Bartonella henselae is not culturable using routine microbiological techniques, PCR on bone biopsy or serology is required to make a diagnosis. Recommendation: Send a blood sample for Bartonella henselae serology in children with osteomyelitis, negative Blood Cultures and a history of cat exposure, such cases should be discussed with microbiology first. Kingella kingae can be difficult to grow and its recovery can be enhanced using blood culture media. Recommendation: Bone biopsies should be collected using aseptic technique and placed in sterile universal containers, where possible a portion of sample or fluid should be directly inoculated into a paediatric blood culture bottle. Recommendation: Bone biopsies should be undertaken in immunocompromised children, when tuberculosis is suspected, when the clinical and radiological diagnosis is uncertain, after treatment failure on first line therapy or if surgery is planned anyway.īone biopsies are not essential in most children and Blood Cultures are the microbiological investigation of choice, however, in some situations obtaining microbiological confirmation is critical to successful therapy. Baseline white cell count can be helpful, again the WCC may be normal at least initially in acute haematogenous osteomyelitis. NB CRP is occasionally normal, at least initially, in acute haematogenous osteomyelitis.
#Bartonella sketchy micro full
Recommendation: Full blood count and CRP should be sent from all patients being treated with intravenous antimicrobials at baseline.ĬRP is more sensitive than ESR, increases and responds to treatment earlier. Blood Cultures provide a microbiological diagnosis in ~60% of cases. If PVL-SA is suspected please Discuss with Microbiology.īlood tests Recommendation: Blood Cultures should be sent prior to starting antimicrobials in all patients.īone biopsies are rarely performed in children therefore the microbiological diagnosis of osteomyelitis usually relies on blood cultures. General supportive treatment is needed and such cases often require ICU care. An aggressive approach to imaging, surgical drainage and anti-microbial medication is required. Where a child has bone and/or joint infection and has severe systemic disease and in particular an associated chest infection then PVL (Panton-Valentine Leucocidin) variant SA infection should be suspected. Panton Valentine Leukocidin Staphylococcus Aureus (PVL-SA) Infection is usually acute but a more insidious sub-acute variant is recognized reflecting an altered balance of bacterial virulence and host resistance. These are medical and possibly surgical emergencies. On occasion the child will present with septic shock reflecting delayed diagnosis or an unusually aggressive organism. stepping on a rusty nail etc.Įxamination shows swelling and bony tenderness to palpation especially in subcutaneous bones. Any relevant history of recent trauma should be elicited e.g. It is important to ask about: penicillin allergies, Haemophilus influenzae vaccination status and information on previous MRSA carriage/infection because these will influence empirical therapy. Older children will provide an account of increasing localized pain and demonstrate a limp. In infants the history is necessarily sketchy but systemic features as above and “pseudoparalysis” of the affected limb draws the parents’ attention. The typical history is of a previously well child who develops a febrile illness and malaise with localized pain in an extremity. Tuberculosis should be considered in more insidious infections with epidemiological risk factors or typical radiological findings. Since Bartonella henselae is not culturable using routine microbiological techniques, PCR on bone biopsy is required to make a diagnosis. Osteomyelitis is a very rare manifestation of cat-scratch disease (de Kort et al., 2006). Pseudomonas aeruginosa should be considered when puncture wounds to the sole of the foot are the cause of infection. Salmonella species should be considered in children with haemaglobinopathies. Neisseria meningitidis, Haemophilus influenzae, Enterobacteriacaea, and other streptococci are uncommon causes of osteomyelitis (Chometon et al., 2007). The most common causes of osteomyelitis in children >5 to 16 years are Staphylococcus aureus and streptococci(Yagupsky et al., 1992). Guideline for the management of osteomyelitis in children and infants (Chometon et al., 2007 Rasmont et al., 2008 Yagupsky et al., 1992).