Figure 2.19. Osteomyelitis of the proximal end of the right femur with marked bony changes. Note the marked increase in the size of the hip joint. This again demonstrates that joint swelling may be the first indication of the development of osteomyelitis. The reason for the common involvement of joints in the neonatal period is that sinusoidal vessels, termed transphyseal vessels, connect the two separate circulatory systems seen in the bones of older children (the metaphyseal loops which derive from the diaphyseal nutrient artery and the epiphyseal vessels which course through the epiphyseal cartilage canals). With skeletal maturation the transphyseal vessels obliterate (8 to 18 months) and the epiphyseal and metaphyseal systems become totally separate.
Figure 2.21. Osteomyelitis usually occurs in the long bones, but in the neonate frequently occurs in other bones such as the clavicle and ribs. This infant demonstrates inflammation and swelling over the right clavicle due to a staphylococcal osteomyelitis.
Figure 2.23. This infant presented with fever, lethargy and poor feeding at 4 days of age. He then developed a generalized rash which resembled scarlatina. Blood culture was positive for a Staphylococcus aureus phage type which produces an erythrogenic toxin, hence the appearance of the rash.
Figure 2.24. Close-up of the rash in the same infant.
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