Early Diagnosis and Management of Neonatal Acute Hematogenous Osteomyelitis: A Case Report

Sushma¹, Nandipatti², Mary Chandrika³, Aljin V*⁴

This study determines the importance of early diagnosis and aggressive treatment in neonatal acute hematogenous osteomyelitis to prevent severe complications.

Abstract

Background: Neonatal acute hematogenous osteomyelitis (NAHO) is a rare yet severe condition caused by bacterial infection of bone and marrow due to hematogenous spread. This case report details a 21-day-old male neonate diagnosed with NAHO of the left distal femur. The infant presented with knee swelling and restricted movement of the left lower extremity, but lacked fever or systemic symptoms, complicating diagnosis. Diagnostic imaging and blood cultures confirmed Staphylococcus aureus as the pathogen. Treatment with intravenous Ceftriaxone sodium for three weeks led to significant clinical improvement and complete recovery. Method: The diagnosis was established through a combination of imaging studies (X-ray, CT, MRI), which revealed bone destruction, periosteal reaction, and abnormal cartilage signal intensity. Blood cultures confirmed Staphylococcus aureus. The patient was treated with intravenous Ceftriaxone sodium for three weeks, with regular follow-up and assessments to monitor clinical response and recovery. Conclusion: Early diagnosis and aggressive antibiotic therapy are crucial in managing NAHO to prevent serious complications such as chronic osteomyelitis and growth disturbances. This case emphasizes the importance of high clinical suspicion, comprehensive imaging, and timely microbiological studies. The positive outcome underscores the effectiveness of early intervention and highlights the need for heightened awareness among clinicians dealing with neonates presenting with subtle infection signs.

Keywords: Neonatal osteomyelitis, Staphylococcus aureus, Ceftriaxone therapy, Diagnostic imaging, Early intervention.

References

Arnold, S. R., Elias, D., Buckingham, S. C., et al. (2006). Changing patterns of acute hematogenous osteomyelitis and septic arthritis: Emergence of community-associated methicillin-resistant Staphylococcus aureus. Journal of Pediatric Orthopaedics, 26(6), 703-708.

Brady, R. A., Leid, J. G., Calhoun, J. H., Costerton, J. W., & Shirtliff, M. E. (2008). Osteomyelitis and the role of biofilms in chronic infection. FEMS Immunology & Medical Microbiology, 52(1), 13-22. https://doi.org/10.1111/j.1574-695X.2007.00357.x

Brook, I. (2008). Microbiology and management of joint and bone infections due to anaerobic bacteria. Journal of Orthopaedic Science, 13(2), 160-169. https://doi.org/10.1007/s00776-007-1207-1

Carter, K., Doern, C., Jo, C. H., & Copley, L. A. (2016). The clinical usefulness of polymerase chain reaction as a supplemental diagnostic tool in the evaluation and the treatment of children with septic arthritis. Journal of Pediatric Orthopaedics, 36(2), 167-172. https://doi.org/10.1097/BPO.0000000000000411

Castellazzi, L., Mantero, M., & Esposito, S. (2016). Update on the management of pediatric acute osteomyelitis and septic arthritis. International Journal of Molecular Sciences, 17(6), 855. https://doi.org/10.3390/ijms17060855

Dodwell, E. R. (2013). Osteomyelitis and septic arthritis in children: Current concepts. Current Opinion in Pediatrics, 25(1), 58-63. https://doi.org/10.1097/MOP.0b013e32835c2b42

Hong, D. K., & Gutierrez, K. (2018). Osteomyelitis. In S. S. Long, C. G. Prober, & M. Fischer (Eds.), Principles and Practice of Pediatric Infectious Diseases (5th ed., pp. 480-486). Elsevier.

Iliadis, A. D., & Ramachandran, M. (2017). Paediatric bone and joint infections. EFORT Open Reviews, 2(1), 7-12. https://doi.org/10.1302/2058-5241.2.160027

Krogstad, P. (2014). Osteomyelitis. In J. Cherry, G. J. Demmler-Harrison, S. L. Kaplan, W. J. Steinbach, & P. J. Hotez (Eds.), Feigin and Cherry's Textbook of Pediatric Infectious Diseases (7th ed., pp. 711-727). Elsevier Saunders.

Peltola, H., & Pääkkönen, M. (2014). Acute osteomyelitis in children. The New England Journal of Medicine, 370(4), 352-360. https://doi.org/10.1056/NEJMra1213956

Riise, Ø. R., Kirkhus, E., Handeland, K. S., et al. (2008). Childhood osteomyelitis: Incidence and differentiation from other acute onset musculoskeletal features in a population-based study. BMC Pediatrics, 8, 45. https://doi.org/10.1186/1471-2431-8-45

Saavedra-Lozano, J., Falup-Pecurariu, O., Faust, S. N., et al. (2017). Bone and joint infections. Pediatric Infectious Disease Journal, 36(8), 788-799. https://doi.org/10.1097/INF.0000000000001635

Sarkissian, E. J., Gans, I., Gunderson, M. A., Myers, S. H., Spiegel, D. A., & Flynn, J. M. (2016). Community-acquired methicillin-resistant Staphylococcus aureus musculoskeletal infections: Emerging trends over the past decade. Journal of Pediatric Orthopaedics, 36(3), 323-327. https://doi.org/10.1097/BPO.0000000000000439

Weiss-Salz, I., & Yagupsky, P. (2012). Kingella kingae infections in children: An update. In N. Curtis, A. Finn, & A. J. Pollard (Eds.), Hot Topics in Infection and Immunity in Children VIII: Advances in Experimental Medicine and Biology (Vol. 719, pp. 67-80). Springer.

Yeo, A., & Ramachandran, M. (2014). Acute haematogenous osteomyelitis in children. BMJ, 348, g66. https://doi.org/10.1136/bmj.g66