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Hematogenous osteomyelitis in children: Epidemiology, pathogenesis, and microbiology


Osteomyelitis refers to an infection of bone. It is usually bacterial in origin. Microorganisms can be introduced into bone in three ways:

Hematogenous delivery

Direct inoculation (usually traumatic, but also surgical)

Local invasion from a contiguous infection

In children, acute osteomyelitis is generally hematogenous in origin. Unique anatomic characteristics of the growing skeleton also affect the site of infection, pathogenesis, and clinical features of the disease on account of hematogenous spread.


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Literature review current through: Nov 2014. | This topic last updated: Jan 10, 2014.
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  1. Blyth MJ, Kincaid R, Craigen MA, Bennet GC. The changing epidemiology of acute and subacute haematogenous osteomyelitis in children. J Bone Joint Surg Br 2001; 83:99.
  2. Arnold SR, Elias D, Buckingham SC, et al. Changing patterns of acute hematogenous osteomyelitis and septic arthritis: emergence of community-associated methicillin-resistant Staphylococcus aureus. J Pediatr Orthop 2006; 26:703.
  3. Nelson JD. Acute osteomyelitis in children. Infect Dis Clin North Am 1990; 4:513.
  4. Goergens ED, McEvoy A, Watson M, Barrett IR. Acute osteomyelitis and septic arthritis in children. J Paediatr Child Health 2005; 41:59.
  5. Knudsen CJ, Hoffman EB. Neonatal osteomyelitis. J Bone Joint Surg Br 1990; 72:846.
  6. de Jesus LE, Fernandes A, Sias SM, et al. Neonatal osteomyelitis and complex nephro-ureteral duplication. Surg Infect (Larchmt) 2011; 12:73.
  7. Wong M, Isaacs D, Howman-Giles R, Uren R. Clinical and diagnostic features of osteomyelitis occurring in the first three months of life. Pediatr Infect Dis J 1995; 14:1047.
  8. Martínez-Aguilar G, Avalos-Mishaan A, Hulten K, et al. Community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus musculoskeletal infections in children. Pediatr Infect Dis J 2004; 23:701.
  9. Gonzalez BE, Martinez-Aguilar G, Hulten KG, et al. Severe Staphylococcal sepsis in adolescents in the era of community-acquired methicillin-resistant Staphylococcus aureus. Pediatrics 2005; 115:642.
  10. Krogstad P. Osteomyelitis. In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th, Cherry JD, Harrison GJ, Kaplan SL, et al. (Eds), Elsevier Saunders, Philadelphia 2014. p.711.
  11. Weber-Chrysochoou C, Corti N, Goetschel P, et al. Pelvic osteomyelitis: a diagnostic challenge in children. J Pediatr Surg 2007; 42:553.
  12. Dich VQ, Nelson JD, Haltalin KC. Osteomyelitis in infants and children. A review of 163 cases. Am J Dis Child 1975; 129:1273.
  13. Fernandez M, Carrol CL, Baker CJ. Discitis and vertebral osteomyelitis in children: an 18-year review. Pediatrics 2000; 105:1299.
  14. Ham KN, Hurley JV, Ryan GB, Storey E. Localization of particulate carbon in metaphyseal vessels of growing rats. Aust J Exp Biol Med Sci 1965; 43:625.
  15. Anderson CE, Parker J. Invasion and resorption in enchondral ossification. An electron microscopic study. J Bone Joint Surg Am 1966; 48:899.
  16. Emslie KR, Nade S. Pathogenesis and treatment of acute hematogenous osteomyelitis: evaluation of current views with reference to an animal model. Rev Infect Dis 1986; 8:841.
  17. Pöyhiä T, Azouz EM. MR imaging evaluation of subacute and chronic bone abscesses in children. Pediatr Radiol 2000; 30:763.
  18. Ramos OM. Chronic osteomyelitis in children. Pediatr Infect Dis J 2002; 21:431.
  19. Ogden JA. Pediatric osteomyelitis and septic arthritis: the pathology of neonatal disease. Yale J Biol Med 1979; 52:423.
  20. Green WT. Osteomyelitis of infants: A disease different from osteomyelitis of older children. Arch Surg 1936; 32:462.
  21. Trueta J. The three types of acute hematogenous osteomyelitis: A clinical and vascular study. J Bone Joint Surg Br 1959; 41:671.
  22. Perlman MH, Patzakis MJ, Kumar PJ, Holtom P. The incidence of joint involvement with adjacent osteomyelitis in pediatric patients. J Pediatr Orthop 2000; 20:40.
  23. Conventry MB, Ghormley RK, Kernohan JW. Intervertebral disc: Its microscopic anatomy and pathology. J Bone Joint Surg 1945; 27:105.
  24. Cushing AH. Diskitis in children. Clin Infect Dis 1993; 17:1.
  25. Bonhoeffer J, Haeberle B, Schaad UB, Heininger U. Diagnosis of acute haematogenous osteomyelitis and septic arthritis: 20 years experience at the University Children's Hospital Basel. Swiss Med Wkly 2001; 131:575.
  26. Karwowska A, Davies HD, Jadavji T. Epidemiology and outcome of osteomyelitis in the era of sequential intravenous-oral therapy. Pediatr Infect Dis J 1998; 17:1021.
  27. Floyed RL, Steele RW. Culture-negative osteomyelitis. Pediatr Infect Dis J 2003; 22:731.
  28. Bocchini CE, Hulten KG, Mason EO Jr, et al. Panton-Valentine leukocidin genes are associated with enhanced inflammatory response and local disease in acute hematogenous Staphylococcus aureus osteomyelitis in children. Pediatrics 2006; 117:433.
  29. Gonzalez BE, Teruya J, Mahoney DH Jr, et al. Venous thrombosis associated with staphylococcal osteomyelitis in children. Pediatrics 2006; 117:1673.
  30. McCaskill ML, Mason EO Jr, Kaplan SL, et al. Increase of the USA300 clone among community-acquired methicillin-susceptible Staphylococcus aureus causing invasive infections. Pediatr Infect Dis J 2007; 26:1122.
  31. Ritz N, Curtis N. The role of Panton-Valentine leukocidin in Staphylococcus aureus musculoskeletal infections in children. Pediatr Infect Dis J 2012; 31:514.
  32. Ibia EO, Imoisili M, Pikis A. Group A beta-hemolytic streptococcal osteomyelitis in children. Pediatrics 2003; 112:e22.
  33. Bradley JS, Kaplan SL, Tan TQ, et al. Pediatric pneumococcal bone and joint infections. The Pediatric Multicenter Pneumococcal Surveillance Study Group (PMPSSG). Pediatrics 1998; 102:1376.
  34. Yagupsky P, Porsch E, St Geme JW 3rd. Kingella kingae: an emerging pathogen in young children. Pediatrics 2011; 127:557.
  35. Verdier I, Gayet-Ageron A, Ploton C, et al. Contribution of a broad range polymerase chain reaction to the diagnosis of osteoarticular infections caused by Kingella kingae: description of twenty-four recent pediatric diagnoses. Pediatr Infect Dis J 2005; 24:692.
  36. Chometon S, Benito Y, Chaker M, et al. Specific real-time polymerase chain reaction places Kingella kingae as the most common cause of osteoarticular infections in young children. Pediatr Infect Dis J 2007; 26:377.
  37. Kiang KM, Ogunmodede F, Juni BA, et al. Outbreak of osteomyelitis/septic arthritis caused by Kingella kingae among child care center attendees. Pediatrics 2005; 116:e206.
  38. De Jonghe M, Glaesener G. [Type B Haemophilus influenzae infections. Experience at the Pediatric Hospital of Luxembourg]. Bull Soc Sci Med Grand Duche Luxemb 1995; 132:17.
  39. Sakellaris G, Kampitakis E, Karamitopoulou E, et al. Cat scratch disease simulating a malignant process of the chest wall with coexistent osteomyelitis. Scand J Infect Dis 2003; 35:433.
  40. Mirakhur B, Shah SS, Ratner AJ, et al. Cat scratch disease presenting as orbital abscess and osteomyelitis. J Clin Microbiol 2003; 41:3991.
  41. Hajjaji N, Hocqueloux L, Kerdraon R, Bret L. Bone infection in cat-scratch disease: a review of the literature. J Infect 2007; 54:417.
  42. Bartkowski SB, Zapala J, Heczko P, Szuta M. Actinomycotic osteomyelitis of the mandible: review of 15 cases. J Craniomaxillofac Surg 1998; 26:63.
  43. Galgiani JN, Ampel NM, Catanzaro A, et al. Practice guideline for the treatment of coccidioidomycosis. Infectious Diseases Society of America. Clin Infect Dis 2000; 30:658.
  44. Corrall CJ, Merz WG, Rekedal K, Hughes WT. Aspergillus osteomyelitis in an immunocompetent adolescent: a case report and review of the literature. Pediatrics 1982; 70:455.
  45. Gill FM, Sleeper LA, Weiner SJ, et al. Clinical events in the first decade in a cohort of infants with sickle cell disease. Cooperative Study of Sickle Cell Disease. Blood 1995; 86:776.
  46. Bennett OM. Salmonella osteomyelitis and the hand-foot syndrome in sickle cell disease. J Pediatr Orthop 1992; 12:534.
  47. Webb DK, Serjeant GR. Haemophilus influenzae osteomyelitis complicating dactylitis in homozygous sickle cell disease. Eur J Pediatr 1990; 149:613.
  48. Chambers JB, Forsythe DA, Bertrand SL, et al. Retrospective review of osteoarticular infections in a pediatric sickle cell age group. J Pediatr Orthop 2000; 20:682.
  49. Burnett MW, Bass JW, Cook BA. Etiology of osteomyelitis complicating sickle cell disease. Pediatrics 1998; 101:296.
  50. HOOK EW, CAMPBELL CG, WEENS HS, COOPER GR. Salmonella osteomyelitis in patients with sickle-cell anemia. N Engl J Med 1957; 257:403.
  51. Syrogiannopoulos GA, McCracken GH Jr, Nelson JD. Osteoarticular infections in children with sickle cell disease. Pediatrics 1986; 78:1090.
  52. Sadat-Ali M. The status of acute osteomyelitis in sickle cell disease. A 15-year review. Int Surg 1998; 83:84.