Osteomyelitis in childhood
Acute hematogenic osteomyelitis is a typical disease in children, especially between the ages of 3 and 15. Osteomyelitis in infancy or childhood usually occurs in the area of the long bones of the thigh (femoral metaphysis). The disease spreads under the periosteum (subperiosteum) and can spread into the bone marrow or via vascular connections into the adjacent joint.
It leads to acute symptoms with fever, chills, severe local pain, swelling, redness, overheating and relieving postures. As pathogens of osteomyelitis in childhood, so-called gram-positive pathogens (e.g. Staphylococcus aureus, Group A streptococci) are in the foreground. The targeted pathogen-sensitive antibiotic therapy of the disease is also based on these pathogens.
In principle, hematogenic osteomyelitis should be considered in infants with pain in the extremities, redness and swelling, and in poor general condition. If osteomyelitis is suspected in infants or children, the osteomyelitis disease must be diagnosed or ruled out by means of imaging (X-ray, ultrasound, magnetic resonance imaging) after a clinical examination. In general, caution must be exercised with general infections, as hematogenic endogenous osteomyelitis occurs after general infections.
A typical example of the development of endogenous hematogenic osteomyelitis in infancy is infection of the umbilical cord.If, for example, the above-mentioned symptoms occur during osteomyelitis examinations, it can be assumed that the bone is acutely inflamed. The disease can also be detected in the blood. Typical for inflammations in the body is an increase in the concentration of white blood cells (= leukocytes; leukocytosis), as well as a significantly increased blood sedimentation rate (= BSG).
This diagnosis of osteomyelitis is only of importance in the case of an acute form, since in the case of chronic osteomyelitis both values show only a moderate increase. In the case of acute osteomyelitis, the pathogen can also be detected during the diagnostic procedure by means of a blood culture or puncture of the inflamed bone. This then also provides important information about the therapeutic measures to be taken in the course of an antibiotic treatment.
Antibiosis must be pathogen-specific in order to be effective. Osteomyelitis usually only becomes visible in an advanced stage of the disease. Bone changes are usually only visible two to three weeks after the onset of the disease.
Then, however, visible changes (cf. X-ray) in the form of calcifications (= ossifications), lighter spots and/or detachment of periosteum from the bone become apparent. If the osteomyelitis is chronic, blood vessel occlusion can lead to reduced blood flow to the bone, which may even lead to a bone infarction.
The result of a bone infarction is the death of certain bone parts, which then remain as residual bodies (= sequesters) in the infected area. This can be recognized as a light-colored border in X-ray diagnostics, since dead bone tissue is usually answered by the formation of new bone tissue. The light-colored border is therefore connective tissue.
Furthermore, osteomyelitis can be diagnosed by means of sonography (= ultrasound examination). On the positive side, it should be mentioned that, for example, the detachment of periosteum from the bone, which is caused by the formation of abscesses, can be seen earlier than in the X-ray image. As a further diagnostic measure of osteomyelitis, the so-called skeletal scintigraphy can be used. This diagnostic method uses very weak radioactive preparations (= radiopharmaceuticals) to detect inflammatory processes. –> Continue to the topic osteomyelitis therapy
