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PEDIATRICS Vol. 112 No. 1 July 2003, pp. e22-e26

ELECTRONIC ARTICLE

Group A ß-Hemolytic Streptococcal Osteomyelitis in Children

Ekopimo O. Ibia, MD, MPH*,{ddagger}, Menfo Imoisili, MD, MPH*,§ and Andreas Pikis, MD*,{ddagger},§

* Department of Infectious Diseases, Children’s National Medical Center, Washington, DC
{ddagger} Center for Drug Evaluation and Research, Food and Drug Administration, Rockville, Maryland
§ Oral Infection and Immunity Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland

Objective Little attention has been given to acute hematogenous osteomyelitis (AHO) caused by group A ß-hemolytic Streptococcus (GABHS), although up to 10% of cases are caused by this microorganism. The objective of this study was to define the clinical and laboratory characteristics of AHO caused by GABHS.

Methods. Between January 1983 and June 1999, 29 patients were treated at Children’s National Medical Center with AHO caused by GABHS. The characteristics of these patients were compared with those of 28 patients with AHO caused by Streptococcus pneumoniae and those of a matched sample of 45 patients with AHO caused by Staphylococcus aureus.

Results. Median ages of children with GABHS, S pneumoniae, and S aureus AHO were 36.0, 13.7, and 96.0 months, respectively. On admission, patients with GABHS AHO had a mean temperature of 38.9 ± 1.3°C and a mean white blood cell count of 17 000 ± 7800/mm3, findings similar to those from patients with S pneumoniae AHO. Patients with S aureus AHO had significantly lower admission temperature (38.1 ± 1.1°C) and white blood cell count (10 600 ± 4900/mm3). Varicella infection was the risk factor in 5 cases (17%) of GABHS AHO, whereas none of the cases of AHO caused by S pneumoniae and S aureus was associated with varicella infection. Adjacent septic arthritis occurred in 22%, 28%, and 61% of children with GABHS, S aureus, and S pneumoniae AHO, respectively. Admission erythrocyte sedimentation rate and frequency of bacteremia were similar in all groups. However, time to normalization of erythrocyte sedimentation rate was longer for GABHS and S aureus than for S pneumoniae AHO. GABHS, like S pneumoniae, affected fewer nonextremity bones compared with S aureus.

Conclusions. GABHS should be considered in preschool- and early school-aged children who are suspected of having AHO and whose clinical and laboratory features are characterized by high fever and marked leukocytosis. It should also be highly considered in any child with AHO associated with varicella infection.

Key Words: acute hematogenous osteomyelitis • group A ß-hemolytic streptococcus • varicella

Abbreviations: AHO, acute hematogenous osteomyelitis • GABHS, group A ß-hemolytic Streptococcus • WBC, white blood cell • ESR, erythrocyte sedimentation rate

Received for publication Oct 9, 2002; Accepted Feb 20, 2003.


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