|
Year |
2002 |
|---|---|
|
Question Number |
137 |
|
Category |
Orthopaedic Disease |
Question
The incidence of acute hematogenous osteomyleitis resulting from Haemophilus influenzae has
1- increased markedly.
2- decreased markedly.
3- remained the same.
4- remained the same as the incidence of Staphylococcus aureus.
5- remained the same as other gram positive organisms.
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Answer (click for answer)
Preferred Answer: 2
Haemophilus influenzae has been a major cause of infectious diseases in children and has been attributed as a significant cause of septic arthritis and osteomyelitis in children. The study shows that the Haemophilus influenzae vaccine has reduced the incidence of bone and joint infections because of Haemophilus influenzae to near 0. These findings suggest that coverage of Haemophilus influenzae as part of the empiric antibiotic coverage may be no longer needed in the management of acute hematogenous osteomyelitis and septic arthritis in children.
In the recent past, Haemophilus influenzae has been a major cause of infectious diseases in children, and 95% of these infections were due to Serotype b. Serotype b has been the primary cause of bacterial meningitis and epiglottitis, and has been a significant cause of pericarditis, pneumonia, cellulitis, septic arthritis, and osteomyelitis.
The incidence of the disease was impressive. Haemophilus influenzae meningitis developed in one in 500 children in the United States before widespread vaccination. Nearly one in 200 children would experience a major infection with this organism before age 5 years. The peak incidence of disease was at age 7 months with infections during the first 2 months of age being extremely rare because of transplacental maternal antibodies. Older children, in whom immunity to the disease was developing after infection, were still carriers of the organism. Therefore, attendance at day care centers has been a major risk factor for the development of disease in young children. The infection rate in boys and girls was approximately equal, and there was a higher incidence of infection in the black population, and in the lower socioeconomic class, most likely because of healthcare access.
Reference: Bowerman SG, Greene NE, Mencio GA: Decline of bone and joint infections attributable to haemophilus influenza type b. Clin Orthop 1997; 341:128-133.