Osteomielitis de calcáneo en niños. Observaciones de una serie de casos.

Abstract

Objectives : calcaneus osteomyelitis is an uncommon bone infection in children, with subtle clinical findings and no important immunologic response, requiring diagnostic imaging to make a diagnosis. This is a clinical study made with patients diagnosticated with calcaneus osteomielitis. Materials and methods : this is a retrospective study of patients with calcaneus ostomyelitis during a 5-year follow up. The variables analyzed were age, gender, affected side, previous trauma or disease, time to diagnosis and treatment period. Results : nine patients were recluted. Six of them with secretion cultures; which 4 were positive with S. aureus. (three with methicillin-resistant S. aureus and one case methicillin - sensitive) and Pseudomonas aeruginosa in two cases. Magnetic resonance imaging (MRI) was neccesary in 6 patients, with findings sugestive of osteomyelitis in all of them. Conclusion: a high-suspect index is essential to diagnosis, besides imaging studies and laboratory exams. Inicial VSG and PCR were positive in all patients and had a tendency to lowering during treatment. CRP correlated with clinical improvement and was an important marker to iniciate orally antymicrobial treatment.  MRI and bone scan were an accurate resource in diagnosis. Staphylococcus aureus is the most common microorganism in this and other studies. P. aeruginosa was associated with accidental heel puncture.Early antimicrobial therapy is the main choice. Surgery is needed in some selected cases.