Follow-up of osteomyelitis of infants with systemic serum parameters and bone scintigraphy.
OBJECTIVE
To prevent orthopedic sequelae in acute hematogenous pyogenic osteomyelitis (AHPO) of infants early diagnosis, recognition of recurrence and effective therapy is needed. This retrospective study of 47 infants with bacteriologically confirmed AHPO concerned with an analysis of the diagnostic value of systemic serum parameters compared to bone scintigraphy (BSC).


METHODS
AHPO was characterized initially and during the course of disease by clinical findings, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total and differential white blood cell (WBC) count, BSC, and plain radiography.


RESULTS
CRP was the most effective serum parameter for follow-up of disease. The first sign of BSC to signal adequate response to antibiotic treatment was the decrease or normalization of hyperperfusion. Escape from therapy or poor prognosis, even when the serum parameters were normalized, was signaled by the recurrence of focal hyperperfusion and the persistent or increasing local uptake ratios on the 3-h-image over 6 weeks during a course of antibiotic treatment.


CONCLUSIONS
Antibiotic treatment masks the clinical presentation, and the radiographic findings, causes non-characteristic laboratory findings, but do not prevent the scintigraphic visualization; BSC and serum parameters used in the right completion are the most successful and efficient modalities for follow-up of AHPO. Maintenance of antibiotic therapy should be done until BSC findings have reverted to normal.
Aigner
R M
RM
Department of Radiology, University Hospital, Graz, Austria.
Fueger
G F
GF
Vejda
M
M
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000453:epidemiology*; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D010019:Osteomyelitis / Q000097:blood* / Q000000981:diagnostic imaging* / Q000188:drug therapy; D011859:Radiography; D011877:Radionuclide Imaging; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002097:C-Reactive Protein