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Unexpectedly high incidences of chronic non-bacterial as compared to bacterial osteomyelitis in children

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Abstract

Historically, osteomyelitis was considered an infectious disorder. More recently, inflammatory mechanisms were recognized causing a significant proportion of pediatric osteomyelitis. This study was to compare characteristics of children with chronic non-bacterial (CNO) and bacterial osteomyelitis (BOM). A chart review of osteomyelitis patients from the departments of pediatrics, pediatric surgery, orthopedic surgery, and oral and maxillofacial surgery was conducted in a tertiary referral center, covering the years 2004–2014. Institutional incidences of CNO (n = 49) and BOM (n = 56) were comparable. Differentiation between CNO and BOM based on clinical or laboratory findings was mostly impossible. However, children with BOM more frequently presented with local inflammatory signs (47 vs. 68 %, p = 0.040), fever (12 vs. 38 %, p = 0.003), and abscesses (0 vs. 39 %, p < 0.001). Peripheral arthritis (14 vs. 0 %, p < 0.001), inflammatory bowel disease (10 vs. 2 %, p = ns), and hyperostosis (29 vs. 4 %, p = 0.001) were more common in CNO. Whole-body MRI was performed in 76 % of CNO patients, unveiling multifocal lesions in 80 % (CRMO). Though considered a rare disorder, institutional incidences of CNO were comparable to BOM, and the discrimination between CNO and BOM solely based on clinical aspects was mostly impossible. This is of special interest, since a correct and timely diagnosis is of utmost importance for long-term outcomes in both disorders. Whole-body MRIs should be considered in chronic osteomyelitis to (1) detect clinically inapparent lesions in CNO and (2) indirectly exclude (usually unifocal) chronic bacterial infections. Prospective studies are warranted to establish evidence-based diagnostic and therapeutic approaches to CNO.

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Acknowledgments

The authors thank Prof. G. Fitze (pediatric surgery), Prof. G. Lauer (oral and maxillofacial surgery), and Dr. F. Thielemann (orthopedic surgery) for their support during the identification of pediatric patients with osteomyelitis. We thank Prof. H. Girschick for critically reading the manuscript and helpful discussion. The work of C.M.H was supported by the intramural MeDDrive program, TU Dresden, Germany.

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Authors and Affiliations

  1. Pediatric Rheumatology and Immunology, Children’s Hospital Dresden, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    A. Schnabel, R. Berner & C. M. Hedrich

  2. Institute for Medical Informatics and Biometry, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    U. Range

  3. Department of Radiology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany

    G. Hahn

  4. Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Freiberger Str. 37, 01067, Dresden, Germany

    T. Siepmann

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  1. A. Schnabel
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Correspondence to A. Schnabel or C. M. Hedrich.

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The work of Christian Hedrich (CH) was supported by the intramural MeDDrive program, University of Technology Dresden, Germany. CH participated in advisory board meetings on systemic JIA, Novartis Pharmaceuticals and received honoraria for presentations from Roche Pharmaceuticals and CSL Behring. Reinhard Berner (RB) received honoraria from Infectopharm, GSK, and MedUpdate GmbH for presentations and manuscripts. CH and RB currently participate in a clinical trial on bacterial osteomyelitis, Cubist Pharmaceuticals.

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Schnabel, A., Range, U., Hahn, G. et al. Unexpectedly high incidences of chronic non-bacterial as compared to bacterial osteomyelitis in children. Rheumatol Int 36, 1737–1745 (2016). https://doi.org/10.1007/s00296-016-3572-6

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  • DOI: https://doi.org/10.1007/s00296-016-3572-6

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