1. Pediatrics Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE
2. Radiology Department, Hospital de São José, Centro Hospitalar de Lisboa Central, EPE
3. Orthopaedics Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE
4. Hematology Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE
5. Infeccious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE
- Excellence in Pediatrics, 8-10 dezembro 2016, Londres (Comunicação Oral)
Introduction: Children with sickle cell disease (SCD) are at risk of bone infarcts and also of bone infections (BI). The clinical differentiation between a bone infarct and BI is often a diagnostic challenge. Although the two entities bear remarkable similarities to one another, the management and outcomes are quite different.
Purpose: Analyse the diagnosis, management and outcome of patients with SCD admitted in our hospital with BI.
Materials and Methods: Retrospective and descriptive study. We retrospectively reviewed the records of all children with SCD admitted in our hospital in the last 6 years, with definitive diagnosis of acute or chronic osteomyelitis and/or septic arthritis and analysed demographic data including symptoms at presentation, analytical, radiological and treatment data.
Results: We identified 12 patients, 10 with acute infections and 2 with chronic osteomyelitis. Patients with acute infections, 6 boys and 4 girls, had a median age at first episode of 7 years (minimum 9 months, maximum 14 years), 2 patients with septic arthritis, 5 with osteomyelitis (1 with 2 episodes) and 3 with septic arthritis and osteomyelitis. All patients had pain, 63,6% (n=7) had fever and 63,6% (n=7) inflammatory signs. Median duration of endovenous (ev) antibiotic treatment was 26 days, median time of total antibiotic treatment was 6,7 weeks and 5 cases needed surgery. The median gap between initial symptoms and diagnosis was 11,5 days. Most patients (63%) were treated with cefotaxime (63%) plus gentamicin (100%). Pathogens were isolated in 2 cases: Serratia marcescens and Enterococcus faecium. MRI was performed in 10 cases and ultrasonography in 8 cases. Two patients later developed chronic osteomyelitis. We also report 2 patients with chronic osteomyelitis at time of first admittance with median ev antibiotic treatment duration of 153 days, total antibiotic treatment of 18,4 weeks and both underwent surgery. The most commonly affected bones were femur (n=4) and tibia (n=4) followed by lumbar and dorsal vertebra (n=3). The most affected joints were hip (n=2) and elbow (n=2). Three patients remain with lower limb dysmetria. The median follow-up time was 2,5 years.
Conclusions: Timely diagnosis and appropriate treatment are the paramount to minimizing complications in BI however it’s often challenging to differentiate these two entities from a clinical and radiological point of view. Total antibiotic duration regimens still remain controversial since data is still lacking for children with BI.
Palavras-chave: Anemia células falciformes, artrite séptica, osteomielite.