The microbiome mediates epiphyseal bone loss and metabolomic changes after acute joint trauma in mice.

OBJECTIVE: To compare the early responses to joint injury in conventional and germ-free mice. DESIGN: Post-traumatic osteoarthritis (PTOA) was induced using a non-invasive anterior cruciate ligament rupture model in 20-week old germ-free (GF) and conventional C57BL/6 mice. Injury was induced in the left knees of n = 8 GF and n = 10 conventional mice. To examine the effects of injury, n = 5 GF and n = 9 conventional naïve control mice were used. Mice were euthanized 7 days post-injury, followed by synovial fluid recovery for global metabolomic profiling and analysis of epiphyseal trabecular bone by micro-computed tomography (µCT). Global metabolomic profiling assessed metabolic differences in the joint response to injury between GF and conventional mice. Magnitude of trabecular bone volume loss measured using µCT assessed early OA progression in GF and conventional mice. RESULTS: µCT found that GF mice had significantly less trabecular bone loss compared to conventional mice, indicating that the GF status was protective against early OA changes in bone structure. Global metabolomic profiling showed that conventional mice had greater variability in their metabolic response to injury, and a more distinct joint metabolome compared to their corresponding controls. Furthermore, differences in the response to injury in GF compared to conventional mice were linked to mouse metabolic pathways that regulate inflammation associated with the innate immune system. CONCLUSIONS: These results suggest that the gut microbiota promote the development of PTOA during the acute phase following joint trauma possibly through the regulation of the innate immune system.

Physeal separation in pediatric osteomyelitis.

In children, acute osteomyelitis, an infection of the bone, is most commonly hematogeneous in origin. Osteomyelitis is most often diagnosed with magnetic resonance imaging (MRI) and findings may include marrow signal changes on T1 and T2, with abnormal enhancement after gadolinium. Imaging helps detect any associated intraosseous or subperiosteal abscesses, which may require orthopedic drainage. In this pictorial essay, we demonstrate the association of acute pediatric osteomyelitis with physeal separation, resulting in what may be confused for simple trauma, although there was no known history of trauma in any of the cases we researched. All of the cases had a large subperiosteal fluid collection with marked separation of the epiphysis from the metaphysis. It is important to recognize this potential association in osteomyelitis, as it is readily visible by radiographs and may lead to diagnostic uncertainty.

Brodie abscess of the femoral capital epiphysis in a 2-year-old child caused by Kingella kingae.

We report the case of a Brodie abscess of the femoral capital epiphysis from which Kingella kingae was isolated. This is to the best of our knowledge the first report of a Brodie abscess of the femoral capital epiphysis from which K. kingae was isolated.

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

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.

Fusobacterium nucleatum Osteomyelitis in 3 Previously Healthy Children: A Case Series and Review of the Literature.

Fusobacterium nucleatum is a rare cause of monomicrobial osteomyelitis in children. We describe the cases of 3 children with F. nucleatum osteomyelitis of the distal femoral epiphysis with concurrent septic arthritis and review 6 other cases reported in the literature. Our report emphasizes the importance of maintaining a high index of suspicion for anaerobic osteomyelitis, given its atypical presentation and the unique growth requirements of anaerobic bacteria.

Primary epiphyseal osteomyelitis caused by mycobacterium species in otherwise healthy toddlers.

BACKGROUND: Mycobacterial osteomyelitis involving only the epiphysis of a long bone is extremely rare, and its clinical and radiographic features remain unclear. The purpose of this study was to characterize mycobacterial epiphyseal osteomyelitis and to identify differences between its features and those reported for epiphyseal osteomyelitis caused by bacteria or unidentified pathogens. METHODS: We retrospectively reviewed the cases of eight children (five males and three females) who presented at a median age of nineteen months (range, twelve to twenty-five months). Clinical findings were compiled. Radiographs and magnetic resonance imaging (MRI) were used to determine local spread of the abscess outside the epiphysis during the disease course. At the time of the latest follow-up evaluation, the presence of limited joint mobility or growth disturbance was determined. Physeal damage was evaluated with use of MRI. RESULTS: Pathogens were identified through multiplex polymerase chain reaction. Mycobacterium bovis bacille Calmette-Guérin (BCG, Tokyo-172 strain) was identified in four patients; Mycobacterium tuberculosis, in three patients; and nontuberculous mycobacterium, in one patient. The lesion was located at the distal femoral epiphysis in six patients, at the proximal tibial epiphysis in one patient, and at the proximal humeral epiphysis in one patient. The abscess was confined to the epiphysis at the time of initial presentation but, over time, extended outside the epiphysis in seven cases. The lesion was initially located in the cartilaginous epiphysis in two patients, which could be diagnosed only on MRI. Seven patients worsened despite surgical drainage and medication, and five required additional surgery. At follow-up at a mean of 4.1 years (range, 1.3 to 7.8 years), focal physeal damage was evident in five patients, and clinical growth disturbance was evident in one patient. CONCLUSIONS: In contrast to the reported benign features of epiphyseal osteomyelitis caused by bacteria or unidentified pathogens, mycobacterial epiphyseal osteomyelitis seems to have an unfavorable clinical course that tends to lead to physeal damage. MRI is useful for early diagnosis of a cartilaginous lesion and evaluation of abscess spread and physeal damage. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Acute haematogenous osteomyelitis in children: is there any evidence for how long we should treat?

PURPOSE OF REVIEW: Despite diagnostic and therapeutic advances, acute haematogenous osteomyelitis in children continues to cause significant morbidity and disease burden. The molecular epidemiology of causal organisms has wide geographic variation, but regardless of cause children often require several weeks of inpatient parenteral antibiotic therapy. This review focuses on antibiotic treatment and length of antibiotic therapy. RECENT FINDINGS: Currently there is no international and little local consensus regarding the route or duration for antibiotic treatment of acute haematogenous osteomyelitis in children. Although there are encouraging data from review papers and case series, no randomized controlled trial has been conducted to show good evidence for shorter courses of parenteral antibiotic treatment. Prospective studies show effective treatment for a wide variety of antibiotic agents, but there are few comparative studies. Overall treatment for 4-6 weeks is considered standard therapy, but the laboratory or clinical parameters that would determine the decision to switch to oral therapy remain undefined. SUMMARY: Evidence-based data about the route and duration of intravenous antibiotic treatment for acute haematogenous osteomyelitis in children are still limited to observational and retrospective studies. A randomized controlled trial will provide much needed data.

Treatment of acute salmonella epiphyseal osteomyelitis using computed tomography-guided drainage in a child without sickle cell disease.

Salmonella osteomyelitis occurs infrequently in children without sickle cell disease. Similarly, acute osteomyelitis of the epiphysis has been rarely reported. We present a case of primary epiphyseal osteomyelitis caused by Salmonella in the distal femur of an otherwise healthy 17-month-old child. Before isolating an organism, parenteral nafcillin provided ineffective clinical, radiographic, and laboratory responses. Repeated fluoroscopic-guided percutaneous surgical drainages allowed for identification of the Salmonella, but did not resolve the epiphyseal infection, as the infection focus was missed. In the effort to eradicate the infection yet minimize further trauma to the epiphysis, computed tomography-guided drainage was performed and the infection subsequently resolved. Owing to its greater localization accuracy and minimal invasiveness, the computed tomography-guided intervention allowed for precise drainage without compromising the contiguous growth plate. At latest follow-up, the patient was ambulating well, had a normal knee examination, and had no evidence of leg length discrepancy or growth disturbance.

Atypical mycobacterial granulomatous epiphyseal osteomyelitis in an immunocompetent child.

Osteomyelitis caused by atypical mycobacteria is rare in children. The majority of affected patients have had some kind of predisposing factor, namely a penetrating injury or surgery, or were immune-compromised. Our experience shows that this diagnosis should be considered in apparently healthy children as well. The use of polymerase chain reaction has now made it possible to identify the pathogen in cases that were previously diagnosed as granulomatous osteomyelitis. We present a case of atypical mycobacterial osteomyelitis affecting the distal femoral epiphysis in an immunocompetent 10-year-old child. The diagnosis in this case was made by the use of the polymerase chain reaction assay.

Análise microbiológica de ossos de cäes conservados por longo período de tempo na glicerina a 98 por cento à temperatura ambiente, objetivando a enxertia óssea / Microbiology analysis of dog bones stocked for long period of time on glycerin 98 percent at room temperature, aiming allograft bone surgery

Objetivo: Verificar crescimento de microorganismos em amostras de glicerina e ossos armazenados durante nove anos. Métodos: Realizou-se a análise microbiológica da epífise e da medula de ossos conservados na glicerina a 98 por cento, bem como da própria glicerina que os contêm. Resultado: O crescimento microbiano observado não foi estatisticamente significante. Conclusão: A glicerina é um excelente meio para conservação de tecido ósseo por longo período de tempo.