儿童A组β溶血性链球菌骨髓炎

Group A beta-hemolytic streptococcal osteomyelitis in children.

作者信息

Ibia Ekopimo O, Imoisili Menfo, Pikis Andreas

机构信息

Department of Infectious Diseases, Children's National Medical Center, Washington, DC, USA.

出版信息

Pediatrics. 2003 Jul;112(1 Pt 1):e22-6. doi: 10.1542/peds.112.1.e22.

DOI:10.1542/peds.112.1.e22

PMID:12837901

Abstract

OBJECTIVE

Little attention has been given to acute hematogenous osteomyelitis (AHO) caused by group A beta-hemolytic Streptococcus (GABHS), although up to 10% of cases are caused by this microorganism. The objective of this study was to define the clinical and laboratory characteristics of AHO caused by GABHS.

METHODS

Between January 1983 and June 1999, 29 patients were treated at Children's National Medical Center with AHO caused by GABHS. The characteristics of these patients were compared with those of 28 patients with AHO caused by Streptococcus pneumoniae and those of a matched sample of 45 patients with AHO caused by Staphylococcus aureus.

RESULTS

Median ages of children with GABHS, S pneumoniae, and S aureus AHO were 36.0, 13.7, and 96.0 months, respectively. On admission, patients with GABHS AHO had a mean temperature of 38.9 +/- 1.3 degrees C and a mean white blood cell count of 17 000 +/- 7800/mm3, findings similar to those from patients with S pneumoniae AHO. Patients with S aureus AHO had significantly lower admission temperature (38.1 +/- 1.1 degrees C) and white blood cell count (10 600 +/- 4900/mm3). Varicella infection was the risk factor in 5 cases (17%) of GABHS AHO, whereas none of the cases of AHO caused by S pneumoniae and S aureus was associated with varicella infection. Adjacent septic arthritis occurred in 22%, 28%, and 61% of children with GABHS, S aureus, and S pneumoniae AHO, respectively. Admission erythrocyte sedimentation rate and frequency of bacteremia were similar in all groups. However, time to normalization of erythrocyte sedimentation rate was longer for GABHS and S aureus than for S pneumoniae AHO. GABHS, like S pneumoniae, affected fewer nonextremity bones compared with S aureus.

CONCLUSIONS

GABHS should be considered in preschool- and early school-aged children who are suspected of having AHO and whose clinical and laboratory features are characterized by high fever and marked leukocytosis. It should also be highly considered in any child with AHO associated with varicella infection.

摘要

目的

A组β溶血性链球菌（GABHS）所致急性血源性骨髓炎（AHO）虽占病例总数的10%，但一直未受到足够关注。本研究旨在明确GABHS所致AHO的临床及实验室特征。

方法

1983年1月至1999年6月期间，29例GABHS所致AHO患儿在儿童国家医疗中心接受治疗。将这些患儿的特征与28例肺炎链球菌所致AHO患儿以及45例金黄色葡萄球菌所致AHO患儿的匹配样本进行比较。

结果

GABHS、肺炎链球菌和金黄色葡萄球菌所致AHO患儿的中位年龄分别为36.0、13.7和96.0个月。入院时，GABHS所致AHO患儿的平均体温为38.9±1.3℃，平均白细胞计数为17000±7800/mm³，与肺炎链球菌所致AHO患儿的结果相似。金黄色葡萄球菌所致AHO患儿的入院体温（38.1±1.1℃）和白细胞计数（10600±4900/mm³）显著较低。水痘感染是5例（17%）GABHS所致AHO的危险因素，而肺炎链球菌和金黄色葡萄球菌所致AHO病例均与水痘感染无关。GABHS、金黄色葡萄球菌和肺炎链球菌所致AHO患儿中，分别有22%、28%和61%发生了邻近化脓性关节炎。所有组的入院红细胞沉降率和菌血症发生率相似。然而，GABHS和金黄色葡萄球菌所致AHO患儿红细胞沉降率恢复正常的时间比肺炎链球菌所致AHO患儿更长。与金黄色葡萄球菌相比，GABHS与肺炎链球菌一样，累及非四肢骨骼的情况较少。