Osteomielitis aguda en la infancia / Acute osteomyelitis in children

Fundamento. La escasa cualidad de la evidencia en la que se fundamentan las actuaciones en la osteomielitis aguda del niño. Objetivo. Repasar los principales aspectos de la enfermedad, como son su epidemiología, etiología, patogenia, clínica y diagnóstico, con los datos que pueden aportar el laboratorio y la imagen, para finalizar con la opción terapéutica empírica, antes de conocer el posible agente etiológico, las recomendaciones sobre la duración, las vías de empleo, los posibles controles antes de dar por finalizada la antibioticoterapia, así como las posibles complicaciones evolutivas. Conclusiones. En la actualidad, en nuestro entorno, los microorganismos causales entre la población inmunocompetente no han variado. La gammagrafía y la resonancia magnética serian las pruebas idóneas para establecer el diagnóstico. El tratamiento antibiótico se establecería empíricamente en la fase inicial, con una planificación secuencial, con una fase intravenosa de entre 5 y 7 días, inicialmente, para seguir de forma oral hasta completar 4 o 6 semanas. En aquellos casos de evoluciones anómalas con tratamientos bien orientados y planificados se deberá pensar en la posibilidad de agentes etiológicos inhabituales, cuando no se han detectado, o en la presencia de la toxina leucocidina Panton- Valentine(AU)

Background. There is little high quality evidence regarding the management of acute osteomyelitis in children. Objective. To outline the following main aspects of the disease: the epidemiology, etiology, pathogenesis, clinical manifestations, diagnostic laboratory and imaging tests, empiric therapy before culture and sensitivity results are known, recommendations for the route and duration of antibiotic treatment, investigations to consider before discontinuing antibiotics, and the potential complications likely to occur. Conclusions. In our environment, the causative microorganisms among immunocompetent children have not changed. Both the technetium bone scan and magnetic resonance imaging are the ideal tests to establish the diagnosis. Antibiotic therapy is initiated empirically. It is administered intravenously for 5 to 7 days, and then orally to complete a total of 4 to 6 weeks. In cases of an unusual response despite appropriate treatment, less common pathogens or the production of Panton-Valentine leukocidin toxin should be considered(AU)

Distal humeral epiphysiolysis in the newborn: utility of sonography and differential diagnosis.

Fracture-separation of the distal humeral epiphysis in newborn is a rare entity, usually the result of a traumatic delivery. It can mimic elbow dislocation and, due to the absence of ossification of the epiphysis at that time, cannot be diagnosed radiographically. However, ultrasound is an important diagnostic tool for this purpose because it is able to clearly visualize the cartilaginous epiphysis. In addition, it allows the differential diagnosis with posterior elbow dislocation whose therapeutic management and prognosis are different. We report the case of a preterm newborn in which a fracture-separation of the distal humeral epiphysis was diagnosed with the help of sonography. The purpose of this report is to emphasize the utility of echography as a cheap, available, and noninvasive tool for the evaluation of the nonossified epiphysis in the newborn elbow.