- Fever, malaise, severe pain at the site of infection, fatigue, irritability, restriction of movement (pseudo paralysis of limb in neonates) local edema, erythema, and tenderness
- A history of recent trauma, surgery, or infection of another organ If the infection is close to a joint there may be a ‘sympathetic’ effusion or concomitant septic arthritis.
Note: Risk Factors: Poor social economic status, immunosuppression and or malnutrition
Investigations
- Total and differential White Blood Cell count
- Erythrocyte sedimentation Rate
- C- Reactive protein
- Urinalysis
- Urine for Culture and Sensitivity
- Blood for Culture and Sensitivity or
- Aspirated pus for Culture and Sensitivity
- Bone Biopsy for Culture and Sensitivity
- Polymerase Chain Reaction (PCR) for special case like Kingella kingae species
- Bone Scan using Technetium –99 in acute infection
- Ultrasound
- Plain X-ray
- CT scan in complex anatomical regions like shoulder, pelvic, spine
Pharmacological Treatment
B: cloxacillin (IV) 1–2g 6hourly then continue with ampicillin + cloxacillin (FDC) (PO) 500mg 8hourly to complete 3-6weeks course or until CRP and x-ray become negative
OR
C: ampicillin + sulbactam (FDC) (IV) 3g 6hourly for two weeks
THEN
B: amoxillin + clavulanate (FDC)(PO) 625mg 12hourly for 4weeks
Patients with penicillin allergy consider:
S: clindamycin (IV) 60mg 6hourly for 2weeks then orally to complete 4-6weeks
AND
C: ciprofloxacin (IV) 400mg 12hourly for 2weeks then orally to complete 4-6weeks
For sickle cell patient if salmonella spp is suspected consider:
C: ciprofloxacin (IV) 400mg 12hourly for 4weeks, you may change to oral after 2weeks
Surgical management
Surgical drainage and bone window recommended in all cases presenting with history lasting > 24 hours,