{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:18:24Z","timestamp":1790831904095,"version":"4.1.0"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Osteoarticular infections (OAIs) in children persist to be a major clinical concern due to their potential long-term impact on bone growth and joint function. Despite careful sampling, a significant proportion of OAIs remain culture-negative, historically obscuring the true epidemiology of these conditions. At the same time, subacute osteomyelitis is increasingly being detected and recognized as a distinct osteoarticular infection. Subacute hematogenous osteomyelitis (SAHO) is often under-recognized, as it is typically characterized by localized pain, mild or absent systemic manifestations, non-contributory laboratory tests and blood cultures, but positive radiological findings. This review focuses on the phenomenon of so-called culture-negative OAIs, exploring their microbiological basis, the role of fastidious and atypical microorganisms, parallels with subacute osteomyelitis, and the role of modern diagnostic technologies.<\/jats:p>","DOI":"10.3389\/fped.2026.1775415","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T05:29:26Z","timestamp":1778477366000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Reflections on so-called culture-negative osteoarticular infections in pediatric populations"],"prefix":"10.3389","volume":"14","author":[{"given":"Ahmer Ahmad","family":"Khan","sequence":"first","affiliation":[{"name":"Pediatric Orthopedics and Traumatology Unit, Department of Pediatric Surgery, Geneva University Hospitals","place":["Geneva, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"De Marco","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics and Traumatology Unit, Department of Pediatric Surgery, Geneva University Hospitals","place":["Geneva, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elio","family":"Paris","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics and Traumatology Unit, Department of Pediatric Surgery, Geneva University Hospitals","place":["Geneva, Switzerland"]},{"name":"Faculty of Medicine, University of Geneva","place":["Geneva, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"Vazquez","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics and Traumatology Unit, Department of Pediatric Surgery, Geneva University Hospitals","place":["Geneva, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Steiger-Tuk","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics and Traumatology Unit, Department of Pediatric Surgery, Geneva University Hospitals","place":["Geneva, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Dayer","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics and Traumatology Unit, Department of Pediatric Surgery, Geneva University Hospitals","place":["Geneva, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitri","family":"Ceroni","sequence":"additional","affiliation":[{"name":"Pediatric Orthopedics and Traumatology Unit, Department of Pediatric Surgery, Geneva University Hospitals","place":["Geneva, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1016\/j.pcl.2005.02.005","article-title":"Bone and joint infections in children","volume":"52","author":"Gutierrez","year":"2005","journal-title":"Pediatr Clin North Am"},{"key":"B2","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1097\/00006565-199902000-00012","article-title":"Etiology of septic arthritis in children: an update for the 1990s","volume":"15","author":"Luhmann","year":"1999","journal-title":"Pediatr Emerg Care"},{"key":"B3","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1097\/MOP.0b013e32835c2b42","article-title":"Osteomyelitis and septic arthritis in children: current concepts","volume":"25","author":"Dodwell","year":"2013","journal-title":"Curr Opin Pediatr"},{"key":"B4","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/S1684-1182(10)60051-5","article-title":"Acute community-acquired osteoarticular infections in children: high incidence of concomitant bone and joint involvement","volume":"43","author":"Chen","year":"2010","journal-title":"J Microbiol Immunol Infect"},{"key":"B5","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1097\/00009957-199910000-00014","article-title":"Epidemiologic, bacteriologic, and long-term follow-up data of children with acute hematogenous osteomyelitis and septic arthritis: a ten-year review","volume":"8","author":"Christiansen","year":"1999","journal-title":"J Pediatr Orthop Part B"},{"key":"B6","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1046\/j.1442-200x.2000.01267.x","article-title":"Septic arthritis in childhood","volume":"42","author":"\u00c7aksen","year":"2000","journal-title":"Pediatr Int"},{"key":"B7","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1111\/j.1440-1754.2005.00538.x","article-title":"Acute osteomyelitis and septic arthritis in children","volume":"41","author":"Goergens","year":"2005","journal-title":"J Paediatr Child Health"},{"key":"B8","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1302\/0301-620X.83B1.0830099","article-title":"The changing epidemiology of acute and subacute haematogenous osteomyelitis in children","volume":"83","author":"Blyth","year":"2001","journal-title":"J Bone Joint Surg Br"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1097\/00006454-199811000-00012","article-title":"Epidemiology and outcome of osteomyelitis in the era of sequential intravenous-oral therapy","volume":"17","author":"Karwowska","year":"1998","journal-title":"Pediatr Infect Dis J"},{"key":"B10","doi-asserted-by":"publisher","first-page":"736","DOI":"10.55275\/JPOSNA-2023-736","article-title":"Appropriate antibiotic duration in pediatric bone and joint infection: a systematic review","volume":"5","author":"Hunter","year":"2023","journal-title":"J Pediatr Orthop Soc N Am"},{"key":"B11","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1097\/01241398-199909000-00020","article-title":"Culture-negative septic arthritis in children","volume":"19","author":"Lyon","year":"1999","journal-title":"J Pediatr Orthop"},{"key":"B12","doi-asserted-by":"publisher","first-page":"25","DOI":"10.3390\/microorganisms10010025","article-title":"Kingella kingae osteoarticular infections approached through the prism of the pediatric orthopedist","volume":"10","author":"DeMarco","year":"2021","journal-title":"Microorganisms"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1837","DOI":"10.1128\/JCM.00144-09","article-title":"New real-time PCR-based method for Kingella kingae DNA detection: application to samples collected from 89 children with acute arthritis","volume":"47","author":"Ilharreborde","year":"2009","journal-title":"J Clin Microbiol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e20191509","DOI":"10.1542\/peds.2019-1509","article-title":"Kingella kingae and osteoarticular infections","volume":"144","author":"Samara","year":"2019","journal-title":"Pediatrics"},{"key":"B15","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1097\/INF.0000000000004743","article-title":"Plasma microbial cell-free DNA sequencing for the detection of Kingella kingae pediatric spinal infections","volume":"44","author":"Ahmed","year":"2025","journal-title":"Pediatr Infect Dis J"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e02192","DOI":"10.1016\/j.idcr.2025.e02192","article-title":"The cruciality of increasing index of suspicion for atypical Bartonella henselae in pediatric patients: a case series","volume":"40","author":"Vazquez","year":"2025","journal-title":"IDCases"},{"key":"B17","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1093\/jpids\/piz089","article-title":"Moraxella lacunata subacute osteomyelitis in a child","volume":"10","author":"Mehmeti","year":"2021","journal-title":"J Pediatric Infect Dis Soc"},{"key":"B18","doi-asserted-by":"publisher","first-page":"4897","DOI":"10.12998\/wjcc.v11.i20.4897","article-title":"Subacute osteomyelitis due to Staphylococcus caprae in a teenager: a case report and review of the literature","volume":"11","author":"Vazquez","year":"2023","journal-title":"World J Clin Cases"},{"key":"B19","doi-asserted-by":"publisher","first-page":"514","DOI":"10.3390\/microorganisms14020514","article-title":"A Swiss retrospective case series of pediatric primary subacute hematogenous osteomyelitis","volume":"14","author":"Paris","year":"2026","journal-title":"Microorganisms"},{"key":"B20","doi-asserted-by":"publisher","first-page":"2010","DOI":"10.1111\/jpc.15408","article-title":"Subacute osteomyelitis caused by Fusobacterium nucleatum in a healthy child","volume":"57","author":"Almuzam","year":"2021","journal-title":"J Paediatr Child Health"},{"key":"B21","first-page":"15","article-title":"Haemophilus influenzae as a cause of brodie\u2019s abscess in an infant","volume":"144","author":"Kurlandsky","year":"1979","journal-title":"Johns Hopkins Med J"},{"key":"B22","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s12941-017-0186-0","article-title":"Aggregatibacter actinomycetemcomitans osteomyelitis in a 12 year old boy: case report emphasizing the importance of tissue culture, and review of literature","volume":"16","author":"Sharma","year":"2017","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1470","DOI":"10.1053\/j.gastro.2014.03.001","article-title":"The intestinal metabolome: an intersection between microbiota and host","volume":"146","author":"Ursell","year":"2014","journal-title":"Gastroenterology"},{"key":"B24","doi-asserted-by":"publisher","first-page":"5721","DOI":"10.1128\/JCM.43.11.5721-5732.2005","article-title":"Defining the normal bacterial flora of the oral cavity","volume":"43","author":"Aas","year":"2005","journal-title":"J Clin Microbiol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"100843","DOI":"10.1016\/S2666-5247(24)00049-1","article-title":"Integrating research on bacterial pathogens and commensals to fight infections: an ecological perspective","volume":"5","author":"Maier","year":"2024","journal-title":"Lancet Microbe"},{"key":"B26","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1038\/s41586-021-03986-2","article-title":"Unravelling the collateral damage of antibiotics on gut bacteria","volume":"599","author":"Maier","year":"2021","journal-title":"Nature"},{"key":"B27","doi-asserted-by":"publisher","first-page":"3097","DOI":"10.1038\/s41564-024-01850-3","article-title":"A framework for understanding collective microbiome metabolism","volume":"9","author":"Huelsmann","year":"2024","journal-title":"Nat Microbiol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1126\/science.ade2516","article-title":"Community instability in the microbial world","volume":"378","author":"Huelsmann","year":"2022","journal-title":"Science"},{"key":"B29","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.micinf.2015.01.004","article-title":"How bacterial pathogens colonize their hosts and invade deeper tissues","volume":"17","author":"Ribet","year":"2015","journal-title":"Microbes Infect"},{"key":"B30","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1111\/prd.12553","article-title":"The role of viruses in oral mucosal lesions","volume":"96","author":"Dommisch","year":"2024","journal-title":"Periodontol 2000"},{"key":"B31","volume-title":"The Lives of a Cell: Notes of a Biology Watcher","author":"Thomas","year":"1974"},{"key":"B32","doi-asserted-by":"publisher","first-page":"e20","DOI":"10.2106\/JBJS.CC.17.00144","article-title":"Chronic osteomyelitis caused by Haemophilus parainfluenzae: a case report","volume":"8","author":"Ramachandran","year":"2018","journal-title":"JBJS Case Connect"},{"key":"B33","first-page":"271","article-title":"Clinical characteristics of invasive Haemophilus aphrophilus infections","volume":"38","author":"Huang","year":"2005","journal-title":"J Microbiol Immunol Infect"},{"key":"B34","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/j.diagmicrobio.2004.08.005","article-title":"Epidural abscess and osteomyelitis due to Actinobacillus actinomycetemcomitans","volume":"50","author":"Patel","year":"2004","journal-title":"Diagn Microbiol Infect Dis"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.CC.21.00101","article-title":"Fusobacterial pelvic osteomyelitis with brodie\u2019s abscess in a 10-year-old boy requiring surgical evacuation: a case report","volume":"11","author":"Kokkonen","year":"2021","journal-title":"JBJS Case Connect"},{"key":"B36","doi-asserted-by":"publisher","first-page":"7108047","DOI":"10.1155\/2019\/7108047","article-title":"Subacute osteomyelitis of the pediatric talus: a first report of brodie\u2019s abscess from Morganella morganii","volume":"2019","author":"Harris","year":"2019","journal-title":"Case Rep Orthop"},{"key":"B37","first-page":"e21.00011","article-title":"Pediatric acetabular osteomyelitis treated with hip arthroscopy","volume":"5","author":"Lovse","year":"2021","journal-title":"J Am Acad Orthop Surg Glob Res Rev"},{"key":"B38","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1302\/0301-620X.47B3.526","article-title":"Primary subacute pyogenic osteomyelitis","volume":"47","author":"Harris","year":"1965","journal-title":"J Bone Joint Surg Br"},{"key":"B39","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1302\/0301-620X.51B3.458","article-title":"Subacute haematogenous osteomyelitis","volume":"51","author":"King","year":"1969","journal-title":"J Bone Joint Surg Br"},{"key":"B40","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1097\/00003086-197310000-00010","article-title":"Subacute osteomyelitis in children","volume":"96","author":"Gledhill","year":"1973","journal-title":"Clin Orthop"},{"key":"B41","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1097\/01241398-198208000-00003","article-title":"Subacute hematogenous osteomyelitis in children: a retrospective study","volume":"2","author":"Roberts","year":"1982","journal-title":"J Pediatr Orthop"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1565","DOI":"10.3928\/0147-7447-19861101-13","article-title":"Subacute pyogenic osteomyelitis","volume":"9","author":"Gillespie","year":"1986","journal-title":"Orthopedics"},{"key":"B43","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1302\/0301-620X.69B5.3680342","article-title":"Osteomyelitis in a general hospital. A five-year study showing an increase in subacute osteomyelitis","volume":"69","author":"Jones","year":"1987","journal-title":"J Bone Joint Surg Br"},{"key":"B44","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1097\/01241398-199603000-00017","article-title":"Subacute hematogenous osteomyelitis: are biopsy and surgery always indicated?","volume":"16","author":"Hamdy","year":"1996","journal-title":"J Pediatr Orthop"},{"key":"B45","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1007\/s11832-016-0739-3","article-title":"Primary subacute hematogenous osteomyelitis in children: a clearer bacteriological etiology","volume":"10","author":"Spyropoulou","year":"2016","journal-title":"J Child Orthop"},{"key":"B46","doi-asserted-by":"publisher","first-page":"1570","DOI":"10.2106\/JBJS.M.00791","article-title":"Primary epiphyseal or apophyseal subacute osteomyelitis in the pediatric population: a report of fourteen cases and a systematic review of the literature","volume":"96","author":"Ceroni","year":"2014","journal-title":"J Bone Joint Surg Am"},{"key":"B47","doi-asserted-by":"publisher","first-page":"107","DOI":"10.2106\/00004623-198163010-00014","article-title":"Primary subacute epiphyseal osteomyelitis","volume":"63","author":"Green","year":"1981","journal-title":"J Bone Joint Surg Am"},{"key":"B48","doi-asserted-by":"publisher","first-page":"1707","DOI":"10.1007\/s00264-008-0625-9","article-title":"Role of MRI in detecting early physeal changes due to acute osteoarticular infection around the knee joint: a pilot study","volume":"33","author":"Wardak","year":"2009","journal-title":"Int Orthop"},{"key":"B49","doi-asserted-by":"publisher","first-page":"e354","DOI":"10.1097\/BPO.0000000000001187","article-title":"Improved diagnosis and treatment of bone and joint infections using an evidence-based treatment guideline","volume":"38","author":"Quick","year":"2018","journal-title":"J Pediatr Orthop"},{"key":"B50","doi-asserted-by":"publisher","first-page":"5501","DOI":"10.7150\/thno.45554","article-title":"Liquid biopsy for infectious diseases: a focus on microbial cell-free DNA sequencing","volume":"10","author":"Han","year":"2020","journal-title":"Theranostics"},{"key":"B51","first-page":"271","article-title":"Clinical characteristics of invasive Haemophilus aphrophilusinfections","volume":"38","author":"Huang","year":"2005","journal-title":"J Microbiol Immunol Infect"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1775415\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T05:29:27Z","timestamp":1778477367000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1775415\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":51,"alternative-id":["10.3389\/fped.2026.1775415"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1775415","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,11]]},"article-number":"1775415"}}