ABSTRACT
Introdução: A saúde bucal é um aspecto que não deve ser subestimado pelos pacientes, principalmente se considerar que as infecções odontogênicas podem levar a quadros graves, incluindo complicações cervicotorácicas, como Mediastinite e cervicofaciais, como Angina de Ludwig. Para tanto, é imprescindível que os profissionais da odontologia saibam reconhecer os principais sinais e sintomas dessas infecções, sua evolução, conhecer as complicações associadas e qual o manejo adequado. Objetivo: Assim, é objetivo deste trabalho, relatar, discutir um caso clínico de uma infecção odontogênica grave que acarretou em complicação cervical, com trajeto em direção ao mediastino, necessitando manejo multidisciplinar, e explorar os principais aspectos desse quadro e a conduta necessária, que exige, no mínimo, intervenção cirúrgica, antibioticoterapia e manutenção das vias aéreas. Relato de caso: O caso trata de um paciente com infecção odontogênica, iniciada como uma pericoronarite do dente 38 semieruptado, que evoluiu para a área cervical, demandando imediata drenagem nesta região pois encaminhava-se para uma mediastinite. Após a drenagem cervical e antibioticoterapia e, assim que houve redução do trismo, foi removido o dente 38, evoluindo para a cura.Conclusões:As infecções odontogênicas, principalmente as que acometem os espaços fasciais e cervicais profundos, são potencialmente graves e devem ter suas principais manifestações clínicas entre os domínios de conhecimento dos profissionais Bucomaxilofaciais, pois necessitam de diagnóstico preciso, manejo rápido e tratamento adequado e precoce, considerando a velocidade com que podem evoluir (AU).
Introduction: Oral healthis an aspect that should not be underestimated by patients, especially considering that dental infections can lead to serious symptoms, including cervicothoracic complications, such as Mediastinitis and cervicofacial complications, such as Ludwig's Angina. Therefore, it is essential that dental professionals know how to recognize the main signs and symptoms of these infections, their evolution, know the associated complications and appropriate management.Objective: Thus, this work aims to report and discuss a clinical case of a serious odontogenic infection that resulted in a cervical complication, with a path towards the mediastinum, requiring multidisciplinary management, and to explore the main aspects of this condition and the necessary conduct, which requires, at least, surgical intervention, antibiotic therapy and airway maintenance.Case report: The case concerns a patient with odontogenic infection, which began as pericoronitis of semi-erupted tooth 38, which progressed to the cervical area, requiring immediate drainage in this region as it was heading towards mediastinitis. After cervical drainage and antibiotic therapy and, as soon as the trismus was reduced, tooth 38 was removed, progressing towards healing.Conclusions: Odontogenic infections, especially those that affect the fascial and deep cervical spaces, are potentially serious and should have their main clinical manifestations among the domains of knowledge ofOral and Maxillofacial professionals, as they require accurate diagnosis, rapid management and adequate and early treatment, considering the speed at which they can evolve (AU).
Introducción: La salud bucal es un aspecto que los pacientes no deben subestimar, especialmente considerando que las infecciones odontógenas pueden derivar en afecciones graves, incluidas complicaciones cervicotorácicas, como la mediastinitis, y complicaciones cervicofaciales, como la angina de Ludwig.Para ello, es fundamental que los profesionales odontológicos sepan reconocer las principales señalesy síntomas de estas infecciones, su evolución, conocer las complicaciones asociadas y el manejo adecuado.Objetivo: Así,el objetivo de este trabajo es reportar y discutir un caso clínico de infección odontogénica grave que resultó en una complicación cervical, con trayecto hacia el mediastino, que requirió manejo multidisciplinario, y explorar los principales aspectos de esta condicióny las medidas necesarias, que requiere, como mínimo, intervención quirúrgica, terapia con antibióticos y mantenimiento de las vías respiratorias.Reporte de caso: El caso se trata de un paciente con una infección odontogénica, que comenzó como pericoronaritis del diente 38 semi-erupcionado, la cual progresó hacia la zona cervical, requiriendo drenaje inmediato en esta región ya que se encaminaba para una mediastinitis.Después del drenaje cervical y la terapia antibiótica y, una vez reducido el trismo, se extrajo el diente 38, evolucijjonando hacia la cura.Conclusiones: Las infecciones odontogénicas, especialmente aquellas que afectan los espacios fasciales y cervicales profundos, son potencialmente graves y deben tener sus principales manifestaciones clínicas entre los dominios del conocimiento de los profesionales Orales y Maxilofaciales, pues requieren de un diagnóstico certero, un manejo rápido y un tratamiento adecuado y temprano, considerando la velocidad a la que pueden evolucionar (AU).
Subject(s)
Humans , Male , Adult , Drainage/instrumentation , Infection Control, Dental , Ludwig's Angina/pathology , Mediastinitis , Osteomyelitis , Radiography, Dental/instrumentation , Tomography, X-Ray Computed/instrumentation , Oral and Maxillofacial SurgeonsABSTRACT
Introducción: La osteomielitis es una infección ósea, que afecta con frecuencia a pacientes en edades pediátricas, con comportamiento variado en dependencia de la vía de llegada al hueso, tipo de germen y respuesta del huésped. Objetivo: Describir el comportamiento de un grupo de pacientes pediátricos con osteomielitis. Método: Se realizó estudio observacional descriptivo en 39 pacientes atendidos en el Hospital Pediátrico Provincial Dr. Eduardo Agramonte Piña de la ciudad de Camagüey, en el periodo comprendido desde el primero de enero de 2018 al 31 de diciembre del año 2022, y un total de 60 meses con diagnóstico de osteomielitis. Resultados: De los 39 pacientes investigados predominó el sexo masculino sobre el femenino (2,2:1). La edad promedio fue de 9 años. El promedio de estadía hospitalaria fue de 14,8 días. Las zonas más afectadas fueron las manos, el fémur y tibia distal. Predominó el tratamiento quirúrgico (2,2:1) con relación al conservador. La vía hematógena de llegada al hueso fue la más frecuente en el 86,4 porciento de los casos. El paso a la cronicidad fue la complicación más encontrada (el 33 porciento). El germen aislado con mayor frecuencia fue el Staphylococcus aureus(en el 85 porciento de los enfermos). Los antimicrobianos más indicados fueron la cefazolina, amikacina y fosfocina. Conclusiones: Los resultados obtenidos en la investigación aportan elementos importantes desde el punto de vista epidemiológico en pacientes pediátricos que sufren de osteomielitis, lo que permite implementar estrategias de diagnósticas y terapéuticas en este grupo de pacientes.(AU)
Introduction: Osteomyelitis is an infection in the bone, most frequently affecting patients in pediatric ages, with a variety of behavior on how to reach the bone, type of germ and host response. Objective: To describe the behavior of a group of pediatric patients affected with osteomyelitis. Method: A descriptive observational study was conducted in 39 patients attended at the Hospital Provincial Pediátrico Dr. Eduardo Agramonte Piña in the city of Camagüey, from January 1 2018 to December 31 2022. Patients diagnosed with osteomyelitis throughout 60 months in total. Results: Of the 39 patients studied, the male sex predominated over the female (2.2 to 1). The average age was 9 years old. The average lenght of hospital stay was 14.8 days. The most affected areas were the hands, femur and distal tibia. Surgical treatment predominated (2.2 to 1) in relation to conservative treatment. In the 86.4 percent of cases, hematogenous osteomyelitis was the most frequent infection. The transition to chronic osteomyelitis was the most common complication (33 percent). The most common isolated germ was staphylococcus aureus (in 85 percent of the patients). The most indicated antimicrobials agents were cefazolin, amikacin and fostomycin (Fosfocin). Conclusions: The results of this research provided some important elements base on the epidemiological point of view for pediatric patients with osteomyelitis, also allowed the implementation of diagnostic and therapeutic strategies in this group of patients.(AU)
Introdução: A osteomielite é uma infeção óssea, que afecta frequentemente afecta frequentemente doentes do grupo etário pediátrico, com um comportamento variado, dependendo da via de entrada no osso, do tipo de germe e da resposta do hospedeiro. Objectivo: Mostrar o comportamento de um grupo de doentes pediátricos com osteomielite. Método: Foi realizado um estudo observacional descritivo em 39 pacientes tratados no Hospital Pediátrico Provincial Dr. Eduardo Agramonte Piña, na cidade de Camagüey, no período de 1 de janeiro de 2018 a 31 de dezembro de 2022, e um total de 60 meses com diagnóstico de osteomielite. Resultados: Dos 39 pacientes investigados, o sexo masculino predominou sobre o feminino (2,2 para 1). A idade média foi de 9 anos. A média de permanência hospitalar foi de 14,8 dias. As regiões mais acometidas foram as mãos, o fêmur e a tíbia distal. O tratamento cirúrgico predominou (2,2 para 1) sobre o tratamento conservador. A via hematogénica para o osso foi a mais frequente em 86,4 porcento dos casos. A transição para a cronicidade é a complicação mais frequentemente encontrada (33 porcento). O germe mais frequentemente isolado foi o Staphylococcus aureus (em 85 porcento dos doentes). Os antimicrobianos mais frequentemente indicados foram a cefazolina, a amicacina e a fosfocina. Conclusões: Os resultados obtidos na pesquisa fornecem elementos importantes do ponto de vista epidemiológico em pacientes pediátricos portadores de osteomielite, permitindo a implementação de estratégias diagnósticas e terapêuticas neste grupo de pacientes.(AU)
Subject(s)
Humans , Male , Female , Child , Osteomyelitis/surgery , Osteomyelitis/therapy , Osteomyelitis/epidemiology , Pediatrics , Cross-Sectional StudiesABSTRACT
Introducción: la osteomielitis crónica no bacteriana (CNO) es una enfermedad autoinflamatoria ósea y se manifiesta con un amplio espectro clínico, presentándose con afectación monofocal o multifocal. Dado que no es siempre multifocal o recurrente, o ambas, fue propuesto que CNO se utilice como un término que comprenda a todas las presentaciones y la osteomielitis multifocal crónica recurrente (CRMO) se utilice para formas recurrentes y multifocales. Objetivo: presentar un caso clínico inédito, de baja prevalencia a nivel mundial, en una adolescente portadora de una enfermedad autoinflamatoria ósea que planteó desafíos diagnósticos y terapéuticos. Descripción: adolescente, mujer, 11 años, previamente sana que se presentó con dorso-lumbalgia invalidante de un mes de evolución, sin otra sintomatología asociada. Tras varias consultas en emergencia, ingresa a planta de internación pediátrica del Hospital Central de las Fuerzas Armadas (HCFFAA) en octubre de 2021. Resonancia nuclear magnética (RNM) de columna evidencia foco de edema óseo en cuerpo de T11, hemograma normal; VES 48 mm/h, ANA, anti-DNA, FR y HLA B27 negativos. Resultados: luego de descartar procesos infecciosos, oncohematológicos y una vez obtenido el resultado de una biopsia por punción ósea que evidenciaba elementos inflamatorios, se llegó al diagnóstico de CNO en el mes de febrero de 2022, tiempo récord comparando este caso con la literatura internacional. El diagnóstico de esta entidad clínica promedio a nivel mundial es de 12 meses.
Introduction: chronic Non-Bacterial Osteomyelitis (CNO) is an autoinflammatory bone disease that presents a broad clinical spectrum with monofocal or multifocal involvement. Since it is not always multifocal and/or recurrent, it was proposed that CNO be used as a term that encompasses all presentations and Chronic Recurrent Multifocal Osteomyelitis (CRMO) for recurrent and multifocal forms. Objective: to present an unprecedented low prevalence clinical case of an adolescent carrier of an autoinflammatory bone disease that posed diagnostic and therapeutic challenges. Description: a previously healthy female adolescent, 11 years old presented disabling lower back pain for a month without other associated symptoms. After several emergency consultations, she was admitted to the pediatric hospitalization at the Armed Forces Hospital (HCFFAA) in October 2021. A spine MRI showed a T11 body bone edema focus, normal blood count; ESR 48 mm/h, ANA, Anti DNA, RF and negative HLA B27. Results: after ruling out infectious and oncohematological processes, and once the result of a bone puncture biopsy was obtained, which showed inflammatory elements, an ONC diagnosis was made in February 2022, a record time comparing this case with the international literature. The average diagnosis of this clinical condition worldwide is 12 months.
Introdução: a Osteomielite Crônica Não Bacteriana (CNO) é uma doença óssea autoinflamatória, manifestando-se com amplo espectro clínico, apresentando-se com acometimento monofocal ou multifocal. Como nem sempre é multifocal e/ou recorrente, foi proposto que CNO seja usado como um termo que engloba todas as apresentações e Osteomielite Multifocal Recorrente Crônica (OMC) e que seja usado para formas recorrentes e multifocais. Objetivo: apresentar um caso clínico inédito, de baixa prevalência mundial, no caso de uma adolescente portadora de uma doença óssea autoinflamatória que representou desafios diagnósticos e terapêuticos. Descrição: adolescente do sexo feminino, 11 anos, previamente saudável, apresentava há um mês dorso-lombalgia incapacitante sem outros sintomas associados. Após várias consultas de urgência, foi internada na enfermaria pediátrica do Hospital Central das Forças Armadas (HCFFAA) em outubro de 2021. RM da coluna mostra foco de edema ósseo no corpo de T11, hemograma normal; ESR 48 mm/h, ANA, Anti DNA, RF e HLA B27 negativos. Resultados: após a exclusão de processos infecciosos e onco-hematológicos e obtido o resultado de uma biópsia por punção óssea, que evidenciou elementos inflamatórios, o diagnóstico de CNO foi feito em fevereiro de 2022, tempo recorde comparando este caso com a literatura internacional. A média de diagnóstico dessa entidade clínica no mundo é de 12 meses.
Subject(s)
Humans , Female , Child , Osteomyelitis/diagnosis , Osteomyelitis/drug therapy , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Ketoprofen/administration & dosage , Methotrexate/administration & dosage , Chronic Disease , Immunomodulating Agents/administration & dosageABSTRACT
La osteomielitis (OM) se define como la inflamación ósea de origen infeccioso. La forma aguda es frecuente en la edad pediátrica. El absceso de Brodie es un tipo de osteomielitis subaguda, históricamente con baja incidencia, pero que actualmente se presenta un aumento de la misma. De poca repercusión clínica, con pruebas de laboratorio inespecíficas y estudios radiológicos de difícil interpretación, es crucial la sospecha diagnóstica. Se asemeja a procesos neoplásicos, benignos o malignos. Recae en la experiencia del profesional realizar el diagnóstico adecuado. El tratamiento consiste en antibioticoterapia, tanto parenteral como por vía oral, y eventualmente drenaje quirúrgico. Presentamos una paciente sana que consultó por una tumoración en topografía de clavícula izquierda de 3 meses de evolución. Se realizó diagnóstico de absceso de Brodie, inició tratamiento y se obtuvo una buena respuesta. Resulta imprescindible tener un alto índice de sospecha de esta entidad para no someter al paciente a estudios, pruebas invasivas o tratamientos erróneos, y evitar secuelas a futuro.
Osteomyelitis is defined as an inflammation of the bone caused by infection. Acute osteomyelitis is common in pediatrics. A Brodie abscess is a type of subacute osteomyelitis, with a historically low incidence; however, its incidence is currently increasing. Given its little clinical impact, with non-specific laboratory tests and radiological studies of difficult interpretation, diagnostic suspicion is crucial. It resembles neoplasms, either benign or malignant. An adequate diagnosis falls on the health care provider's experience. Treatment consists of antibiotics, both parenteral and oral, with potential surgical drainage. Here we describe the case of a healthy female patient with a tumor found in the topography of the left clavicle 3 months before. She was diagnosed with Brodie abscess; treatment was started with a good response. A high index of suspicion of Brodie abscess is critical to avoid invasive tests and studies or inadequate treatments, and to prevent future sequelae.
Subject(s)
Humans , Female , Child , Osteomyelitis/drug therapy , Osteomyelitis/therapy , Abscess/drug therapy , Clavicle , Disease Progression , Anti-Bacterial Agents/therapeutic useABSTRACT
Abstract Osteomyelitis is defined as the inflammation of the either medullary, cortical, or cancellous bone, including nerves and blood vessels, causing necrosis and bone sequestrum formation; this condition has become a rare pathology, and odontogenic infections are considered the most frequent causal factor. This case shows a patient with bi-maxillary osteomyelitis caused by Actinomyces spp, which was worsened for severe COVID-19 infection. Patient was submitted at surgery as, amplified total bilateral maxillectomy through the surgical technique Weber-Fergusson, and prolonged use of combination of antibiotics, achieved a good recovery. Two years later follow- up, the patient no show imaging or clinical evidence of the infection of osteomyelitis. The present case shows an interesting relationship between a rare infection and its association with COVID-19.
Resumen La osteomielitis se define como la inflamación del hueso medular, cortical o esponjoso, incluyendo nervios y vasos sanguíneos, causando necrosis y formación de secuestro óseo; esta condición es una patología rara, y las infecciones odontogénicas son consideradas como el factor causal más frecuente. En este caso, se muestra un paciente con osteomielitis bi-maxilar causada por Actinomyces spp, la cual empeoró por la infección de COVID-19 severo. El paciente fue sometido a una cirugía, maxilectomía bilateral total amplificada, a través de la técnica quirúrgica de Weber- Fergusson, y el uso prolongado de una combinación de antibióticos, logrando una buena recuperación. A los 2 años de seguimiento, el paciente no mostró evidencia clínica o imagenológica de la infección de osteomielitis. El presente caso muestra una interesante relación entre una infección rara y su asociación con COVID-19.
Subject(s)
Humans , Male , Middle Aged , Osteomyelitis/diagnostic imaging , Actinomycosis/drug therapy , Surgery, Oral , COVID-19ABSTRACT
La osteomielitis primaria de esternón es muy infrecuente en niños, con menos de 100 casos publicados hasta la actualidad. Su presentación clínica es a menudo inespecífica, lo que causa un retraso en el diagnóstico. Se presentan dos nuevos casos de osteomielitis primaria de esternón. Ambos referían un cuadro de fiebre, malestar general, dolor torácico y rechazo del decúbito, con eritema preesternal en uno de los casos. La velocidad de sedimentación globular y la proteína C-reactiva estaban elevadas en ambos casos. El diagnóstico se confirmó mediante estudios de imagen y en un caso se aisló Staphylococcus aureus sensible a meticilina en el hemocultivo. Ambos se recuperaron sin complicaciones con tratamiento antibiótico. Debe tenerse en cuenta la osteomielitis primaria de esternón en el diagnóstico diferencial del dolor torácico, especialmente si se acompaña de fiebre, signos inflamatorios locales, intolerancia al decúbito o elevación de reactantes de fase aguda.
Primary sternal osteomyelitis is very rare in children, with less than 100 cases published to date. Its clinical presentation is often non-specific, which results in a diagnostic delay. Here we describe 2 new cases of primary sternal osteomyelitis. Both referred fever, malaise, chest pain, and refusal to lie down, with pre-sternal erythema in one of the cases. The erythrocyte sedimentation rate and C-reactive protein values were high in both cases. The diagnosis was confirmed by imaging studies; methicillin-sensitive Staphylococcus aureus was isolated in the blood culture of one of them. Both recovered without complications with antibiotic treatment. Primary sternal osteomyelitis should be considered in the differential diagnosis of chest pain, especially if accompanied by fever, local inflammatory signs, intolerance to lying down, or increased acute phase reactants.
Subject(s)
Humans , Female , Infant , Child , Osteomyelitis/diagnosis , Osteomyelitis/drug therapy , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus aureus , Chest Pain/drug therapy , Delayed Diagnosis , Fever , Anti-Bacterial Agents/therapeutic useABSTRACT
Abstract Ewing sarcoma is the most common malignant bone tumor of the pelvis in children and young adults. Even with aggressive treatment, its survival rate is amongst the poorest. Classical presentation may not be the rule. It may simulate clinically, imagiologically and histopathologically other nonmalignant entities. Therefore, its suspicion should not be overlooked. We report two cases of pelvic Ewing sarcoma: the first mimicking eosinophilic granuloma, and the second mimicking osteomyelitis. In the latter, we also report an atypical finding of its natural history: an initial response to antibiotic and anti-inflammatory treatment. In both cases, we highlight the possibility of an inconclusive percutaneous bone biopsy and the importance of immunochemistry and cytogenetics for the definitive diagnosis.
Resumo O sarcoma de Ewing é o tumor ósseo maligno da pelve mais comum em crianças e adultos jovens. Mesmo com tratamento agressivo, sua taxa de sobrevivência está entre as piores. A apresentação clássica pode não ser a regra. Ele pode simular clinicamente, imaginologicamente e histopatologicamente outras entidades não malignas. Portanto, sua suspeita não deve ser negligenciada. Relatamos dois casos de sarcoma pélvico: o primeiro imitando granuloma eosinofílico e o segundo imitando osteomielite. Neste último, também relatamos um achado atípico de sua história natural: uma resposta inicial ao antibiótico e ao tratamento anti-inflamatório. Em ambos os casos, destacamos a possibilidade de uma biópsia óssea percutânea inconclusiva e a importância da imunoquímica e da citogenética para o diagnóstico definitivo.
Subject(s)
Humans , Male , Adult , Osteomyelitis , Pelvic Neoplasms , Sarcoma, Ewing , Anti-Inflammatory Agents, Non-Steroidal , Kimura DiseaseABSTRACT
Introduction. The identity of Staphylococcus aureus virulence factors involved in chronic osteomyelitis remains unresolved. SapS is a class C non-specific acid phosphatase and a well-known virulence factor that has been identified in S. aureus strain 154 but in protein extracts from rotting vegetables. Objective. To identify the SapS gene and characterize the activity of SapS from S. aureus strains: 12 isolates from bone infected samples of patients treated for chronic osteomyelitis and 49 from a database with in silico analysis of complete bacterial genomes. Materials and methods. The SapS gene was isolated and sequenced from 12 S. aureus clinical isolates and two reference strains; 49 S. aureus strains and 11 coagulase-negative staphylococci were tested using in silico PCR. Culture media semi-purified protein extracts from the clinical strains were assayed for phosphatase activity with p-nitro-phenyl- phosphate, O-phospho-L-tyrosine, O-phospho-L-serine, and OphosphoL-threonine in conjunction with various phosphatase inhibitors. Results. SapS was detected in the clinical and in-silico S. aureus strains, but not in the in silico coagulase-negative staphylococci strains. Sec-type I lipoprotein-type N-terminal signal peptide sequences; secreted proteins, and aspartate bipartite catalytic domains coding sequences were found in the SapS nucleotide and amino acid sequence analysis. SapS dephosphorylated with p-nitro-phenyl-phosphate and ophosphoLtyrosine were selectively resistant to tartrate and fluoride, but sensitive to vanadate and molybdate. Conclusion. SapS gene was found in the genome of the clinical isolates and the in silico S. aureus strains. SapS shares biochemical similarities with known virulent bacterial, such as protein tyrosine phosphatases, suggesting it may be a virulence factor in chronic osteomyelitis.
Introducción. Se desconoce la identidad de los factores de virulencia de Staphylococcus aureus implicados en la osteomielitis crónica. Sin embargo, SapS, una fosfatasa ácida no específica de clase C, es un factor de virulencia reconocido y ya fue identificada en la cepa 154 de S. aureus, pero en extractos proteicos de vegetales podridos. Objetivo. Detectar el gen SapS y caracterizar la actividad de la fosfatasa SapS en cepas de S. aureus aisladas de pacientes con osteomielitis crónica y en las reportadas en una base de datos de análisis in silico de genomas bacterianos completos. Materiales y métodos. Se aisló y secuenció el gen SapS en los 12 aislamientos clínicos de S. aureus y en dos cepas de referencia; estas secuencias se analizaron junto con las secuencias de las cepas reportadas en la base de datos de genomas bacterianos: 49 cepas de S. aureus y 11 cepas de estafilococos negativos para coagulasa. Se evalúo la actividad de la fosfatasa SapS, presente en los extractos de los sobrenadantes de los cultivos de las cepas clínicas, mediante la hidrólisis de fosfato p-nitrofenil, O-fosfo-L- tirosina, O-fosfo-L serina y O-fosfo-L treonina junto con varios inhibidores de fosfatasas. Resultados. Se detectó el gen SapS en el genoma de las cepas clínicas y en las 49 cepas de S. aureus analizadas in silico, pero no en las 11 cepas de estafilococos negativos para coagulasa. La secuenciación de SapS reveló un péptido señal presente en el extremo N-terminal de proteínas extracelulares y los dominios bipartitos de aspartato (DDDD) en su sitio catalítico. SapS hidroliza selectivamente el fosfato p-nitrofenil y la O-fosfo-L-tirosina, pero es sensible a vanadato y molibdato. Conclusión. Se encontró SapS en el genoma de S. aureus de las cepas clínicas y de las cepas de simulación computacional. La SapS con actividad específica para la hidrólisis de la O-fosfo-L-tirosina comparte similitudes bioquímicas con las fosfatasas-tirosina bacterianas, por lo que puede formar parte de la red de factores de virulencia de la osteomielitis crónica.
Subject(s)
Osteomyelitis , Staphylococcus aureus , Virulence FactorsABSTRACT
SUMMARY: The Masquelet technique or membrane induction is considered new in many ways, born under the need to seek therapeutic options in patients with extensive bone lesions. Since this technique was proposed, hopeful and reproducible results have been reported to different centers throughout the world. That is why in this work we seek to collect information from different authors and their case reports, in addition to presenting a case handled in the O'higgins region with this technique. OBJECTIVES: To review the literature regarding general results in bone consolidation in cases similar to the one exposed, in addition to exposing the Masquelet Technique as management in a patient with extensive bone loss, due to a firearm wound. METHODS: descriptive observational study, in addition to a systematic review in databases such as PubMed/MEDLINE, Elsevier, Cochrane and manually through the Internet in journals and public bodies. This work seeks to collect information from different authors and their case reports, in addition to delving into the technique itself, evaluating its indications, contraindications and protocol to follow. The patient's signature of an informed consent was requested, which is explicitly voluntary, in which he authorizes the review of his file, his background and the use of images and / or x-rays pertinent to the research. RESULTS: Inclusion and exclusion criteria were defined to analyze the characteristics of the selected articles. We present the clinical case of a 27-year-old male patient who suffers high-energy injury by firearm in the middle third of the right leg with exposure and loss of musculoskeletal tissue of 12 cm in diameter, polyfragmentary fracture of the proximal third of tibia and fibula, initially damage control is performed which is complicated by presenting osteomyelitis in said limb. It is handled with Masquelet technique. The induction time was approximately 4 months, after the second surgical time the lesion is consolidated in three months showing results similar to the literature studied.
Subject(s)
Humans , Male , Adult , Orthopedics/methods , Osteogenesis , Bone and Bones/surgery , Osteomyelitis , Regeneration , Bone and Bones/injuries , Bone Cements , Treatment Outcome , Polymethyl Methacrylate/chemistry , Fractures, Bone/therapyABSTRACT
BACKGROUND: Diabetic foot osteomyelitis (DFO) is a serious complication of infected ulcers in a diabetic patient. The identification of the infecting microorganisms is generally by culture, which causes a bias. Recently, metagenomics has been used for microbial identification. AIM: To systematically review the scientific literature related to DFO in the last 10 years to evaluate if culture and metagenomics are complementary. MATERIAL AND METHODS: To carry out the systematic review, PRISMA and Rayyan were used for the selection of studies, using three databases, using the keywords diabetes, osteomyelitis, culture and microbiome. Articles in English or Spanish were included, containing information related to bacterial identification in DFO. Characteristics of the technique, patients and frequency of bacterial appearance were collected. RESULTS: Twenty six articles were included, 19 used culture and 7 metagenomics. The patients were predominantly men (68%), with an average age of 61 years, 83% had type 2 diabetes and comorbidities, mainly vascular and neuropathy. The Families with the highest frequency of appearance using the culture technique were Enterobacteriaceae (29.3%) and Staphylococcaceae(28.3%) and with metagenomics Peptoniphilaceae (22.1%) and Staphylococcaceae (9.4%). Peptoniphilaceae were not identified in culture, although they were frequently identified by metagenomics. Methicillin- resistant Staphylococcus aureus, regularly identified by culture, was not identified using metagenomics. CONCLUSIONS: Comparing results, there is a certain complementarity between microbiological culture and sequencing to identify bacteria present in DFO.
Subject(s)
Humans , Male , Female , Middle Aged , Osteomyelitis/etiology , Osteomyelitis/microbiology , Diabetic Foot/complications , Diabetic Foot/diagnosis , Diabetic Foot/drug therapy , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Methicillin-Resistant Staphylococcus aureus , Bacteria , Anti-Bacterial Agents/therapeutic useABSTRACT
Tanto la osteomielitis como la osteoartritis séptica en el período neonatal son patologías infrecuentes. La afectación ósea de la columna cervical es aún más rara, siendo excepcional en neonatos. Son patologías graves, con elevada morbimortalidad, donde el diagnóstico y tratamiento precoz agresivo son de suma importancia para el pronóstico vital y funcional. Presentamos el caso de un neonato que presentó una sepsis a S. Aureus multirresistente, asociada a una osteomielitis de la primera vértebra cervical y a una osteoartritis séptica de la cadera izquierda. Fue tratado precozmente de forma quirúrgica y con antibioticoterapia, presentando una buena evolución.
Both osteomyelitis and septic osteoarthritis in the neonatal period are infrequent pathologies. Bone involvement of the cervical spine is even rarer, being exceptional in neonates. These are serious pathologies, with high morbimortality, where early diagnosis and aggressive treatment are of utmost importance for the vital and functional prognosis. We present the case of a neonate who presented with sepsis due to multidrug-resistant S. Aureus, associated with osteomyelitis of the first cervical vertebra and septic osteoarthritis of the left hip. He was treated early surgically and with antibiotic therapy, presenting a good evolution
Tanto a osteomielite como a osteoartrose séptica no período neonatal são patologias raras. O envolvimento ósseo da coluna cervical é ainda mais raro, sendo excepcional nos recém-nascidos. Estas são patologias graves, com elevada morbimortalidade, onde o diagnóstico precoce e o tratamento agressivo são da maior importância para o prognóstico vital e funcional. Apresentamos o caso de um recém-nascido que apresentou sepse devido a S. Aureus multirresistente, associado a osteomielite da primeira vértebra cervical e osteoartrose séptica da anca esquerda. Foi tratado precocemente cirurgicamente e com terapia antibiótica, com uma boa evolução.
Subject(s)
Humans , Male , Infant, Newborn , Osteomyelitis/diagnosis , Cervical Atlas/pathology , Staphylococcal Infections/diagnosis , Hip/pathology , Osteomyelitis/drug therapy , Rifampin/therapeutic use , Staphylococcal Infections/drug therapy , Vancomycin/therapeutic use , Delayed Diagnosis , Neonatal Sepsis , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic useABSTRACT
Objective: To summarize the clinical characteristics and treatments of chronic non-bacterial osteomyelitis with autoimmune hepatitis in children. Methods: A child who had chronic non-bacterial osteomyelitis with autoimmune hepatitis was admitted to the Department of Gastroenterology of the Children's Hospital Capital Institute of Pediatrics at April 2022. The clinical data was retrospectively analyzed. Using the keywords of "chronic non-bacterial osteomyelitis""autoimmune hepatitis" in Chinese and English, the literature from database establishment to December 2022 in CNKI, Wanfang, China Biomedical Literature Database and Pubmed was searched. Combined with this case, the clinical characteristics and treatment of chronic non-bacterial osteomyelitis combined with autoimmune hepatitis were analyzed. Results: A 5 years and 3 months girl was admitted to the Department of Gastroenterology of Children's Hospital, Capital Institute of Pediatrics for "transaminase elevated for 1 year and swelling of right maxillofacial area for half a year". The physical examinations at admission found a 4.0 cm × 4.0 cm swelling area with tenderness before the right ear, abdominal distention with visible abdominal wall vein, firm and enlarged liver (10.0 cm below the xiphoid and 4.5 cm below the right ribs), and splenomegaly (Line Ⅰ 10.0 cm, Line Ⅱ 11.5 cm, and Line Ⅲ 25.0 cm). There was no redness, swelling or restriction of the limbs. Laboratory examination found abnormal liver function with alanine aminotransferase 118 U/L, aspartate aminotransferase 227 U/L, γ-glutamyltransferase 360 U/L, and positive direct anti-human globulin test; immunology test found immunoglobulin G 41.60 g/L and a homogeneous type of antinuclear antibody of 1∶1 000; the autoimmune hepatitis antibody test found a positive anti-smooth muscle antibody (1∶100). Liver biopsy showed moderate interfacial inflammation and the patient was diagnosed with autoimmune hepatitis (International Autoimmune Hepatitis Group 19). The imaging findings showed extensive involvement of the bilateral mandible, while the right side was severe. There were expansile bone changes, thinning of the bone cortex, and significant swelling of the surrounding soft tissue in the mandibular body, mandibular angle, and mandibular ramus. After treatment of glucocorticoid, the swelling of the right maxillofacial region disappeared and the transaminase returned to normal. Only one case was reported before in English and none in Chinese. The two cases were both girls whose main clinical features were joint pain and swelling. The previous case started with pain in both knee joints, and developed liver injury during treatment while this case had liver injury as the initial clinical presentation. Besides, the affected sites and degrees of arthritis in the 2 cases were different. After glucocorticoid treatment, the clinical symptoms were alleviated, and transaminases returned to normal. Conclusions: Chronic non bacterial osteomyelitis may involve the liver and manifest as autoimmune hepatitis. Glucocorticoids therapy is effective.
Subject(s)
Female , Humans , Child , Glucocorticoids , Retrospective Studies , Hepatitis, Autoimmune/drug therapy , Alanine Transaminase , Osteomyelitis/drug therapyABSTRACT
Skull base osteomyelitis is a rare, refractory, and potentially fatal disease primarily caused by otogenic and sino rhinogenic infections. At times, it can mimic neoplasia complicating the diagnosis. With the use of antibiotics, advancements in diagnostic methods, and skull base surgical techniques, the mortality rate has significantly improved. However, the successful diagnosis and treatment of the disease is still challenging due to delayed diagnosis, lengthy treatment course, a tendency for relapse and lack of guidelines. Therefore, this article aims to review the progress in the diagnosis and treatment of skull base osteomyelitis.
Subject(s)
Humans , Otitis Externa/diagnosis , Skull Base , Osteomyelitis/complications , Anti-Bacterial Agents/therapeutic use , Diagnosis, DifferentialABSTRACT
Introducción: El absceso epidural espinal piógeno es la localización de una colección infecciosa dentro del canal raquídeo, por fuera del saco dural. El diagnóstico es difícil y las consecuencias son devastadoras a causa de la compresión o el compromiso vascular. La resonancia magnética tiene una alta sensibilidad y especificidad diagnósticas que aumentan si se administra un medio de contraste. Los objetivos de este estudio fueron: determinar la reproducibilidad inter- e intraobservador, y discriminar los distintos parámetros y diferencias entre especialidades. materiales y métodos: Veintisiete observadores independientes evaluaron 5 parámetros: región, ubicación, compromiso, asociación y perivertebral, absceso extravertebral anterior, lateral o posterior. Se analizaron 35 casos en tres oportunidades, se utilizó el coeficiente kappa. Resultados: El nivel de acuerdo global intra- e interobservador global fue kappa 0,76; los valores obtenidos fueron: región 0,94; ubicación 0,88; compromiso 0,55; asociación 0,67 y perivertebral 0,77. Los tres primeros parámetros dan noción de volumen y los dos últimos reflejan la presencia de focos infecciosos vertebrales por fuera del conducto. Conclusiones: La clasificación morfológica propuesta es de uso simple y tiene una muy buena tasa de reproducibilidad intra- e interobservador. Los parámetros con mayor reproducibilidad son: región y ubicación (>0,87). Nivel de Evidencia: III
Introduction: A pyogenic spinal epidural abscess is an infectious collection inside the spinal canal, outside the dural sac. The diagnosis is difficult and the consequences are devastating due to compression or vascular compromise. MRI has a high diagnostic sensitivity and specificity, which improves when a contrast medium is used. Objectives: To determine the inter- and intra-observer reproducibility, and to discriminate the different parameters and differences between specialties. Materials and methods: Twenty-seven independent observers evaluated 5 parameters: region, location, involvement, association, and perivertebral, anterior, lateral, or posterior extravertebral abscess. The kappa coefficient was used to analyze 35 cases on three occasions. Results: The overall intra- and inter-observer global agreement level is kappa 0.76, with the following values obtained: region 0.94; location 0.88; involvement 0.55; association 0.67 and perivertebral abscess 0.77. The first three parameters indicate volume, while the final two indicate the presence of vertebral infectious foci outside the canal. Conclusions: The proposed morphological classification is simple to use and has high intra- and inter-observer reproducibility. The most reproducible parameters are region and location (>0.87). Level of Evidence: III
Subject(s)
Osteomyelitis , Spinal Diseases , Discitis , Epidural Abscess , InfectionsABSTRACT
Introducción: la infección osteo-articular es una patología compleja, y su prevalencia esta en aumento. Conocer las principales características de su presentación clínica, etiología y evolución permite mejorar su abordaje. Material y métodos: estudio observacional, retrospectivo, período 01 de enero 2020 a 31 diciembre 2020 en el Instituto Nacional de Ortopedia y Traumatología. Se incluyeron todos los pacientes adultos ingresados con diagnóstico clínico de infección osteo-articular y que fueron asistido en conjunto por Enfermedades Infecciosas y Traumatología en el período de estudio. Todos los casos contaban con uno o más cultivos microbiológicos profundos. Resultados: hubo 132 pacientes con infección osteo-articular, la relación hombre-mujer fue 2 a 1 y una media de 53 años. La presentación clínica fue con dolor, fístula y signos fluxivos locales. Las infecciones más frecuentes fueron de fracturas y prótesis articulares. El 54% de las infecciones fue por cocos gram positivos, 31% por enterobacterias y 13% bacilos gram negativos no fermentadores. En cuanto al perfil de sensibilidad 33% de los cocos fueron meticilino resistentes y 43% de las enterobacterias multirresistentes. Conclusión: La patología mas frecuente en 2 de cada 3 ingresos fue la infección de fracturas y la asociada a material implantado. A la complejidad habitual del tratamiento quirúrgico y antimicrobiano de esta patología se suma que 3 de cada 10 microorganismos aislados fueron resistentes.
Introduction: osteoarticular infections are a complex condition that are gradually increasing in prevalence. Learning about its clinical presentation, etiology and evolution will enable improving its management. Method: observational, retrospective study of cases seen at the National Orthopedic and Traumatology Institute from January 1st, 2020 to December 31st, 2020. All adult patients admitted with clinical diagnosis of osteoarticular infection who were assisted jointly by the Infectious Diseases and Traumatology units in the above mentioned period were included in the study. All cases had at least one deep microbiological cultures. Results: there were 132 patients with osteoarticular infection, female to male ratio was 2-to-1 and average age was 53 years old. Clinical presentation was characterized by pain, fistula and local fluxiye signs. The most frequent infections were fracture and prosthetic joint infections. Fifty four percent of infections were caused by gram-positive coccus, 31% were caused by enterobacteria and 13% by nonfermenting gram-negative bacilli (NFGNB). As to the sensitivity profile, 33% of cocci were methicillin-resistant and 43% of enterobacteria were multidrug-resistant. Conclusions: the most frequent pathology in 2 out of three hospitalizations were fracture infection and infections in orthopedic-related devices. The usual complexity.
Introdução: a infecção osteoarticular é uma patologia complexa, e sua prevalência está aumentando. Conhecer as principais características da sua apresentação clínica, etiologia e evolução permite-nos melhorar a sua abordagem. Material e métodos: estudo observacional, retrospectivo, que inclui pacientes atendidos no período 1º de janeiro -a 31 de dezembro de 2020 no Instituto Nacional de Ortopedia e Traumatologia. Foram incluídos todos os pacientes adultos internados com diagnóstico clínico de infecção osteoarticular atendidos conjuntamente por especialistas em Infecciologia e Traumatologia. Em todos os casos foram realizadas uma ou mais culturas microbiológicas profundas. Resultados: foram incluídos 132 pacientes diagnosticados com infecção osteoarticular, a relação homem-mulher foi de 2 para 1 e a idade média foi 53 anos. A apresentação clínica foi: dor, fístula e sinais inflamatórios agudos locais. As infecções mais frequentes foram as associadas a fraturas e próteses articulares. 54% das infecções foram devidas a cocos Gram positivos, 31% a enterobactérias e 13% a bacilos Gram negativos não fermentadores. Em relação ao perfil de sensibilidade, 33% dos cocos eram resistentes à meticilina e 43% das enterobactérias eram multirresistentes. Conclusão: a patologia mais frequente em 2 dos 3 internamentos foi a infecção das fracturas e estava associada ao material implantado. Acrescenta-se à complexidade usual do tratamento cirúrgico e antimicrobiano desta doença o fato de que 3 em cada 10 microrganismos isolados eram resistentes.
Subject(s)
Osteomyelitis , Prosthesis-Related Infections , Fractures, Bone/complications , Retrospective StudiesABSTRACT
PURPOSE@#The study aimed to identify the risk factors of recurrence in chronic osteomyelitis (COM) and to document the microbiological patterns pre- and intra-operatively and at recurrence, if any.@*METHODS@#We performed retrospective review on COM patients treated with surgical debridement and a 6-week course of antibiotics. The patients with symptoms of osteomyelitis for at least 6 weeks, present or past episodes of discharging sinus, documentation of bone sequestration in operative notes or preoperative images were included in the study. Patients with symptoms of osteomyelitis < 6 weeks, lack of history of discharging sinus or lack of evidence of sequestration in preoperative images or intraoperative notes were excluded. Logistic regression models were used to assess the impact of risk factors of recurrence. Cohen-Kappa scores were derived to see the concordance between pre-operative and intra-operative isolates and at recurrence.@*RESULTS@#Totally, 147 COM patients (115 males and 32 females, mean age (33 ± 19) years) were included in this study. Recurrence was noted in 28 patients (19.0%). Polymicrobial growth and extended spectrum beta-lactamase producing Enterobacteriaceae increased the chance of recurrence. Cierny-Mader stage-1, hematogenous aetiology and negative intraoperative culture reduced the chance of recurrence. Concordance between pre-operative and intra-operative cultures was 59.85% (Kappa score 0.526, p < 0.001) and between index surgery and at recurrence was 23.81% (Kappa score 0.155, p < 0.001). Lack of knowledge of causative organism preoperatively did not affect outcome. At mean follow-up (42 ± 15) months, all patients were apparently infection free for at least 1 year.@*CONCLUSION@#Polymicrobial growth and multi-drug resistant organisms increase the risk of recurrence in COM. Patients' age, gender, diabetes mellitus, previous failed treatment, duration of symptoms, haemoglobin, white cell count, C-reactive protein and erythrocyte sedimentation rate at presentation did not have any impact on the recurrence of infection. Pre-operative isolation of organism is of questionable value. Recurrences of infections do occur and are more of re-infections than relapses. Diligent isolation of organism must be attempted even in re-debridements. Even patients with recurrences do well with appropriate debridement and antibiotic therapy.
Subject(s)
Male , Female , Humans , Adolescent , Young Adult , Adult , Middle Aged , Debridement , Anti-Bacterial Agents/therapeutic use , Treatment Outcome , Osteomyelitis/surgery , Recurrence , Retrospective StudiesABSTRACT
SPeripheral sympathectomy is a procedure which has shown high rates of decreasing ischemic pain, recover functionality and wound healing, preventing the progression of the disease and further complications. We present a female patient with severe Raynaud´s phenomenon secondary to localized cutaneous systemic sclerosis complicated who presented digital ulcer treated with a sympathectomy of the radial and ulnar artery at the wrist level, undergoing post-operative follow-up.
Subject(s)
Humans , Female , Middle Aged , Raynaud Disease/surgery , Sympathectomy/methods , Ulnar Artery/innervation , Osteomyelitis , Raynaud Disease/etiology , Regional Blood Flow/physiology , Scleroderma, Localized , Scleroderma, Systemic , Follow-Up Studies , Radial Artery/innervationABSTRACT
A Osteomielite dos Maxilares (OM) é uma inflamação óssea, de origem na maioria infecciosa, podendo atingir a porção medular e cortical dos ossos maxilares. Apresenta-se em maior extensão na mandíbula, devido ao pobre suprimento sanguíneo que essa possui, sendo mais prevalente em homens entre a faixa etária de 40 a 60 anos. Sua etiologia está relacionada principalmente às infecções odontogênicas, infecções secundárias e corpos estranhos ocasionais, como os implantes dentários. Tem-se por objetivo apresentar um relato de caso clínico sobre OM na região posterior da mandíbula, bem como sua associação a uma insatisfatória implantação dentária onde houve desenvolvimento de lesão peri-implantar. Paciente do gênero feminino, 53 anos, melanoderma, apresentou dor crônica, abaulamento ósseo sem outros sinais significativos na região de molares inferiores no lado direito, radiograficamente visualizava-se imagem mista sendo sugestiva de sequestro ósseo. Na história pregressa relatou ter realizado explantação na referida região após ser diagnosticada com peri implantite. Ao final do estudo concluiu-se que a afecção teve como causa a infecção bacteriana proveniente de contaminação durante a inserção de implante dentário. Optou-se por remoção cirúrgica do osso necrótico e inflamado... (AU)
Osteomyelitis of the Jaws (OM) is a bone inflammation, of mostly infectious origin, which can affect the medullary and cortical portion of the maxillary bones. It presents itself to a greater extent in the mandible, due to the poor blood supply that it has, being more prevalent in men between the age group of 40 to 60 years. Its etiology is mainly related to odontogenic infections, secondary infections and occasional foreign bodies, such as dental implants. The objective is to present a clinical case report on OM in the posterior region of the mandible, as well as its association with an unsatisfactory dental implantation, where there was development of a peri-implant lesion. Female patient, 53 years old, melanoderma, presented chronic pain, bone bulging without other significant signs in the region of lower molars on the right side, radiographically a mixed image was visualized, suggesting bone sequestration. In her previous history, she reported having performed explantation in that region after being diagnosed with peri-implantitis. At the end of the study, it was concluded that the disease was caused by bacterial infection from contamination during dental implant insertion. We opted for surgical removal of the necrotic and inflamed bone... (AU)
La osteomielitis de los maxilares (OM) es una inflamación de los huesos, en su mayoría de origen infeccioso, que puede afectar la porción medular y cortical de los huesos maxilares. Se presenta en mayor medida en la mandíbula, debido a la escasa irrigación sanguínea que tiene, siendo más prevalente en hombres entre el grupo de edad de 40 a 60 años. Su etiología se relaciona principalmente con infecciones odontogénicas, infecciones secundarias y cuerpos extraños ocasionales, como los implantes dentales. El objetivo es presentar un reporte de caso de OM en la región posterior de la mandíbula, así como su asociación con una implantación dentaria insatisfactoria a partir de la cual desarrollamos una lesión periimplantaria. Paciente femenina, 53 años, melanodermia, presenta dolor crónico, tumefacción ósea con otros signos significativos en región molar inferior del lado derecho, radiográficamente se visualiza imagen mixta sugestiva de pérdida ósea. En su historia previa menciona haber realizado una explantación en esa región tras ser diagnosticada de periimplantitis. Al final del estudio, se concluyó que la enfermedad fue causada por una infección bacteriana provocada por la contaminación durante la inserción del implante dental. Se optó por la extirpación quirúrgica de la piel necrótica e inflamada... (AU)
Subject(s)
Humans , Female , Middle Aged , Osteomyelitis/surgery , Maxillary Diseases/surgery , Osteomyelitis/etiology , Osteomyelitis/diagnostic imaging , Maxillary Diseases/etiology , Maxillary Diseases/diagnostic imaging , Dental Implants/adverse effects , Cross-Sectional Studies , Peri-Implantitis/complicationsABSTRACT
INTRODUCCIÓN: El diagnóstico y tratamiento oportuno de las infecciones osteoarticulares (IOA) pediátricas son imperativos para evitar complicaciones y secuelas, siendo relevante conocer la microbiología local. OBJETIVO: Describir las características de las IOA pediátricas tratadas en nuestro centro. PACIENTES Y MÉTODOS: Estudio observacional descriptivo. Se analizaron pacientes bajo 15 años de edad tratados por IOA. entre los años 2004 y 2020. Se evaluaron características clínicas, de laboratorio, microbiología y tratamiento. RESULTADOS: Se incluyeron 126 pacientes (63,5% hombres), con una mediana de edad de 5,09 años (rango: 0,5-14,6 años); 61,1% artritis séptica (AS), 38,9% osteomielitis (OM). Un 92,9% presentó dolor y 68,3% fiebre. La localización más frecuente en AS fue rodilla (33,7%) y en OM tibia (30,6%) y fémur (30,6%). Se identificó agente en 77 pacientes (61,1%), siendo más frecuentes Staphylococcus aureus (n = 44), Kingella kingae (n = 13) y Streptococcuspyogenes (n = 8). Los cuatro pacientes con reacción de polimerasa en cadena (RPC) universal positiva para K. kingae no fueron detectados por otros métodos. CONCLUSIÓN: El agente más frecuente sigue siendo S. aureus, observándose un aumento en la resistencia de éste en comparación con series nacionales anteriores, y, por primera vez en nuestro medio, se comunica la detección de K. kingae, específicamente relacionada al uso de técnicas moleculares.
BACKGROUND: Timely diagnosis and treatment of pediatric osteoarticular infections (OAI) are imperative to avoid complications and sequelae, being relevant to know the local microbiology. AIM: To describe the characteristics of pediatric OAI treated in our center. METHODS: Descriptive observational study. Patients under 15 years of age treated for OAI between 2004 and 2020 were analyzed. Clinical, laboratory, microbiology and treatment characteristics were evaluated. RESULTS: 126 patients (63.5% men) were included, median age of 5.09 years (range: 0.5-14.6 years); 61.1% had septic arthritis (AS), 38.9% osteomyelitis (OM). Pain was present in 92.9% and fever in 68.3%. The most frequent location in AS was the knee (33.7%) and in OM the tibia (30.6%) and femur (30.6%). Agents were identified in 77 patients (61.1%), the most frequent being Staphylococcus aureus (n = 44), Kingella kingae (n = 13) and Streptococcus pyogenes (n = 8). The 4 patients with positive universal polymerase chain reaction (PCR) for K. kingae were not detected by other methods. CONCLUSION: The most frequent agent continues to be S. aureus, with an increase in its resistance, and this is the first report of K. kingae as a cause of OAI in Chile, specifically related to the use of molecular techniques.