title: Primary subacute epiphyseal osteomyelitis caused by Mycobacterium species in young children: a modern diagnostic approach.
abstract: Primary epiphyseal subacute osteomyelitis (PESAO) caused by Mycobacterium species in young children is poorly recognized. We aimed to define the spectrum of this uncommon condition and to propose a novel diagnostic approach. We performed a systematic review of the literature on the PubMed website by selecting all reports of isolated infantile PESAO caused by Mycobacterium species since 1975. We identified 350 citations, of which 174 were assessed for eligibility based on title and abstract. The full text of 81 eligible citations was screened, and relevant data of 15 children under 4 years of age with mycobacterial PESAO were extracted. These data were pooled with those from our Institution. Data from 16 children were reviewed. The median age was 16 ± 7 months and the male:female ratio 1.7. The knee was the most common infection site (94%). The diagnosis of mycobacterial disease was delayed in all cases (range, 2 weeks to 6 months), and initially presumed by histology in 15 children (94%). Microbiologically proven diagnosis was confirmed by bone cultures in 8 of the 15 children (53%), and by specific PCR in 2 of the 3 culture-negative bone specimens (67%). Three children experienced long-term orthopedic complications despite surgical drainage and prolonged antimycobacterial regimens. All recently reported cases came from high-burden tuberculosis areas. Mycobacterium species contribute to the burden of infantile PESAO in endemic tuberculosis areas and may cause growth disturbances. We argue in favor of the early recognition of mycobacterial disease by specific molecular assays in children with infantile PESAO living in high-burden areas.
authors.affiliation: Research Unit on Infectious and Emerging Tropical Diseases (URMITE), Inserm U1095, UMR 63, CNRS 7278, IRD 198, University Hospital Institute Méditerranée Infection, Aix-Marseille University, Marseille, France. nawal.elho@gmail.com.|Department of Pediatric Orthopedics, University La Timone Children's Hospital, Aix-Marseille University, Marseille, France. nawal.elho@gmail.com.
authors.forename: N
authors.initials: N
authors.lastname: El Houmami
authors.affiliation: Department of Pediatric Emergency Medicine, University North Hospital, APHM Public Hospitals, Aix-Marseille University, Marseille, France.
authors.forename: P
authors.initials: P
authors.lastname: Minodier
authors.affiliation: Department of Pathology, University La Timone Hospital, APHM Public Hospitals, Aix-Marseille University, Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Bouvier
authors.affiliation: Research Unit on Infectious and Emerging Tropical Diseases (URMITE), Inserm U1095, UMR 63, CNRS 7278, IRD 198, University Hospital Institute Méditerranée Infection, Aix-Marseille University, Marseille, France.
authors.forename: H
authors.initials: H
authors.lastname: Seligmann
authors.affiliation: Department of Pediatric Orthopedics, University La Timone Children's Hospital, Aix-Marseille University, Marseille, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Jouve
authors.affiliation: Research Unit on Infectious and Emerging Tropical Diseases (URMITE), Inserm U1095, UMR 63, CNRS 7278, IRD 198, University Hospital Institute Méditerranée Infection, Aix-Marseille University, Marseille, France.
authors.forename: D
authors.initials: D
authors.lastname: Raoult
authors.affiliation: Research Unit on Infectious and Emerging Tropical Diseases (URMITE), Inserm U1095, UMR 63, CNRS 7278, IRD 198, University Hospital Institute Méditerranée Infection, Aix-Marseille University, Marseille, France.
authors.forename: P-E
authors.initials: PE
authors.lastname: Fournier
mesh_terms: D002675:Child, Preschool; D004838:Epiphyses / Q000382:microbiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D025202:Molecular Diagnostic Techniques / Q000379:methods; D009161:Mycobacterium / Q000302:isolation & purification*; D009164:Mycobacterium Infections / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology*; D010019:Osteomyelitis / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology*