A Case of Acute Osteomyelitis: An Update on Diagnosis and Treatment

Chiappini, Elena; Mastrangelo, G; Lazzeri, Simone

doi:10.3390/ijerph13060539

Cited by 37 publications

(41 citation statements)

References 35 publications

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“…Similarly, in other studies, leukocytosis has been reported only in 36% of children, but increased ESR was observed in 91% of children and CRP in 81% of them [27]. As expected, we observed a low sensitivity of X-ray imaging [28] and US [4]. …”

Section: Discussionsupporting

confidence: 89%

Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

Chiappini

Camposampiero

Lazzeri

et al. 2017

IJERPH

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Background: Paediatric acute hematogenous osteomyelitis (AHOM) is a serious disease requiring early diagnosis and treatment. To review the clinical presentation, management and organisms responsible for AHOM, and to explore risk factors for complicated AHOM, a large cohort referring to a single center over a 6-year period was evaluated. Methods: Data from children with AHOM, hospitalized between 2010 and 2015, and aged > 1 month, were retrospectively collected and analyzed. Results: 121 children (median age 4.8 years; 55.4% males) were included. Fever at onset was present in 55/121 children (45.5%); the lower limb was most frequently affected (n = 68/121; 56.2%). Microbiological diagnosis (by culture and/or polymerase chain reaction (PCR)) was reached in 33.3% cases. Blood and pus/biopsy culture sensitivities were 32.4% and 46.4%, respectively. PCR sensitivity was 3.6% (2/55) on blood, and 66.6% (16/24) on pus/biopsy sample. Staphylococcus aureus was the most commonly identified pathogen (n = 20); no methicillin-resistant Staphylococcus aureus (MRSA) was isolated, 10.0% (n = 2) strains were Panton-Valentine-Leukocidin (PVL) producer; 48.8% (59/121) cases were complicated. At univariate analysis, factors associated with complicated AHOM were: recent fever episode, fever at onset, upper limb involvement, white blood count (WBC) ≥ 12,000/µL, C reactive protein (CRP) ≥ 10 mg/L, S. aureus infection. At multivariate analyses S. aureus infection remained the only risk factor for complicated AHOM (aOR = 3.388 (95%CI: 1.061–10.824); p-value = 0.039). Conclusions: In this study microbiological diagnosis was obtained in over one third of cases. Empiric treatment targeting methicillin-sensitive Staphylococcus aureus seems to be justified by available microbiological data.

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Section: Discussionsupporting

confidence: 89%

Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

Chiappini

Camposampiero

Lazzeri

et al. 2017

IJERPH

Self Cite

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“…CT, which is suitable for patients with contraindications to MRI [8], is useful for nding necrotic bones, which assists in the diagnosis of chronic osteomyelitis. MRI has a high sensitivity (82% -100%) and speci city (75% -99%) and is helpful for reaching a diagnosis of osteomyelitis [9]. MRI helps locate lesions, de ne the extent of the destruction, track the development of the disease and plan surgical interventions.…”

Section: Discussionmentioning

confidence: 99%

Diabetes With Osteomyelitis in Rare Sites With Sepsis as the First Diagnosis: Three Case Reports and Literature Review

Zhou

Jiang

2020

Preprint

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Background: Osteomyelitis is an infectious bone disease. Common clinical symptoms are fever, local limb pain and redness. Anti-infective treatment is commonly used, but the efficacy varies in different patients. Sometimes surgery is needed to relieve patients' symptoms. Diabetic patients have a high risk of osteomyelitis due to long-term hyperglycemia, activated inflammatory response and immune deficiency.Patient Concerns: In our study, the three patients were men who were admitted to the hospital due to fever and pain. Two patients had upper limb pain, and the third had lumbar spine pain. All of them had blood cultures that suggested bacterial infections and increased levels of C-reactive protein.Diagnosis: Two patients in our study had osteomyelitis that was verified by magnetic resonance imaging; osteomyelitis was confirmed by postoperative histopathological examination in the third patient.Interventions: All patients received intravenous infusion of antibiotics to treat osteomyelitis. The third patient underwent debridement of the lumbar spine.Outcomes: Among the three patients, two recovered after adjustment of the antibiotic therapy, and one recovered after a surgical operation.Conclusion: Our study reports three patients with diabetes with osteomyelitis in rare sites. We should be aware that diabetes is one of the risk factors for osteomyelitis. When diabetic patients present with fever and pain, healthcare professionals should be alert to the possibility of osteomyelitis. Blood tests are helpful for clarifying the degree of inflammation, and imaging tests are helpful for locating the infection site. However, for some atypical cases, we cannot rely too much on auxiliary examinations, and we need to pay attention to the clinical symptoms and signs. Glycemic control and anti-infective therapy are common methods for the treatment of osteomyelitis, and surgical intervention should be considered if necessary to relieve local symptoms.

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“…In der Literatur beschrieben werden auch Pilze und Viren als seltene Verursacher der Erkrankung [4,5]. In seltenen Fällen und insbesondere bei Kindern liegt eine nicht chronische, nicht bakterielle Erkrankung vor, die als autoinflammatorische Erkrankung dem rheumatischen Formenkreis zuzuordnen ist [6].…”

Section: Definition Des Begriffs Osteomyelitisunclassified

Osteomyelitis

Tiemann¹

2020

Orthopädie und Unfallchirurgie up2date

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A Case of Acute Osteomyelitis: An Update on Diagnosis and Treatment

Cited by 37 publications

References 35 publications

Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

Diabetes With Osteomyelitis in Rare Sites With Sepsis as the First Diagnosis: Three Case Reports and Literature Review

Osteomyelitis

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