I just came back from the hospital where my five-year-old niece is being treated for an infected knee joint. They have no idea how she got this but say it can be treated with antibiotics. It’s some kind of a staph infection. Is there danger that it could be that new MRSA infection I hear about?

According to Dr. Lawson Copley, a professor of orthopedic surgery at the University of Texas Southwestern (Dallas, Texas), serious bone and soft tissue infections in children are on the rise and have become more serious and more complex than ever before. Pediatric musculoskeletal infections can be deep, wide spread, and deadly.

What has changed to bring this all about? MRSA— methicillin-resistive staphylococcus aureus infection. MRSA is a staph infection that has become resistant to all but one antibiotic. Early, accurate diagnosis is very important. Recognizing telltale symptoms gets the process started. Pain, tenderness, swelling, redness, loss of motion, and a distinct limp or difficulty walking are common first symptoms.

The diagnosis can be delayed when medical staff is fooled into thinking the child has a superficial (skin deep) infection called cellulitis. Or it may look like an isolated and contained abscess when, in fact, there is a deeper, more widespread and invasive infection. Sometimes it goes clear to the bone as in the case of osteomyelitis (bone infection). Areas affected most often include the spine, pelvis, and arms or legs. In some cases, it isn’t until a bone fracture or visible deformity occurs that the diagnosis is made.

Lab studies are done to identify the specific bacteria and help direct which antibiotic to use. Blood is drawn and studied. Blood tests help reveal the presence and type of infection. Whenever possible, fluid is also removed from the affected joint or a bit of the affected tissue is taken for laboratory analysis. The information gained from these tests also helps aid in selecting an antibiotic that will be most effective.

The use of MRIs today has helped identify the full extent of these infections. Other imaging studies with X-rays, CT scans, ultrasonography, and bone scans provide vital details about the location, size, and depth of infection. Any part of the soft tissues can be affected including skin, muscle, joint, and/or bone. Antibiotics and surgery remain the mainstay of treatment.