22 - Biomarkers for pediatric bacterial musculoskeletal infections in Lyme disease endemic regions

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 22
Publication Number: 22.11

Caroline G. Kahane, Boston Children's Hospital, Boston, MA, United States; Lise E. Nigrovic, Boston Children's Hospital, Boston, MA, United States; Anupam B. Kharbanda, Childrens Minnesota, Minneapolis, MN, United States; Desiree Noel Wagner. Neville, UPMC Childrens Hospital of Pittsburgh, Pittsburgh, PA, United States; Amy D. Thompson, Nemours Children's Hospital, Wilmington, DE, United States; Fran Balamuth, Perelman School of Medicine at the University of Pennsylvania, philadelphia, PA, United States; Laura L. Chapman, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Michael Levas, Medical College of Wisconsin, Pewaukee, WI, United States; John Branda, Harvard Medical School, South Grafton, MA, United States; Mark Kellogg, Harvard Medical School, Boston, MA, United States; Michael Monuteaux, Boston Children's Hospital, Boston, MA, United States; Todd W. Lyons, Boston Children's Hospital, Wayland, MA, United States

Presenting Author(s)

Caroline G. Kahane, MD (she/her/hers)

Clinical Fellow
Boston Children's Hospital
Boston, Massachusetts, United States

Background:

Bacterial musculoskeletal infections (MSKIs) require prompt recognition and treatment. However, these infections can be challenging to diagnose due to clinical overlap with other conditions including Lyme arthritis.

Objective: To evaluate the accuracy of routinely available blood biomarkers to differentiate children with an MSKI from those with Lyme disease and other inflammatory arthritis.

Design/Methods: We conducted a prospective cohort study of children 1 to 21 years of age with monoarthritis who presented to one of eight Pedi Lyme Net emergency departments (EDs) located in Lyme endemic areas for evaluation of potential Lyme disease. Our primary outcome was the presence of an MSKI defined as septic arthritis with growth of pathogenic bacteria in synovial fluid culture or blood culture with a synovial fluid pleocytosis ( > 50,000 WBC/high powered field) or osteomyelitis/pyomyositis based on results of bone scan or magnetic resonance imaging. We compared the diagnostic accuracy of each of these biomarkers [absolute neutrophil count (ANC), c-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and procalcitonin (PCT)] to white blood cell (WBC) for the identification of an MSKI using the area under the curve (AUC) for the receiver operating characteristic (ROC) curve.

Results: We identified 1,423 children with monoarthritis with a median age of 7 years [interquartile range (IQR) 4-11 years] and 907 (63.7%) male. Among these 1,423 children, 82 (5.8%) had an MSKI, 407 (28.6%) Lyme arthritis and 934 (65.6%) other inflammatory arthritis. Overall, children with an MSKI had higher WBC count, ANC, CRP, ESR and PCT than those with other types of arthritis (Figure 1). When compared to WBC count [AUC 0.63; 95% confidence interval (CI) 0.55, 0.71], CRP (0.84; 95% CI 0.80, 0.89, p < 0.05), PCT (0.82, 95% CI 0.77, 0.88; p < 0.05) and ESR (0.77, 95% CI 0.71-0.82, p < 0.05) had a higher AUC, while ANC had a similar AUC (Figure 2).

Conclusion(s): Commonly available biomarkers can assist in the initial approach to a potential MSKI in a child. However, no single biomarker has high enough accuracy to be used in isolation, especially in Lyme disease endemic areas.
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