source: American Society of Pediatric Hematology/Oncology

year: 2017

authors: Julie Weisman, Deepika Darbari, Yaser Diab

Background:
Patients with sickle cell disease (SCD) are at increased risk for Osteomyelitis (OM). Diagnosis of OM in this population is challenging and there is limited pediatric data on the characteristics and outcomes of OM in this population.

Objectives:
To report characteristics and outcomes of OM in children with SCD treated at our center over the last 10 years.

Results:
Thirty children with SCD (18 males, median age 12 years) were treated for OM at our institution during the study period. The genotype was SS in 27 patients, SC in 2, and SF in 1. Sites of involvement included lower extremity (11), upper extremity (10), pelvis (2), vertebrae (2), scapula (1), clavicle (1), hand (1), ribs (1) and mandible (1). Leukocytosis (>15,000/mm3) was observed in 13 patients (43%) at presentation. Baseline erythrocyte sedimentation rate was elevated (>20 mm/hour) in 29 patients (97%) but marked elevation (>100 mm/hour) was present in 3 patients (10%). Baseline C-reactive protein was elevated (>10 mg/L) in 13 patients (43%). Bacteremia was present in 6 patients (20%). Magnetic resonance imaging (MRI) findings were suggestive of OM in 18 patients (60%) and indeterminate in the remaining patients. The diagnosis of OM was confirmed in 3 patients (bone biopsy), probable in 6 patients (organism isolated from blood or abscess), and presumed in the remaining cases based on clinical, laboratory, and MRI findings. Non-typhoidal Salmonella was isolated from cultures in 9 (30%) patients [bone biopsy (3), abscess (3), and blood (6)] while no organism was found in the remaining 21 (70%) patients. All patients were treated with prolonged antibiotic therapy. Six patients required surgical drainage/debridement. Two patients developed chronic OM. There were no mortalities and complete resolution of OM was achieved in all patients.

Conclusion:
Despite improvements in the management of SCD over the past decade, OM continues to be a serious infection in children with SCD associated with significant morbidity. The majority of patients are treated for presumed diagnosis of OM without definitive confirmation. Non-typhoidal Salmonella was the only organism identified in our patient cohort.

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