Fusobacterium Species in Osteoarticular Infections in Childhood-A Systematic Review with Data Synthesis and a Case Series in the Acetabular and Hip Joint Regions.

Background

In paediatric osteoarticular infections, microorganism detection is unsuccessful in up to 55% of cases, which is not satisfactory for targeted antibiotic therapy. In particular, anaerobic fusobacteria may be underdiagnosed owing to a lack of knowledge about their properties.

Methods

Based on three of our own cases and a systematic literature review regarding paediatric osteoarticular fusobacterial infections, we extracted characteristic variables and synthesised them in terms of frequencies and mean comparisons. We followed the CARE and PRISMA guidelines.

Results

In our three patients with hip area infections (aged 11, 12, and 16 years; two males and one female; two with Fusobacterium nucleatum [FNU] and one with Fusobacterium necrophorum [FNE]), we only detected FNU with PCR. The patient with an FNE infection showed a septic and protracted course with six surgical interventions and secondary coxarthrosis during the follow-up. The FNU infections were milder and healed without sequelae. In the literature, there are no articles with more than 3 cases; overall, we identified 38 case reports and 3 case series with a total of 45 patients. Across all synthesised cases (73% boys), the age was 9.2 ± 4.1 years. Most patients (42%) were affected by hip joint arthritis, with or without accompanying acetabular or femoral osteomyelitis, followed by knee joint arthritis, with or without osteomyelitis, in 24% of patients. In 49% of cases, there was an ear, nose, and throat focus. Depending on the affected structure, arthrotomy (33%), arthroscopy (11%), bone (24%), and soft tissue (9%) debridement were performed, with 34% of the procedures having to be performed several times. Penicillins, metronidazole, and clindamycin were the most used antibiotics. In 32 cases (71%), the authors reported healing without sequelae.

Conclusions

When samples are collected in the operating theatre for paediatric osteoarticular infections, orthopaedic surgeons should also ensure correct anaerobic sampling and consider the possibility of performing PCR. A typical child with an osteoarticular fusobacterial infection is a boy of approximately 10 years of age with an infection in the hip area and a previous infection in the ENT area.