osteomyelitis akut pada anak-anak

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    ACUTE OSTEOMYELITISIN CHILDREN

    A. Ayu FaradibaC111 09 823

    SupervisorProf. dr. Chairuddin Rasjad, M.D., Ph.D

    Journal Reading

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    OSTEOMYELITIS

    In children, an acute bone infection is mostoften hematogenous in origin.Bacteria may reach bone through directinoculation from traumatic wounds, byspreading from adjacent tissue affected bycellulitis or septic arthritis, or throughhematogenous seeding.

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    ETIOLOGY

    Age : neonatal, childrenGender : male : female, 4:1

    Trauma : hematom in metaphysisLocation : bone metaphysisNutrition : environment and poor immunity

    microorganism

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    COMMON MANIFESTATIONS

    Classic clinicalmanifestations inchildrenlimping or an inability towalk,fever and focaltenderness,sometimes visible

    redness and swellingaround a long bone,more often in a legthan in an arm

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    COMMON MANIFESTATIONS

    Calcaneal osteomyelitis may proceedinsidiously and lead to a delay in seekingtreatment.Spinal osteomyelitis is characteristicallymanifested as back painPain on a digital rectal examination suggestssacral osteomyelitis.

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    COMMON MANIFESTATIONS

    It is classified as :acute if the duration of the illness has

    been less than 2 weeks,subacute for a duration of 2 weeks to 3months,

    chronic for a longer duration.

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    LABORATORIUM EXAMINATION

    If physical examination suggests boneinvolvement, further tests areperformed.Lab:

    WBC until 30.000LEDErithrocyte sedimen rateSerum C-reactive protein (CRP) andprocalcitonin levels are sensitive as

    diagnostic tests and useful in follow-up

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    LABORATORIUM EXAMINATION

    Antibody anti-stafilokokusexamination

    Blood culture and sensitivity testFeces examination

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    RADIOLOGY EXAMINATION

    Soft tissue swellingBone destructioncan be seen inmetaphysis.The rat bite inbone that is oftenseen inosteomyelitisbecomes visible onplain radiography 2to 3 weeks after theonset of symptomsand signs.

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    DIAGNOSIS

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    Figure 1. Skeletal Distribution of Acute Osteomyelitis in Children. Osteomyelitis may affect anybone, with a predilection for the tubular bones of the arms and legs. Estimated percentages of all

    cases according to the data in Krogstad,1 Gillespie and Mayo,4 Peltola et al.,9 and Dartnell et al.12are shown. Darker shades of red denote a higher burden of infection.

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    MANAGEMENT : ANTIBIOTIC TREATMENT

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    MANAGEMENT : SWITCH FROM INTRAVENOUSTO ORAL MEDICATION

    Traditionally, a child with osteomyelitisreceived intravenous medication for

    weeks, with a switch to oral medicationwhen recovery was almost complete.Three trials showed no change in

    outcomes when the intravenous phasewas shorter than a week.

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    MANAGEMENT : DURATION OF TREATMENT ANDDIFFICULT TO TREAT PATHOGENS

    There are some other caveats in relationto shorter treatments as well. Although

    data are lacking on the use of shortertreatments in neonates,immunocompromised or malnourished

    patients, and patients with sickle celldisease, these patients are likely to need alonger course of medication.

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    ROLE OF SURGERY

    Conservative treatment is effectivein up to 90% of cases of acute

    osteomyelitis if it is diagnosed earlyin the course of the illness

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    ROLE OF SURGERY

    Since it is conceivable thatextensive inter- vention in the initial,

    critical moments of treat- mentproduces more harm than benefit,perhaps only trepanation ordrainage should be performed.

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    CASE REPORT

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    RESPONSE TO TREATMENT AND OUTCOMES

    Usually, active infection is eliminated rathereasily with well targeted antibiotics, whereasthe inflammatory process, which ultimatelyheals the bone, may persist for months. NSAIDs may be used to mitigate symptoms.

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    THANK YOU