Escherichia coli and Enterococcus spp. isolation in maxillary osteomyelitis: a case report and literature review with special consideration of immunocompetent individuals

Abstract

The occurrence of maxillary osteomyelitis is rare in immunologically normal hosts. The nature of such infections is mainly polymicrobial, commonly attributable to micro-organisms present in the oral cavity. A case of acute maxillary osteomyelitis with Escherichia coli and Enterococcus spp. infection is described in an otherwise healthy young female. Cases of maxillary osteomyelitis reported in immunocompetent individuals lacking any predisposing factors are also reviewed. The lesion presented as a painful bone swelling and incomplete wound healing after tooth extraction, showing radiolucency with irregular borders. The isolated microbial species were E. coli and Enterococcus spp. Contamination from an extra-oral source through the wound may be implicated in the pathogenesis. A combination of surgical and antibiotic treatment proved to be successful. Nine maxillary osteomyelitis cases have been reported in the literature in immunocompetent individuals. Isolation of enteric bacteria was not described in any of those cases. Osteomyelitis should be included in the differential diagnosis of maxillary osteolytic lesions even in healthy individuals. The microbiological diagnosis is important for the antimicrobial intervention. This review shows that the main causative infectious agents in osteomyelitis remain unclear, as various bacteria have been reported to be involved. Clinical relevanceThis report brings the total number of maxillary osteomyelitis cases affecting immunocompetent individuals reported in the English literature to 10. Despite its infrequent occurrence, this inflammatory condition is relevant to clinicians, as the identification of the microbial species in osteomyelitis is essential for the appropriate selection of treatment due to the risk of the infection spreading to the neighboring anatomic structures.