Typhoid osteitis in infancy.

In 1835 Maisonneuve first recognized osteomyelitis as a complication of typhoid and since then this bone lesion, although well known, has been reported only occasionally. Murphy (1916) collected 164 cases of typhoid periostitis and osteitis occurring in 18,840 cases of typhoid infection reported by 15 authors, an incidence of 0 82% of bone involvement. Veal (1939) also found osteitis in less than 1% of typhoid infections. In discussing the age incidence Murphy (1916) reported six cases (0*9 %) of typhoid periostitis occurring in the age-group 1 to 10 years in a total of 68 cases at all ages. By comparison, in a series of 411 cases of septic osteomyelitis at all ages he found 108 (26%) in the first decade. Winslow (1923) found 101 proven cases in the literature and he added two of his own. Four of these occurred in the first decade, the youngest being 2 years old. Of this series 68 had one and 23 had two bones involved. Veal (1939) also recorded multiple bone involvement in less than 5% of cases. Typhoid lesions tend to remain localized in contrast to paratyphoid B infections which tend to spread through the length of the bone. Webb-Johnson (1917) illustrated the extreme rarity of bone involvenent in paratyphoid B infections, recording only two instances in a study of 1,038 examples of this disease. Tlhere may be a wide variation in the latent period between the acute idlness and the subsequent bone involvement. In Winslow's 101 cases the bone manifestations occurred during the acute attack in nine, at an unspecified date during convalescence in 53, and months or years after convalescence in 20 cases. The tibia appears to be the bone most commonly affected. Morse and Geiser (1950) reported a case of typhoid osteomyelitis treated with chloramphenicol. Typhoid bone lesions are extremely rare in infancy and we wish to record two cases.