title: Unexpectedly high incidences of chronic non-bacterial as compared to bacterial osteomyelitis in children.
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.
authors.affiliation: Pediatric Rheumatology and Immunology, Children's Hospital Dresden, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany. anja.schnabel@uniklinikum-dresden.de.
authors.forename: A
authors.identifier: http://orcid.org/0000-0001-8716-2552
authors.initials: A
authors.lastname: Schnabel
authors.affiliation: Institute for Medical Informatics and Biometry, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Range
authors.affiliation: Department of Radiology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Hahn
authors.affiliation: Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Freiberger Str. 37, 01067, Dresden, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Siepmann
authors.affiliation: Pediatric Rheumatology and Immunology, Children's Hospital Dresden, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Berner
authors.affiliation: Pediatric Rheumatology and Immunology, Children's Hospital Dresden, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany. christian.hedrich@uniklinikum-dresden.de.
authors.forename: C M
authors.initials: CM
authors.lastname: Hedrich
mesh_terms: D000293:Adolescent; D001424:Bacterial Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010019:Osteomyelitis / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D012189:Retrospective Studies
keywords: Bacterial osteomyelitis; CNO; CRMO; Infection; Inflammation; Non-bacterial osteomyelitis