American Medical Association Family Medical Guide - American Medical Association [209]
If osteomyelitis is left untreated or if treatment with medication does not clear up the infection, the bacteria can spread and multiply in the bloodstream and cause blood poisoning (see page 937).
Symptoms and diagnosis
The symptoms of osteomyelitis, which develop gradually over 2 or 3 days, usually include redness, swelling, and pain in the affected bone. Other symptoms include fever, chills, fatigue, and nausea. A diagnosis of osteomyelitis is based on the symptoms and the results of a physical examination. To confirm the diagnosis, the doctor may order X-rays or a bone scan and blood tests to check for infection. In some cases, the doctor may recommend a bone biopsy.
Treatment
To treat acute osteomyelitis, the doctor may admit your child to the hospital for bed rest and to immobilize the affected arm or leg with splints or a cast. He or she will also prescribe a 6-week course of oral antibiotics (which may be given intravenously at first). In some cases, a doctor may recommend minor surgery to drain and clean out the infection in the bone. Rarely, surgery may be necessary to remove infected or damaged bone or surrounding tissue.
Juvenile Rheumatoid Arthritis
Juvenile rheumatoid arthritis is an autoimmune disorder in which the immune system mistakenly produces antibodies (infection-fighting proteins) that attack and damage joints and other tissues throughout the body. The disorder may be mild or severe and occurs more often in girls than in boys. The cause is not known.
Juvenile rheumatoid arthritis can develop at any time between ages 6 months and 16 years, but it often begins between ages 2 and 5. Episodes of juvenile rheumatoid arthritis can come and go for years and they frequently disappear by the time a child reaches puberty. Each episode lasts a few weeks and tends to be less severe than the previous one. In some cases, juvenile rheumatoid arthritis leads to partial or disabling deformities. If the irises (the colored part of the eyes) become inflamed, partial or complete blindness can result.
With treatment, most children and young adults with juvenile rheumatoid arthritis are able to lead full, active lives.
Symptoms
The symptoms of juvenile rheumatoid arthritis include redness, swelling, warmth, stiffness, and pain in the affected joints. The child’s temperature usually fluctuates, often from normal (98.6°F) in the morning to about 103°F in the evening. The child may have a poor appetite and may lose weight. A blotchy, red rash may break out over the trunk, arms, and legs. Mild anemia (see page 610) often develops because the disorder blocks production of blood cells by the bone marrow. The child may have redness and pain around one or both eyes and may be sensitive to bright light.
The areas of inflammation in rheumatoid arthritis can vary widely from child to child. In addition to the area around the eyes, the lymph glands in the neck and armpits may swell, or the outer membrane of the heart may become inflamed (called pericarditis; see page 596), causing chest pain. The joints—usually the knees, ankles, elbows, and neck—can become swollen, stiff, and painful. In some cases, the joints become deformed over time. If your child has symptoms of juvenile rheumatoid arthritis, see the doctor right away.
Diagnosis
To diagnose juvenile rheumatoid arthritis, the doctor will ask about your child’s symptoms, take a detailed health history, and perform a physical examination. He or she also may order blood tests, X-rays of the affected areas, and a biopsy of the membrane that encloses one of the affected joints. In a biopsy, a small amount of tissue is removed from the membrane for examination under a microscope. The doctor also may recommend laboratory analysis of the fluid inside the joints (synovial fluid).