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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Subacute osteomyelitis is a chronic low-grade infection of bone characterized by a lack of systemic manifestations. The onset is insidious. Pain is the most common symptom, and has usually been present for several months before the initial evaluation. Swelling and tenderness over the area of involved bone may also be seen. Laboratory evaluation is unrevealing, with a normal white blood cell count and differential. The erythrocyte sedimentation rate may also be normal. The most common organism cultured from a subacute osteomyelitis is a staphylococcus species. Twenty-five percent of subacute bone infections are sterile. The most common manifestation of a subacute osteomyelitis in a child is a geographic lytic metaphyseal lesion (Brodie's abscess). Treatment of a culture positive infection includes surgical debridement and antibiotic therapy. A sterile abscess can be treated conservatively without antibiotics, provided the patient's symptoms are improving and the lesion is regressing radiographically.
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PMID:Subacute osteomyelitis. 217 15

Between 1990 and 1998 we saw 21 children with primary subacute haematogenous osteomyelitis. Pain, swelling and a limp had been present for two to 12 weeks with little functional impairment. Laboratory tests were non-contributory. The lesions were classified radiologically into metaphyseal, diaphyseal, epiphyseal and vertebral. There were 24 sites involved, with most (20) being in the tibia; 17 lesions were in the diaphysis, five in the metaphysis and two in the epiphysis. The diagnosis was confirmed histologically in all cases. Staphylococcus aureus was cultured in six patients. Healing occurred in all patients after treatment with antibiotics for six weeks and radiological improvement was seen after three to six months. Subacute osteomyelitis develops as a result of increased host resistance and decreased bacterial virulence. The radiological features can mimic various benign or malignant bone tumours and non-pyogenic infections. Histological confirmation is necessary to avoid a delay in diagnosis.
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PMID:Primary subacute haematogenous osteomyelitis in children. 1124 47

The aim of this study is to report the pathogens which were found most frequently to be responsible for osteo-articular infections in infants and children in Belgium, and to propose an appropriate empirical antibiotic therapy applicable before identification of the responsible pathogen. Clinical presentation, imaging and blood biology are also reviewed and analysed. Fifty-six cases of osteo-articular infections (acute/subacute osteomyelitis, osteo-arthritis, septic arthritis, spondylodiscitis, sacro-iliitis) treated between 2001 and 2007 were retrospectively reviewed, focusing on clinical, biological, microbiological and radiological data. Septic arthritis, acute osteomyelitis, septic osteoarthritis and sacro-iliitis often have a loud clinical (fever, pain, inflammatory signs) and biological presentation. Subacute osteomyelitis and spondylodiscitis are almost asymptomatic, but for functional impairment. The responsible pathogen was isolated in 38% of the cases. The most frequent pathogen was Staphylococcus Aureus, followed by Pneumococcus, Streptococcus A and B, Kingella Kingae, and Haemophilus. None of them were resistant to usual antibiotics. Functional impairment is the only constant symptom of osteo-articular infections. Other clinical and biological symptoms may be absent, making diagnosis often difficult. We recommend oxacillin (> 5 years) or a combination of oxacillin with cefotaxime (< 5 years) in the empirical treatment of osteo-articular infection, and a total of 4 weeks of treatment.
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PMID:Osteoarticular infections in Belgian children: a survey of clinical, biological, radiological and microbiological data. 1868 65

Osteoid osteoma is a solitary, benign lesion of bone causing significant nocturnal pain. Magnetic resonance imaging (MRI), computed tomography (CT), and bone scan are commonly used in this diagnosis. A case of osteoid osteoma of the distal femur mimicking chronic osteomyelitis with Brodie's abscess is reported and discussed. Initial radiographs and MRI showed a lesion of the distal femur consistent with subacute osteomyelitis with a Brodie's abscess. Because primary malignant tumor could not be eliminated, surgical biopsy was carried out. Histological examination showed a typical nidus consistent with the diagnosis of osteoid osteoma. Subacute osteomyelitis (Brodie's abscess) may be difficult to distinguish from other malignant or benign bone lesions as osteoid osteoma. CT usually is recommended as the best imaging procedure to identify the nidus and confirm the diagnosis. MRI also can be used for this purpose. Surgical biopsy remains mandatory for unclear lesions before deciding on appropriate treatment.
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PMID:Osteoid osteoma mimicking Brodie's abscess in a 13-year-old girl. 2367 80