Hematogenous osteomyelitis caused by Streptococcus anginosus group in a previously healthy child

Abstract

Osteomyelitis is an important disease in children because of the risk of developing permanent disability. Staphylococcus aureus (89%) and the group A streptococci are the two major pathogens responsible for osteomyelitis in immunocompetent children. Musculoskeletal infections caused by Haemophilus influenzae type b (Hib) have decreased considerably in recent years because of widespread immunization of infants against Hib. Other bacterial pathogens rarely cause osteomyelitis in immunocompetent children, especially in circumstances without any predisposing risk factors. Viridans streptococci are known as organisms with low virulence. However, the Streptococcus anginosus group (SAG) is characterized by a propensity to form abscesses. Members of the SAG are found in the human respiratory tract, the gastrointestinal tract, and the female genitourinary tract as normal flora. The SAG has often been associated with dental caries, endocarditis, abdominal abscess, or brain abscess. Bacteremia caused by the SAG is often associated with an identifiable source of infection, profound neutropenia, or abdominal surgery. Herein, we report a case of hematogenous osteomyelitis of the femur caused by the SAG in a previously healthy 10-year-old boy without any risk factors. To our knowledge, this is the first report of the SAG osteomyelitis developed in an otherwise healthy child.