RT Book, Section
A1 Arnold, Sandra
A2 Shah, Samir S.
SR Print(0)
ID 6909843
T1 Chapter 47. Osteomyelitis
T2 Pediatric Practice: Infectious Disease
YR 2009
FD 2009
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-148924-9
LK accesspediatrics.mhmedical.com/content.aspx?aid=6909843
RD 2024/04/20
AB Osteomyelitis  is  an  inflammatory  condition  of  bones  usually  caused  by  bacterial,  or  more  rarely,  fungal  infection.  Acute  hematogenous  osteomyelitis  (AHO)  is  the  most  common  form  of  osteomyelitis  in  children.1  It  occurs  as  a  result  of  hematogenous  deposition  of  bacteria  within  bone  following  symptomatic  or  asymptomatic  bacteremia.  The  time  from  onset  of  symptoms  to  diagnosis  is  usually  rapid,  within  14  days,  although  certain  sites  of  infection  (particularly  vertebral  and  calcaneal)  may  have  a  more  insidious  course  and  present  subacutely.2  Chronic  osteomyelitis  presents  with  either  chronic,  persistent,  low-grade  symptoms  or  an  exacerbation  of  symptoms  after  a  period  of  relative  disease  quiescence.3  The  reported  duration  of  symptoms  required  to  establish  a  diagnosis  of  chronic  osteomyelitis  is  quite  varied,  ranging  from  6  weeks  to  6  months.  The  distinction  between  acute  and  chronic  osteomyelitis  is  important  as  it  helps  define  the  necessary  treatment  modalities  given  that  a  longer  duration  of  symptoms  before  treatment  may  allow  for  the  development  of  necrotic  bone  and  soft  tissues.  Nonhematogenous  osteomyelitis  occurs  with  direct  contamination  of  bone  from  trauma,  surgery,  or  spread  of  infection  from  an  adjacent  soft  tissue  infection.4  This  may  present  as  acute  or  chronic  infection.  The  primary  focus  of  this  chapter  will  be  AHO  as  it  is  the  form  of  disease  that  will  be  seen  most  commonly  in  primary  care.