Subacute osteomyelitis (Brodies abscess)

 Subacute osteomyelitis (Brodies abscess)

Osseous infection > 2wks without acute Sx

Less common than acute hematogenous osteomyelitis (AHO)

Lack of systemic illness -> delayed diagnosis

Lab may be normal or slightly elevated


S. aureus is most common

Location is more diverse than AHO


Pathophysiology

Host-pathogen relationship : bacterial virulence↓ & Host resistance↑

Inadequate treatment of AHO

40% of subacute OM : recent treatment of antibiotics for other infection (Roberts JM et al. 1982)



Classification

Treatment

Biopsy to rule out malignancy

Culture to confirm pathogen


6weeks course of oral antistaphylococcal antibiotics

Primary regimen

IV : Nafcillin, Oxacillin, Flucloxacillin, Cefazolin

PO : Dicloxacillin, Cephalexin


<5y-o : Kingella kingae. Should be covered : Clindamycin is recommended (McCarthy 2005)


Complication

Inadequate treatment -> can progress to chronic OM


Rare report of growth disturbance

Few report of LLD d/t growth stimulation


Subacute osteomyelitis
Pathophysiology
Classification
Treatment
Complication

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