Skip to main content

Advertisement

SpringerLink
Log in

Primary subacute epiphyseal osteomyelitis caused by Mycobacterium species in young children: a modern diagnostic approach

  • Review
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ceroni D, Belaieff W, Cherkaoui A et al (2014) Primary epiphyseal or apophyseal subacute osteomyelitis in the pediatric population: a report of fourteen cases and a systematic review of the literature. J Bone Joint Surg Am 96:1570–1575

    Article  PubMed  Google Scholar 

  2. Brookes M (1958) The vascularization of long bones in the human foetus. J Anat 92:261–267

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Yoo WJ, Choi IH, Yun YH et al (2014) Primary epiphyseal osteomyelitis caused by mycobacterium species in otherwise healthy toddlers. J Bone Joint Surg Am 96:e145

    Article  PubMed  Google Scholar 

  4. Held M, Laubscher M, Mears S et al (2016) Diagnostic accuracy of the Xpert MTB/RIF assay for extrapulmonary tuberculosis in children with musculoskeletal infections. Pediatr Infect Dis J 35:1165–1168

    Article  PubMed  Google Scholar 

  5. Pommelet V, Vincent QB, Ardant MF et al (2014) Findings in patients from Benin with osteomyelitis and polymerase chain reaction-confirmed Mycobacterium ulcerans infection. Clin Infect Dis 59:1256–1264

    Article  PubMed  Google Scholar 

  6. Lee AS, Campbell JA, Hoffman EB (1995) Tuberculosis of the knee in children. J Bone Joint Surg (Br) 77:313–318

    Article  CAS  Google Scholar 

  7. Newton SM, Brent AJ, Anderson S et al (2008) Paediatric tuberculosis. Lancet Infect Dis 8:498–510

    Article  PubMed  Google Scholar 

  8. Tebruegge M, Ritz N, Curtis N et al (2015) Diagnostic tests for childhood tuberculosis: past imperfect, present tense and future perfect. Pediatr Infect Dis J 34:1014–1019

    Article  PubMed  Google Scholar 

  9. Yagupsky P (2004) Kingella kingae: from medical rarity to an emerging paediatric pathogen. Lancet Infect Dis 4:358–367

    Article  PubMed  Google Scholar 

  10. Levy PY, Fournier PE, Fenollar F et al (2013) Systematic PCR detection in culture-negative osteoarticular infections. Am J Med 126:1143.e25–e33

    Article  CAS  Google Scholar 

  11. Bergdahl S, Felländer M, Robertson B (1976) BCG osteomyelitis: experience in the Stockholm region over the years 1961-1974. J Bone Joint Surg (Br) 58:212–216

    CAS  Google Scholar 

  12. Cheung JP, Ho KW, Lam YL et al (2012) Unusual presentations of osteoarticular tuberculosis in two paediatric patients. BMJ Case Rep 2012; doi:10.1136/bcr-2012-006714

  13. Chen SC, Huang SC, Wu CT (1998) Nonspinal tuberculous osteomyelitis in children. J Formos Med Assoc 97:26–31

    CAS  PubMed  Google Scholar 

  14. Ohtera K, Kura H, Yamashita T et al (2007) Long-term follow-up of tuberculosis of the proximal part of the tibia involving the growth plate. A case report. J Bone Joint Surg Am 89:399–403

    Article  PubMed  Google Scholar 

  15. González Herranz J, Farrington DM, Angulo Gutiérrez J et al (1997) Peripheral osteoarticular tuberculosis in children: tumor-like bone lesions. J Pediatr Orthop B 6:274–282

    Article  PubMed  Google Scholar 

  16. Kant KS, Agarwal A, Suri T et al (2014) Tuberculosis of knee region in children: a series of eight cases. Trop Doct 44:29–32

    Article  PubMed  Google Scholar 

  17. Dodd PJ, Gardiner E, Coghlan R et al (2014) Burden of childhood tuberculosis in 22 high-burden countries: a mathematical modelling study. Lancet Glob Health 2:e453–e459

    Article  PubMed  Google Scholar 

  18. Abel L, El-Baghdadi J, Bousfiha AA et al (2014) Human genetics of tuberculosis: a long and winding road. Philos Trans R Soc Lond B Biol Sci 369:20130428

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gardner DJ, Azouz EM (1988) Solitary lucent epiphyseal lesions in children. Skeletal Radiol 17:497–504

    Article  CAS  PubMed  Google Scholar 

  20. Sailhan F, Chotel F, Parot R, SOFOP (2009) Chondroblastoma of bone in a pediatric population. J Bone Joint Surg Am 91:2159–2168

    Article  PubMed  Google Scholar 

  21. Rockberg J, Bach BA, Amelio J et al (2015) Incidence trends in the diagnosis of giant cell tumor of bone in Sweden since 1958. J Bone Joint Surg Am 97:1756–1766

    Article  PubMed  Google Scholar 

  22. Boisson-Dupuis S, Bustamante J, El-Baghdadi J et al (2015) Inherited and acquired immunodeficiencies underlying tuberculosis in childhood. Immunol Rev 264:103–120

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Bustamente J, Boisson-Dupuis S, Abel L et al (2014) Mendelian susceptibility to mycobacterial disease: genetic, immunological, and clinical features of in-borne errors of IFN-γ immunity. Semin Immunol 26:454–470

    Article  Google Scholar 

  24. Bousfiha AA, Jeddane L, Ailal F et al (2013) Primary immunodeficiency diseases worldwide: more common than generally thought. J Clin Immunol 33:1–7

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We acknowledge Dr Won Joon Yoo (MD) from the Division of Pediatric Orthopedics, Seoul National University Children’s Hospital, Seoul, South Korea, Dr Jason Pui Yin Cheung (MD) from the Department of Orthopedics and Traumatology, Queen Mary Hospital, Hong Kong, China, and Dr Kumar Shashikant (MS) from the Department of Pediatric Orthopedics, Chacha Nehru Bal Chikitsalaya, Delhi, India, for sharing personal data. We thank Dr Laurent Abel (MD, PhD) from the Laboratory of Human Genetics of Infectious Diseases, Necker Medical School, Paris, France, for his helpful comments.

Author information

Authors and Affiliations

  1. 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

    N. El Houmami, H. Seligmann, D. Raoult & P.-E. Fournier

  2. Department of Pediatric Orthopedics, University La Timone Children’s Hospital, Aix-Marseille University, Marseille, France

    N. El Houmami & J.-L. Jouve

  3. Department of Pediatric Emergency Medicine, University North Hospital, APHM Public Hospitals, Aix-Marseille University, Marseille, France

    P. Minodier

  4. Department of Pathology, University La Timone Hospital, APHM Public Hospitals, Aix-Marseille University, Marseille, France

    C. Bouvier

Authors
  1. N. El Houmami
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Minodier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Bouvier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Seligmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J.-L. Jouve
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. Raoult
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P.-E. Fournier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. El Houmami.

Ethics declarations

Funding

The Méditerranée Infection Foundation funded this work. We also thank the support of the A*MIDEX project (number ANR-11-IDEX-0001-02) and the French National Research Agency.

Conflicts of interest

The authors have no conflicts of interest to disclose.

Informed consent

Informed consent was obtained from child’s parents by our Institution.

Financial disclosure

The authors have no relevant financial relationships to disclose regarding this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

El Houmami, N., Minodier, P., Bouvier, C. et al. Primary subacute epiphyseal osteomyelitis caused by Mycobacterium species in young children: a modern diagnostic approach. Eur J Clin Microbiol Infect Dis 36, 771–777 (2017). https://doi.org/10.1007/s10096-016-2886-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-016-2886-3

Keywords

Search

Navigation