Changing pattern of osteomyelitis in infants and children

A retrospective analysis of 332 children with osteomyelitis (OM), managed f rom 1966 to 1996, was undertaken to evaluate etiology, clinical course and treatment results. In 64% of all patients positive bacterial cultures were obtained, Staphylococcus aureus, streptococci, pneumococci, and Haemophilus influenzae were the most frequently cultured pathogens. In two-thirds of t he cases long bones (femur, tibia, humerus) were affected. Osteoarthritis o r suppurative arthritis was evident in 27%; 32 of 170 (19%) re-evaluated pa tients had moderate or severe sequelae. Risk factors for an unfavorable cou rse were the onset of disease in early infancy, suppurative arthritis, and an affected epiphysis. Suppurative arthritis, in particular, needs early ev acuation to prevent sequelae. In recent years we observed an increasing num ber of patients presenting with atypical forms of OM. Since 1989 10 patient s were considered to have chronic recurrent multifocal OM (CRMO). In 6 of t hem the clavicle was involved; their ages ranged from 3 to 14 years. The er ythrocyte sedimentation rate was elevated (median 48, range 9-110 mm), whil e other inflammatory parameters like C-reactive protein (median 9, range <5 -85 mg/l) or leucocyte count were slightly elevated or normal. Histopatholo gy was stage-dependent, with a predominance of lymphoplasmacellular infiltr ation. A nonbacterial origin of CRMO is probable but not proven. Histopatho logy is not suitable for differentiation between bacterial and nonbacterial forms of bone inflammation.