Paediatric Osteomyelitis in a Tertiary Hospital in South-South Nigeria; Clinical Experience at Federal Medical Centre Asaba
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Published
Nov 17, 2020
Page:
57-64
Main Article Content
N. K. Emeagui
Department of Surgery, Federal Medical Centre, Asaba, Delta State, Nigeria.
G. O. Obu
Department of Surgery, Federal Medical Centre, Asaba, Delta State, Nigeria.
H. I. O. Opara
Department of Paediatrics, Federal Medical Centre, Asaba, Delta State, Nigeria.
O. D. Emeagui
Department of Paediatrics, Federal Medical Centre, Asaba, Delta State, Nigeria.
O. C. Ajaegbu
Department of Paediatrics, Federal Medical Centre, Asaba, Delta State, Nigeria.
S. E. Esievoadje
Department of Paediatrics, Federal Medical Centre, Asaba, Delta State, Nigeria.
A. Urhi
Department of Paediatrics, Federal Medical Centre, Asaba, Delta State, Nigeria.
Abstract
Background: The incidence of Osteomyelitis is disproportionately higher in low-income countries (43-200 per 100,000 children) compared to high-income countries (1.94-13 per 100,000 children).These infections remains a significant threat to proper growth and development of children in low-income countries, and this is partly due to late presentation to the hospital coupled with wanton unorthodox pre-hospital intervention by traditional healers.
Aim: To determine the clinical and microbiological profile of paediatric osteomyelitis at Federal Medical Centre Asaba.
Methods: This is a 4year single centre retrospective study of all paediatric osteomyelitis managed in this hospital from January 2014 to December 2018. Important data such as type (acute, subacute and chronic) of osteomyelitis, bone involved, bone sites (epiphyseal, metaphyseal or diaphyseal) affected, microbiological culture results (implicated microorganisms), and genotype, treatment and outcome of treatment were expressed as frequencies and mean ± standard deviations, and Pearson’s Chi square test was used to measure associations. P values ˂ .05 were considered statistically significant.
Results: Forty (40) out of 3657 children had osteomyelitis, 17 (42.5%), 4(10%) and 19 (47.5%) were diagnosed with acute, subacute and chronic osteomyelitis respectively. The prevalence of osteomyelitis in this study was 1%. The children were between the ages of 6 months to 17 years with a mean age of 8.1 ± 4.23 years and spent an average of 19 ± 14 days on admission. Low and middle socioeconomic status were significantly associated with the risk of infection (P = .04). Tibia (47.5%) and femur (25%) were the commonest bones involved. Staphylococcus aureus accounted for 52.5% of cases and the metaphysis was the commonest site involved. The sickle cell heamoglobin to normal heamoglobin genotype ratio is 1:3. Out-come was favourable 87.5% of the cases.
Conclusion: Low socioeconomic class is a risk factor for paediatric osteomyelitis in our locality. Early diagnosis and prompt treatment are vital in ensuring favourable outcome.
Keywords:
Paediatric, bone infections, osteomyelitis.
Article Details
How to Cite
Emeagui, N. K., Obu, G. O., Opara, H. I. O., Emeagui, O. D., Ajaegbu, O. C., Esievoadje, S. E., & Urhi, A. (2020). Paediatric Osteomyelitis in a Tertiary Hospital in South-South Nigeria; Clinical Experience at Federal Medical Centre Asaba. Journal of Advances in Medicine and Medical Research, 32(21), 57-64. https://doi.org/10.9734/jammr/2020/v32i2130694
Section
Original Research Article
References
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Hong DK, Gutierrez K. Osteomyelitis. In: Long SS, Prober CG, Fischer M, editors. Principles and Practice of Pediatric Infectious Diseases. 5th ed. Philadelphia, PA: Elsevier. 2018;480-486.
Agaja SB, Ayorinde RO. Chronic Osteomyelitis in Ilorin, Nigeria. S Afr J Surg. 2008:46(4):116-8. PMID: 19051955
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Gerber JS, Coffin SE. Smathers SA, Zaoutis TE. Trends in the incidence of methicillin-resistant Staphylococcus aureus infection in children’s hospitals in the United States. Clin. Infect. Dis. 2009;49(1):65-71. DOI: 10.1086/599348 PMID: 19463065 PMCID: PMC2897056
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Ilharreborde B, Bidet P, Lorrot M, Even J, Mariani- Kurkdjian P, Ligouri S, Vitoux C, Lefevre Y, Doit C, Fitoussi F, Pennecot G, Bingen E, Mazda K, Bonacorsi S. New realtime PCR-based method for Kingella kingae DNA detection: application to samples collected from 89 children with acute arthritis. J Clin Microbiol. 2009;47(6):1837-41. DOI: 10.1128/JCM.00144-09.Epub 2009 Apr 15. Erratum in: J Clin Microbiol. 2009;47(9):3071. PMID: 19369442 PMCID: PMC2691089
Basmaci R, Yagupsky P, Ilharreborde B, Guyot K, Porat N, Chomton M, Thiberge JM, Mazda K, Bingen E, Bonacorsi S, Bidet P. Multilocus sequence typing and rtx A toxin gene sequencing analysis of Kingella kingae isolates demonstrates genetic diversity and international clones. PLoS One. 2012;7(5):e38078. DOI:10.1371/journal.pone.0038078. Epub 2012 May 31. PMID: 2269358 PMCID: PMC3365011
Lehours P, Freydiere AM, Richer O, Burucoa C, Boisset S, Lanotte P, Prere MF, Ferroni A, Lafuente C, Vandenesch F, Megraud F, Menard A. The rtx A toxin gene of Kingella kingae: a pertinent target for molecular diagnosis of osteoarticular infections. J Clin Microbiol. 2011;49:1245-50. DOI: 10.1128/JCM.01657-10 PMCID: PMC3122863 PMID: 21248099
Brischetto A, Leung G, Marshall CS, Bowen AC. A Retrospective Case-series of Children with Bone and Joint Infection from Northern Australia. Medicine. 2016;95(8):e2885. DOI: 10.1097/MD 0000000000002885 PMCID: PMC4779023 PMID: 26937926
Riise AER, Kirkhus E, Handeland KS, Flato B, Wathne KO. Childhood osteomyelitis – incidence and differentiation from other acute onset musculoskeletal features in a population-based study. BMC Pediatr. 2008;8:45. DOI: 10.1186/1471-2431-8-45 PMID: 18937840 PMCID: PMC2588573
Blyth MJ, Kincaid R, Craigen MA, Bennet GC. The changing epidemiology of acute and subacute haematogenous osteomyelitis in children. J Bone Joint Surg Br. 2001;83(1):99-102. DOI: 10.1302/0301- 620x.83b1.10699 PMID: 11245548
Dartnell J, Ramachandran M, Katchburian M. Haematogenous acute and subacute paediatric osteomyelitis: a systematic review of the literature. J Bone Joint Surg Br. 2012;94(5):584-595. DOI: 10.1302/0301-620X.94B5.28523 PMID: 22529075
Okubo Y, Nochioka K, Testa M. Nationwide survey of pediatric acute osteomyelitis in the USA. J Pediatr Orthop B. 2017;26(6):501-506. DOI:10.1097/BPB0000000000000441 PMID: 28230612
Eyichukwu GO, Anyaehie UE. Outcome of management of chronic osteomyelitis at National Orthopaedic Hospital Enugu. Niger J Med. 2009;18(2):194-8. DOI: 10.4314/njm.v18i245064 PMID:19630329
Ikpeme IA, Ngim NE, Ikpeme AA. Diagnosis and treatment of pyogenic bone infections. Afr Health Sci. 2010:10(1):82-8. PMID: 20811530. PMCID: PMC 2895795
Daoud A, Saighi-Bouaouina A. Treatment of sequestra, pseudoarthroses, and defects in the long bones of Children who have Chronic haematogenous Osteomyelitis. J Bone Joint Surg Am. 1989;71(10):1448-68. PMID: 2592386
Atijosan O, Rischewski D, Simms V, Kuper H, Linganwa B, Nuhi A, Foster A, Lavy C. A national survey of musculoskeletal impairement in Rwanda: prevalence, causes and service implications. PLoS One. 2008;3(7):e2851. DOI: 10.1371/journal.pone.0002851 PMID: 18682849;PMCID: PMC2483936
Jones HW, Beckles VLL, Akinola B, Stevenson AJ, Harrison WJ. Chronic haematogenous osteomyelitis. J Bone Joint Surg Br. 2011;93-B(8):1005-1010. DOI:10.1302/0301-620X.93B8.25954.
Onche I.I, Obiano SK.Chronic Osteomyelitis of Long Bones: Reasons for delay in presentation. Niger J Med. 2004;13(4):355-358.
Malcius D, Jonkus M, Kuprionis G, Maleckas A, Monastyreckiene E, Uktveris R, Rinkevicius S, Barauskas V. The accuracy of different imaging techniques in diagnosis of acute hematogenous ostyeomyelitis. Medicina (Kaunas). 2009;45(8): 624-31. PMID: 19773621
Thomsen I, Creech CB. Advances in the Diagnosis and Management of Pediatric Osteomyelitis. Curr Infect Dis Rep. 2011;13:451. Available: https://doi.org/10.1007/s11908- 011-0202-z
Facts Sheets- Malnutrition-World Health Organization; 2020. Available: www.who.int/news-room/fact-sheets/detail/malnutrition.Accessed on October 29th 2020.
Igbedoh SO. Undernutrition in Nigeria: dimension, causes and remedies for alleviation in a changing Socio-economic environment. Nutr. Health. 1993;9(1):1-14. DOI:10.1177/026010609300900101. PMID : 8414269
Nigeria: Nutrition Profile; 2018. Available: www.usaid.gov Accessed on October 29th 2020
Ali AM, Maya E, Lakhoo K. Challenges in managing paediatric osteomyelitis in the developing world: analysis of cases presenting to a tertiary referral centre in Tanzania. Afr J Paediatr Surg. 2014;11(4):308-11. DOI:10.4103/0189-6725.143136 PMID: 25323179
Stanley CM, Rutherford GW, Morshed S, Coughlin RR, Beyeza T. Estimating the healthcare burden of osteomyelitis in Uganda. Trans R Soc Trop Med Hyg. 2010;104(2):139-142. DOI:10.1016/j.trstmh.2009.05.014
Ibingira CB. Chronic osteomyelitis in a Ugandan rural setting. East Afr Med J. 2003;80(5):242-6. DOI: 10.4314/eamj. v 80 i5.8694 PMID: 16167739
Harris AM, Bramley AM, Jain S, Arnold SR, Ampofo K Self WH et al. Influence of Antibiotics on the Detection of Bacteria by Culture-Based and Culture-Independent Diagnostic Tests in Patients Hospitalized With Community-Acquired Pneumonia. Open Forum Infect Dis; 2017. DOI: 10.1093/ofid/ofx014 PMCID: PMC5414111. PMID: 28480285
Lampe RM. Osteomyelitis. In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson Textbook of Paediatrics. 17th ed. Saunders; Philadelphia: 2004;500-502.
Dabov GD. Osteomyelitis. In: Canale ST, Beaty JH, editors. Campbell’s Operative Orthopaedics 11th ed. Mosby Elsevier Philadelphia. 2008;1:695-721.
Hong DK, Gutierrez K. Osteomyelitis. In: Long SS, Prober CG, Fischer M, editors. Principles and Practice of Pediatric Infectious Diseases. 5th ed. Philadelphia, PA: Elsevier. 2018;480-486.
Agaja SB, Ayorinde RO. Chronic Osteomyelitis in Ilorin, Nigeria. S Afr J Surg. 2008:46(4):116-8. PMID: 19051955
Wirbel R, Hermans K. Surgical treatment of Chronic Osteomyelitis in Children admitted from developing countries. Afr J Paediatr Surg. 2014;11(4):297- 303. DOI: 10.4103/0189-6725.143133 PMID:25323177
Sukswai P, Kovitvanitcha D, Thumkunanon V, Chotpitayasunondh T, Sangtawesin V, Jeerathanyasakun Y. Acute Haematogenous Osteomyelitis and Septic arthritis in Children: Clinical characteristics and outcomes study. J Med Assoc Thai. 2011:94(suppl3):S209-S16. PMID: 22043778
Gerber JS, Coffin SE. Smathers SA, Zaoutis TE. Trends in the incidence of methicillin-resistant Staphylococcus aureus infection in children’s hospitals in the United States. Clin. Infect. Dis. 2009;49(1):65-71. DOI: 10.1086/599348 PMID: 19463065 PMCID: PMC2897056
Kremers HM, Nwojo ME, Ransom JE, Wood-Wentz CM, Melton LJ 3rd, Huddleston PM 3rd. Trends in the epidemiology of Osteomyelitis: a population based study, 1969 to 2009. J Bone Joint Surg Am. 2015;97(10):837-845. DOI:10.2106/JBJS.N.01350
Bauer T, Lhotellier L, Mamoudy P, Lortat-Jacob A. Infection osseuse sur os continuau niveau du member inferieur: a propos de 127 cas [Infection on continuous bone of lower limb: 127 cases]. Rev Chir Orthop Reparatrice Appar Mot. French. 2007;93(8):807-17. DOI: 10.1016/s0035-1040(07)78464-7 PMID: 18166953
Peltola H. Worldwidw Haemophilus influenza Type b Disease at the Beginning of the 21st century: Global analysis of the Disease Burden 25years after the use of the polysaccharide vaccine and a Decade after the Advent of Conjugates. Clin Microbiol Rev. 2000;13(2):302-317. DOI: 10.1128/cmr.13.2.302- 317.2000 PMCID: PMC100154 PMID: 10756001
Ebong WW. Acute Osteomyelitis in Nigerians with Sickle cell disease. Ann Rheum Dis. 1986;45(11):911-5. DOI: 10.1136/ard.45.11.911 PMID:3789826 PMCID: PMC1002018
Adeyokunnu AA, Hendrickse RG. Salmonella Osteomyelitis in Childhood. A report of 63 cases seen in Nigerian Children of whom 57 had Sickle cell anaemia. Arch Dis Child. 1980;55(3):175-84. DOI: 10.1136/adc.55.3.175 PMID: 7387161 PMCID: PMC1626764
Yagupsky P, Dagan R, Howard CW, Einhorn M, Kassis I, Simu A. High prevalence of Kingella kingae in joint fluid from children with septic arthritis revbealed by the BACTEC blood culture system. J Clin Microbiol. 1992;30:1278-81 [PMC free article] [PubMed] [Google scholar].
Yagupsky P. Outbreaks of of Kingella kingae Infections in Daycare Facilities. Emerg Infect Dis. 2014;20(5):746-53. DOI: 10.3201/eid 2005. 131633 PMID: 24750782 PMCID: PMC4012814
Ilharreborde B, Bidet P, Lorrot M, Even J, Mariani- Kurkdjian P, Ligouri S, Vitoux C, Lefevre Y, Doit C, Fitoussi F, Pennecot G, Bingen E, Mazda K, Bonacorsi S. New realtime PCR-based method for Kingella kingae DNA detection: application to samples collected from 89 children with acute arthritis. J Clin Microbiol. 2009;47(6):1837-41. DOI: 10.1128/JCM.00144-09.Epub 2009 Apr 15. Erratum in: J Clin Microbiol. 2009;47(9):3071. PMID: 19369442 PMCID: PMC2691089
Basmaci R, Yagupsky P, Ilharreborde B, Guyot K, Porat N, Chomton M, Thiberge JM, Mazda K, Bingen E, Bonacorsi S, Bidet P. Multilocus sequence typing and rtx A toxin gene sequencing analysis of Kingella kingae isolates demonstrates genetic diversity and international clones. PLoS One. 2012;7(5):e38078. DOI:10.1371/journal.pone.0038078. Epub 2012 May 31. PMID: 2269358 PMCID: PMC3365011
Lehours P, Freydiere AM, Richer O, Burucoa C, Boisset S, Lanotte P, Prere MF, Ferroni A, Lafuente C, Vandenesch F, Megraud F, Menard A. The rtx A toxin gene of Kingella kingae: a pertinent target for molecular diagnosis of osteoarticular infections. J Clin Microbiol. 2011;49:1245-50. DOI: 10.1128/JCM.01657-10 PMCID: PMC3122863 PMID: 21248099
Brischetto A, Leung G, Marshall CS, Bowen AC. A Retrospective Case-series of Children with Bone and Joint Infection from Northern Australia. Medicine. 2016;95(8):e2885. DOI: 10.1097/MD 0000000000002885 PMCID: PMC4779023 PMID: 26937926
Riise AER, Kirkhus E, Handeland KS, Flato B, Wathne KO. Childhood osteomyelitis – incidence and differentiation from other acute onset musculoskeletal features in a population-based study. BMC Pediatr. 2008;8:45. DOI: 10.1186/1471-2431-8-45 PMID: 18937840 PMCID: PMC2588573
Blyth MJ, Kincaid R, Craigen MA, Bennet GC. The changing epidemiology of acute and subacute haematogenous osteomyelitis in children. J Bone Joint Surg Br. 2001;83(1):99-102. DOI: 10.1302/0301- 620x.83b1.10699 PMID: 11245548
Dartnell J, Ramachandran M, Katchburian M. Haematogenous acute and subacute paediatric osteomyelitis: a systematic review of the literature. J Bone Joint Surg Br. 2012;94(5):584-595. DOI: 10.1302/0301-620X.94B5.28523 PMID: 22529075
Okubo Y, Nochioka K, Testa M. Nationwide survey of pediatric acute osteomyelitis in the USA. J Pediatr Orthop B. 2017;26(6):501-506. DOI:10.1097/BPB0000000000000441 PMID: 28230612
Eyichukwu GO, Anyaehie UE. Outcome of management of chronic osteomyelitis at National Orthopaedic Hospital Enugu. Niger J Med. 2009;18(2):194-8. DOI: 10.4314/njm.v18i245064 PMID:19630329
Ikpeme IA, Ngim NE, Ikpeme AA. Diagnosis and treatment of pyogenic bone infections. Afr Health Sci. 2010:10(1):82-8. PMID: 20811530. PMCID: PMC 2895795
Daoud A, Saighi-Bouaouina A. Treatment of sequestra, pseudoarthroses, and defects in the long bones of Children who have Chronic haematogenous Osteomyelitis. J Bone Joint Surg Am. 1989;71(10):1448-68. PMID: 2592386
Atijosan O, Rischewski D, Simms V, Kuper H, Linganwa B, Nuhi A, Foster A, Lavy C. A national survey of musculoskeletal impairement in Rwanda: prevalence, causes and service implications. PLoS One. 2008;3(7):e2851. DOI: 10.1371/journal.pone.0002851 PMID: 18682849;PMCID: PMC2483936
Jones HW, Beckles VLL, Akinola B, Stevenson AJ, Harrison WJ. Chronic haematogenous osteomyelitis. J Bone Joint Surg Br. 2011;93-B(8):1005-1010. DOI:10.1302/0301-620X.93B8.25954.
Onche I.I, Obiano SK.Chronic Osteomyelitis of Long Bones: Reasons for delay in presentation. Niger J Med. 2004;13(4):355-358.
Malcius D, Jonkus M, Kuprionis G, Maleckas A, Monastyreckiene E, Uktveris R, Rinkevicius S, Barauskas V. The accuracy of different imaging techniques in diagnosis of acute hematogenous ostyeomyelitis. Medicina (Kaunas). 2009;45(8): 624-31. PMID: 19773621
Thomsen I, Creech CB. Advances in the Diagnosis and Management of Pediatric Osteomyelitis. Curr Infect Dis Rep. 2011;13:451. Available: https://doi.org/10.1007/s11908- 011-0202-z
Facts Sheets- Malnutrition-World Health Organization; 2020. Available: www.who.int/news-room/fact-sheets/detail/malnutrition.Accessed on October 29th 2020.
Igbedoh SO. Undernutrition in Nigeria: dimension, causes and remedies for alleviation in a changing Socio-economic environment. Nutr. Health. 1993;9(1):1-14. DOI:10.1177/026010609300900101. PMID : 8414269
Nigeria: Nutrition Profile; 2018. Available: www.usaid.gov Accessed on October 29th 2020
Ali AM, Maya E, Lakhoo K. Challenges in managing paediatric osteomyelitis in the developing world: analysis of cases presenting to a tertiary referral centre in Tanzania. Afr J Paediatr Surg. 2014;11(4):308-11. DOI:10.4103/0189-6725.143136 PMID: 25323179
Stanley CM, Rutherford GW, Morshed S, Coughlin RR, Beyeza T. Estimating the healthcare burden of osteomyelitis in Uganda. Trans R Soc Trop Med Hyg. 2010;104(2):139-142. DOI:10.1016/j.trstmh.2009.05.014
Ibingira CB. Chronic osteomyelitis in a Ugandan rural setting. East Afr Med J. 2003;80(5):242-6. DOI: 10.4314/eamj. v 80 i5.8694 PMID: 16167739
Harris AM, Bramley AM, Jain S, Arnold SR, Ampofo K Self WH et al. Influence of Antibiotics on the Detection of Bacteria by Culture-Based and Culture-Independent Diagnostic Tests in Patients Hospitalized With Community-Acquired Pneumonia. Open Forum Infect Dis; 2017. DOI: 10.1093/ofid/ofx014 PMCID: PMC5414111. PMID: 28480285