Department of Pediatrics, Division of Infectious Diseases, Emory University, Atlanta, Georgia.
Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.
Pediatr Blood Cancer. 2020 Oct;67(10):e28517. doi: 10.1002/pbc.28517. Epub 2020 Jul 25.
Children with sickle cell disease (SCD) are at increased risk for bacterial infections including osteomyelitis (OM). Fever and bone pain, key presenting symptoms of OM, are common in SCD, thus complicating diagnosis. We reviewed presentation, imaging features, and microbiologic etiologies of children with SCD treated for OM.
The comprehensive SCD clinical database of children and adolescents with SCD followed at a single, large tertiary pediatric center were searched to identify all diagnostic coding for potential cases of osteomyelitis in children ages 6 months to 21 years from 2010 to 2019. Medical charts were reviewed to determine OM diagnostic probability based on radiographic and microbiologic findings and the duration of prescribed antibiotic treatment for OM.
Review of 3553 patients (18 039 person-years) identified 20 episodes of probable OM in 19 children. Magnetic resonance imaging (MRI) findings to support OM were definitive in 4/19 (21%), probable in 10/19 (53%), suspected in 5/19 (26%), based on blinded radiologist review. Blood and/or operative cultures from bone and tissue debridement isolated Salmonella species in seven (35%) cases and methicillin-susceptible Staphylococcus aureus (MSSA) in two (10%). Six patients received antibiotic treatment prior to obtainment of cultures. Of culture-positive cases, MRI findings for OM were definitive or probable in six of nine (67%), suspected in three of nine (33%).
Distinction between OM and sickle-related bone infarct or vasoocclusion is difficult based on imaging findings alone. Early attainment of blood and operative cultures increases the likelihood of identifying and adequately treating OM.
镰状细胞病（SCD）患儿发生细菌感染（包括骨髓炎（OM））的风险增加。骨髓炎的主要表现症状是发热和骨痛，这在 SCD 中很常见，从而使诊断复杂化。我们回顾了接受骨髓炎治疗的 SCD 患儿的临床表现、影像学特征和微生物病因。
对在一家大型三级儿科中心接受治疗的儿童和青少年 SCD 综合临床数据库进行了搜索，以确定从 2010 年到 2019 年期间 6 个月至 21 岁所有可能患有骨髓炎的儿童的潜在病例的诊断编码。通过影像学和微生物学发现以及骨髓炎规定抗生素治疗的持续时间，对病历进行了审查，以确定骨髓炎的诊断概率。
对 3553 名患者（18039 人年）进行了回顾，发现 19 名儿童中有 20 例可能患有骨髓炎。根据盲法放射科医生的评估，MRI 检查结果明确支持骨髓炎的有 4/19（21%）例，可能支持骨髓炎的有 10/19（53%）例，疑似骨髓炎的有 5/19（26%）例。从骨和组织清创术中的血液和/或培养物中分离出了 7 例（35%）沙门氏菌和 2 例（10%）耐甲氧西林金黄色葡萄球菌（MSSA）。6 例患者在获得培养物之前接受了抗生素治疗。在培养阳性的病例中，9 例中的 6 例（67%）的 MRI 检查结果明确或可能支持骨髓炎，9 例中的 3 例（33%）疑似骨髓炎。
仅凭影像学表现难以区分骨髓炎和镰状细胞相关的骨梗死或血管阻塞。尽早获得血液和手术培养物可增加识别和充分治疗骨髓炎的可能性。
