasciitis, and pyomyositis, can occur in previously healthy children and lead to severe long-term morbidity if not recognized and treated promptly. Early diagnosis is crucial, and initial presentation is often to the primary care pediatrician. In addition to making a diagnosis, identification of the causative organism is imperative, especially in light of increasing resistance patterns. Identification may be

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