title: Bacterial Osteomyelitis or Nonbacterial Osteitis in Children: A Study Involving the German Surveillance Unit for Rare Diseases in Childhood.
abstract: BACKGROUND
  Although bacterial osteomyelitis (BO) is a commonly recognized diagnosis in pediatrics, it is often difficult to distinguish from nonbacterial osteitis (NBO). The goal of our study was to distinguish between the 2 disease entities and better define NBO.
  
  
  METHODS
  Using the German Surveillance Unit for Rare Diseases in Childhood (Erhebungseinheit für Seltene Paediatrische Erkrankungen in Deutschland), this prospective study during a 5-year period captured 657 patients at first diagnosis of either BO (n = 378) or NBO (n = 279) while analyzing epidemiologic, clinical and radiologic data.
  
  
  RESULTS
  BO was reported in 1.2 per 100,000 children with a higher prevalence in younger male patients (58%), and NBO was reported in 0.45 per 100,000 children. BO patients tended to present with fevers (68%), elevated inflammation markers (82%) and local swelling (62%) but a shorter course of symptoms than NBO patients. NBO patients presented in good general health (86%) and were more likely to have multifocal lesions (66%). Staphylococcus aureus was the most prominent pathogen (83%), with only one methicillin-resistant S. aureus reported. Complications ranged from arthritis adjacent to the lesion to hyperostosis and vertebral fractures.
  
  
  CONCLUSIONS
  BO and NBO can be distinguished based on symptoms, associated diseases and inflammation markers. NBO should always be considered in pediatric patients presenting with bone lesions and pain, especially in young female patients presenting with good general health, minimal inflammation markers and multifocal lesions in the vertebrae, clavicle and sternum.
authors.affiliation: From the Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Veit
authors.initials: V
authors.lastname: Grote
authors.forename: Colen C G
authors.initials: CC
authors.lastname: Silier
authors.forename: Agnes M
authors.initials: AM
authors.lastname: Voit
authors.forename: Annette F
authors.initials: AF
authors.lastname: Jansson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015576:Hyperostosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D007223:Infant; D008297:Male; D010000:Osteitis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D010019:Osteomyelitis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D011446:Prospective Studies; D062486:Public Health Surveillance; D035583:Rare Diseases / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D013131:Spine / Q000473:pathology; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D013211:Staphylococcus aureus / Q000254:growth & development / Q000302:isolation & purification