MRSA Femoral Osteomyelitis from Superinfected Scabies Lesions: A Pediatric Case Report

Marco Ugo Andrea Sartorio, Alice Marianna Munari, Patrizia Carlucci, Paola Erba, Valeria Calcaterra and Valentina Fabiano
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Marco Ugo Andrea Sartorio: Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
Alice Marianna Munari: Pediatric Radiology and Neuroradiology, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy
Patrizia Carlucci: Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
Paola Erba: Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
Valeria Calcaterra: Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy
Valentina Fabiano: Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy

IJERPH, 2022, vol. 19, issue 2, 1-6

Abstract: Scabies is a skin infestation from the Sarcoptes scabiei . It is considered a public health issue causing concern in developing countries and is considered a “neglected tropical disease” by the World Health Organization (WHO). Scabies skin lesions may cause severe itching and can be the portal of entry for opportunistic and pathogenic bacteria, which can cause serious systemic infections. We report the case of a 3-year-old boy with recurrent scabies infections who presented to the emergency department because of a fever and refusal to walk. Blood tests showed neutrophilic leukocytosis and significantly increased C reactive protein (CRP) and procalcitonin. Upon medical examination, his right thigh was extremely painful upon palpation, knee flexion was lost and he was unable to stand, so magnetic resonance imaging (MRI) was performed. MRI showed osteomyelitis of metaphysis and distal diaphysis of the right femur with associated subperiosteal purulent collection and concomitant pyomyositis and fasciitis of the distal right thigh. Blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). The patient received a long course of intravenous antibiotic therapy and his condition slowly improved. Follow-up femur X-ray showed a mixed pattern of erosion and sclerosis at the meta-diaphyseal region and periosteal reaction at the diaphyseal region. This case highlights the importance of early scabies diagnosis even in Western countries where poverty and household overcrowding are uncommon. Early diagnosis, timely initiation of proper treatment and evidence of clinical resolution are important elements to prevent recurrence of infection and serious systemic superinfections even from multi-drug resistant bacteria. Clinical consequences from unrecognized disease or inadequate eradication are preventable.

Keywords: ectoparasitic infestations; methicillin-resistant Staphylococcus aureus; neglected disease; osteomyelitis; pediatrics; public health; scabies; superinfection (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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