Technetium phosphate bone scan in the diagnosis of septic arthritis in childhood

International Nuclear Information System (INIS)

Sundberg, S.B.; Savage, J.P.; Foster, B.K.

1989-01-01

The technetium phosphate bone scans of 106 children with suspected septic arthritis were reviewed to determine whether the bone scan can accurately differentiate septic from nonseptic arthropathy. Only 13% of children with proved septic arthritis had correct blind scan interpretation. The clinically adjusted interpretation did not identify septic arthritis in 30%. Septic arthritis was incorrectly identified in 32% of children with no evidence of septic arthritis. No statistically significant differences were noted between the scan findings in the septic and nonseptic groups and no scan findings correlated specifically with the presence or absence of joint sepsis

Septic arthritis caused by Peptostreptococcus asaccharolyticus

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Carlos Costa

2016-07-01

Full Text Available Peptostreptococcus spp are commensal organisms, usually involved in periodontal disease. Peptostreptococcus asaccharolyticus is an anaerobic gram-negative cocci, difficult to isolate due to its slow growth. Septic arthritis by this microorganism is a rare entity, but it can occur by hematogenous dissemination from a distant focus. Colonization and growth are more likely to occur in an already damaged articulation. We report the case of a 57 year-old woman with peripheral spondyloarthritis who developed knee septic arthritis by Peptostreptococcus asaccharolyticus.

Leucocyte esterase in the rapid diagnosis of paediatric septic arthritis.

LENUS (Irish Health Repository)

Kelly, E G

2013-02-01

Septic arthritis may affect any age group but is more common in the paediatric population. Infection is generally bacterial in nature. Prompt diagnosis is crucial, as delayed treatment is associated with lifelong joint dysfunction. A clinical history and application of Kocher\\'s criteria may indicate that there is a septic arthritis. However, definitive diagnosis is made on culture of septic synovial fluid. The culture process can take over 24h for the initial culture to yield bacterial colonies. Leucocyte esterase is released by leucocytes at the site of an infection. We hypothesise that leucocyte esterase can be utilized in the rapid diagnosis of septic arthritis and shorten the time to decisive treatment whilst simultaneously decreasing unnecessary treatment of non-septic joints.

Lactate and T2 measurements of synovial aspirates at 1.5 T: differentiation of septic from non-septic arthritis

International Nuclear Information System (INIS)

Wiener, Edzard; Zanetti, Marco; Hodler, Juerg; Pfirrmann, Christian W.A.

2008-01-01

The aim of this study was to differentiate septic from non-septic arthritis by measuring lactate concentration with 1 H magnetic resonance spectroscopy (HMRS) and by estimating total protein content with the assessment of T 2 values. In 30 patients with acute arthritis, synovial fluid was aspirated. Lactate concentrations were analyzed with single voxel HMRS at 1.5 T. T 2 relaxation times were mapped with a multi-spin echo sequence. All samples underwent microbiological testing and routine laboratory analysis to quantify lactate concentration and total protein content. Values obtained in septic and non-septic arthritis were compared with a Mann-Whitney U test. Synovial fluid from patients with septic arthritis (n=10) had higher concentrations of lactate (11.4 ± 4.0 mmol/L) and higher total protein content (51.8 ± 10.7 g/L) than fluid obtained in non-septic arthritis (n=20; 5.2±1.1 mmol/L and 40.4±6.9 g/L, respectively, p 2 relaxation times (as an indicator of total protein content) were moderately correlated to laboratory-confirmed lactate concentration (r 2 =0.71) and total protein content (r 2 =0.73). Markedly increased lactate concentrations (>6 mmol/L) in combination with low T 2 values ( 2 may be of value in the differentiation of septic from non-septic arthritis. (orig.)

Bilateral Acromioclavicular Septic Arthritis as an Initial Presentation of Streptococcus pneumoniae Endocarditis

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Neda Hashemi-Sadraei

2014-01-01

Full Text Available Infective endocarditis (IE is infrequently associated with septic arthritis. Moreover, septic arthritis of the acromioclavicular (AC joint is rarely reported in the literature. We report a case of Streptococcus pneumoniae IE in a patient who presented with bilateral AC joint septic arthritis and we review the literature on the topic.

MR imaging of transient synovitis: differentiation from septic arthritis

International Nuclear Information System (INIS)

Yang, W.J.; Im, S.A.; Lim, G.Y.; Chun, H.J.; Jung, N.Y.; Sung, M.S.; Choi, B.G.

2006-01-01

Transient synovitis is the most common cause of acute hip pain in children. However, MR imaging findings in transient synovitis and the role of MR imaging in differentiating transient synovitis from septic arthritis have not been fully reported. To describe the MR findings of transient synovitis and to determine whether the MR characteristics can differentiate this disease entity from septic arthritis. Clinical findings and MR images of 49 patients with transient synovitis (male/female 36/13, mean age 6.1 years) and 18 patients with septic arthritis (male/female 10/8, mean age 4.9 years) were retrospectively reviewed. MR findings of transient synovitis were symptomatic joint effusion, synovial enhancement, contralateral joint effusion, synovial thickening, and signal intensity (SI) alterations and enhancement in surrounding soft tissue. Among these, SI alterations and enhancement in bone marrow and soft tissue, contralateral joint effusion, and synovial thickening were statistically significant MR findings in differentiating transient synovitis from septic arthritis. The statistically significant MR findings in transient synovitis are contralateral (asymptomatic) joint effusions and the absence of SI abnormalities of the bone marrow. It is less common to have SI alterations and contrast enhancement of the soft tissues. The statistically significant MR findings in septic arthritis are SI alterations of the bone marrow, and SI alterations and contrast enhancement of the soft tissue. Ipsilateral effusion and synovial thickening and enhancement are present in both diseases

Tuberculous osteomyelitis/arthritis of the first costo-clavicular joint and sternum.

Science.gov (United States)

Patel, Prasan; Gray, Robin R

2014-12-28

A young Somali immigrant presents with a two-year history of a large, firm, painful right anterolateral chest wall sternal mass. The patient denied any history of trauma or infection at the site and did not have a fever, erythematous lesion at the site, clubbing, or lymphadenopathy. A lateral chest radiograph demonstrated a low density mass isolated to the subcutaneous soft tissue overlying the sternum, ribs and clavicle. Computed tomography (CT) with contrast demonstrated a cystic lesion in the right anterolateral chest wall deep to the pectoralis muscle. Enhanced CT of the chest demonstrated sclerosis and destruction of the rib and costochondral joint and manubrio-sternal joint narrowing. Ultrasound-guided biopsy and aspiration returned 500 cc of purulent, cloudy yellow, foul-smelling fluid. Acid-fact bacilli stain and the nucleic acid amplification test identified and confirmed Mycobacterium tuberculosis. A diagnosis of tuberculous osteomyelitis/septic arthritis was made and antibiotic coverage for tuberculosis was initiated.

Septic Arthritis of The Hip Joint presenting as Acute Abdomen ...

African Journals Online (AJOL)

These cases illustrate the maxim that any painful movement of the hip joint with associated unexplained fever should raise suspicion of septic arthritis. The close relationship of the hip joint to the pelvis sometimes confuses hip diseases with pelvic pathologies. Key Words: Septic arthritis, acute abdomen, pathological ...

Gram staining in the diagnosis of acute septic arthritis.

Science.gov (United States)

Faraj, A A; Omonbude, O D; Godwin, P

2002-10-01

This study aimed at determining the sensitivity and specificity of Gram staining of synovial fluid as a diagnostic tool in acute septic arthritis. A retrospective study was made of 22 patients who had arthroscopic lavage following a provisional diagnosis of acute septic arthritis of the knee joint. Gram stains and cultures of the knee aspirates were compared with the clinical and laboratory parameters, to evaluate their usefulness in diagnosing acute arthritis. All patients who had septic arthritis had pain, swelling and limitation of movement. CRP was elevated in 90% of patients. The incidence of elevated white blood cell count was higher in the group of patients with a positive Gram stain study (60%) as compared to patients with a negative Gram stain study (33%). Gram staining sensitivity was 45%. Its specificity was however 100%. Gram staining is an unreliable tool in early decision making in patients requiring urgent surgical drainage and washout.

Osteomyelitis in lower limbs and pulmonary septic emboli - a case report and radiological diagnosis

International Nuclear Information System (INIS)

Doria, Angela Schwarz; Amaro Junior, Edson; Torre, Marcia Barbosa; Bogus, Luis Carlos Nogueira; Andrade, Marcio Ramalho; Barba, Mario Flores; Scatigno Neto, Andre

1996-01-01

The authors describe a case of osteomyelitis in the lower limbs with subsequent septic emboli pulmonary spread, as a complication of the prior clinical presentation. They discuss clinical and pathological aspects, as well as, the possibility of diagnosis utilizing plain radiography, computed tomography and scintigraphy. (author)

Acute hematogenous septic arthritis of the knee in adults.

Science.gov (United States)

Sreenivas, T; Nataraj, A R; Menon, Jagdish

2013-10-01

To evaluate the factors associated with acute hematogenous septic arthritis of the knee in adults and to assess the outcome after open knee arthrotomy. We performed a prospective evaluation of 26 adult patients with acute nongonococcal septic arthritis of the knee presenting within 7 days. All patients underwent open knee arthrotomy, and final evaluation by means of Knee society score of the affected knee was compared with the contra lateral normal knee. The average duration of symptoms at the time of presentation was 3.9 days. Staphylococcus aureus was the commonest bacteria isolated in 17 (65.4 %) patients. The average duration of follow-up in our study was 18.5 months. In our study, Knee society score decreases as the age of the patient advances (P < 0.05) and also it was found to be low (P < 0.05) in the affected knee as compared to contra lateral normal knee. Our study shows that age of the patient at presentation is critical as it shows significant reduction in knee score. This explains that the septic arthritis may contribute to the progression of age-related degeneration of the knee joint. There appears to be no definite contributing factors or conditions associated with acute hematogenous septic arthritis of the knee in adults, although further study may be warranted regarding this matter.

Evidence-based diagnostics: adult septic arthritis.

Science.gov (United States)

Carpenter, Christopher R; Schuur, Jeremiah D; Everett, Worth W; Pines, Jesse M

2011-08-01

Acutely swollen or painful joints are common complaints in the emergency department (ED). Septic arthritis in adults is a challenging diagnosis, but prompt differentiation of a bacterial etiology is crucial to minimize morbidity and mortality. The objective was to perform a systematic review describing the diagnostic characteristics of history, physical examination, and bedside laboratory tests for nongonococcal septic arthritis. A secondary objective was to quantify test and treatment thresholds using derived estimates of sensitivity and specificity, as well as best-evidence diagnostic and treatment risks and anticipated benefits from appropriate therapy. Two electronic search engines (PUBMED and EMBASE) were used in conjunction with a selected bibliography and scientific abstract hand search. Inclusion criteria included adult trials of patients presenting with monoarticular complaints if they reported sufficient detail to reconstruct partial or complete 2 × 2 contingency tables for experimental diagnostic test characteristics using an acceptable criterion standard. Evidence was rated by two investigators using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS). When more than one similarly designed trial existed for a diagnostic test, meta-analysis was conducted using a random effects model. Interval likelihood ratios (LRs) were computed when possible. To illustrate one method to quantify theoretical points in the probability of disease whereby clinicians might cease testing altogether and either withhold treatment (test threshold) or initiate definitive therapy in lieu of further diagnostics (treatment threshold), an interactive spreadsheet was designed and sample calculations were provided based on research estimates of diagnostic accuracy, diagnostic risk, and therapeutic risk/benefits. The prevalence of nongonococcal septic arthritis in ED patients with a single acutely painful joint is approximately 27% (95% confidence interval [CI] = 17

Familial Mediterranean fever mimicking septic arthritis: distinguishing with diffusion weighted imaging

International Nuclear Information System (INIS)

Oner, Ali Yusuf; Ucar, Murat; Akpek, Sergin; Tokgoz, Nil

2007-01-01

FMF arthritis is generally monoarticular in origin. The affected joint is hot, tender, red and mimics septic arthritis. Conventional imaging findings, including magnetic resonance imaging (MRI) and ultrasound, do not help differentiate between these two entities. The final diagnosis depends on culture of the synovial fluid, and therefore initiation of proper drug therapy can be delayed. Diffusion weighted imaging (DWI), with its ability to detect altered water-proton mobility, might play an important role as a fast and non-invasive problem-solving tool in this setting. We here present MRI and DWI findings of a case of FMF arthritis mimicking septic arthritis. (orig.)

Streptococcus agalactiae: an emerging cause of septic arthritis.

Science.gov (United States)

Louthrenoo, Worawit; Kasitanon, Nuntana; Wangkaew, Suparaporn; Hongsongkiat, Sith; Sukitawut, Waraporn; Wichainun, Ramjai

2014-03-01

Invasive Streptococcus agalactiae infection in nonpregnant women has been reported increasingly worldwide. This study reports the clinical features and outcome of S. agalactiae septic arthritis in Thai patients. The medical records of cases with septic arthritis seen between July 1990 and December 2010 were reviewed. Only those with S. agalactiae were included in this study. From 244 cases of septic arthritis, 38 (15.57%, 13 men and 25 women) were caused by S. agalactiae, with 34 of them (89.48%) occurring between 2008 and 2010. Their mean age was 52.89 (SD, 18.95) years. Twenty-four of the 38 patients (63.16%) had 1 or more underlying disease that might predispose to joint infection. Fever and joint pain were the most common symptoms presented. Eleven cases (28.95%) presented monoarthritis, 15 (39.47%) oligoarthritis, and 12 (31.58%) polyarthritis, with a mean joint involvement of 3.34 (SD, 2.35) joints (range, 1-8). Cellulitis was seen in 27 cases (71.05%). Blood cultures were positive in 31 patients (81.58%). Thirty-five of the 38 synovial fluid specimens obtained were enough for cultures and stain smears, with 24 (68.57%) growing S. agalactiae and 19 (54.29%) showing gram-positive cocci. All isolates were sensitive to penicillin. Ten patients (26.31%) received arthroscopic drainage. The articular outcome was good in 11 patients, fair in 24, and poor in 3. There were no deaths. Streptococcus agalactiae is an emerging cause of septic arthritis in Thai patients. Physicians should be especially aware of this condition in patients presenting with acute oligopolyarthritis and prominent cellulitis.

Predictive Factors for Differentiating Between Septic Arthritis and Lyme Disease of the Knee in Children.

Science.gov (United States)

Baldwin, Keith D; Brusalis, Christopher M; Nduaguba, Afamefuna M; Sankar, Wudbhav N

2016-05-04

Differentiating between septic arthritis and Lyme disease of the knee in endemic areas can be challenging and has major implications for patient management. The purpose of this study was to identify a prediction rule to differentiate septic arthritis from Lyme disease in children presenting with knee pain and effusion. We retrospectively reviewed the records of patients younger than 18 years of age with knee effusions who underwent arthrocentesis at our institution from 2005 to 2013. Patients with either septic arthritis (positive joint fluid culture or synovial white blood-cell count of >60,000 white blood cells/mm(3) with negative Lyme titer) or Lyme disease (positive Lyme immunoglobulin G on Western blot analysis) were included. To avoid misclassification bias, undiagnosed knee effusions and joints with both a positive culture and positive Lyme titers were excluded. Historical, clinical, and laboratory data were compared between groups to identify variables for comparison. Binary logistic regression analysis was used to identify independent predictive variables. One hundred and eighty-nine patients were studied: 23 with culture-positive septic arthritis, 26 with culture-negative septic arthritis, and 140 with Lyme disease. Multivariate binary logistic regression identified pain with short arc motion, history of fever reported by the patient or a family member, C-reactive protein of >4 mg/L, and age younger than 2 years as independent predictive factors for septic arthritis. A simpler model was developed that showed that the risk of septic arthritis with none of these factors was 2%, with 1 of these factors was 18%, with 2 of these factors was 45%, with 3 of these factors was 84%, or with all 4 of these factors was 100%. Although septic arthritis of the knee and Lyme monoarthritis share common features that can make them difficult to distinguish clinically, the presence of pain with short arc motion, C-reactive protein of >4.0 mg/L, patient-reported history of

Bilateral septic arthritis of the temporo mandibular joint: case report.

Science.gov (United States)

Ayachi, Samia; Mziou, Zouha; Moatemri, Ramzi; Khochtali, Habib

2016-01-01

Septic arthritis of the temporo-mandibular joint (TMJ) is a rare disease that has been reported infrequently. To the best of the authors' knowledge, only one case of bilateral TMJ septic arthritis has been reported. The contamination may result from direct extension of adjacent infection (dental or ENT), from hematogenous spread of blood-borne organisms or from direct inoculation. The most common presenting are trismus and pain, although swelling, tenderness and erythema have also been described. In addition, patients may develop fever, regional lymphadenopathy and malocclusion. Through a successively bilateral case of TMJ arthritis, without obvious portal of entry of the bacteria, we will analyze characteristics and treatment of this disease.

Arthroscopic Treatment of Septic Arthritis of the Elbow in a 4-Year-Old Girl

Directory of Open Access Journals (Sweden)

Masashi Koide

2015-01-01

Full Text Available Pediatric septic arthritis is uncommon and has been traditionally treated by joint aspiration or open arthrotomy. There are some reports about arthroscopic surgery in pediatric septic arthritis of the knee, hip, and shoulder. However, there is no report for the case of elbow. We report a case of pediatric septic arthritis of elbow treated with arthroscopically with good clinical condition at 3-year follow-up. This paper is based on a report first published in Japanese (Tojo (2012.

Clinical presentation and treatment of septic arthritis in children.

Science.gov (United States)

Moro-Lago, I; Talavera, G; Moraleda, L; González-Morán, G

The aim of this study is to determine the epidemiological features, clinical presentation, and treatment of children with septic arthritis. A retrospective review was conducted on a total of 141 children with septic arthritis treated in Hospital Universitario La Paz (Madrid) between the years 2000 to 2013. The patient data collected included, the joint affected, the clinical presentation, the laboratory results, the appearance, Gram stain result, and the joint fluid culture, as well as the imaging tests and the treatment. Most (94%) of the patients were less than 2 years-old. The most common location was the knee (52%), followed by the hip (21%). The septic arthritis was confirmed in 53%. No type of fever was initially observed in 49% of them, and 18% had an ESR (mm/h) or CRP (mg/l) less than 30 in the initial laboratory analysis. The joint fluid was purulent in 45% and turbid in 12%. The Gram stain showed bacteria in 4%. The fluid culture was positive in 17%. Staphylococcus aureus was the most common pathogen found, followed by Streptococcus agalactiae, Streptococcus pneumoniae, and Kingella kingae. Antibiotic treatment was intravenous administration for 7 days, followed by 21 days orally. Surgery was performed in 18% of cases. The diagnosis was only confirmed in 53% of the patients. Some of the confirmed septic arthritis did not present with the classical clinical/analytical signs, demonstrating that the traumatologist or paediatrician requires a high initial level of clinical suspicion of the disease. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Septic arthritis due to Legionella cincinnatiensis: case report and review of the literature.

Science.gov (United States)

Banderet, Florian; Blaich, Annette; Soleman, Evelin; Gaia, Valeria; Osthoff, Michael

2017-08-01

Legionella spp. are an important cause of pulmonary and rarely extrapulmonary infections. L. cincinnatiensis has only been implicated in five cases to date. We herein report the first case of L. cincinnatiensis septic arthritis in a 90-year old lady with a past medical history of chronic kidney disease. She developed septic arthritis of her left wrist after having received intraarticular corticosteroid injections and oral corticosteroids administered for presumed chondrocalcinosis. Appropriate antimicrobial treatment of L. cincinnatiensis septic arthritis was delayed until identification of this organism in joint biopsies by broad-range bacterial PCR targeting the 16S rRNA gene with subsequent rDNA sequence analysis and by culture on special media. Reviewing all reported cases of septic arthritis caused by Legionella spp. other than L. cincinnatiensis it is notable that diagnosis was established by PCR in the majority of cases and only subsequently confirmed by special culture. Although most patients were immunosuppressed, outcome was favourable. Treatment consisted of a fluoroquinolone alone or in combination with rifampicin or a macrolide. Our case highlights the need for a high index of suspicion for infections with unusual/fastidious organisms when symptoms are suggestive of septic arthritis but conventional methods fail to identify a causative organism.

Candida septic arthritis with rice body formation: A case report and review of literature

International Nuclear Information System (INIS)

Jeong, Yu Mi; Cho, Hyun Yee; Lee, Sheen Woo; Hwang, Yun Mi; Kim, Young Kyu

2013-01-01

Rice body formation in a joint or bursa is a rare condition, and is usually associated with rheumatoid arthritis or tuberculous arthritis. Here we describe a case of multiple rice body formation in a shoulder joint and in adjacent bursae, which was confirmed to be due to septic arthritis by Candida species. To the best of our knowledge, rice body formation in Candida septic arthritis in an immune-competent patient has not been previously reported.

Candida septic arthritis with rice body formation: A case report and review of literature

Energy Technology Data Exchange (ETDEWEB)

Jeong, Yu Mi; Cho, Hyun Yee; Lee, Sheen Woo; Hwang, Yun Mi; Kim, Young Kyu [Gachon University, Gil Hospital, Incheon (Korea, Republic of)

2013-06-15

Rice body formation in a joint or bursa is a rare condition, and is usually associated with rheumatoid arthritis or tuberculous arthritis. Here we describe a case of multiple rice body formation in a shoulder joint and in adjacent bursae, which was confirmed to be due to septic arthritis by Candida species. To the best of our knowledge, rice body formation in Candida septic arthritis in an immune-competent patient has not been previously reported.

Septic arthritis and subsequent fatal septic shock caused by Vibrio vulnificus infection

DEFF Research Database (Denmark)

Emamifar, Amir; Asmussen Andreasen, Rikke; Andersen, Nanna Skaarup

2015-01-01

Vibrio vulnificus is a rare but potential fatal bacterium that can cause severe infections. Wound infections, primary sepsis and gastroenteritis are the most common clinical features. Septic arthritis caused by V. vulnificus is an atypical presentation that has been reported in only two case...

Pneumococcal polyarticular septic arthritis after a single infusion of infliximab in a rheumatoid arthritis patient: a case report

Directory of Open Access Journals (Sweden)

Hayashi Masatoshi

2012-03-01

Full Text Available Abstract Introduction We present a case of Streptococcus pneumoniae polyarticular septic arthritis in a patient with rheumatoid arthritis receiving a single infusion of infliximab. Case presentation A 38-year-old Japanese man with a 5-year history of seronegative rheumatoid arthritis had previously received sulphasalazine and methotrexate therapies and was on regular low-dose prednisolone therapy. Despite these treatments, his disease activity remained high and infliximab was introduced in addition to methotrexate, prednisolone, and folic acid. However, he was admitted to hospital with a fever of 40.6°C, chills, and polyarthralgia eight days after the first infusion of infliximab. His joints were swollen, painful, and warm. Laboratory data showed marked acute inflammation. He was diagnosed with bacterial septic polyarthritis, and emergency surgical joint lavage and drainage was performed at the knees along with needle aspiration and lavage of the ankles and right wrist. He was then given intravenous antibiotic therapy for 31 days. He made a good recovery and was discharged on day 37. Conclusions We believe this is the first reported case of severe pneumococcal septic arthritis requiring hospitalization in a patient treated with infliximab. S. pneumonia is now a well-recognized but uncommon cause of polyarticular septic arthritis that can lead to cessation of therapy, as in our patient's case.

MRI findings of treated bacterial septic arthritis

International Nuclear Information System (INIS)

Bierry, Guillaume; Huang, Ambrose J.; Chang, Connie Y.; Torriani, Martin; Bredella, Miriam A.

2012-01-01

The purpose of this study was to report the MRI findings that can be encountered in successfully treated bacterial septic arthritis. The study included 12 patients (8 male and 4 female; mean age 38 years, range 9-85) with 13 proven cases of bacterial septic arthritis. The joints involved were hip (n = 3), knee (n = 3), shoulder (n = 2), sacroiliac (n = 2), ankle (n = 1), wrist (n = 1), and elbow (n = 1). MRI examinations following surgical debridement and at initiation of antibiotic therapy and after successful treatment were compared for changes in effusion, synovium, bone, and periarticular soft tissues. Imaging findings were correlated with microbiological and clinical findings. Joint effusions were present in all joints at baseline and regressed significantly at follow-up MRI (p = 0.001). Abscesses were present in 5 cases (38 %), and their sizes decreased significantly at follow-up (p = 0.001). Synovial enhancement and thickening were observed in all joints at both baseline and follow-up MRI. Myositis/cellulitis was present in 10 cases (77 %) at baseline and in 8 cases (62 %) at follow-up MRI. Bone marrow edema was present in 10 joints (77 %) at baseline and persisted in 8 joints (62 %). Bone erosions were found in 8 joints (62 %) and persisted at follow-up MRI in all cases. The sizes of joint effusions and abscesses appear to be the factors with the most potential for monitoring therapy for septic arthritis, since both decreased significantly following successful treatment. Synovial thickening and enhancement, periarticular myositis/cellulitis, and bone marrow edema can persist even after resolution of the infection. (orig.)

MRI findings of treated bacterial septic arthritis

Energy Technology Data Exchange (ETDEWEB)

Bierry, Guillaume; Huang, Ambrose J.; Chang, Connie Y.; Torriani, Martin; Bredella, Miriam A. [Massachusetts General Hospital and Harvard Medical School, Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States)

2012-12-15

The purpose of this study was to report the MRI findings that can be encountered in successfully treated bacterial septic arthritis. The study included 12 patients (8 male and 4 female; mean age 38 years, range 9-85) with 13 proven cases of bacterial septic arthritis. The joints involved were hip (n = 3), knee (n = 3), shoulder (n = 2), sacroiliac (n = 2), ankle (n = 1), wrist (n = 1), and elbow (n = 1). MRI examinations following surgical debridement and at initiation of antibiotic therapy and after successful treatment were compared for changes in effusion, synovium, bone, and periarticular soft tissues. Imaging findings were correlated with microbiological and clinical findings. Joint effusions were present in all joints at baseline and regressed significantly at follow-up MRI (p = 0.001). Abscesses were present in 5 cases (38 %), and their sizes decreased significantly at follow-up (p = 0.001). Synovial enhancement and thickening were observed in all joints at both baseline and follow-up MRI. Myositis/cellulitis was present in 10 cases (77 %) at baseline and in 8 cases (62 %) at follow-up MRI. Bone marrow edema was present in 10 joints (77 %) at baseline and persisted in 8 joints (62 %). Bone erosions were found in 8 joints (62 %) and persisted at follow-up MRI in all cases. The sizes of joint effusions and abscesses appear to be the factors with the most potential for monitoring therapy for septic arthritis, since both decreased significantly following successful treatment. Synovial thickening and enhancement, periarticular myositis/cellulitis, and bone marrow edema can persist even after resolution of the infection. (orig.)

Pyogenic arthritis, pyoderma gangrenosum, and acne (PAPA) syndrome: differential diagnosis of septic arthritis by regular detection of exceedingly high synovial cell counts.

Science.gov (United States)

Löffler, W; Lohse, P; Weihmayr, T; Widenmayer, W

2017-08-01

Pyogenic arthritis, pyoderma gangrenosum and acne syndrome was diagnosed in a 42-year-old patient, after an unusual persistency of high synovial cell counts had been noticed. Clinical peculiarities and problems with diagnosing septic versus non-septic arthritis are discussed.

Septic arthritis: a 12 years retrospective study in a rheumatological university clinic

Directory of Open Access Journals (Sweden)

L. Riato

2011-09-01

Full Text Available Background: Septic arthritis is a disabling and potentially life-threatening condition that requires prompt diagnosis and treatment. The most important risk factors are joint prosthesis, pre-existing joint disease and immunosuppressive drugs. The aim of our study therefore was to revaluate all septic arthritis cases discharged from our Rheumatologic Unit in the last 12 years, to assess the risk factors, the clinical and laboratory characteristics, the causative microorganisms and its possible increase in frequency. Methods: The medical records of 42 consecutive patients with septic arthritis discharged from our Rheumatology Unit between January 1995 and December 2006 were reviewed. The patients ranged in age from 23 to 90 and there isn’t gender predominance. Septic arthritis was diagnosed based on the finding of purulent material in the joint space and/or the isolation of a bacterial pathogen from joint fluid. Demographic data, risk factors, co-morbidity, clinical manifestations, time interval between symptoms onset and diagnosis, treatment and laboratory data including serum white blood cell count, erythrocyte sedimentation rate (ESR, C reactive protein (CRP, synovial white blood cells and culture results were analysed. We considered these parameters in the whole population and in two different age groups (≤60, >60 and tried to determine if there was a change of microorganisms involved in septic arthritis during the years. Results: Of 42 patients, 47% were aged 60 and younger. Only 10 patients were admitted to our unit before 2001. A predisposing factor was recorded in 90,5% of cases: 15 patients had rheumatoid arthritis, 8 were diabetic, 6 had seronegative arthritis, 4 had a connective tissue disease, 8 patients had a prosthetic infection and 3 were subjected recently to arthrocentesis. We found that patients aged 60 and younger were more frequently affected by joint disease and had a synovial white blood cell count lower than patients

Imaging of Posttraumatic Arthritis, Avascular Necrosis, Septic Arthritis, Complex Regional Pain Syndrome, and Cancer Mimicking Arthritis.

Science.gov (United States)

Rupasov, Andrey; Cain, Usa; Montoya, Simone; Blickman, Johan G

2017-09-01

This article focuses on the imaging of 5 discrete entities with a common end result of disability: posttraumatic arthritis, a common form of secondary osteoarthritis that results from a prior insult to the joint; avascular necrosis, a disease of impaired osseous blood flow, leading to cellular death and subsequent osseous collapse; septic arthritis, an infectious process leading to destructive changes within the joint; complex regional pain syndrome, a chronic limb-confined painful condition arising after injury; and cases of cancer mimicking arthritis, in which the initial findings seem to represent arthritis, despite a more insidious cause. Copyright © 2017 Elsevier Inc. All rights reserved.

Distinguishing Pediatric Lyme Arthritis of the Hip from Transient Synovitis and Acute Bacterial Septic Arthritis: A Systematic Review and Meta-analysis.

Science.gov (United States)

Cruz, Aristides I; Anari, Jason B; Ramirez, Jose M; Sankar, Wudbhav N; Baldwin, Keith D

2018-01-25

Objective Lyme arthritis is an increasingly recognized clinical entity that often prompts orthopaedic evaluation in pediatric patients. While Lyme arthritis is most common in the knee, the clinical presentation of Lyme arthritis of the hip can be similar to both acute bacterial septic arthritis and transient synovitis. Accurately distinguishing these clinical entities is important since the definitive treatment of each is distinct. Because there is limited literature on monoarticular Lyme arthritis of the hip, the purpose of this study was to perform a systematic review and meta-analysis of clinical and laboratory parameters associated with Lyme arthritis (LA) of the hip and compare them to septic arthritis (SA) and transient synovitis (TS).  Study design A systematic review of the literature was performed using the following search terms, including the variants and plural counterparts "hip" and "Lyme arthritis." A final database of individual patients was assembled from the published literature and direct author correspondence, when available. A previously published cohort of patients with hip transient synovitis or septic arthritis was used for comparative analysis. A comparative statistical analysis was performed to the assembled database to assess differences in laboratory and clinical variables between the three diagnoses.  Results Data on 88 patients diagnosed with Lyme arthritis of the hip was collected and consolidated from the 12 articles meeting inclusion criteria. The average age of patients presenting with Lyme arthritis was 7.5 years (± 3.5 years), the mean erythrocyte sedimentation rate (ESR), and the C-reactive protein (CRP) was 41 mm/hr and 3.9 mg/L, respectively. Peripheral white blood cell (WBC) count averaged 10.6 x 10 9 cells/L with the synovial WBC count averaging 55,888 cells/mm 3 . Compared to a previous cohort of patients with confirmed transient synovitis or septic arthritis, the 95% confidence interval for ESR was 21 - 33 mm

Successful staged hip replacement in septic hip osteoarthritis in osteopetrosis: a case report

Directory of Open Access Journals (Sweden)

Manzi Giovanni

2012-04-01

Full Text Available Abstract Background Osteopetrosis is a rare, inherited, bone disorder, characterized by osteosclerosis, obliteration of the medullary cavity and calcified cartilage. The autosomal dominant form is compatible with a normal life span, although fractures often result from minimal trauma, due to the pathologic nature of bone. Osteomyelitis is common in patients with osteopetrosis because of a reduced resistance to infection, attributed to the lack of marrow vascularity and impairment of white cell function. Only one case of osteomyelitis of the proximal third of the femur has been previously reported, treated with several repeated debridements and finally with femoral head resection. Here we present for the first time a case of a staged implant of a cementless total hip prosthesis for the treatment of a septic hip in femoral neck nonunion in osteopetrosis. Case presentation A 36-years-old woman, affected by autosomal dominant osteopetrosis was referred to our department because of a septic hip arthritis associated with femoral neck septic non-union, with draining fistulas. The infection occurred early after a plate osteosynthesis for a closed perthrocanteric fracture of the femur and persisted in spite of osteosynthesis removal, surgical debridement and external fixation. In our hospital the patient underwent accurate debridement, femoral head and greater trochanter resection, preparation of the diaphyseal intramedullary canal and implant of an antibiotic-loaded cement spacer. The spacer was exchanged after one month, due to infection recurrence and four months later, a cementless total hip arthroplasty was implanted, with no clinical and laboratory signs of infection recurrence at two years follow-up. Conclusions In case of hip septic arthritis and proximal femur septic non-union, femoral head resection may not be the only option available and staged total hip arthroplasty can be considered.

Multidrug resistant bacteria isolated from septic arthritis in horses

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Rodrigo G. Motta

Full Text Available ABSTRACT: Septic arthritis is a debilitating joint infectious disease of equines that requires early diagnosis and immediate therapeutic intervention to prevent degenerative effects on the articular cartilage, as well as loss of athletic ability and work performance of the animals. Few studies have investigated the etiological complexity of this disease, as well as multidrug resistance of isolates. In this study, 60 horses with arthritis had synovial fluid samples aseptically collected, and tested by microbiological culture and in vitro susceptibility test (disk diffusion using nine antimicrobials belonging to six different pharmacological groups. Bacteria were isolated in 45 (75.0% samples, as follows: Streptococcus equi subsp. equi (11=18.3%, Escherichia coli (9=15.0%, Staphylococcus aureus (6=10.0%, Streptococcus equi subsp. zooepidemicus (5=8.3%, Staphylococcus intermedius (2=3.3%, Proteus vulgaris (2=3.3%, Trueperella pyogenes (2=3.3%, Pseudomonas aeruginosa (2=3.3%, Klebsiella pneumoniae (1=1.7%, Rhodococcus equi (1=1.7%, Staphylococcus epidermidis (1=1.7%, Klebsiella oxytoca (1=1.7%, Nocardia asteroides (1=1.7%, and Enterobacter cloacae (1=1.7%. Ceftiofur was the most effective drug (>70% efficacy against the pathogens in the disk diffusion test. In contrast, high resistance rate (>70% resistance was observed to penicillin (42.2%, enrofloxacin (33.3%, and amikacin (31.2%. Eleven (24.4% isolates were resistant to three or more different pharmacological groups and were considered multidrug resistant strains. The present study emphasizes the etiological complexity of equine septic arthritis, and highlights the need to institute treatment based on the in vitro susceptibility pattern, due to the multidrug resistance of isolates. According to the available literature, this is the first report in Brazil on the investigation of the etiology. of the septic arthritis in a great number of horses associated with multidrug resistance of the isolates.

Septic arthritis and arthropathy of the rotator cuff: remember this association

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Danilo Sobreira

2016-08-01

Full Text Available ABSTRACT OBJECTIVE: To describe occurrences of septic glenohumeral arthritis among patients with arthropathy of the rotator cuff, and to highlight the importance of correct diagnosis and surgical procedures. METHODOLOGy: Eight surgical drains were installed in seven patients with glenohumeral pyoarthritis. All the patients presented arthropathy of the rotator cuff (four males and three females. Six patients presented pyoarthritis in the dominant shoulder. The age range was from 53 to 93 years (mean: 74 years. The mean duration of the symptoms before the surgical lavage was six weeks. Six patients underwent treatment consisting of a combination of arthroscopic irrigation and debridement, and one patient was treated by means of open arthrotomy. All the patients received systemic antibiotic therapy in accordance with their bacterial sensitivity. RESULTS: All seven patients achieved satisfactory results, taking into consideration especially the improvement of pain and the patients' satisfaction. The functional assessment was performed using the University of California Los Angeles (UCLA scale. Only one patient needed to go through another arthroscopic procedure. Staphylococcus aureus was isolated from four cultures and Escherichia coli from one culture. There were two situations in which the patients used empirical antibiotic therapy and the cultures showed negative results. Among the associated procedures, tenotomy of the biceps was performed in four cases, resection of the lateral third of the clavicle due to osteomyelitis in one case and arthrotomy of the knee in one case. CONCLUSION: Surgical treatment was effective in the cases of arthritis associated with arthropathy of the rotator cuff. In patients with arthropathy of the rotator cuff and subclinically altered laboratory signs, the possibility of pyoarthritis should always be suspected.

Childhood Pyogenic Septic Arthritis as Seen in a Teaching Hospital ...

African Journals Online (AJOL)

accounted for 44 (83%) of the 53 patients seen with pyogenic septic arthritis. ... significantly more involved than the left and the left hip more than right. .... disease, malnutrition, and HIV were the predisposing and ..... fracture care in Nigeria.

Ribonucleotide reductase class III, an essential enzyme for the anaerobic growth of Staphylococcus aureus, is a virulence determinant in septic arthritis.

Science.gov (United States)

Kirdis, Ebru; Jonsson, Ing-Marie; Kubica, Malgorzata; Potempa, Jan; Josefsson, Elisabet; Masalha, Mahmud; Foster, Simon J; Tarkowski, Andrzej

2007-01-01

Staphylococcus aureus is the most common cause of joint infections. It also contributes to several other diseases such as pneumonia, osteomyelitis, endocarditis, and sepsis. Bearing in mind that S. aureus becomes rapidly resistant to new antibiotics, many studies survey the virulence factors, with the aim to find alternative prophylaxis/treatment regimens. One potential virulence factor is the bacterial ability to survive at different oxygen tensions. S. aureus expresses ribonucleotide reductases (RNRs), which help it to grow under both aerobic and anaerobic conditions, by reducing ribonucleotides to deoxyribonucleotides. In this study, we investigated the role of RNR class III, which is required for anaerobic growth, as a virulence determinant in the pathogenesis of staphylococcal arthritis. The wild-type S. aureus strain and its isogenic mutant nrdDG mutant were inoculated intravenously into mice. Mice inoculated with the wild-type strain displayed significantly more severe arthritis, with significantly more synovitis and destruction of the bone and cartilage versus mutant strain inoculated mice. Further, the persistence of bacteria in the kidneys was significantly more pronounced in the group inoculated with the wild-type strain. Together these results indicate that RNR class III is an important virulence factor for the establishment of septic arthritis.

Interleukin-33 Receptor (ST2 Deficiency Improves the Outcome of Staphylococcus aureus-Induced Septic Arthritis

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Larissa Staurengo-Ferrari

2018-05-01

Full Text Available The ST2 receptor is a member of the Toll/IL-1R superfamily and interleukin-33 (IL-33 is its agonist. Recently, it has been demonstrated that IL-33/ST2 axis plays key roles in inflammation and immune mediated diseases. Here, we investigated the effect of ST2 deficiency in Staphylococcus aureus-induced septic arthritis physiopathology. Synovial fluid samples from septic arthritis and osteoarthritis individuals were assessed regarding IL-33 and soluble (s ST2 levels. The IL-33 levels in samples from synovial fluid were significantly increased, whereas no sST2 levels were detected in patients with septic arthritis when compared with osteoarthritis individuals. The intra-articular injection of 1 × 107 colony-forming unity/10 μl of S. aureus American Type Culture Collection 6538 in wild-type (WT mice induced IL-33 and sST2 production with a profile resembling the observation in the synovial fluid of septic arthritis patients. Data using WT, and ST2 deficient (−/− and interferon-γ (IFN-γ−/− mice showed that ST2 deficiency shifts the immune balance toward a type 1 immune response that contributes to eliminating the infection due to enhanced microbicide effect via NO production by neutrophils and macrophages. In fact, the treatment of ST2−/− bone marrow-derived macrophage cells with anti-IFN-γ abrogates the beneficial phenotype in the absence of ST2, which confirms that ST2 deficiency leads to IFN-γ expression and boosts the bacterial killing activity of macrophages against S. aureus. In agreement, WT cells achieved similar immune response to ST2 deficiency by IFN-γ treatment. The present results unveil a previously unrecognized beneficial effect of ST2 deficiency in S. aureus-induced septic arthritis.

Brucella Septic Arthritis: Case Reports and Review of the Literature

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Fatehi Elnour Elzein

2016-01-01

Full Text Available Brucellosis is one of the commonest zoonotic infections worldwide. The disease is endemic in Saudi Arabia, the Middle East, and the Mediterranean area. Osteoarticular involvement is a frequent manifestation of brucellosis. It tends to involve the sacroiliac joints more commonly; however, spondylitis and peripheral arthritis are increasingly reported. Brucellosis can be overlooked especially in the presence of companion bacteria. Hence, it should be suspected in all patients with septic arthritis in endemic areas or in patients visiting such areas.

Cutibacterium acnes Septic Arthritis of the Nonoperated Knee: A Case Report

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Okoroha, Kelechi R.; Gabbard, Michael D.; Fitts, Jamal; Banka, Trevor R.

2017-01-01

Cutibacterium (Propionibacterium) acnes , a gram-positive bacillus with low pathogenicity, is an uncommon but known cause of prosthetic joint infections, particularly related to shoulder surgery. C. acnes , however, is an extremely rare pathogen in the nonoperated knee joint. This report details an uncommon case of C. acnes septic knee arthritis after multiple intra-articular steroid injections in a 56-year-old male patient. After an indolent presentation and late diagnosis, the patient underwent surgical debridement with IV antibiotic management. This case illustrates that intra-articular corticosteroid injections for the management of osteoarthritis are not without risk. Literature supporting their use remains limited and clinicians should use proficient clinical judgment for appropriate patient selection for these injections. Vigilance following injections or aspirations of the knee should be maintained to identify the indolent clinical presentation of C. acnes septic arthritis. PMID:28825032

Septic arthritis of the adult ankle joint secondary to Salmonella enteritidis: a case report.

LENUS (Irish Health Repository)

Munigangaiah, Sudarshan

2011-09-01

Salmonella septic arthritis in healthy individuals is a rare phenomenon. However, septic arthritis of the native adult ankle joint in healthy patients has not been previously described in the published data. This is a case report of a 70-year-old farmer who presented with a 2-week history of a painful, swollen right ankle and an inability to bear weight. He had no history of ankle injury or any predisposing conditions. Joint aspirations were positive for Salmonella enteritidis that was successfully treated with right ankle arthrotomy and washout, along with a 6-week course of intravenous antibiotic therapy.

First diagnosis of septic arthritis in a dinosaur.

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Anné, Jennifer; Hedrick, Brandon P; Schein, Jason P

2016-08-01

Identification and interpretation of pathologies in the fossil record allows for unique insights into the life histories of extinct organisms. However, the rarity of such finds limits not only the sample size for palaeopathologic studies, but also the types of analyses that may be performed. In this study, we present the first occurrence of a palaeopathology in a vertebrate from the Mesozoic of the East Coast of North America (Appalachia), a pathologic ulna and radius of an indeterminate hadrosaur from the Navesink Formation (New Jersey). X-ray microtomography allowed for both detailed and more accurate diagnosis of the pathologic condition as well as virtual conservation of the specimen. Based on extant archosaurian comparisons, the hadrosaur was diagnosed with severe septic arthritis affecting the proximal ulna and radius. Diagnosis was based on erosion of the joint and highly reactive periosteal bone growth and fusion of the elements. To the best of our knowledge, this is the first recorded account of septic arthritis in dinosaurs. The severity of the pathology suggests the animal suffered with this condition for some time before death. Unfortunately, only the ulna and radius were found. Thus, the extent to which the condition spread to other parts of the body is unknown.

First diagnosis of septic arthritis in a dinosaur

Science.gov (United States)

Anné, Jennifer; Hedrick, Brandon P.; Schein, Jason P.

2016-08-01

Identification and interpretation of pathologies in the fossil record allows for unique insights into the life histories of extinct organisms. However, the rarity of such finds limits not only the sample size for palaeopathologic studies, but also the types of analyses that may be performed. In this study, we present the first occurrence of a palaeopathology in a vertebrate from the Mesozoic of the East Coast of North America (Appalachia), a pathologic ulna and radius of an indeterminate hadrosaur from the Navesink Formation (New Jersey). X-ray microtomography allowed for both detailed and more accurate diagnosis of the pathologic condition as well as virtual conservation of the specimen. Based on extant archosaurian comparisons, the hadrosaur was diagnosed with severe septic arthritis affecting the proximal ulna and radius. Diagnosis was based on erosion of the joint and highly reactive periosteal bone growth and fusion of the elements. To the best of our knowledge, this is the first recorded account of septic arthritis in dinosaurs. The severity of the pathology suggests the animal suffered with this condition for some time before death. Unfortunately, only the ulna and radius were found. Thus, the extent to which the condition spread to other parts of the body is unknown.

Prognostic factors associated with mortality in patients with septic arthritis

DEFF Research Database (Denmark)

Asmussen Andreasen, Rikke; Andersen, Nanna Skaarup; Just, Søren Andreas

2017-01-01

OBJECTIVES: To evaluate the 30-day mortality rate of septic arthritis (SA) in adults in Funen, central Denmark, and to explore whether, at the time of SA presentation, risk factors for the 30-day mortality rate could be revealed. Our secondary objective was to describe the microbiological...... factor for death was liver disease at time of presentation [odds ratio (OR) 40.40, 95% confidence interval (CI) 5.38-303]. The other factors tested such as age > 65 years, elevated temperature, rheumatoid arthritis (RA), prostheses, and diabetes mellitus (DM) did not reach statistical significance...

Septic arthritis of the ankle due to Salmonella enteritidis.

LENUS (Irish Health Repository)

Dineen, Patrick F

2011-06-01

Salmonella septic arthritis in healthy, immunocompetent patients is extremely rare. We present the case of a 70-year-old man who presented with a one-day history of painful swelling of his ankle from which was aspirated pus which subsequently grew Salmonella enteritidis. There was no history of trauma or symptoms consistent with Salmonella enterocolitis. Our patient recovered fully after two weeks on intravenous ceftriaxone and six weeks on oral ciprofloxacin. Salmonella is a notifiable disease in the European Union and the United States of America, and is associated with outbreaks as a result of food contamination. The nature of Salmonella arthritis and its appropriate management are outlined.

Nontyphoidal Salmonella Septic arthritis of the elbow in a healthy ...

African Journals Online (AJOL)

A case of rarely encountered nontyphoidal Salmonella septic arthritis of the elbow in an infant with no preexisting disease is reported. Salmonella etiology was not suspected in this case, and the diagnosis was made only after bacterial isolation. Aspiration of the infected joint with radiological guidance initially failed to give a ...

Gram and acridine orange staining for diagnosis of septic arthritis in different patient populations.

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Cunningham, Gregory; Seghrouchni, Khalid; Ruffieux, Etienne; Vaudaux, Pierre; Gayet-Ageron, Angèle; Cherkaoui, Abdessalam; Godinho, Eduardo; Lew, Daniel; Hoffmeyer, Pierre; Uçkay, Ilker

2014-06-01

The sensitivity of Gram staining is known to be suboptimal for the diagnosis of native joint septic arthritis. We lack information about the accuracy of Gram compared to other microscopic staining techniques for predicting infection in different patient populations. This was a cohort study with cost evaluations at the Orthopaedic Service of Geneva University Hospitals (January 1996-October 2012). Among 500 episodes of arthritis (196 with immunosuppression, 227 with underlying arthroplasties and 69 with gout or other crystals in synovial fluid), Gram staining revealed pathogens in 146 episodes (146/500, 29 %) or in 146 of the 400 culture-positive episodes (37 %). Correlation between the Gram and acridine staining of the same sample was good (Spearman 0.85). Overall, the sensitivity, specificity, positive predictive value and negative predictive value of Gram stain for rapid diagnosis of septic arthritis was 0.37, 0.99, 0.99 and 0.28, respectively, compared to microbiological cultures. Quite similar values were recorded across the different patient subpopulations, in particular for sensitivity values that were 0.33 for patients with prosthetic joint infections, 0.40 for immunosuppressed patients, 0.36 for patients under antibiotic administration and 0.52 for patients with concomitant crystalline disease. The sensitivity of Gram or acridine orange staining for a rapid diagnosis of episodes of septic arthritis is suboptimal compared to microbiological culture, regardless of underlying conditions, immunosuppression or antibiotic therapy. The sensitivity in the presence of synovial fluid crystals is moderate. Acridine orange and Gram stains are equivalent.

Lumbar facet septic arthritis. Report of two cases

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Juan Manuel Velasco

2017-02-01

Full Text Available We report two cases with isolated septic arthritis of a lumbar facet after a non articular infection, and sepsis. Being a rarity, it is a condition that goes frequently unnoticed, unless taken into account directly. If it is not treated on time, it can leave serious sequelae. The treatment may vary, according to the time of diagnosis. It might have a good response to antibiotic therapy alone, or it may be necessary to associate surgical drainage.

False-Negative Rate of Gram-Stain Microscopy for Diagnosis of Septic Arthritis: Suggestions for Improvement

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Paul Stirling

2014-01-01

Full Text Available We quantify the false-negative diagnostic rate of septic arthritis using Gram-stain microscopy of synovial fluid and compare this to values reported in the peer-reviewed literature. We propose a method of improving the diagnostic value of Gram-stain microscopy using Lithium Heparin containers that prevent synovial fluid coagulation. Retrospective study of the Manchester Royal Infirmary microbiology database of patients undergoing synovial fluid Gram-stain and culture between December 2003 and March 2012 was undertaken. The initial cohort of 1896 synovial fluid analyses for suspected septic arthritis was reduced to 143 after exclusion criteria were applied. Analysis of our Gram-stain microscopy yielded 111 false-negative results from a cohort size of 143 positive synovial fluid cultures, giving a false-negative rate of 78%. We report a false-negative rate of Gram-stain microscopy for septic arthritis of 78%. Clinicians should therefore avoid the investigation until a statistically significant data set confirms its efficacy. The investigation's value could be improved by using Lithium Heparin containers to collect homogenous synovial fluid samples. Ongoing research aims to establish how much this could reduce the false-negative rate.

[Resection of a carpal bone row in a Pustertaler Sprinze cow with chronic purulent arthritis of the carpal joint and osteomyelitis].

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Kofler, J; Peterbauer, C

2014-01-01

This case report describes the clinical and radiographic findings and the surgical treatment of a serofibrinous arthritis of the antebrachiocarpal joint and of a chronic purulent arthritis of the intercarpal and carpometacarpal joints with osteomyelitis of the distal carpal bones and subchondral osteomyelitis of the proximal metacarpal bones in a cow of the breed "Pustertaler Sprinze". The therapy comprised an arthrotomy of both joint spaces and the resection of the distal row of the carpal bones. The right forelimb had been immobilised for 70 days by a full limb cast. After this period, radiographs revealed an ob- vious ankylosis of the carpal joint, and the cow showed only a slight lameness. Six years postoperatively this cow was still in the herd and had produced six calves.

Diagnostics of septic arthritis in the sternoclavicular region - 10 consecutive patients and literature review

International Nuclear Information System (INIS)

Bodker, Tina; Jurik, Anne Grethe; Toettrup, Mikkel; Kjaer Petersen, Klaus

2013-01-01

Background: Septic arthritis in the sternoclavicular (SC) region is rare and may be difficult to diagnose clinically and radiologically. It mainly affects immunocompromised persons, and can clinically be misinterpreted as tumor and rheumatic disorders. Lacking radiological reference standard, a multimodality approach may contribute to a prolonged diagnostic process. Purpose: To describe the diagnostics of septic arthritis in the SC region. Material and Methods: Between 2001 and 2011, 10 patients with Staphylococcus infection in the SC region were investigated in our institution. Clinical, biochemical, radiological, and microbiological findings were studied retrospectively; all CT and MR examinations were re-evaluated. Results: Initial radiography in nine patients and ultrasonography in six patients were inconclusive resulting in supplementary MRI and/or CT. Five patients examined by MRI were immediately diagnosed with septic arthritis whereas CT in five patients led to the diagnosis in only one. Three were subsequently diagnosed by MRI, but delayed more than 2.5 weeks, and one was diagnosed by surgery. The median time to diagnosis was 1.5 weeks. The delay caused by imaging was 0 days to 11.5 weeks (median 0 days). By re-evaluation overlooked complications included mediastinitis in seven patients (three diffuse, four localized), and abscesses and pleuritis each in four patients. Conclusion: Awareness of infection in the SC region is important to avoid diagnostic delay. MRI is proposed as the initial imaging procedure

Septic Bursitis in an 8-Year-Old Boy

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Panagiotis Kratimenos

2014-01-01

Full Text Available Background. The prepatellar bursa can become inflamed owing to repeated trauma. Prepatellar bursitis is extremely rare in children. Methods. We report the case of an 8-year-old boy who was treated for an erythematous, swollen, and severely painful right knee, fever, inability to bear weight on the leg, and purulent material draining from a puncture wound. We describe the differential diagnosis for tender swollen knee, including infection, gout, rheumatoid arthritis, and osteoarthritis. If untreated, prepatellar bursitis can progress to patellar osteomyelitis. Results. Wound cultures grew Streptococcus pyogenes, with the infection resolving with amoxicillin. Conclusions. A high index of suspicion is necessary in children presenting with prepatellar bursitis to prevent potentially devastating sequelae of infection of the septic joint.

Embolia pulmonar séptica de origen cutáneo Septic pulmonary embolism of cutaneous origin

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Agustina Sosa Beláustegui

2012-08-01

Full Text Available La embolia pulmonar séptica es una enfermedad grave y poco frecuente que se caracteriza por presentar infiltrados pulmonares bilaterales asociados a un foco infeccioso extrapulmonar. Se relaciona principalmente a endocarditis derecha, tromboflebitis pelviana, accesos vasculares y menos frecuentemente a infecciones profundas como osteomielitis, artritis séptica o piomiositis. El Staphylococcus aureus meticilino-resistente adquirido en la comunidad (SAMR-AC es un patógeno emergente, con alta virulencia y de rápida propagación, que afecta a sujetos sin enfermedades previas relacionadas o factores de riesgo conocidos. Causa infecciones de piel y partes blandas y con menor frecuencia infecciones graves como fascitis necrotizante, artritis séptica, osteomielitis, piomiositis y neumonía necrotizante. Su epidemiología, patogenia y manifestaciones clínicas difieren de las causadas por el SAMR adquirido en el hospital. Presentamos el caso de un varón de 67 años con embolias pulmonares sépticas causadas por SAMR-AC con origen en una infección cutánea.Septic pulmonary embolism is a serious and rare illness characterized by pulmonary infiltrates associated with an extrapulmonary infectious focus. It is mainly related to right-sided endocarditis, pelvic thrombophlebitis, vascular access and less frequently to deep infections such as osteomyelitis, septic arthritis and pyomyositis. The community-acquired methicillin-resistant Staphylococcus aureus (MRSA is an emerging pathogen with high virulence and rapid spread involving subjects without previous related diseases or known risk factors. It causes infections of skin and soft tissue and less frequently other serious infections such as necrotizing fascitits, septic arthritis, osteomyelitis, pyomyositis and necrotizing pneumonia. Epidemiologically, pathogenesis and clinical manifestations differ from those caused by MRSA acquired in the hospital. We present the case of a 67 year-old male with septic

Diagnostics of septic arthritis in the sternoclavicular region

DEFF Research Database (Denmark)

Bodker, Tina; Tottrup, Mikkel; Petersen, Klaus Kjaer

2013-01-01

diagnosed with septic arthritis whereas CT in five patients led to the diagnosis in only one. Three were subsequently diagnosed by MRI, but delayed more than 2.5 weeks, and one was diagnosed by surgery. The median time to diagnosis was 1.5 weeks. The delay caused by imaging was 0 days to 11.5 weeks (median...... 0 days). By re-evaluation overlooked complications included mediastinitis in seven patients (three diffuse, four localized), and abscesses and pleuritis each in four patients. Conclusion: Awareness of infection in the SC region is important to avoid diagnostic delay. MRI is proposed as the initial...

MR imaging assessment of clinical problems in rheumatoid arthritis

International Nuclear Information System (INIS)

Narvaez, Jose A.; Roca, Yolanda; Aguilera, Carlos; Narvaez, Javier

2002-01-01

Although MR imaging has been increasingly recognized as a useful tool in the diagnosis of early rheumatoid arthritis (RA) and in the assessment of disease activity, these applications have not yet been usually included in the routine management of this condition. Our goal is to review the current role of MRI in the everyday clinical management of patients with RA. The usefulness of MRI in the evaluation of articular and para-articular changes in specific locations, mainly the craniocervical region and the temporomandibular joint, are reviewed. Clinical problems derived from local extra-articular involvement, such as tenosynovitis, ''rice-bodies'' bursitis, and Baker's cyst rupture, are also described. Finally, we also review the value of MRI in evaluation of some complications of RA such as tendinous rupture, osteonecrosis, stress fracture, and septic arthritis/osteomyelitis. (orig.)

Microbiology and management of joint and bone infections due to anaerobic bacteria.

Science.gov (United States)

Brook, Itzhak

2008-03-01

To describes the microbiology, diagnosis, and management of septic arthritis and osteomyelitis due to anaerobic bacteria. The predominant anaerobes in arthritis are anaerobic Gram-negative bacilli (AGNB) including the Bacteroides fragilis group, Fusobacterium spp., Peptostreptococcus spp., and Propionibacterium acnes. Infection with P. acnes is associated with a prosthetic joint, previous surgery, and trauma. B. fragilis group is associated with distant infection, Clostridium spp. with trauma, and Fusobacterium spp. with oropharyngeal infection. Most cases of anaerobic arthritis, in contrast to anaerobic osteomyelitis, involved a single isolate, and most cases are secondary to hematogenous spread. The predominant anaerobes in osteomyelitis are Bacteroides, Peptostreptococcus, Fusobacterium, and Clostridium spp. as well as P. acnes. Conditions predisposing to bone infections are vascular disease, bites, contiguous infection, peripheral neuropathy, hematogenous spread, and trauma. Pigmented Prevotella and Porphyromonas spp. are mostly isolated in skull and bite infections, members of the B. fragilis group in hand and feet infections, and Fusobacterium spp. in skull, bite, and hematogenous long bone infections. Many patients with osteomyelitis due to anaerobic bacteria have evidence of an anaerobic infection elsewhere in the body that is the source of the organisms involved in the osteomyelitis. Treatment of arthritis and osteomyelitis involving anaerobic bacteria includes symptomatic therapy, immobilization in some cases, adequate drainage of purulent material, and antibiotic therapy effective against these organisms. Anaerobic bacteria can cause septic arthritis and osteomyelitis. Correct diagnosis and appropriate therapy are important contributor to successful outcome.

Functional Outcome and Graft Retention in Patients With Septic Arthritis After Anterior Cruciate Ligament Reconstruction: A Systematic Review.

Science.gov (United States)

Makhni, Eric C; Steinhaus, Michael E; Mehran, Nima; Schulz, Brian S; Ahmad, Christopher S

2015-07-01

To provide a comprehensive review of clinical and functional outcomes after treatment for septic arthritis after anterior cruciate ligament reconstruction. A systematic review of the literature was performed. Two reviewers assessed and confirmed the methodologic quality of each study. Studies that met the inclusion criteria were assessed for pertinent data, and when available, similar outcomes were combined to generate frequency-weighted means. Nineteen studies met the inclusion and exclusion criteria for this review, reporting on a total of 203 infected knees. The mean age was 27.5 years and the mean length of follow-up was 44.2 months, with male patients comprising 88% of the population. Hamstring and bone-patellar tendon-bone autografts were used in 63% and 33% of patients, respectively, with 78% of patients retaining their grafts. The studies reported mean flexion and extension deficits of 5.8° and 1.0°, respectively, and laxity testing showed a mean difference of 1.9 mm. The studies reported mean Lysholm, International Knee Documentation Committee, and Tegner scores of 82.1, 68.2, and 5.6, respectively. Of the patients, 83% reported an ability to return to activities of daily living whereas 67% reported a return to their preinjury level of athletics. Evidence of new degenerative changes was seen in 22% of patients. Septic arthritis after anterior cruciate ligament reconstruction remains a very infrequent event, affecting 0.5% of patients. On average, outcomes in these patients are comparable with those in patients in whom infection does not develop, including postoperative range of motion, residual instability, Lysholm scores, and return to preinjury level of activity. These patients do exhibit decreased International Knee Documentation Committee scores compared with patients without septic arthritis, however. The impact of this differential is not clear, but this scoring difference suggests that septic arthritis may be associated with more severe symptoms

Surgical Management of Multijoint Septic Arthritis due to Rat-Bite Fever in a Pediatric Patient: A Case Study

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Adam M. Wegner

2017-01-01

Full Text Available In the United States, rat-bite fever is a rare systemic illness principally caused by Streptobacillus moniliformis, an organism found in the nasopharyngeal flora of rodents. Infection through direct exposure to rat excreta such as saliva, urine, or feces can lead to fever, rash, and an asymmetric migratory polyarthritis. As rodents are becoming more popular as pets, more pediatric cases are being documented. We report a pediatric case of delayed onset septic arthritis in the left wrist and right knee due to S. moniliformis from a rat bite. Previously reported pediatric case studies of suppurative arthritis due to S. moniliformis have only involved the hip. This case study demonstrates the importance of a thorough exposure history and consideration of zoonotic infections as a cause of septic arthritis in a pediatric patient that requires antibiotics and surgical intervention.

Temporomandibular Joint Ankylosis as a Complication of Neonatal Septic Arthritis; Report of two cases

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Noor J. Al-Saadi

2015-11-01

Full Text Available Temporomandibular joint (TMJ ankylosis as a complication of neonatal septic arthritis is rarely reported in the literature. We report two clinical cases of unilateral TMJ ankylosis occurring in paediatric patients subsequent to neonatal septic arthritis. The first case was a 15-month-old male infant who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in May 2010. According to the published English scientific literature, he is the youngest person yet to be diagnosed with this condition. The second case was a five-year-old female who presented to the Al-Nahda Hospital, Muscat, Oman, in October 2011. Both cases presented with facial asymmetry and trismus. They subsequently underwent gap arthroplasty and interpositional temporalis muscle and fascia grafts which resulted in an immediate improvement in mouth opening. Postoperatively, the patients underwent active jaw physiotherapy which was initially successful. Both patients were followed up for a minimum of two years following their surgeries.

Rat-bite fever presenting with rash and septic arthritis.

Science.gov (United States)

Kanechorn Na Ayuthaya, Rajyani; Niumpradit, Nucha

2005-11-01

Rat-bite fever is an uncommon disease known for its endemicity to occur worldwide. Although most patients tend to develop mild symptoms with improvement from conventional antibiotics, it can progress with severe complications with a mortality rate as high as 13% without proper treatment. The authors report a complicated case of rat bite-fever involving a 61-year old woman who presented with fever petechial rash, and septic arthritis following a rat bite. Initially, multiple antibiotics were administered but were not effective. As a consequence, invasive procedures such as arthrotomy and joint debridement were done and prolonged antibiotic was administered until clinical resolution. Since many cases do not have a history of rat bite and may present with fever, rashes, and arthritis it is essential to distinguish it from other diseases. Here, the authors will provide details on the etiology, clinical manifestations, diagnosis, and management to aid prompt detection and treatment of the disease.

Candida Osteomyelitis: Analysis of 207 Pediatric and Adult Cases (1970–2011)

Science.gov (United States)

Gamaletsou, Maria N.; Kontoyiannis, Dimitrios P.; Sipsas, Nikolaos V.; Moriyama, Brad; Alexander, Elizabeth; Roilides, Emmanuel; Brause, Barry; Walsh, Thomas J.

2012-01-01

Background. The epidemiology, pathogenesis, clinical manifestations, management, and outcome of Candida osteomyelitis are not well understood. Methods. Cases of Candida osteomyelitis from 1970 through 2011 were reviewed. Underlying conditions, microbiology, mechanisms of infection, clinical manifestations, antifungal therapy, and outcome were studied in 207 evaluable cases. Results. Median age was 30 years (range, ≤ 1 month to 88 years) with a >2:1 male:female ratio. Most patients (90%) were not neutropenic. Localizing pain, tenderness, and/or edema were present in 90% of patients. Mechanisms of bone infection followed a pattern of hematogenous dissemination (67%), direct inoculation (25%), and contiguous infection (9%). Coinciding with hematogenous infection, most patients had ≥2 infected bones. When analyzed by age, the most common distribution of infected sites for adults was vertebra (odds ratio [OR], 0.09; 95% confidence interval [CI], .04–.25), rib, and sternum; for pediatric patients (≤18 years) the pattern was femur (OR, 20.6; 95% CI, 8.4–48.1), humerus, then vertebra/ribs. Non-albicans Candida species caused 35% of cases. Bacteria were recovered concomitantly from 12% of cases, underscoring the need for biopsy and/or culture. Candida septic arthritis occurred concomitantly in 21%. Combined surgery and antifungal therapy were used in 48% of cases. The overall complete response rate of Candida osteomyelitis of 32% reflects the difficulty in treating this infection. Relapsed infection, possibly related to inadequate duration of therapy, occurred among 32% who ultimately achieved complete response. Conclusions. Candida osteomyelitis is being reported with increasing frequency. Localizing symptoms are usually present. Vertebrae are the most common sites in adults vs femora in children. Timely diagnosis of Candida osteomyelitis with extended courses of 6–12 months of antifungal therapy, and surgical intervention, when indicated, may improve

MR imaging assessment of clinical problems in rheumatoid arthritis

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Narvaez, Jose A.; Roca, Yolanda; Aguilera, Carlos [Department of CT and MR Imaging, Hospital Duran i Reynals, Universitaria de Bellvitge, Barcelona (Spain); Narvaez, Javier [Department of Medicine, Delfos Medical Center, Barcelona (Spain)

2002-07-01

Although MR imaging has been increasingly recognized as a useful tool in the diagnosis of early rheumatoid arthritis (RA) and in the assessment of disease activity, these applications have not yet been usually included in the routine management of this condition. Our goal is to review the current role of MRI in the everyday clinical management of patients with RA. The usefulness of MRI in the evaluation of articular and para-articular changes in specific locations, mainly the craniocervical region and the temporomandibular joint, are reviewed. Clinical problems derived from local extra-articular involvement, such as tenosynovitis, ''rice-bodies'' bursitis, and Baker's cyst rupture, are also described. Finally, we also review the value of MRI in evaluation of some complications of RA such as tendinous rupture, osteonecrosis, stress fracture, and septic arthritis/osteomyelitis. (orig.)

Septic arthritis by Sphingobacterium multivorum in immunocompromised pediatric patient

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Maiana Darwich Mendes

Full Text Available Abstract Objective: To report a case septic arthritis with a rare pathogen in a immunosuppressed child. Case description: Male patient, 6 years old, had liver transplant five and half years ago due to biliary atresia. Patient was using tacrolimus 1mg q.12h. This patient started to have pain in left foot and ankle and had one episode of fever 3 days before hospital admission. Physical examination showed weight 17kg, height 109cm, temperature 36.4°C, with pain, swelling and heat in the left ankle, without other clinical signs. Initial tests: hemoglobin 11.7g/dL hematocrit 36.4%, leukocyte count 17,600µL-1 (7% banded neutrophils, 70% segmented neutrophils, 2% eosinophils, basophils 1%, 13% lymphocytes, 7% monocytes C-reactive protein 170.88mg/L. Joint ultrasound showed moderate effusion in the site. Patient was submitted to surgical procedure and Sphingobacterium multivorum was isolated from the effusion. The germ was susceptible to broad spectrum cephalosporins (ceftriaxone and cefepime and fluoroquinolones (ciprofloxacin and levofloxacin, and it was resistant to carbapenemic antibiotics and aminoglycosides. He was treated intravenously with oxacillin for 15 days and ceftriaxone for 13 days, and orally with ciprofloxacin for 15 days, with good outcome. Comments: The S. multivorum is a gram negative bacillus that belongs to Flavobacteriaceae family and it is considered non-pathogenic. It has rarely been described as a cause of infections in humans, especially in hospital environment and in immunosuppressed patients. This case report is relevant for its unusual etiology and for the site affected, which may be the first case of septic arthritis described.

Polyarticular Septic Arthritis Caused by Haemophilus influenzae Serotype f in an 8-Month-Old Immunocompetent Infant: A Case Report and Review of the Literature

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Raheel Ahmed Ali

2015-01-01

Full Text Available Background. The standard use of vaccinations against pathogens has resulted in a decreased incidence of musculoskeletal infections caused by these previously common bacterial pathogens. Consequently, the incidence of infections caused by atypical bacteria is rising. This report presents a case of septic arthritis caused by non-type b H. influenzae in a pediatric patient. Methods. We report a case of an infant with polyarticular septic arthritis caused by H. influenzae serotype f. A literature review was conducted with the inclusion criteria of case reports and studies published between 2004 and 2013 addressing musculoskeletal H. influenzae infections. Results. An 8-month-old female presented with pain and swelling in her right ankle and left elbow. The patient was diagnosed with septic arthritis and underwent incision and drainage. Wound and blood cultures were positive for Haemophilus influenzae serotype f. In addition to treatment with IV antibiotics, the patient underwent immunocompetency studies, which were normal. Subsequent follow-up revealed eradication of the infection. Conclusions. Haemophilus influenzae non-type b may cause serious invasive infections such as sepsis or septic arthritis in children with or without predisposing factors such as immunodeficiency or asplenia. Optimal treatment includes surgical management, culture driven IV antibiotics, and an immunologic workup.

Osteomyelitis in lower limbs and pulmonary septic emboli - a case report and radiological diagnosis; Osteomielite em membros inferiores e embolia septica pulmonar na infancia - relato de um caso e diagnostico por imagem

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Doria, Angela Schwarz [Hospital de Clinicas (HCFMUSP), Sao Paulo, SP (Brazil). Instituto de Crianca. Servico de Diagnostico por Imagem; Amaro Junior, Edson [Hospital de Clinicas (HCFMUSP), Sao Paulo, SP (Brazil). Inst. de Radiologia; Torre, Marcia Barbosa; Bogus, Luis Carlos Nogueira; Andrade, Marcio Ramalho; Barba, Mario Flores [Hospital de Clinicas (HCFMUSP), Sao Paulo, SP (Brazil). Instituto da Crianca. Servico de Radiologia; Scatigno Neto, Andre [Hospital de Clinicas (HCFMUSP), Sao Paulo, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

1996-11-01

The authors describe a case of osteomyelitis in the lower limbs with subsequent septic emboli pulmonary spread, as a complication of the prior clinical presentation. They discuss clinical and pathological aspects, as well as, the possibility of diagnosis utilizing plain radiography, computed tomography and scintigraphy. (author) 10 refs., 7 figs.

Epidemiology of septic arthritis of the knee at Hospital das Clínicas, Universidade de São Paulo

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Camilo Partezani Helito

2014-01-01

Conclusion: S. aureus is still the most common pathogen in acute knee infections in our environment. Gram staining, absence of fever and normal leukocyte count cannot be used to rule out septic arthritis.

Utility of combined 99mTc-phosphate and 67Ga imaging in diagnosis of septic arthritis

International Nuclear Information System (INIS)

Seto, H.; Tonami, H.; Hisada, K.

1978-01-01

A case of septic arthritis diagnosed by combined 99m Tc-phosphate and 67 Ga imaging, which preceded positive cultures of the infecting organism, is presented. A previously healthy 10-year-old girl complained of pain in the left hip with persistent fever. Initial laboratory studies showed a normal white cell count and negative blood cultures. A septic process was not confirmed. Blood flow studies and bone images with 99mTc-phosphate showed markedly increased perfusion in the left hip joint without extension to bone. Subsequent 67 Ga images revealed a marked increase in radioactivity in the same region, indicating the presence of a septic process. Serial blood cultures and arthrocentesis showed Staphylococcus aureus. The patient improved on antibiotics

Septic arthritis due to tubercular and Aspergillus co-infection

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Mukesh Kumar

2016-01-01

Full Text Available Aspergillus septic arthritis is a rare and serious medical and surgical problem. It occurs mainly in immunocompromised patients. Aspergillus fumigatus is the most common causative organism followed by Aspergillus flavus. The most common site affected is knee followed by shoulder, ankle, wrist, hip and sacroiliac joint. Debridement and voriconazole are primary treatment of articular aspergilosis. To the best of our knowledge, there are no reported cases of co-infection of tuberculosis (TB and Aspergillus infecting joints. We report a case of co-infection of TB and A. flavus of hip and knee of a 60-year-old male, with type 2 diabetes mellitus. He was treated with debridement, intravenous voriconazole, and antitubercular drugs.

Septic arthritis due to tubercular and Aspergillus co-infection.

Science.gov (United States)

Kumar, Mukesh; Thilak, Jai; Zahoor, Adnan; Jyothi, Arun

2016-01-01

Aspergillus septic arthritis is a rare and serious medical and surgical problem. It occurs mainly in immunocompromised patients. Aspergillus fumigatus is the most common causative organism followed by Aspergillus flavus. The most common site affected is knee followed by shoulder, ankle, wrist, hip and sacroiliac joint. Debridement and voriconazole are primary treatment of articular aspergilosis. To the best of our knowledge, there are no reported cases of co-infection of tuberculosis (TB) and Aspergillus infecting joints. We report a case of co-infection of TB and A. flavus of hip and knee of a 60-year-old male, with type 2 diabetes mellitus. He was treated with debridement, intravenous voriconazole, and antitubercular drugs.

Osteoid osteoma masquerading tubercular arthritis or osteomyelitis on MRI: Case series and review of literature

International Nuclear Information System (INIS)

Singh, Jatinder Pal; Srivastava, Smita; Singh, Dharmendra

2015-01-01

Magnetic resonance imaging (MRI) scans for osteoid osteoma could be misleading and can be misinterpreted as tuberculosis, especially when used as the principal modality of investigation. We retrospectively reviewed cases presenting to our institute for second opinion and selected six cases that were referred to our institute with a provisional diagnosis of tubercular arthritis or osteomyelitis and were identified to have osteoid osteoma. We reviewed the literature on typical and atypical clinical and radiological presentations of osteoid osteoma depending upon their location and present radiological features on MRI that should alert the radiologists toward a correct diagnosis

Photopenia of the femoral head on 3 phase bone scan using Tc-99m MDP with acute irritable hip in the preschool children: comparison with MR findings

International Nuclear Information System (INIS)

Ryu, Young Hoon; Lee, Jong Doo; Yoon, Choon Sik; Suh, Jin Suck; Jeon, Tae Joo

1998-01-01

The child with acute irritable hip is always a diagnostic challenge. Photopenia of femur head is described in Legg-Calve-Perthes disease (LCP). However, it can be seen in cases of septic arthritis (SA) with interruption of vascular supply. Despites being uncommon, recognition of SA as a cause of photopenia is important and requires urgent referral to decompression and drainage. This study was to evaluate causes and scintigraphic features of photopenia of femur head in patients with acute irritable hip and to correlate them with MR findings. 15 patients with acute irritable hip showed photopenia of femur head on bone scan were included. Mean age was 5.3 yrs ( 9 months to 8 yrs). There were 9 patients with LCP and 3 with septic arthritis combined with osteomyelitis. All parents underwent 3 phase bone scan and hip MRI within 2 days interval. Patterns of photopenia of femur head was divided into partial, complete and extending to the metaphysis. All patients with LCP showed partial photopenia confined to femur epiphysis. Whereas, 1 with septic arthritis demonstrated complete photopenia of femur head and in 2 with septic arthritis and 3 with septic arthritis combined with osteomyelitis revealed complete photopenia of femur head extending to the metaphyseal area. In cases with septic arthritis, increased uptake affecting both sides of hip joint except for photopenic area is also noted. On MRI, all patients with LCP showed abnormalities confined to the epiphysis. In cases with septic arthritis, abnormalities are not confined to the epiphysis and marrow edema and joint effusion were also noted. In evaluating photopenia of the femur head, it would be helpful to distinguish between the photopenia localized to the femoral epiphysis as seen in cases of LCP and complete photopenia of femur head with extension to the metaphysis as seen in cases of septic arthritis. Recognition of complete with extension to the metaphysis help guide urgent proper management of septic arthritis

Photopenia of the femoral head on 3 phase bone scan using Tc-99m MDP with acute irritable hip in the preschool children: comparison with MR findings

Energy Technology Data Exchange (ETDEWEB)

Ryu, Young Hoon; Lee, Jong Doo; Yoon, Choon Sik; Suh, Jin Suck; Jeon, Tae Joo [College of Medicine, Yonsei Univ., Seoul (Korea, Republic of)

1998-07-01

The child with acute irritable hip is always a diagnostic challenge. Photopenia of femur head is described in Legg-Calve-Perthes disease (LCP). However, it can be seen in cases of septic arthritis (SA) with interruption of vascular supply. Despites being uncommon, recognition of SA as a cause of photopenia is important and requires urgent referral to decompression and drainage. This study was to evaluate causes and scintigraphic features of photopenia of femur head in patients with acute irritable hip and to correlate them with MR findings. 15 patients with acute irritable hip showed photopenia of femur head on bone scan were included. Mean age was 5.3 yrs ( 9 months to 8 yrs). There were 9 patients with LCP and 3 with septic arthritis combined with osteomyelitis. All parents underwent 3 phase bone scan and hip MRI within 2 days interval. Patterns of photopenia of femur head was divided into partial, complete and extending to the metaphysis. All patients with LCP showed partial photopenia confined to femur epiphysis. Whereas, 1 with septic arthritis demonstrated complete photopenia of femur head and in 2 with septic arthritis and 3 with septic arthritis combined with osteomyelitis revealed complete photopenia of femur head extending to the metaphyseal area. In cases with septic arthritis, increased uptake affecting both sides of hip joint except for photopenic area is also noted. On MRI, all patients with LCP showed abnormalities confined to the epiphysis. In cases with septic arthritis, abnormalities are not confined to the epiphysis and marrow edema and joint effusion were also noted. In evaluating photopenia of the femur head, it would be helpful to distinguish between the photopenia localized to the femoral epiphysis as seen in cases of LCP and complete photopenia of femur head with extension to the metaphysis as seen in cases of septic arthritis. Recognition of complete with extension to the metaphysis help guide urgent proper management of septic arthritis.

Synovial fluid sedimentation in the immobile patient: a commentary on modern septic arthritis and the addition of a new variable confounding diagnosis

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Cunningham G

2013-01-01

Full Text Available Gregory Cunningham,1 Brendan Ricciardo21Royal Perth Hospital, Perth, Western Australia, Australia; 2Bunbury Regional Hospital, Bunbury, Western Australia, AustraliaAbstract: Septic arthritis is a serious cause of morbidity and mortality. Despite recent advances, monoarticular and polyarticular septic arthritis (SA have a mortality rate of approximately 11% and 30%, respectively. SA has a 40% risk of permanent loss of joint function. Diagnosis of SA is difficult, given that no rapidly available individual test proves 100% sensitive or 100% specific. There are no previous reports on the phenomenon of synovial fluid sedimentation in an immobile patient, although the occurrence has been identified in vitro. This commentary also presents an extended report of a patient who had been immobile and supine for 24 hours before her right knee was aspirated and treated for septic arthritis. Due to her immobilization, the synovial fluid had settled. The color and opacity of the sequential aliquots from one arthrocentesis was noted to change from light straw-colored, to thick opaque purulent material. Laboratory reports showed increasing white cell counts (WCCs, from 2.6 × 109 to 78 × 109 between the sequential samples. This demonstrates a newly identified phenomenon of sedimentation. This might have led to a diagnostic difficulty, had the knee not been fully aspirated. Aspiration serves as a diagnostic tool, because it collects a sample, but it also serves as a treatment measure, because it removes purulent material. Complete aspiration of the joint should be performed for full therapeutic benefit and to avoid the potential diagnostic confusion of a falsely low WCC due to this newly identified phenomenon of synovial fluid sedimentation in the immobile patient.Keywords: septic arthritis, inflammatory arthritis, joint, sedimentation, orthopedic

Detection of Neisseria meningitidis in a paediatric patient with septic arthritis using multiplexed diagnostic PCR targeting meningitis/encephalitis (ME).

LENUS (Irish Health Repository)

O'Sullivan, Donnchadh

2018-03-23

Neisseria meningitidis is associated with meningitis and septicemia. Septic meningococcal arthritis is relatively uncommon and its diagnosis associated with clinical and microbiological challenges. Early recognition and treatment is required to prevent joint destruction.

Septic arthritis as the first sign of Candida tropicalis fungaemia in an acute lymphoid leukemia patient

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Vicari Perla

2003-01-01

Full Text Available Fungal infections caused by Candida species have increased in incidence during the past two decades in England, North America and Europe. Candidal arthritis is rare in patients who are not intravenous drug users or are who not using a prostheses. We report the case of a 24-year-old man with acute lymphoid leukemia, who developed Candida tropicalis arthritis during an aplastic period after chemotherapy. This is the eighth case described in the literature of C. tropicalis causing arthritis without intra-articular inoculation. We call attention to an unusual first sign of fungal infection: septic arthritis without intra-articular inoculation. However, this case differs from the other seven, since despite therapy a fast and lethal evolution was observed. We reviewed reported cases, incidence, risk factors, mortality and treatment of neutropenic patients with fungal infections.

Mycobacterium avium-intracellulare cellulitis occurring with septic arthritis after joint injection: a case report

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Murdoch David M

2007-02-01

Full Text Available Abstract Background Cellulitis caused by Mycobacterium avium-intracellulare has rarely been described. Mycobacterium avium-intracellulare is a rare cause of septic arthritis after intra-articular injection, though the causative role of injection is difficult to ascertain in such cases. Case presentation A 57-year-old with rheumatoid arthritis treated with prednisone and azathioprine developed bilateral painful degenerative shoulder arthritis. After corticosteroid injections into both acromioclavicular joints, he developed bilateral cellulitis centered over the injection sites. Skin biopsy showed non-caseating granulomas, and culture grew Mycobacterium avium-intracellulare. Joint aspiration also revealed Mycobacterium avium-intracellulare infection. Conclusion Although rare, skin and joint infections caused by Mycobacterium avium-intracellulare should be considered in any immunocompromised host, particularly after intra-articular injection. Stains for acid-fast bacilli may be negative in pathologic samples even in the presence of infection; cultures of tissue specimens should always be obtained.

Gonococcal arthritis

Science.gov (United States)

Disseminated gonococcal infection (DGI); Disseminated gonococcemia; Septic arthritis - gonococcal arthritis ... Gonococcal arthritis is an infection of a joint. It occurs in people who have gonorrhea , which is caused by ...

Lumbar facet joint septic arthritis presenting atypically as acute abdomen – A case report and review of the literature

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Aysha Rajeev

2016-01-01

Conclusion: The atypical presentation of facet joint septic arthritis is one of the reasons why early diagnosis is elusive. Definitive diagnoses with MRI and bacterial culture as well as prolonged antibiotic therapy are recommended in this condition.

Septic arthritis of a lumbar facet joint: Detection with bone SPECT imaging

International Nuclear Information System (INIS)

Swayne, L.C.; Dorsky, S.; Caruana, V.; Kaplan, I.L.

1989-01-01

We present a rare case of septic arthritis of a lumbar facet joint with an associated epidural abscess resulting from Staphylococcus aureus. The infection was initially detected with planar bone scintigraphy and precisely localized with single photon emission computed tomography bone scintigraphy, despite an initially negative radiologic evaluation that included radiographs of the lumbar spine, lumbar myelography, and a postmyelography x-ray computed tomography scan. In the appropriate clinical setting, a bone scan demonstrating unilateral increased activity within the spine should raise the suspicion of inflammatory involvement of the posterior elements

MRI evaluation of infectious and non-infectious synovitis: preliminary studies in a rabbit model

International Nuclear Information System (INIS)

Strouse, P.J.; DiPietro, M.A.; Teo, E.L.H.J.; Londy, F.; Chrisp, C.E.; Doi, K.

1999-01-01

Background. Literature on magnetic resonance imaging (MR) evaluation of inflammatory joint effusions is sparse. Objective. To describe an animal model for studying infectious and non-infectious joint effusions with magnetic resonance imaging. Materials and methods. Ten rabbit knees with septic arthritis and four with talc synovitis were imaged with MR. Contralateral knees injected with saline served as controls. Fat saturation T2-weighted and gadolinium-enhanced T1-weighted images were assessed for joint effusion, and periarticular and adjacent intraosseous increased signal or enhancement. Each knee was cultured and underwent pathologic examination. Results. Both Staphylococcus aureus and talc produced effusions in all knees. The degree of periarticular signal and enhancement was greater in infected knees than talc-injected knees. No abnormal enhancement was seen within bone. Pathologic examination showed a greater degree of inflammation and joint destruction in the infected knees, but no evidence of osteomyelitis. Conclusion. A greater degree of abnormal signal and enhancement seen on MR suggests a more vigorous inflammatory process, as seen with septic arthritis. In spite of advanced septic arthritis, no enhancement was evident within bone, suggesting that enhancement within bone is not an expected finding in isolated septic arthritis and should raise concern for osteomyelitis. (orig.)

Abscess Formation after Septic Arthritis in the Sternoclavicular Joint of Two Healthy Men

DEFF Research Database (Denmark)

Henriksen, Jeppe; Tang, Mariann; Hjortdal, Vibeke

2015-01-01

Abscess formation after septic arthritis in the sternoclavicular joint is a rare phenomenon in healthy people without immune suppression, intravenous drug abuse, or diabetes. Here we report two cases with formation of abscess in two middle-aged men, with no relevant comorbidities and no obvious...... sites of infection. The abscesses were both treated surgically with debridement followed by negative pressure wound therapy and antibiotics. The cases differ in diagnostic procedures and delay of diagnosis and broach the issues of handling a rare disease....

Septic arthritis of the hip in a Cambodian child caused by multidrug-resistant Salmonella enterica serovar Typhi with intermediate susceptibility to ciprofloxacin treated with ceftriaxone and azithromycin.

Science.gov (United States)

Pocock, J M; Khun, P A; Moore, C E; Vuthy, S; Stoesser, N; Parry, C M

2014-08-01

Septic arthritis is a rare complication of typhoid fever. A 12-year-old boy without pre-existing disease attended a paediatric hospital in Cambodia with fever and left hip pain. A hip synovial fluid aspirate grew multidrug-resistant Salmonella enterica ser. Typhi with intermediate susceptibility to ciprofloxacin. Arthrotomy, 2 weeks of intravenous ceftriaxone and 4 weeks of oral azithromycin led to resolution of symptoms. The optimum management of septic arthritis in drug-resistant typhoid is undefined.

Osteomyelitis and Osteonecrosis in Inflammatory Bowel Disease

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Hugh J Freeman

1997-01-01

Full Text Available Osteomyelitis and osteonecrosis are skeletal disorders seen in patients with inflammatory bowel disease (IBD. Osteomyelitis usually occurs in the pelvic bones, especially in complicated Crohn's disease, presumably by direct extension from a pelvic inflammatory mass, abscess or fistulous tract. Diagnosis of osteomyelitis may be difficult and can lead to spinal extension of the septic process with a resultant neurological deficit, including paraplegia. Osteonecrosis or avascular necrosis has been reported in patients with either ulcerative colitis or Crohn's disease, often, but not exclusively, during or following steroid treatment. The disease is often multifocal, but its natural history is unknown, especially if diagnosed early with modern imaging methods, such as magnetic resonance. In IBD patients, the relationship between osteonecrosis and steroid use is unknown. An adverse steroid effect on bones, especially the femoral heads, may develop in some patients with IBD but, to date, this hypothesis remains unproven. Critical evaluation of published data reveals no consistent association between osteonecrosis and steroid treatment in IBD patients.

the current susceptibility pattern of methicillin resistant ...

African Journals Online (AJOL)

DJFLEX

RESISTANT STAPHYLOCOCCUS AUREUS TO ANTIBIOTICS IN. PORT HARCOURT ... pneumonia, urinary tract infections, wound sepsis, septic arthritis, osteomyelitis and .... in a neonatal and pediatric intensive care unit. Peditric-Med. Clin.

Abscess Formation after Septic Arthritis in the Sternoclavicular Joint of Two Healthy Men

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Jeppe Henriksen

2015-01-01

Full Text Available Abscess formation after septic arthritis in the sternoclavicular joint is a rare phenomenon in healthy people without immune suppression, intravenous drug abuse, or diabetes. Here we report two cases with formation of abscess in two middle-aged men, with no relevant comorbidities and no obvious sites of infection. The abscesses were both treated surgically with debridement followed by negative pressure wound therapy and antibiotics. The cases differ in diagnostic procedures and delay of diagnosis and broach the issues of handling a rare disease.

[Tropical pyomyositis simulating septic arthritis in AIDS patients. Two cases].

Science.gov (United States)

Abouzahir, A; Bouchama, R; Azennag, M; Garcin, J M

2004-01-01

Tropical pyomyositis (TP) is an acute bacterial infection of skeletal muscles characterized by rapid formation of abscesses. Since the beginning of the AIDS epidemic, interest in TP has increased because of its rising incidence in association with HIV infection and of the problems that it poses for differential diagnosis. Occurrence of TP is a criterion for classification of HIV infected patients in WHO disease stage III. The purpose of this report is to describe two HIV-infected patients who presented TP simulating septic arthritis of the hip and knee respectively. Medical imaging was particularly useful in establishing accurate topographic diagnosis and needle drainage in decreasing the duration of hospitalization and avoiding the need for surgical debridement. Needle puncture must be guided by ultrasound or scan imaging.

Isolated septic facet joint arthritis as a rare cause of acute and chronic low back pain – a case report and literature review

International Nuclear Information System (INIS)

Klekot, Dominika; Zimny, Anna; Czapiga, Bogdan; Sąsiadek, Marek

2012-01-01

The most common cause of low back pain is degenerative disease of the intervertebral disc and other structures of the lumbar spine. However, in some cases other less frequent causes of such pain can be seen, for example septic facet joint arthritis. Until now, only 40 cases of such inflammatory changes within the spine have been reported in the literature. The disease is probably underestimated due to improper diagnostic pathway. The authors describe a case of a 53-year-old woman who was repeatedly hospitalized during a five-month period because of an acute, severe low back pain, with sphincter dysfunction, partially resembling sciatic symptoms. Physical examinations revealed also focal tenderness in the area of the lumbar spine. Inflammatory markers (ESR – erythrocyte sedimentation rate, CRP – C-reactive protein) were elevated. Conservative analgetic treatment brought only partial and temporary relief of the pain and symptoms. The final accurate diagnosis of isolated septic facet joint arthritis at the level of L5/S1 was established after several months from the onset of the first symptoms, after performing various imaging examinations, including bone scintigraphy as well as CT and MRI of the lumbosacral spine. The patient fully recovered after antibiotic therapy and surgery, which was proven in several follow-up examinations showing no relevant pathology of the lumbar spine. The authors broadly describe the etiology and clinical symptoms of the septic facet joint arthritis as well as the significant role of imaging methods, especially MRI, in diagnostic process. The authors also discuss currently available treatment options, both conservative and surgical. The diagnostic procedure of septic facet joint arthritis requires several steps to be taken. Establishing a correct diagnosis may be difficult, that is why it is important to remember about rare causes of low back pain and to perform detailed physical examination, laboratory tests and choose appropriate

Septic arthritis of shoeulder caused by Streptococcus pneumoniae serotype 23F in a female infant. Report of a case

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Flores Nava Gerardo

2014-07-01

Full Text Available We present the case of a female infant previously vaccinated against Streptococcus pneumoniae who developed a septic arthritis in the right shoulder. An artrothomy was performed. The culture of the sy- novial fluid was positive for serotype 23F Streptococcus pneumonia.

Staphylococcal endogenous endophthalmitis in association with pyogenic vertebral osteomyelitis.

Science.gov (United States)

Steeples, L R; Jones, N P

2016-01-01

PURPOSE To describe pyogenic vertebral osteomyelitis as a rare infection associated with endogenous endophthalmitis.METHODS A retrospective review of three patients with endogenous endophthalmitis and sepsis due to underlying Staphylococcal vertebral osteomyelitis presenting during a 21-month time period. The ophthalmic and systemic features and management and outcomes are presented.RESULTS One patient developed unilateral endophthalmitis with cervical spine osteomyelitis, Staphylococcus aureus being isolated from blood cultures. The second presented with bilateral endophthalmitis with disseminated Methicillin-resistant S. aureus (MRSA) infection, with thoracic and lumbar discitis and para-spinal abscesses. MRSA was cultured from vitreous, blood, and synovial fluid. Both patients received prolonged courses of intravenous antibiotics. Intravitreal antibiotic therapy was used in the second patient. Excellent visual and systemic outcomes were achieved in both cases with no ocular complications. The third patient developed lumbar osteomyelitis following spinal surgery and presented with disseminated S. aureus sepsis including unilateral endogenous endophthalmitis. Despite systemic antibiotics and intensive care the patient died.CONCLUSIONS Endogenous endophthalmitis should be suspected in septic patients developing eye symptoms. Endogenous endophthalmitis with staphylococcal bone infection is a rare but serious condition. Osteomyelitis should be considered as an infective source in any such patient reporting bone pain or reduced spinal mobility. Prompt investigation and treatment can achieve favourable visual and systemic outcomes.

Artritis séptica del pubis en dos deportistas Septic arthritis of the pubic symphysis in two athletes

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José A. Andrews

2012-06-01

Full Text Available La artritis séptica de pubis u osteomielitis púbica es la infección que compromete la sínfisis pubiana y su articulación. Es poco frecuente, representando menos del 1% de las osteomielitis. Afecta más a menudo a atletas jóvenes y a mujeres que se someten a cirugía ginecológica o urológica. Se presenta con fiebre y dolor púbico, irradiado a genitales, que aumenta con la movilización de la cadera lo que produce claudicación de la marcha. Debe hacerse el diagnóstico diferencial con la osteítis del pubis que es una condición inflamatoria estéril. La punción guiada por imagen suele ser necesaria para el diagnóstico diferencial con la osteítis del pubis. El diagnóstico se basa en la clínica apoyada en el aislamiento microbiológico, métodos por imágenes e incremento de las proteínas de fase aguda. Los agentes etiológicos más comúnmente encontrados son Staphylococcus aureus, seguidos de bacilos gram negativos, o pueden ser polimicrobianos en posquirúrgicos. El tratamiento antibiótico se ajusta al germen aislado por cultivo, además de antiinflamatorios y reposo. El desbridamiento quirúrgico se requiere hasta en el 55% de los casos. Se recomiendan antibióticos por 6 semanas. Se presentan dos casos de osteomielitis del pubis por S. aureus, con buena respuesta al tratamiento. Ambos pacientes eran jóvenes y deportistas.Septic arthritis of the pubic symphysis, so called osteomyelitis pubis is the infection which involves pubic symphysis and its joint. It is a rare condition, representing less than one percent of all cases of osteomyelitis. It affects most frequently young athletes and women undergoing gynecologic or urologic surgery. It presents itself with fever and pubic pain which irradiates to the genitals and increases when hip is mobilized, and this fact produces gait claudication. Differential diagnosis should be made with pubic osteitis, which is a sterile inflammatory condition. Diagnosis is based on clinic

Editorial Commentary: Graft Removal Versus Retention for Septic Arthritis After Anterior Cruciate Ligament Reconstruction: Accounting for Patient Preference Flips the Script on Current Practice.

Science.gov (United States)

Cote, Mark P

2018-03-01

Septic arthritis is a rare but potentially devastating complication after anterior cruciate ligament (ACL) reconstruction. Studies examining surgical treatment options including graft retention and removal are largely inconclusive. Although the literature indicated that 43.8% of patients who have the graft removed later go on to have a revision ACL reconstruction compared with only 6.5% among those whose graft is retained, this expected-value decision analysis found removal to be the optimal treatment for patients with septic arthritis after ACL reconstruction. This is largely based on patient preference to avoid a late reoperation for residual knee infection. These findings support the concept of utility when considering treatment options for patients with a septic knee. For some, avoiding a late reoperation for a persistent infection is the most important factor and as such graft removal may be the most appropriate treatment to produce a positive outcome among these patients despite the fact that currently, an attempt at graft retention could represent the generally preferred treatment option among practicing surgeons. Copyright © 2017. Published by Elsevier Inc.

Aetiology of arthritis in hospitalised children: an observational study.

Science.gov (United States)

Aupiais, Camille; Ilharreborde, Brice; Doit, Catherine; Blachier, Audrey; Desmarest, Marie; Job-Deslandre, Chantal; Mazda, Keyvan; Faye, Albert; Bonacorsi, Stéphane; Alberti, Corinne; Lorrot, Mathie

2015-08-01

Arthritis in children has many causes and includes septic and viral arthritis, reactive arthritis and juvenile idiopathic arthritis (JIA). We aimed to describe the different types of arthritis among children hospitalised for a first episode of arthritis. Retrospective, descriptive case series study. A French tertiary care centre. Children under 16 years of age hospitalised for an arthritis episode between 1 January 2008 and 31 December 2009. Demographic and clinical features were compared with χ(2) or Fisher's exact tests and non-parametric tests. 173 children were hospitalised for a first episode of arthritis during the study period, with a male/female ratio of 1.14. The most frequent cause of hospitalisation was septic arthritis (43.4% of cases, 69.3% of which were due to Kingella kingae and 10.7% to Staphylococcus aureus). JIA was responsible for 8.1% of cases and arthritis without any definitive diagnosis for 40.4%. Median age at diagnosis was 2.7 years (IQR 0.3-14.6) and was lower in the septic arthritis group (1.5 years; 1.1-3.4) than in the JIA group (4.7 years; 2.5-10.9) (p<0.01). Septic arthritis involved a single joint in 97.3% of cases, while JIA involved four joints in 14.3% of cases and two to four joints in 28.6% of cases (p<0.01). Septic arthritis was the most frequent cause of arthritis in hospitalised children. Despite the increasing application of microbiological molecular methods to synovial fluid analysis, further measures are required to improve the diagnosis of arthritis of unknown cause. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Actinobacillus pleuropneumoniae osteomyelitis in pigs demonstrated by fluorescent in situ hybridization

DEFF Research Database (Denmark)

Jensen, Tim Kåre; Boye, Mette; Hagedorn-Olsen, T.

1999-01-01

Necrotizing osteomyelitis and fibrinopurulent arthritis with isolation of Actinobacillus pleuropneumoniae serotype 2 is reported in two pigs from a herd with lameness and mild coughing problems among 8 to 12-week-old pigs. Application of fluorescent in situ hybridization targeting 16S ribosomal R......, in joints with arthritis, and in bone necroses including lysis of growth plate and suppurative inflammation in the adjacent trabecular metaphysis, thus demonstrating that well-known infections manifest new, unusual lesions....

Osteomyelitis

Science.gov (United States)

... to need IV or oral (taken by mouth) antibiotics at home for several more weeks. Most teens recover completely from osteomyelitis. Can I Prevent Osteomyelitis? The easiest way to prevent yourself from getting osteomyelitis is to practice good hygiene. If you get a cut or a ...

IJMBR ARTHRITIS edited 4.3.1

African Journals Online (AJOL)

MJP

2015-10-28

Oct 28, 2015 ... Findings: Septic arthritis in the index patient developed insidiously and was diagnosed after ... mellitus, malignancy, and rheumatoid arthritis. Others include ... intravenous drug use, anemia, hemodialysis and the extremes of ...

Septic arthritis as a severe complication of elective arthroscopy:clinical management strategies

Directory of Open Access Journals (Sweden)

Imhoff Andreas B

2009-03-01

Full Text Available Abstract Infection of a peripheral joint following arthroscopic surgery presents with an incidence of approximately 0.42% an extremely rare entity. However, septic arthritis is a serious situation possibly leading to an irreparable joint damage. Especially at delayed diagnosis patients' safety can be endangered severely. Only few precise statements regarding diagnosis and therapy have been published so far. Besides an accurate analysis of the patient's anamnesis and the assessment of the C-reactive protein especially arthrocentesis is required for diagnostic workup. For early stage infections arthroscopic therapy is proven to be of value. In addition a calculated and consecutive germ-adjusted antibiotic therapy is essential. In case of persisting signs of infection the indication for re-arthroscopy or conversion to open revision has to be stated in time. The number of necessary revisions is dependent on the initial stage of infection. For pain therapy postoperative immobilization of the affected joint is occasionally essential, if otherwise possibly early mobilization of the joint should be performed.

US Evaluation of Juvenile Idiopathic Arthritis and Osteoarticular Infection.

Science.gov (United States)

Nguyen, Jie C; Lee, Kenneth S; Thapa, Mahesh M; Rosas, Humberto G

2017-01-01

Juvenile idiopathic arthritis (JIA) and osteoarticular infection can cause nonspecific articular and periarticular complaints in children. Although contrast material-enhanced magnetic resonance imaging is the reference standard imaging modality, musculoskeletal ultrasonography (US) is emerging as an important adjunct imaging modality that can provide valuable information relatively quickly without use of radiation or the need for sedation. However, diagnostic accuracy requires a systemic approach, familiarity with various US techniques, and an understanding of maturation-related changes. Specifically, the use of dynamic, Doppler, and/or multifocal US assessments can help confirm sites of disease, monitor therapy response, and guide interventions. In patients with JIA, ongoing synovial inflammation can lead to articular and periarticular changes, including synovitis, tenosynovitis, cartilage damage, bone changes, and enthesopathy. Although these findings can manifest in adult patients with rheumatoid arthritis, important differences and pitfalls exist because of the unique changes associated with an immature and maturing skeleton. In patients who are clinically suspected of having osteoarticular infection, the inability of US to evaluate the bone marrow decreases its sensitivity. Therefore, the US findings should be interpreted with caution because juxtacortical inflammation is suggestive, but neither sensitive nor specific, for underlying osteomyelitis. Similarly, the absence of a joint effusion makes septic arthritis extremely unlikely but not impossible. US findings of JIA and osteoarticular infection often overlap. Although certain clinical scenarios, laboratory findings, and imaging appearances can favor one diagnosis over the other, fluid analysis may still be required for definitive diagnosis and optimal treatment. US is the preferred modality for fluid aspiration and administering intra-articular corticosteroid therapy. © RSNA, 2017.

Premature epiphyseal fusion and degenerative arthritis in chronic recurrent multifocal osteomyelitis

International Nuclear Information System (INIS)

Piddo, C.; Reed, M.H.; Black, G.B.

2000-01-01

A 9-year-old boy was diagnosed with chronic recurrent multifocal osteomyelitis affecting multiple sites. During an 8-year follow-up he developed premature closure of a distal radial epiphysis and degenerative changes in the adjacent radiocarpal joint. (orig.)

Community Acquired Chronic Arthritis due to Pseudomonas aeruginosa in a Previously Healthy Pregnant Woman

Directory of Open Access Journals (Sweden)

Mesut Yilmaz

2014-01-01

Full Text Available Septic arthritis caused by Pseudomonas aeruginosa is uncommon in the immunocompetent population, despite its occurrence in younger patients with open injuries and in intravenous drug abusers. Here we report a case of septic arthritis caused by P. aeruginosa. This case is unique for several reasons. First, it is a case of septic arthritis in a pregnant woman with no traditional risk factors reported in the literature including history of prior traumatic events, hospitalisation, or chronic underlying disease. She was suspected of having transient osteoporosis associated with pregnancy to involve both hip joints. Second, this is the first reported case of a community acquired chronic septic arthritis due to P. aeruginosa involving large joints of both upper and lower extremities. The patient was treated successfully with a combination of ceftazidime and amikacin for 4 weeks followed by oral ciprofloxacin 750 mg twice daily for 8 weeks.

Radionuclide bone scintigraphy in pediatric orthopedics

International Nuclear Information System (INIS)

Conway, J.J.

1986-01-01

Radionuclide bone scintigraphy is highly sensitive and specific for diagnosing the musculoskeletal disorders of childhood. Conditions such as neonatal osteomyelitis, septic arthritis, diskitis of childhood, Legg-Calve-Perthes disease, the osteochondroses, the toddler's fracture, sports injuries, spondylolysis, myositis ossificians, and reflex sympathetic dystrophy are readily defined. High-quality state-of-the-art scintigraphy is essential in infants and young children. 64 references

Ewingella Americana: An Emerging True Pathogen

Directory of Open Access Journals (Sweden)

Syed Hassan

2012-01-01

Full Text Available Infections caused by Ewingella americana have been rarely reported in the literature. Most of the cases that have been reported were among the immunocompromised patients. We report a case of E. americana causing osteomyelitis and septic arthritis of the shoulder joint in a previous intravenous drug abuser. The causative pathogen was identified by synovial fluid analysis and culture.

Multimodality imaging of osteomyelitis

Energy Technology Data Exchange (ETDEWEB)

Elgazzar, A.H. [Cincinnati Univ. Medical Center, OH (United States); Abdel-Dayem, H.M. [Dept. Radiology, New York Medical College, Valhalla, NY (United States)]|[Dept. of Radiology, St. Vinvent`s Hospital and Medical Center, New York, NY (United States); Clark, J.D. [Cincinnati Univ. Medical Center, OH (United States); Maxon, H.R. [Cincinnati Univ. Medical Center, OH (United States)

1995-09-01

After a brief introduction outlining some basic principles regarding the diagnosis of osteomyelitis, pathophysiologic aspects are reviewed. Advantages and disadvantages of each imaging modality and their applications in different forms of osteomyelitis are discussed. The use of different imaging modalities in the diagnosis of special forms of osteomyelitis, including chronic, diabetic foot, and vertebral osteomyelitis, and osteomyelitis associated with orthopedic appliances and sickle cell disease is reviewed. Taking into account the site of suspected osteomyelitis and the presence or absence of underlying pathologic changes and their nature, an algorithm summarizing the use of various imaging modalities in the diagnosis of osteomyelitis is presented. (orig.). With 13 figs., 9 tabs.

Retrocalcaneal bursitis in juvenile chronic arthritis.

OpenAIRE

Goldenstein-Schainberg, C; Homsi, C; Rodrigues Pereira, R M; Cossermelli, W

1992-01-01

Retrocalcaneal bursitis has been described in various adult rheumatic diseases and septic bursitis unrelated to previous bursal disease has been reported in children. The case is reported here of a girl with juvenile chronic arthritis who developed non-septic retrocalcaneal bursitis; the diagnosis was suggested by a combination of clinical and radiographic studies and was confirmed by ultrasonography.

Salmonella osteomyelitis

OpenAIRE

Somsri Wiwanitkit; Viroj Wiwanitkit

2016-01-01

Salmonella infection can cause four predominant clinical syndromes: enteric fever, acute gastroenteritis, bacteraemia with or without metastatic infection, and the asymptomatic carrier state. Salmonella as an aetiological agent in osteomyelitis is essentially rare and salmonella osteomyelitis in itself is predominantly seen in patients with haemoglobinopathies such as sickle cell disease or thalassemia. There are very few cases reported in the literature in which salmonella osteomyelitis is s...

Acute Disseminated Melioidosis Presenting with Septic Arthritis and Diffuse Pulmonary Consolidation in an Otherwise Healthy Adult: A Case Report

Directory of Open Access Journals (Sweden)

Hai Sherng Lee

2015-03-01

Full Text Available Background: Melioidosis is an infectious disease caused by Burkholderia pseudomallei. It is most prevalent in South-East Asia, northern Australia, and the Indian subcontinent. Septic arthritis is a rare manifestation of melioidosis. Melioidosis is usually found in patients with diabetes, heavy alcohol use, or chronic lung disease. Results: We report a case of melioidosis in an otherwise healthy 44-year-old male, who presented with acute painful left knee swelling, high-grade fever associated with chills, rigors and night sweats, and a productive cough. Examination revealed active synovitis with effusion involving his left knee, ankle and elbow joints and scattered crackles over both lung fields. Chest X-ray showed diffuse pulmonary consolidation. Abdominal ultrasound showed splenic micro-abscesses. The diagnosis was made based on a positive blood culture for Burkholderia pseudomallei. He was started on appropriate antibiotics and responded well, becoming afebrile after 48 hours, while his joint effusions disappeared after one week. A repeat chest X-ray after two weeks of intensive antibiotic therapy showed marked improvement. At the time of writing, he was under uneventful outpatient follow-up and still had 12 weeks to complete his course of antibiotics. Conclusion: Septic arthritis only occurs in 4% of patients with melioidosis. When there is diffuse pulmonary involvement, melioidosis may mimic disseminated tuberculosis, other acute disseminated or focal sepsis syndromes, and systemic vasculitis syndromes. This case is relevant for medical literature as melioidosis is emerging and is expanding its known territories worldwide. It should be considered early in the differential diagnoses of patients presenting with constitutional symptoms in endemic areas, so that treatment can be started early to reduce its high mortality and morbidity.

Musculoskeletal disorders associated with HIV infection and AIDS. Part I: Infectious musculoskeletal conditions

International Nuclear Information System (INIS)

Tehranzadeh, Jamshid; Ter-Oganesyan, Ramon R.; Steinbach, Lynne S.

2004-01-01

The musculoskeletal system can be affected by a variety of abnormalities in association with human immunodeficiency virus (HIV) infection. Although not as common as complications involving other organ systems, such as the pulmonary and the central nervous systems, HIV-associated musculoskeletal disorders are sometimes the initial presentation of the viral illness. Knowledge of the existence and the characteristic appearance of the conditions affecting bone, joint, and muscle in HIV-infected patients is valuable to radiologists for diagnosis and to clinicians for detection and appropriate treatment. We reviewed recent literature to provide a comprehensive assessment of the HIV-associated musculoskeletal disorders, and present radiologic examples from our own collection. This article is divided into two parts. In the first part we review the infectious musculoskeletal disorders associated with HIV illness and AIDS, including cellulitis, abscesses, pyomyositis, septic bursitis, septic arthritis, osteomyelitis, and bacillary angiomatosis. We also present a comprehensive spectrum of mycobacterial infections, consisting of tuberculous spondylitis and spondylodiskitis, arthritis, osteomyelitis, and tenosynovitis, as well as infections caused by atypical mycobacteria. Part II of this review will concentrate on non-infectious musculoskeletal conditions, including rheumatic disorders and neoplasms. (orig.)

Musculoskeletal disorders associated with HIV infection and AIDS. Part I: Infectious musculoskeletal conditions

Energy Technology Data Exchange (ETDEWEB)

Tehranzadeh, Jamshid [Department of Radiological Sciences, University of California, Irvine, Irvine, California (United States); Department of Radiological Sciences, Rt. 140, 101 The City Drive ZC 5005, CA 92868-3298, Orange (United States); Ter-Oganesyan, Ramon R. [College of Medicine, University of California, Irvine, Irvine, California (United States); Steinbach, Lynne S. [Department of Radiological Sciences, University of California, San Francisco, San Francisco, California (United States)

2004-05-01

The musculoskeletal system can be affected by a variety of abnormalities in association with human immunodeficiency virus (HIV) infection. Although not as common as complications involving other organ systems, such as the pulmonary and the central nervous systems, HIV-associated musculoskeletal disorders are sometimes the initial presentation of the viral illness. Knowledge of the existence and the characteristic appearance of the conditions affecting bone, joint, and muscle in HIV-infected patients is valuable to radiologists for diagnosis and to clinicians for detection and appropriate treatment. We reviewed recent literature to provide a comprehensive assessment of the HIV-associated musculoskeletal disorders, and present radiologic examples from our own collection. This article is divided into two parts. In the first part we review the infectious musculoskeletal disorders associated with HIV illness and AIDS, including cellulitis, abscesses, pyomyositis, septic bursitis, septic arthritis, osteomyelitis, and bacillary angiomatosis. We also present a comprehensive spectrum of mycobacterial infections, consisting of tuberculous spondylitis and spondylodiskitis, arthritis, osteomyelitis, and tenosynovitis, as well as infections caused by atypical mycobacteria. Part II of this review will concentrate on non-infectious musculoskeletal conditions, including rheumatic disorders and neoplasms. (orig.)

[Definition of the Diagnosis Osteomyelitis-Osteomyelitis Diagnosis Score (ODS)].

Science.gov (United States)

Schmidt, H G K; Tiemann, A H; Braunschweig, R; Diefenbeck, M; Bühler, M; Abitzsch, D; Haustedt, N; Walter, G; Schoop, R; Heppert, V; Hofmann, G O; Glombitza, M; Grimme, C; Gerlach, U-J; Flesch, I

2011-08-01

The disease "osteomyelitis" is characterised by different symptoms and parameters. Decisive roles in the development of the disease are played by the causative bacteria, the route of infection and the individual defense mechanisms of the host. The diagnosis is based on different symptoms and findings from the clinical history, clinical symptoms, laboratory results, diagnostic imaging, microbiological and histopathological analyses. While different osteomyelitis classifications have been published, there is to the best of our knowledge no score that gives information how sure the diagnosis "osteomyelitis" is in general. For any scientific study of a disease a valid definition is essential. We have developed a special osteomyelitis diagnosis score for the reliable classification of clinical, laboratory and technical findings. The score is based on five diagnostic procedures: 1) clinical history and risk factors, 2) clinical examination and laboratory results, 3) diagnostic imaging (ultrasound, radiology, CT, MRI, nuclear medicine and hybrid methods), 4) microbiology, and 5) histopathology. Each diagnostic procedure is related to many individual findings, which are weighted by a score system, in order to achieve a relevant value for each assessment. If the sum of the five diagnostic criteria is 18 or more points, the diagnosis of osteomyelitis can be viewed as "safe" (diagnosis class A). Between 8-17 points the diagnosis is "probable" (diagnosis class B). Less than 8 points means that the diagnosis is "possible, but unlikely" (class C diagnosis). Since each parameter can score six points at a maximum, a reliable diagnosis can only be achieved if at least 3 parameters are scored with 6 points. The osteomyelitis diagnosis score should help to avoid the false description of a clinical presentation as "osteomyelitis". A safe diagnosis is essential for the aetiology, treatment and outcome studies of osteomyelitis. © Georg Thieme Verlag KG Stuttgart · New York.

Retrocalcaneal bursitis in juvenile chronic arthritis.

Science.gov (United States)

Goldenstein-Schainberg, C; Homsi, C; Rodrigues Pereira, R M; Cossermelli, W

1992-01-01

Retrocalcaneal bursitis has been described in various adult rheumatic diseases and septic bursitis unrelated to previous bursal disease has been reported in children. The case is reported here of a girl with juvenile chronic arthritis who developed non-septic retrocalcaneal bursitis; the diagnosis was suggested by a combination of clinical and radiographic studies and was confirmed by ultrasonography. Images PMID:1444631

Pelvic girdle sepsis in childhood. An illustrative case of the difficulty in diagnosis.

LENUS (Irish Health Repository)

Street, John

2012-02-03

The child who presents with fever, limp and hip pain will often undergo multiple diagnostic procedures before a definitive diagnosis is made. We describe a diagnostically challenging case of a 14-year-old boy presenting with an atraumatic painful limp and pyrexia. Eventually the diagnosis of obturator internus muscle abscess with associated ischial osteomyelitis was made. Of the 19 previous cases reported, four children had associated osteomyelitis and were of an older age. Symptomatology varies, clinical examination is non-specific and the diagnosis can be difficult. Haematological indices are more predictive than in cases of classical osteomyelitis or septic arthritis. Subtle features on conventional radiography and isotope bone scanning should not be overlooked while CT and MRI may be complementary in diagnosis.

Life-threatening MRSA sepsis with bilateral pneumonia, osteomyelitis, and septic arthritis of the knee in a previously healthy 13-year-old boy

DEFF Research Database (Denmark)

Hardgrib, Nina; Wang, Michala; Jurik, Anne Grethe

2016-01-01

The incidence and severity of methicillin resistant Staphylococcus aureus (MRSA) infections are increasing and cause high mortality and morbidity. We describe the first pediatric case in Scandinavia with Panton-Valentine leucocidin (PVL) positive MRSA septicemia who developed bilateral pneumonia...... and antimicrobial combination therapy. The outcome was a healthy patient without sequelae, a favorable course unlike those previously described in the literature. This case underlines the necessity of a close interdisciplinary cooperation in children with severe MRSA infection encompassing pneumonia, septic...

Osteomyelitis Infection of Mycobacterium marinum: A Case Report and Literature Review

Directory of Open Access Journals (Sweden)

Hao H. Nguyen

2015-01-01

Full Text Available Mycobacterium marinum (M. marinum is a ubiquitous waterborne organism that grows optimally at temperatures around 30°C. It is a nontuberculous Mycobacterium found in nonchlorinated water with worldwide prevalence. It is the most common atypical Mycobacterium that causes opportunistic infection in humans. M. marinum can cause superficial infections and localized invasive infections in humans, with the hands being the sites most frequently affected. It can cause skin lesions, which are either single, papulonodular lesions, confined to an extremity, or may resemble cutaneous sporotrichosis. This infection can also cause deeper infections including tenosynovitis, bursitis, arthritis, and osteomyelitis. Disseminated infections and visceral involvements have been reported in immunocompromised patients. We here report a case of severe deep soft tissue infection with necrotizing fasciitis and osteomyelitis of the left upper extremity (LUE caused by M. marinum in an immunocompromised patient.

Musculoskeletal infections: ultrasound appearances

Energy Technology Data Exchange (ETDEWEB)

Chau, C.L.F. [Department of Radiology, North District Hospital, NTEC, Fanling, NT, Hong Kong (China)]. E-mail: c8681@yahoo.com; Griffith, J.F. [Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, NTEC, Shatin, NT, Hong Kong (China)

2005-02-01

Musculoskeletal infections are commonly encountered in clinical practice. This review will discuss the ultrasound appearances of a variety of musculoskeletal infections such as cellulitis, infective tenosynovitis, pyomyositis, soft-tissue abscesses, septic arthritis, acute and chronic osteomyelitis, and post-operative infection. The peculiar sonographic features of less common musculoskeletal infections, such as necrotizing fasciitis, and rice body formation in atypical mycobacterial tenosynovitis, and bursitis will also be presented.

Musculoskeletal infections: ultrasound appearances

International Nuclear Information System (INIS)

Chau, C.L.F.; Griffith, J.F.

2005-01-01

Musculoskeletal infections are commonly encountered in clinical practice. This review will discuss the ultrasound appearances of a variety of musculoskeletal infections such as cellulitis, infective tenosynovitis, pyomyositis, soft-tissue abscesses, septic arthritis, acute and chronic osteomyelitis, and post-operative infection. The peculiar sonographic features of less common musculoskeletal infections, such as necrotizing fasciitis, and rice body formation in atypical mycobacterial tenosynovitis, and bursitis will also be presented

Radionuclide bone scintigraphy in pediatric orthopedics

Energy Technology Data Exchange (ETDEWEB)

Conway, J.J.

1986-12-01

Radionuclide bone scintigraphy is highly sensitive and specific for diagnosing the musculoskeletal disorders of childhood. Conditions such as neonatal osteomyelitis, septic arthritis, diskitis of childhood, Legg-Calve-Perthes disease, the osteochondroses, the toddler's fracture, sports injuries, spondylolysis, myositis ossificians, and reflex sympathetic dystrophy are readily defined. High-quality state-of-the-art scintigraphy is essential in infants and young children. 64 references.

[Septic complications after multilocal fractures and multiple traumatic injury].

Science.gov (United States)

Okapa, Robert; Rak, Stanisław; Wenda, Jarosław; Marczyński, Wojciech; Walczak, Piotr; Macias, Julia

2011-01-01

The increase of the number of the multiple traumatic injuries is related to social factors, such as: the development of industry, the change of life style and the conditions of work, the manner and the speed of relocation and the biological factors related with the elongation of life time. According to the World Health Organization data the injuries are one of the main health problems in the world. The clinical analysis of multitrauma patients treated due to the septic complications of the fractures. The material consists of 34 multitrauma patients treated in The Osteomyelitis and Septic Complications Unit in Prof. A. Gruca Orthopedic and Trauma Hospital in Otwock, Poland between 2005 and 2010. The cause of trauma, the timing of arrival to our unit, the number of the days of treatment, the number and the specificity of bone and internal injuries, the bacteriology of bone infections and operative techniques and pharmacologic treatment were analyzed. The causes of the injuries were: road accident (79%), fall from the height (8.8%), others (12.2%). The first stay in our unit was 21 months after the injury on average (1-129 months), the number of stays in the unit was 2,8 on average (1-6), the length of stay was 25.7 days on average (4-108 days). In analyzed group of 34 patients, we found: 12 opened fractures of single bone, 11 opened fractures of more than one bone, 22 closed fractures of single bone, 12 closed fracture of more than one bone. Central nervous system (55.9%), abdominal organs (35.3%) and thorax (29.4%) were the most common internal organs ocuppied with the injury. Osteomyelitis was the most frequently diagnosed in femur (50%) and tibia (41.2%). The main reasons of bone infection were: Methycylin-Sensitive Staphylococcus Aureus (35,3%), Methycylin-Resistant Staphylococcus Aureus (17,3%), Pseudomonas aeruginosa (23,5%), Escherichia coli, Acinetobacter baumani, Enterococcus faecalis. The following treatment was undertaken: the debridement of septic bone

Three-phase [99mTc]diphosphonate scintimetry in septic and nonseptic arthritis of the immature knee: An experimental investigation in dogs

International Nuclear Information System (INIS)

Hansen, E.S.; Hjortdal, V.E.; Noer, I.; Holm, I.E.; Ewald, H.; Buenger, C.

1989-01-01

We compared the informative value of dynamic and static [99mTc]diphosphonate ([99mTc]DPD) scintimetry in early septic arthritis (SA) and chronic nonseptic arthritis (NSA) of the knee in puppies. SA (n = 10), induced by injection of Staphylococcus aureus into one knee, was examined after 48 h. NSA (n = 6) was induced by weekly intraarticular instillation of 1% carrageenan and examined at 2 and 12 weeks. Epiphyseal and metaphyseal count ratios (CRs) between experimental and control joint were calculated in an angiographic phase (0-20 s), a ''blood pool'' phase (20-256 s), and a bone uptake phase (2 hs). Control dogs (n = 4) had a CR of 1.0 in all regions and phases, the coefficients of variation being 0.06 and 0.03 in dynamic and static phases, respectively. In NSA, all scintimetric phases showed decreased metaphyseal uptake and largely unchanged epiphyseal uptake. Generally, SA exhibited vastly increased angiographic uptake in all regions and increased epiphyseal blood pool uptake, whereas delayed epiphyseal uptake varied and delayed metaphyseal uptake tended to decrease. Two septic joints had generalized reduction in dynamic uptake, probably owing to increased intraarticular pressure; in one of these, dynamic uptake in the distal femoral epiphysis (FE) was totally absent, suggesting temporary circulatory arrest during the dynamic scanning procedure. The use of regional dynamic and static [99mTc]DPD scintimetry increased the pathophysiologic and diagnostic value of joint scintigraphy, especially with respect to the early detection of SA and its avascular complications

Osteomyelitis - children

Science.gov (United States)

... 13th ed. Philadelphia, PA: Elsevier; 2017:chap 21. Kaplan SL. Osteomyelitis. In: Kliegman RM, Stanton BF, St. ... Krogstad P. Osteomyelitis. In: Cherry JD, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and ...

[Fungemia and septic arthritis caused by Saprochaete capitata in a patient with fanconi aplastic anemia: a case report].

Science.gov (United States)

Parkan, Ömür Mustafa; Atalay, Mustafa Altay; Koç, Ayşe Nedret; Pala, Çiğdem; Aydemir, Gonca; Kaynar, Leylagül

2017-01-01

Saprochaete capitata (formerly known as Blastoschizomyces capitatus, Trichosporon capitatum, Geotrichum capitatum) is a rare but emerging yeast-like fungus. It is commonly found in environmental sources and can be isolated from skin, gastrointestinal system and respiratory tract of healthy individuals as well. It mainly infects patients with hematological malignancies such as acute myeloid leukemia (AML), especially in the presence of neutropenia; and mortality rates are high in those patients. Although the data about the in vitro antifungal susceptibility are limited, it is being reported that amphotericin B and voriconazole are more effective on S.capitata isolates whereas caspofungin had no activity. Here, we report a case of fungemia and septic arthritis due to S.capitata in a patient with Fanconi aplastic anemia. A 22-year-old male patient with Fanconi aplastic anemia was hospitalized in our hematology department for bone marrow transplantation. Two days after the hospitalization, neutropenic fever developed and multiple nodules similar to candidiasis were detected in his liver with the whole abdomen magnetic resonance imaging (MRI). Caspofungin treatment (single 70 mg/kg loading dose, followed by 1 x 50 mg/kg/day) was started. The patient remained febrile, and his blood culture yielded S.capitata. The treatment regimen was changed to a combination of liposomal amphotericin B (3 mg/kg/day) and voriconazole (2 x 4 mg/kg/day). A few days later, pain and swelling came out on patient's left knee and he underwent a surgical process with the prediagnosis of septic arthritis. Culture of synovial fluid was also positive for S.capitata. On the 26th day of the hospitalization, the patient died due to sepsis and multiple organ failure. Patient's blood and synovial fluid samples were incubated in BacT/Alert automated blood culture system (bioMérieux, France). After receiving the growth signal, yeast cells were seen in Gram staining and cream-coloured, wrinkled, yeast

Radiodiagnostics of maxillary osteomyelitis

International Nuclear Information System (INIS)

Klemova, J.; Jenca, A.; Hanusinova, V.; Danko, J.; Ondrasovicova, J.

2006-01-01

Osteomyelitis is defined as an inflammation or infection in bone tissues - cancellous bone, bone marrow, bone compacta and periosteum due to invasion of infection from surrounding tissues. Maxillary osteomyelitis is less common disease than osteomyelitis of mandible. This can be explained by anatomical structure of maxilla which is mainly composed of sinuses and thin bone lamellae. Such a structure allows rapid propagation of the infection to the surface. There have been examined and treated 70 patients with osteomyelitis of facial bones within past 15 years at Department of stomatology and maxillo-facial surgery of P.J. Safarik University in Kosice. Only four cases were diagnosed as maxillary osteomyelitis. The aim of this study was to mention the differences in anatomy and symptoms of acute and chronic stage of maxillary osteomyelitis and to give a detailed radiographic picture of this affliction. (authors)

CT evaluation of primary epiphyseal bone abscesses

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Azouz, E.M. (Dept. of Radiology, McGill Univ., Montreal Children' s Hospital, PQ (Canada)); Greenspan, A. (Dept. of Radiology, California Univ., Davis School of Medicine, Sacramento, CA (United States)); Marton, D. (Dept. of Radiology, Montreal Univ., Hopital Ste Justine, PQ (Canada))

1993-01-01

We reviewed the clinical, radiographic, and computed tomographic (CT) findings in eight children with a histologically proven diagnosis of epiphyseal or apophyseal osteomyelitis. In all cases the femur was involved: in five the osteomyelitis was localized in the femoral condyle, in two it was in the greater trochanter, and in one it was in the femoral head epiphysis. In four of the six cases of epiphyseal involvement there was associated joint effusion or septic arthritis. CT examination may demonstrate a serpentine tract, a sequestrum, cortical destruction or adjacent soft tissue swelling and can differentiate osteomyelitis from other epiphyseal lucent lesions, particularly chondroblastoma and osteoid osteoma. Early diagnosis helps avoid delays in initiating antibiotic or surgical treatment caused by the unusual (epiphyseal or apophyseal) location of the bone abscess. (orig./GD)

MR imaging of osteomyelitis

International Nuclear Information System (INIS)

Cohen, M.D.; Cory, D.A.; Broderick, N.J.; Smith, J.A.

1988-01-01

Seventeen MR studies were performed on 16 children with acute, chronic, or healed osteomyelitis. Abnormality was detected in the soft tissues and bone marrow in all patients with acute or chronic osteomyelitis. Two of three patients with heated osteomyelitis had normal soft tissues and bone marrow. There was overlap in the appearance of acute and chronic osteomyelitis. The patients with acute osteomyelitis, however, tended to have more extensive soft-tissue abnormality, to have more poorly defined margins to the soft-tissue abnormality, and more poorly defined interfaces between normal and diseased bone marrow. The signal characteristics of diseases soft tissue and marrow were compatible with prolongation of T1 and T2 relaxation times as compared with normal muscles

Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study

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Logoluso Nicola

2011-05-01

Full Text Available Abstract Background Outcome data on two-stage revision surgery for deep infection after septic hip arthritis are limited and inconsistent. This study presents the medium-term results of a new, standardized two-stage arthroplasty with preformed hip spacers and cementless implants in a consecutive series of adult patients with septic arthritis of the hip treated according to a same protocol. Methods Nineteen patients (20 hips were enrolled in this prospective, non-randomized cohort study between 2000 and 2008. The first stage comprised femoral head resection, debridement, and insertion of a preformed, commercially available, antibiotic-loaded cement hip spacer. After eradication of infection, a cementless total hip arthroplasty was implanted in the second stage. Patients were assessed for infection recurrence, pain (visual analog scale [VAS] and hip joint function (Harris Hip score. Results The mean time between first diagnosis of infection and revision surgery was 5.8 ± 9.0 months; the average duration of follow up was 56.6 (range, 24 - 104 months; all 20 hips were successfully converted to prosthesis an average 22 ± 5.1 weeks after spacer implantation. Reinfection after total hip joint replacement occurred in 1 patient. The mean VAS pain score improved from 48 (range, 35 - 84 pre-operatively to 18 (range, 0 - 38 prior to spacer removal and to 8 (range, 0 - 15 at the last follow-up assessment after prosthesis implantation. The average Harris Hip score improved from 27.5 before surgery to 61.8 between the two stages to 92.3 at the final follow-up assessment. Conclusions Satisfactory outcomes can be obtained with two-stage revision hip arthroplasty using preformed spacers and cementless implants for prosthetic hip joint infections of various etiologies.

The diabetic foot: Magnetic resonance imaging evaluation

International Nuclear Information System (INIS)

Beltran, J.; Campanini, D.S.; Knight, C.; McCalla, M.

1990-01-01

Fourteen diabetic patients with suspected foot infection and/or neuropathic joint (Charcot Joint) were evaluated with magnetic resonance imaging (MRI) in an attempt to assess the extent of the infection and also to distinguish infection from the changes seen with neuroarthropathy. The majority of patients with infection had more than one site of involvement and the following diagnoses were made by MRI evaluation: Osteomyelitis (n=8), abscess (n=7), neuropathic joint (n=5), septic arthritis (n=4), and tenosynovitis (n=4). Clinical or surgical/pathological confirmation of the MRI diagnoses was obtained in all but nine sites of infection or cases of neuropathic joint. If the two diagnostic categories of septic arthritis and tenosynovitis are excluded, all but four of the MRI diagnoses were confirmed. A distinctive pattern for neuroarthropathy was identified in five cases, consisting of low signal intensity on T1- and T2-weighted images within the bone marrow space adjacent to the involved joint. We conclude that MRI is a valuable adjunct in the evaluation of the diabetic foot, and that it provides accurate information regarding the presence and extent of infection in this subset of patients. MRI has proven particularly helpful in differentiating neuroarthropathy from osteomyelitis. (orig.)

Cogan's syndrome mimicking acute Lyme arthritis.

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Schwegmann, J P; Enzenauer, R J

1995-05-01

A pediatric case of Cogan's syndrome mimicking acute Lyme arthritis is described. A 12-year-old black boy was admitted to the pediatric service for presumed right knee septic arthritis. Symptoms included acute pain and swelling with decreased range-of-motion. Although the patient's right knee symptoms and positive Lyme serology were consistent with a diagnosis of Lyme arthritis, the presence of sensorineural hearing loss and interstitial keratitis with inflammatory arthritis suggested a diagnosis of Cogan's syndrome. Subsequent Western blot analysis was negative for Borrelia burgdorferi antigens. The patient had dramatic clinical improvement of musculoskeletal and ophthalmologic complaints shortly after receiving high-dose corticosteroids, although residual sensorineural hearing loss persisted.

CT/MRI of musculoskeletal complications of AIDS

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Wyatt, S.H. [Russel H. Morgan Dept. of Radiology and Radiological Science, Baltimore, MD (United States); Fishman, E.K. [Russel H. Morgan Dept. of Radiology and Radiological Science, Baltimore, MD (United States)

1995-10-01

While uncommon, many musculoskeletal disorders may be seen in association with the acquired immune deficiency syndrome (AIDS). Infections such as osteomyelitis, bacterial myositis and septic arthritis, neoplasms such as non-Hodgkin lymphoma and Kaposi sarcoma, and myopathies and polymyositis have been reported in this patient population. Computed tomography and magnetic resonance imaging frequently detect unanticipated musculoskeletal disease in a patient with AIDS, and may further help to distinguish infections from neoplastic disorders. (orig.)

Multiresistant-MRSA tricuspid valve infective endocarditis with ancient osteomyelitis locus

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Gambarati Gianpaolo

2006-07-01

Full Text Available Abstract Background Methicillin-resistant S. aureus (MRSA with low susceptibility to glycopeptides is uncommon. Case presentation The case of a 50-year-old non-drug addict patient presenting with tricuspid valve infective endocarditis (IE by MRSA resistant to vancomycin and linezolid is presented. There was response only to quinupristin/dalfopristin. He had a motorcycling accident four years before undergoing right above-the-knee amputation and orthopaedic fixation of the left limb. There were multiple episodes of left MRSA-osteomyelitis controlled after surgery and vancomycin therapy. MRSA isolated from the blood at the time of IE presented with the same profile than the isolated four years earlier. Sequential treatment with teicoplanin-cotrimoxazole and Linezolid associated to vancomycin – rifampicin – cotrimoxazole had no improvement. Infection was controlled after 28 days of therapy with quinupristin/dalfopristin. Conclusion The literature presents only a few cases of MRSA IE not susceptible to glycopeptides in not drug addicted patients. This case shows the comparison of a highly-resistant MRSA after previous S. aureus osteomyelitis treated with glycopeptides. This is the first description of successful treatment of resistant-MRSA IE of the tricuspid valve complicated by multiple pulmonary septic infarction with quinupristin/dalfopristin

MR imaging evaluation of diabetic foot

International Nuclear Information System (INIS)

Beltran, J.; Campanini, D.S.; McCalla, M.; Knight, C.T.

1988-01-01

Fourteen diabetic patients with suspected foot infection and/or neuropathic joint were evaluated with MR imaging to identify the presence and extent of infection and also to exclude coexistent infection in the neuropathic joint. Osteomyelitis (n = 8), abscess (n = 7), septic arthritis (n = 4), tenosynovitis (n = 4), and neuropathic joint (n = 5) were diagnosed with MR imaging. Osteomyelitis and/or abscess were excluded by MR findings in 13 instances. Most patients with infection had one more than one site of involvement. Clinical or surgical confirmation of the MR diagnoses was obtained in all but nine of the infection sites or cases of neuropathic joint. Only one false-negative diagnosis of osteomyelitis was made in this series. It is concluded that MR imaging provided accurate information regarding the presence and extent of infection and that this information was decisive in patient management

Malignant transformation in chronic osteomyelitis

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Diogo Lino Moura

Full Text Available ABSTRACT INTRODUCTION: Carcinomatous degeneration is a rare and late complication developing decades after the diagnosis of chronic osteomyelitis. OBJECTIVES: To present the results from a retrospective study of six cases of squamous cell carcinoma arising from chronic osteomyelitis. METHODS: Six cases of chronic osteomyelitis related to cutaneous squamous cell carcinoma were identified. The cause and characteristics of the osteomyelitis were analyzed, as well as time up to malignancy, the suspicion signs for malignancy, the localization and histological type of the cancer, and the type and result of the treatment. RESULTS: The mean time between osteomyelitis onset and the diagnosis of malignant degeneration was 49.17 years (range: 32-65. The carcinoma resulted from tibia osteomyelitis in five cases and from femur osteomyelitis in one. The pathological examination indicated cutaneous squamous cell carcinoma in all cases. All the patients were staged as N0M0, except for one, whose lomboaortic lymph nodes were affected. The treatment consisted of amputation proximal to the tumor in all patients. No patient presented signs of local recurrence and only one had carcinoma metastasis. CONCLUSION: Early diagnosis and proximal amputation are essential for prognosis and final results in carcinomatous degeneration secondary to chronic osteomyelitis.

Osteomyelitis beneath pressure sores

International Nuclear Information System (INIS)

Sugarman, B.; Hawes, S.; Musher, D.M.; Klima, M.; Young, E.J.; Pircher, F.

1983-01-01

Twenty-eight pressure sores were evaluated prospectively. Osteomyelitis was reported histologically in nine of 28 bones and pressure-related changes were reported in 14 bones. Roentgenograms suggested the presence of osteomyelitis in four instances of histologically proved osteomyelitis. Technetium Tc 99m medronate bone scans were highly sensitive, showing increased uptake in all cases of osteomyelitis; however, increased uptake also occurred commonly in uninfected bones due to pressure-related changes or other noninfectious causes. Cultures of bone biopsy samples usually disclosed anaerobic bacteria, gram-negative bacilli, or both. The diagnosis of osteomyelitis must be considered if a pressure sore does not respond to local therapy. If the technetium Tc 99m medronate uptake is increased in the involved area, or roentgenographic findings are abnormal, the diagnosis can only be made with certainty by histologic examination of bone. Antibacterial treatment should be selected based on the results of bone culture

Variability in Management of Acute Osteoarticular Infections at a Children’s Hospital and Favorable Outcomes with Increasing Early Transition to Oral Therapy

OpenAIRE

Biary, Nora; Wrotniak, Brian; Islam, Shamim

2017-01-01

Abstract Background To date, there is no established guideline for the treatment of acute pediatric osteoarticular infections (OAI), and considerable variability in management exists amongst providers and across institutions. This study analyzed the recent management and clinical outcomes of OAI at a children’s hospital. Methods Patients admitted with acute osteomyelitis and septic arthritis [OAI] aged 2 months to 18 years at the Women & Children’s Hospital of Buffalo, between 1/1/2013 and 12...

Temporomandibular Joint Septic Arthritis

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Gianfranco Frojo, MD

2018-01-01

Full Text Available Summary:. Infection of the temporomandibular joint (TMJ is a rare pediatric condition resulting from the introduction of pathogens into the joint by hematogenous seeding, local extension, or trauma. Early recognition of the typical signs and symptoms including fever, trismus, preauricular swelling, and TMJ region tenderness are critical in order to initiate further evaluation and prevent feared complications of fibrosis, ankylosis, abnormal facial structure, or persistence of symptoms. Contrast-enhanced computed tomography with ancillary laboratory analysis including erythrocyte sedimentation rate, C-reactive protein, and white blood cell count are beneficial in confirming the suspected diagnosis and monitoring response to therapy. Initial intervention should include empiric parenteral antibiotics, early mandibular mobilization, and joint decompression to provide synovial fluid for analysis including cultures. This report describes a case of TMJ bacterial arthritis in a healthy 6-year-old male who was promptly treated nonsurgically with intravenous antibiotics and localized needle joint decompression with return to normal function after completion of oral antibiotics and physical therapy.

Arthroscopy of septic carpitis in donkeys (Equus asinus

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A.H. Elkasapy

2014-11-01

Full Text Available Experimental septic arthritis was induced in the radiocarpal joint of 18 donkeys by intra-articular injection of Staphylococcus aureus (3-4X106 CFU. The inoculated animals were divided into three groups (6 donkeys in each group. The arthroscopic examination was carried out before induction of septic carpitis and 3 days (group I, 14 days (group II, and 28 days (group III after induction of infection. The arthroscopic examination of group I revealed hyperemia of synovial membrane and hypertrophied villi. In group II, severe hyperemia of synovial membrane, hypertrophied villi, pannus in the joint cavity and beginning of articular cartilage erosion were found. In group III, severe hyperemia of synovial membrane, hypertrophied villi and more prominent articular cartilage erosion were present.

Salmonella enterica serovar Ohio septic arthritis and bone abscess in an immunocompetent patient: a case report

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Kato Hideaki

2012-07-01

Full Text Available Abstract Introduction Non-typhi Salmonella species cause severe extra-intestinal focal infection after occult bacteremia. Although the number of cases of non-typhi salmonellosis is increasing worldwide among patients with immunocompromising conditions such as human immunodeficiency virus infection, infection is uncommon in immunocompetent subjects. We report a case of septic arthritis and bone abscess due to a rare non-typhi Salmonella organism that developed after a prolonged asymptomatic period. Case presentation A 44-year-old Japanese immunocompetent man presented with acute-onset left knee pain and swelling. He had no history of food poisoning, and his most recent travel to an endemic area was 19 years ago. Salmonella enterica serovar Ohio was identified from samples of bone abscess and joint tissue. Arthrotomy and necrotic tissue debridement followed by intravenous ceftriaxone was successful. Conclusions Non-typhi Salmonella species only rarely cause extra-intestinal focal infections in immunocompetent patients. Our case suggests that non-typhi Salmonella species can cause severe focal infections many years after the occult bacteremia associated with food poisoning.

Late septic hip dislocation with multifocal osteomyelitis and malaria: a case report.

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Sreenivas, T; Menon, Jagdish; Nataraj, A R

2012-12-01

A 9-year-old boy presented with high-grade fever associated with pain and swelling in right hip and left leg of 1-week duration. Pus was found on diagnostic aspiration of the right hip joint. Emergency arthrotomy was performed through anterior approach with drill holes in proximal femur and culture showed MRSA. Intravenous antibiotics were given for 4 weeks. Patient symptomatically improved in immediate postoperative period and in bed hip mobilization was started. On eighth postoperative day, child developed high-grade intermittent fever with chills and rigors and diagnosed as plasmodium falciparum malaria. Fever subsided with antimalarial treatment. On twenty-first day, patient complained pain in right hip and X-ray showed posterior hip dislocation with osteomyelitis of proximal femur. Closed reduction and hip spica application was done under general anesthesia. At follow-up, the clinical result was fair with resolution of infection and stiff hip.

Maxillary Osteomyelitis: A Rare Entity

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Ayaaz Habib

2016-01-01

Full Text Available Osteomyelitis of the maxilla is now a rare event with the advent of antibiotics. The two predominant causes are odontogenic infections and sinusitis. Immunocompromised states such as diabetes, HIV, and malnutrition increase the risk of osteomyelitis. It is important to recognize this early as it is a difficult entity to treat with potentially serious consequences. We report an unusual case of right sided maxillary osteomyelitis in a lady with poorly controlled diabetes in rural Lincolnshire. Biopsy of the right maxillary bone showed features of acute osteomyelitis. This responded well to a prolonged course of oral antibiotics.

Definitive Diagnosis of Children Presenting to A Pediatric Emergency Department With Fever and Extremity Pain.

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Vardiabasis, Nicolas V; Schlechter, John A

2017-09-01

Children who present to the emergency department (ED) with complaint of fever and new-onset joint or extremity pain can be a diagnostic dilemma for many emergency and consulting physicians. The purpose of our study was to identify the etiologies of pediatric fever and extremity pain presenting to a tertiary care pediatric ED and to define factors that were associated with advanced imaging, admission, and surgical intervention. The electronic medical records of children presenting to our institution's pediatric ED with fever and extremity pain were retrospectively reviewed. Data collected included demographic characteristics, laboratory studies, diagnostic imaging, need for admission, and surgical procedures. The initial ED diagnosis was consistent with the definitive diagnosis 42% of the time. Children with the inability to bear weight on the affected limb were more likely to have a bacterial infection, such as osteomyelitis, septic arthritis, or intramuscular abscess (p = 0.016). An erythrocyte sedimentation rate >36 mm/hour and C-reactive protein levels >60 mg/L were found in children with osteomyelitis or septic arthritis (p = 0.043 and diagnosis. The inability to bear weight, elevated C-reactive protein levels, and an elevated erythrocyte sedimentation rate are associated with bacterial infection. Magnetic resonance imaging is a useful imaging modality in determining an accurate diagnosis. Copyright © 2017 Elsevier Inc. All rights reserved.

Diagnostic strategies in osteomyelitis

International Nuclear Information System (INIS)

Wheat, J.

1985-01-01

Technetium- 99 pyrophosphate bone scanning often identifies patients with osteomyelitis before roentgenographic findings appear. However, recent studies have shown that 99 Tc bone scanning often gives false-negative results, especially in neonates. The accuracy of computed tomographic scanning and indium-111 leukocyte scanning for diagnosis of early osteomyelitis has not been established. 99 Tc bone scanning often gives false-positive results in patients with other conditions leading to bone injury and repair, such as trauma or recent surgery, further limiting the usefulness of this imaging procedure. Newer imaging techniques have not been adequately evaluated to establish their specificity. Because of their high cost and unproved accuracy, these new imaging procedures should not be routinely applied until their usefulness has been established. Bone biopsy remains the procedure of choice for establishing the diagnosis in patients suspected clinically to have osteomyelitis with negative findings on roentgenography and 99 Tc bone scanning. Although Staphylococcus aureus is the leading cause of osteomyelitis, other pathogens cause 30 to 40 percent of cases. Aspiration or biopsy of the involved bone is usually required to choose appropriate antibiotic therapy. Bone biopsy is essential in chronic osteomyelitis, since cultures of sinus drainage are unreliable. Osteomyelitis in diabetics with foot infection and in association with decubitus ulcers presents special problems. Radionuclide scanning often give false-positive results in these patients. Proper diagnosis usually requires careful assessment of clinical and roentgenographic findings. 33 references

IJMBR ARTHRITIS edited 4.3.1

African Journals Online (AJOL)

MJP

2015-10-28

Oct 28, 2015 ... Findings: Septic arthritis in the index patient developed insidiously and was diagnosed after ... cell disease, joint surgery, bacteremia, diabetes mellitus ... month history of bilateral knee joint pain which were swollen and warm. .... arthrotomy.[1] In the paediatric setting, the knee and shoulder joints are often.

Nocardia brasiliensis infection mimicking juvenile idiopathic arthritis in a 4-year-old girl.

Science.gov (United States)

Kapur, Nitin; Adib, Navid; Grimwood, Keith

2013-11-01

Nocardia are ubiquitous environmental saprophytes that cause pneumonia and disseminated disease in immunocompromised patients. They can also cause localized cutaneous and soft tissue infections in healthy people after direct percutaneous inoculation. Nocardia arthritis is rare in both forms of the disease. Here we present the first published case of a child with septic arthritis caused by N brasiliensis. Importantly, this otherwise well 4-year-old girl had no known history of trauma but presented with transient cutaneous lesions and a 6-week history of arthritis involving the right fourth digit proximal interphalangeal joint without accompanying fever or raised systemic inflammatory markers. She received a diagnosis of juvenile idiopathic arthritis and underwent antiinflammatory and immunosuppressant therapy. After 2 months she developed frank septic arthritis, which necessitated a surgical joint washout, from which an intraoperative swab grew N brasiliensis. The patient received 6 months of high-dose trimethoprim-sulfamethoxazole and remains well more than 4 years after treatment. This unusual case highlights the importance of considering an indolent infection from slow-growing organisms, including Nocardia, when diagnosing the oligoarthritis subtype of juvenile idiopathic arthritis. This is especially relevant when a single joint is involved and response to antiinflammatory therapy is suboptimal because antiinflammatory agents may mask evolving signs of infection.

An Overview of the Percutaneous Antibiotic Delivery Technique for Osteomyelitis Treatment and a Case Study of Calcaneal Osteomyelitis.

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Karr, Jeffrey C

2017-11-01

A percutaneous antibiotic delivery technique (PAD-T) used for the adjunctive management of osteomyelitis is presented. This surgical technique incorporates a calcium sulfate and hydroxyapatite (calcium phosphate) bone void filler acting as a carrier vehicle with either an antibiotic or an antifungal medicine, delivering this combination directly into the area of osteomyelitis. The benefit of the PAD-T is reviewed with a case presentation of a successfully treated calcaneal osteomyelitis. No previously reported PAD-T using a simple bone cortex incision in the adjunctive treatment of osteomyelitis has been reported. The PAD-T safely and effectively uses a calcium sulfate and hydroxyapatite bone void filler carrier vehicle to deliver either an antibiotic or an antifungal medicine directly into the area of osteomyelitis.

Role of radiopharmaceuticals in detection of osteomyelitis

International Nuclear Information System (INIS)

Mack, J.M.; Spencer, R.P.

1990-01-01

Osteomyelitis can present as a significant diagnostic problem in medicine. Knowledge of the presence and extent of infection involving bone is important in determining treatment. In this paper the authors review the role played by radiopharmaceutical techniques in establishing the diagnosis of osteomyelitis. Osteomyelitis has been recognized as one of the most serious complications of emergency surgery to repair severe bone trauma. It is also a complication of surgery for prosthesis placement. In still other instances, osteomyelitis can be of hematogenous origin, without a major wound site. Unlike other infections, it rarely presents with acute symptoms. Osteomyelitis is divided into two categories that are time related: acute, in which clinical signs and symptoms of bone infection have been present for less than 1 month, and chronic, in which symptoms have been present for more than 1 month. The acute type is usually caused by Staphylococcus aureus in children (often secondary to skin infection), whereas in adults it can be secondary to intravenous drug abuse. Predisposing factors such as diabetes mellitus, peripheral vascular disease, and sickle cell disease are important to the outcome of osteomyelitis. One way to determine the microbe causing the infection is direct bone biopsy from the site of suspected osteomyelitis. There is one important limitation for needle biopsy in the diagnosis of osteomyelitis. Biopsies are contraindicated in the small bones of the hands and feet, because of risk of pathologic fracture (and may be relatively contraindicated after diphosphonate therapy and loss of bone mineral)

Acute pseudo-septic arthritis following viscosuplementation of the ...

African Journals Online (AJOL)

A 70-year-old woman with a history of medial femoro-tibial compartment of knee osteoarthritis was admitted for acute arthritis six days after a second intra-articular injection of Hyaluronic acid. The joint fluid was inflammatory, with no crystals, and laboratory tests showed marked inflammation leading to antibiotic treatment for ...

Vertebral osteomyelitis without disc involvement

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Kamani, I.; Syed, I.; Saifuddin, A. E-mail: asaifuddin@aol.com; Green, R.; MacSweeney, F

2004-10-01

Vertebral osteomyelitis is most commonly due to pyogenic or granulomatous infection and typically results in the combined involvement of the intervertebral disc and adjacent vertebral bodies. Non-infective causes include the related conditions of chronic recurrent multifocal osteomyelitis (CRMO) and SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome. Occasionally, these conditions may present purely within the vertebral body, resulting in various combinations of vertebral marrow oedema and sclerosis, destructive lesions of the vertebral body and pathological vertebral collapse, thus mimicking neoplastic disease. This review illustrates the imaging features of vertebral osteomyelitis without disc involvement, with emphasis on magnetic resonance imaging (MRI) findings.

Management of complications of open reduction and internal fixation of ankle fractures.

Science.gov (United States)

Ng, Alan; Barnes, Esther S

2009-01-01

The management of complications resulting from the open reduction and internal fixation of ankle fractures is discussed in detail. The initial radiographic findings of the most common postsurgical complications of ankle fracture reduction are briefly discussed, namely lateral, medial, and posterior malleolar malunion or nonunion, syndesmotic widening, degenerative changes, and septic arthritis with or without concomitant osteomyelitis. Emphasis is placed on the management of these complications, with a review of the treatment options proposed in the literature, a detailed discussion of the authors' recommendations, and an inclusion of different case presentations.

Approach to osteomyelitis treatment with antibiotic loaded PMMA.

Science.gov (United States)

Wentao, Zhang; Lei, Guangyu; Liu, Yang; Wang, Wei; Song, Tao; Fan, Jinzhu

2017-01-01

To reduce the incidence of osteomyelitis infection, local antibiotic impregnated delivery systems are commonly used as a promising and effective approach to deliver high antibiotic concentrations at the infection site. The objective of this review was to provide a literature review regarding approach to osteomyelitis treatment with antibiotic loaded PMMA. Literature study regarding osteomyelitis treatment with antibiotic loaded carriers using key terms Antibiotic, osteomyelitis, biodegradable PMMA through published articles. Hands searching of bibliographies of identified articles were also undertaken. We concluded that Antibiotic-impregnated PMMA beads are useful options for the treatment of osteomyelitis for prolonged drug therapy. Copyright © 2016 Elsevier Ltd. All rights reserved.

Conservative treatment in a patient with diabetic osteomyelitis

DEFF Research Database (Denmark)

Jeppesen, Sune Møller; Frokjaer, J.; Yderstraede, K.

2015-01-01

Diabetic foot ulcers are commonly complicated by bone involvement and osteomyelitis. Diagnosing diabetic osteomyelitis can be problematic. However, positive findings at clinical examination and X-ray may set the diagnosis. Recent guidelines suggest that selected cases of diabetic osteomyelitis ca...

Chronic suppurative osteomyelitis of the mandible

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K Mallikarjun

2011-01-01

Full Text Available Osteomyelitis is an infection of the bone or bone marrow, usually caused by pyogenic bacteria or mycobacterium. Osteomyelitis, inflammatory process of the bone and its structures, can be acute or chronic. Taking a journey from a nonsurgical approach to a surgical one, it appeared to be one osteomyelitis revenge against all our efforts. The pain, the pus, the new bone formation, and all the trouble, this case showed it all. The injudicious use of antibiotics and delay in providing the requisite treatment can cause devastating effects as in the case of an 11-year-old child. A case report on treating osteomyelitis through medication and realizing that surgical excision remains the only realistic approach, the report talks about the investigations and treatment planning done to deal with it.

Septic monoarthritis of the first carpo-metacarpal joint caused by Mycobacterium kansasii.

Science.gov (United States)

Brutus, J P; Lamraski, G; Zirak, C; Hauzeur, J P; Thys, J P; Schuind, F

2005-02-01

A case of septic carpal monoarthritis due to Mycobacterium kansasii developing 16 months after accidental inoculation in a healthy laboratory technician is reported. No predisposing factor such as immunosuppression, preexisting degenerative, inflammatory arthritis or cortisone injection was present. Treatment with antituberculous oral medication alone resulted in resolution of the disease. Synovectomy was unnecessary. Ten years after the initial causative event, the patient remains free of symptoms.

Management of osteomyelitis of the skull base

International Nuclear Information System (INIS)

Benecke, J.E. Jr.

1989-01-01

Osteomyelitis of the skull base is the most severe form of malignant otitis externa. As a result of having treated 13 patients with skull base osteomyelitis over a 4-year period, we have developed a method of staging and monitoring this malady using gallium and technetium scanning techniques. Stage I is localized to soft tissues, stage II is limited osteomyelitis, and stage III represents extensive skull base osteomyelitis. All stages are treated with appropriate antipseudomonal antibiotics. The duration of therapy depends upon the clearing of inflammation as shown on the gallium scan. Each case must be looked at independently and not subjected to an arbitrary treatment protocol

Juvenile Gaucher disease simulating osteomyelitis

International Nuclear Information System (INIS)

Miller, J.H.; Ortega, J.A.; Heisel, M.A.

1981-01-01

A case in which several imaging procedures suggested juvenile Gaucher disease in a child who presented with symptomatology of osteomyelitis is discussed. The 20-month girl was given a Technetium-99m radionuclide skeletal examination which revealed intense uptake of tracer agents along the shaft of the right femur. It was also found that the liver and spleen were dramatically Ga-67 avid. The bone pain symptomatology suggested an osteomyelitis of the femur, but skeletal scintigraphy with Tc-99m-labeled bone tracer demonstrated photopenic areas involving the femur, suggesting that the bone pain may have been due to marrow packed with Gaucher cells. This overexpansion of the marrow may lead to microfractures with remodeling seen radiographically as periosteal new bone and scintigraphically as increased periosteal deposition of tracer agent. The radiogallium study was useful to exclude an underlying osteomyelitis in the involved femurs. Although juvenile Gaucher disease is unusual, it should be considered in any child who presents with the constellation of hepatosplenomegaly and bone pain simulating osteomyelitis

Juvenile Gaucher disease simulating osteomyelitis

Energy Technology Data Exchange (ETDEWEB)

Miller, J.H.; Ortega, J.A.; Heisel, M.A.

1981-10-01

A case in which several imaging procedures suggested juvenile Gaucher disease in a child who presented with symptomatology of osteomyelitis is discussed. The 20-month girl was given a Technetium-99m radionuclide skeletal examination which revealed intense uptake of tracer agents along the shaft of the right femur. It was also found that the liver and spleen were dramatically Ga-67 avid. The bone pain symptomatology suggested an osteomyelitis of the femur, but skeletal scintigraphy with Tc-99m-labeled bone tracer demonstrated photopenic areas involving the femur, suggesting that the bone pain may have been due to marrow packed with Gaucher cells. This overexpansion of the marrow may lead to microfractures with remodeling seen radiographically as periosteal new bone and scintigraphically as increased periosteal deposition of tracer agent. The radiogallium study was useful to exclude an underlying osteomyelitis in the involved femurs. Although juvenile Gaucher disease is unusual, it should be considered in any child who presents with the constellation of hepatosplenomegaly and bone pain simulating osteomyelitis.

Spinal osteomyelitis caused by Proteus mirabilis in a child

NARCIS (Netherlands)

deWeerd, W; Kimpen, JLL; Miedema, CJ

Osteomyelitis due to Proteus mirabilis is rare. Spinal osteomyelitis caused by this organism has only been described in adults. This is the first paediatric case of P. mirabilis vertebral osteomyelitis.

Chronic osteomyelitis of the clavicle

International Nuclear Information System (INIS)

Granick, M.S.; Ramasastry, S.S.; Goodman, M.A.; Hardesty, R.

1989-01-01

Osteomyelitis of the clavicle is an uncommon disease, but it should be considered in patients who present with pain, cellulitis, or drainage in the sternoclavicular area following head and neck surgery, irradiation, subclavian vein catheterization, or immunosuppression. An idiopathic presentation is possible. In contrast to primary osteomyelitis of the clavicle, which is occasionally seen in children, secondary osteomyelitis is quite rare. It is often mistaken for a fracture or a possible neoplasm on plain x-rays. Tomograms and CT scanning are confirmatory, and in early cases, technetium-99m bone scanning can be helpful. Treatment must include early, aggressive surgical debridement of all affected tissues, followed by wound coverage with a well-vascularized flap and perioperative antibiotics

Non-contiguous multifocal vertebral osteomyelitis caused by Serratia marcescens.

Science.gov (United States)

Lau, Jen Xin; Li, Jordan Yuanzhi; Yong, Tuck Yean

2015-03-01

Serratia marcescens is a common nosocomial infection but a rare cause of osteomyelitis and more so of vertebral osteomyelitis. Vertebral osteomyelitis caused by this organism has been reported in few studies. We report a case of S. marcescens vertebral discitis and osteomyelitis affecting multiple non-contiguous vertebras. Although Staphylococcus aureus is the most common cause of vertebral osteomyelitis, rare causes, such as S. marcescens, need to be considered, especially when risk factors such as intravenous heroin use, post-spinal surgery and immunosuppression are present. Therefore, blood culture and where necessary biopsy of the infected region should be undertaken to establish the causative organism and determine appropriate antibiotic susceptibility. Prompt diagnosis of S. marcescens vertebral osteomyelitis followed by the appropriate treatment can achieve successful outcomes.

Nuclear medicine imaging of posttraumatic osteomyelitis

NARCIS (Netherlands)

Govaert, G. A.M.; Glaudemans, Andor W J M

2016-01-01

Introduction: Early recognition of a possible infection and therefore a prompt and accurate diagnostic strategy is essential for a successful treatment of posttraumatic osteomyelitis (PTO). However, at this moment there is no single routine test available that can detect osteomyelitis beyond doubt

CT of osteomyelitis of the spine

International Nuclear Information System (INIS)

Golimbu, C.; Firooznia, H.; Rafii, M.

1984-01-01

Computed tomography (CT) scans were performed in 17 adults with osteomyelitis of the spine. The dominant features were paravertebral soft-tissue swelling, abscess formation, and bone erosion. In two patients there were no findings indicative of osteomyelitis on conventional radiographs, but CT revealed paravertebral abscesses and bone lysis, helping to establish the diagnosis of osteomyelitis, chiefly because of its ability to detect early erosion of spongy vertabral bone, disk involvement, paravertebral soft-tissue swelling or abscess, and extension of the pathology into the spinal canal. Furthermore, CT facilitated closed-needle biopsy, helping to establish the pathologic diagnosis

MRI in diagnostic evaluation of osteomyelitis in children

International Nuclear Information System (INIS)

Stoever, B.; Sigmund, G.; Langer, M.; Brandis, M.

1994-01-01

Several MRI investigations for detecting or excluding acute and non-post-traumatic chronic osteomyelitis were performed in 31 children, osteomyelitis was evident in 21 patients. The sensitivity of MRI for osteomyelitis was 90%, and specificity was 100%. In children with confirmed osteomyelitis 23 follow-up investigations were carried out in order to evaluate duration of the medullary edema. In uncomplicated cases only treated by antibiotics edema regression was evident after 4 weeks and completed after 12-16 weeks. In cases in whom extended concomitant soft-tissue infection was depicted regression of edema was prolonged independent of surgical intervention. The study reveals that at onset of acute osteomyelitis in children MRI can replace technetium 99m-labeled scintigraphy and reduce plain-film investigations. The results support the usefulness of MRI in discrimination of isolated soft-tissue infection and noninfectious diseases of bone. (orig.)

Radiology of skeletal and soft tissue changes

International Nuclear Information System (INIS)

Walker, H.C. Jr.; Coleman, C.C.; Hunter, D.W.

1986-01-01

Skeletal complications are very common in renal transplant patients. Loss of bone mass in the posttransplant period places the skeletal system in jeopardy. Osteonecrosis, while not life threatening, often prevents rehabilitation. Spontaneous fractures are frequent but are usually not a major problem except in the diabetic transplant recipient. Septic arthritis and osteomyelitis are usually successfully managed by conservative measures, except when accompanied by severe occlusive vascular disease. Juvenile onset diabetic patients still may develop disabling neuropathic joint disease or occlusive vascular disease after renal transplantation. The authors hope that successful pancreas transplantation will avert these problems in the future

Nocardia brasiliensis-associated femorotibial osteomyelitis.

Science.gov (United States)

Vanegas, Samuel; Franco-Cendejas, Rafael; Cicero, Antonio; López-Jácome, Esaú; Colin, Claudia; Hernández, Melissa

2014-03-01

We report a case of femorotibial osteomyelitis due to Nocardia brasiliensis. Nocardia spp are a rare cause of bone infections, and the majority of such cases are associated with the spine. This type of osteomyelitis is uncommon, and in the immunocompetent host, is more often related to a chronic evolution following direct inoculation of the microorganism. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Candida albicans osteomyelitis of the cervical spine

International Nuclear Information System (INIS)

Cha, Jang-Gyu; Hong, Hyun-Sook; Koh, Yoon-Woo; Kim, Hee-Kyung; Park, Jung-Mi

2008-01-01

Fungal osteomyelitis is a rare infection that usually develops in immunocompromised patients. Additionally, involvement of the cervical spine by Candida albicans is extremely rare; only three previous cases of Candida vertebral osteomyelitis have been reported in the literature. The diagnosis may be delayed due to nonspecific radiologic findings and a slow progression. We report the CT, MRI, bone scan, and PET-CT findings in a patient who developed Candida osteomyelitis, which was initially misdiagnosed as metastasis, at the atlas and axis following treatment for nasopharyngeal cancer. (orig.)

Septic-embolic and septic-metabolic brain abscess

International Nuclear Information System (INIS)

Weber, W.; Henkes, H.; Kuehne, D.; Felber, S.; Jaenisch, W.; Woitalla, D.

2000-01-01

The hematogeneous spread of bacteria, fungi and protozoa may also reach the brain vessels, which happens mostly through septic emboli. From such an embolus a metastatic focal encephalitis and later a septic-embolic brain abscess may arise. The most frequently underlying infections that may cause septic emboli are bacterial endocarditis as well as bacterial infections of artificial heart valve prostheses. Congenital heart malformations with a right-to-left shunt also play here a certain role. Basically, however, all septic conditions and bacteriemias may cause septic-embolic brain abscesses. They occur frequently as multiple lesions. MRI is superior to CT in depicting the different stages of evolution from focal encephalitis, through the hardly encapsulated early abscess, to the formation of a membrane and later a dense fibrous capsule. The medical treatment of a brain abscess requires properly performed CT or MRI follow-up examinations in order to realize early enough a possible growing of such a lesion. (orig.) [de

Oral Rehabilitation of an Osteopetrosis Patient with Osteomyelitis

OpenAIRE

Tamer Celakil; Merve Dogan; Bilge Gokcen Rohlig; Gulumser Evlioglu; Haluk Keskin

2016-01-01

Osteopetrosis is a congenital disorder characterized by increasing osteoclastic function resulting in osteomyelitis in the jaws. Orofacial findings in osteopetrosis patients are unerupted, malformed, or delayed teeth and many dental caries due to vulnerable enamel and dentin and osteomyelitis. Many reports have described that maxilla is an uncommon site of occurrence for osteomyelitis due to cortical bone morphology and collateral circulation. This report aims to discuss clinical features and...

Aspergillus Osteomyelitis: Epidemiology, Clinical Manifestations, Management, and Outcome

Science.gov (United States)

Gamaletsou, Maria N.; Rammaert, Blandine; Bueno, Marimelle A.; Moriyama, Brad; Sipsas, Nikolaos V.; Kontoyiannis, Dimitrios P.; Roilides, Emmanuel; Zeller, Valerie; Prinapori, Roberta; Tajaldeen, Saad Jaber; Brause, Barry; Lortholary, Olivier; Walsh, Thomas J.

2014-01-01

Background The epidemiology, pathogenesis, diagnosis, and management of Aspergillus osteomyelitis are not well understood. Methods Protocol-defined cases of Aspergillus osteomyelitis published in the English literature were reviewed for comorbidities, microbiology, mechanisms of infection, clinical manifestations, radiological findings, inflammatory biomarkers, antifungal therapy, and outcome. Results Among 180 evaluable patients, 127 (71%) were males. Possible predisposing medical conditions in 103 (57%) included pharmacological immunosuppression, primary immunodeficiency, and neutropenia. Seventy-three others (41%) had prior open fracture, trauma or surgery. Eighty (44%) followed a hematogenous mechanism, 58 (32%) contiguous infections, and 42 (23%) direct inoculation. Aspergillus osteomyelitis was the first manifestation of aspergillosis in 77%. Pain and tenderness were present in 80%. The most frequently infected sites were vertebrae (46%), cranium (23%), ribs (16%), and long bones (13%). Patients with vertebral Aspergillus osteomyelitis had more previous orthopedic surgery (19% vs 0%; P=0.02), while those with cranial osteomyelitis had more diabetes mellitus (32% vs 8%; P=0.002) and prior head/neck surgery (12% vs 0%; P=0.02). Radiologic findings included osteolysis, soft-tissue extension, and uptake on T2-weighted images. Vertebral body Aspergillus osteomyelitis was complicated by spinal-cord compression in 47% and neurological deficits in 41%. Forty-four patients (24%) received only antifungal therapy, while 121(67%) were managed with surgery and antifungal therapy. Overall mortality was 25%. Median duration of therapy was 90 days (range, 10–772 days). There were fewer relapses in patients managed with surgery plus antifungal therapy in comparison to those managed with antifungal therapy alone (8% vs 30%; P=0.006). Conclusions Aspergillus osteomyelitis is a debilitating infection affecting both immunocompromised and immunocompetent patients. The most

Oral Rehabilitation of an Osteopetrosis Patient with Osteomyelitis

Directory of Open Access Journals (Sweden)

Tamer Celakil

2016-01-01

Full Text Available Osteopetrosis is a congenital disorder characterized by increasing osteoclastic function resulting in osteomyelitis in the jaws. Orofacial findings in osteopetrosis patients are unerupted, malformed, or delayed teeth and many dental caries due to vulnerable enamel and dentin and osteomyelitis. Many reports have described that maxilla is an uncommon site of occurrence for osteomyelitis due to cortical bone morphology and collateral circulation. This report aims to discuss clinical features and prosthodontic management of a patient with clinical features of adult form of osteopetrosis and osteomyelitis in both jaws. The patient has reported better masticatory and speech efficiency with removable dentures in maxillary and mandibular jaw and also self-esteem improvement and family interaction.

Oral Rehabilitation of an Osteopetrosis Patient with Osteomyelitis.

Science.gov (United States)

Celakil, Tamer; Dogan, Merve; Rohlig, Bilge Gokcen; Evlioglu, Gulumser; Keskin, Haluk

2016-01-01

Osteopetrosis is a congenital disorder characterized by increasing osteoclastic function resulting in osteomyelitis in the jaws. Orofacial findings in osteopetrosis patients are unerupted, malformed, or delayed teeth and many dental caries due to vulnerable enamel and dentin and osteomyelitis. Many reports have described that maxilla is an uncommon site of occurrence for osteomyelitis due to cortical bone morphology and collateral circulation. This report aims to discuss clinical features and prosthodontic management of a patient with clinical features of adult form of osteopetrosis and osteomyelitis in both jaws. The patient has reported better masticatory and speech efficiency with removable dentures in maxillary and mandibular jaw and also self-esteem improvement and family interaction.

Osteoarticular complications in sicklemic patients after childhood. Diagnostic problems

Energy Technology Data Exchange (ETDEWEB)

Potente, G

1988-01-01

The osteoarticular complications of drepanocytosis-thalassemia (DT) include: (1) infarction, or avascular necrosis (AVN), common at all ages; (2) acute septic arthritis and hematogenous osteomyelitis, that usually affect infants and children. Early diagnosis and treatment of the osteoarticular infectious complications is imperative, to maximize the chances of a favorable outcome, and to prevent the sequelae, i.e. pathological fractures, chronic osteomyelitis. Early roentgenographic features of involved areas are similar in acute osteomyelitis and in AVN-both of which cause painfull bone crises, so as to make osteomyelites (OM) a diagnostic challenge. Four cases of DT are reported. The patients, 17 to 37 years old, presented with bone infarcts. One of them (the youngest) had also multiple osteomyelitis of long bones. The 99m-Tc-MDP bone scans, performed only on the youngest patient, affected by OM, revealed increased uptake in both AVN and in OM locations, without differential diagnostic features. After a review of the literature, a diagnostic protocol is suggested, based on 99m-Tc-nanocolloid marrow scintigraphy for the early differential diagnosis between acute OM (normal or slightly-increased uptake), chronic OM (markedly increased uptake) and AVN (decreased uptake). Furthermore, MR imaging is stressed as the most promising tool, in the next future, for this kind of different diagnosis. 23 refs.

Osteoarticular complications in sicklemic patients after childhood

International Nuclear Information System (INIS)

Potente, G.

1988-01-01

The osteoarticular complications of drepanocytosis-thalassemia (DT) include: 1) infarction, or avascular necrosis (AVN), common at all ages; 2) acute septic arthritis and hematogenous osteomyelitis, that usually affect infants and children. Early diagnosis and treatment of the osteoarticular infectious complications is imperative, to maximize the chances of a favorable outcome, and to prevent the sequelae, i.e. pathological fractures, chronic osteomyelitis. Early roentgenographic features of involved areas are similar in acute osteomyelitis and in AVN-both of which cause painfull bone crises, so as to make osteomyelites (OM) a diagnostic challenge. Four cases of DT are reported. The patients, 17 to 37 years old, presented with bone infarcts. One of them (the youngest) had also multiple osteomyelitis of long bones. The 99m-Tc-MDP bone scans, performed only on the youngest patient, affected by OM, revealed increased uptake in both AVN and in OM locations, without differential diagnostic features. After a review of the literature, a diagnostic protocol is suggested, based on 99m-Tc-nanocolloid marrow scintigraphy for the early differential diagnosis between acute OM (normal or slightly-increased uptake), chronic OM (markedly increased uptake) and AVN (decreased uptake). Furthermore, MR imaging is stressed as the most promising tool, in the next future, for this kind of different diagnosis

Multifocal chronic osteomyelitis of unknown etiology

International Nuclear Information System (INIS)

Kozlowski, K.; Masel, J.; Harbison, S.; Yu, J.; Royal Brisbane Children Hospital; Regional Hospital Bowral

1983-01-01

Five cases of chronic, inflammatory, multifocal bone lesions of unknown etiology are reported. Although bone biopsy confirmed osteomyelitis in each case in none of them were organisms found inspite of an extensive work up. Different clinical course of the disease reflects different aetiology in respective cases. These cases present changing aspects of osteomyelitis emerging since introduction of antibiotics. (orig.)

Candida Parapsilosis Arthritis Involving the Ankle in a Diabetes Patient: A Case Report

International Nuclear Information System (INIS)

Sung, Jin Kyeong; Chun, Kyung Ah

2011-01-01

Candida parapsilosis is a rare opportunistic fungal pathogen of the musculoskeletal region. Immune function of almost all patients is severely disturbed. Most reported cases of septic arthritis of joints by Candida involve the knee, especially Candida parapsilosis. To our knowledge, there has been only one case report of Candida parapsilosis involving the ankle presented on only plain radiography. We report a case of Candida parapsilosis arthritis involving the ankle in a diabetes patient which was shown on MR imaging.

Candida Parapsilosis Arthritis Involving the Ankle in a Diabetes Patient: A Case Report

Energy Technology Data Exchange (ETDEWEB)

Sung, Jin Kyeong; Chun, Kyung Ah [Dept. of Radiology, The Catholic University of Korea Uijeongbu St. Mary' s Hospital, Uijeongbu (Korea, Republic of)

2011-06-15

Candida parapsilosis is a rare opportunistic fungal pathogen of the musculoskeletal region. Immune function of almost all patients is severely disturbed. Most reported cases of septic arthritis of joints by Candida involve the knee, especially Candida parapsilosis. To our knowledge, there has been only one case report of Candida parapsilosis involving the ankle presented on only plain radiography. We report a case of Candida parapsilosis arthritis involving the ankle in a diabetes patient which was shown on MR imaging.

Pulmonary Septic Emboli due to Azygos Vein Septic Thrombosis

Directory of Open Access Journals (Sweden)

Ginius Pradhan

2013-01-01

Full Text Available The triad of extrapulmonary infection, contiguous septic vein thrombosis, and septic pulmonary embolism is a rare complex but associated with significant morbidity and mortality. Septic azygos vein thrombosis is extremely rare and potentially serious since it may also cause pulmonary emboli and sudden death. We report a case of a 32-year-old woman with history of IV drug abuse who presented with epidural abscess and methicillin-resistant S. aureus (MRSA bacteremia. Later she developed signs of septic pulmonary embolism secondary to septic azygos vein thrombosis. With early diagnosis, appropriate antimicrobial therapy, and control of the infectious source, resolution of the illness can be expected for most patients with avoidance of potential complications.

Acute osteomyelitis complicating a simple fracture. A case report.

Science.gov (United States)

Drummond-Webb, J J; Schnaid, E

1983-11-26

Osteomyelitis complicating a simple fracture is unusual, but the reason for its rarity is unknown. We report on a 9-year-old Black boy who developed acute osteomyelitis after sustaining an acute simple fracture of the femur. The causative role of trauma in acute osteomyelitis is discussed and 'the relative resistance of healthy bone' questioned.

Septic encephalopathy and septic encephalitis‬‬.

Science.gov (United States)

Tauber, Simone C; Eiffert, Helmut; Brück, Wolfgang; Nau, Roland

2017-02-01

During the last two decades, septic encephalopathy (SE) was recognized as a clinically relevant problem with a high prevalence in patients at admission and during their hospital stay. SE is a condition associated with increased mortality and morbidity such as long-term cognitive impairment. Areas covered: This review illustrates the pathophysiology of sepsis-associated encephalopathy and encephalitis involving blood-brain-barrier dysfunction and neuroinflammation caused by endothelial and microglial activation by endogenous or pathogen-derived compounds, hypoxia by impaired microvascular regulation and septic shock as well as imbalance of neurotransmitters. The continuum between septic-embolic and septic-metastatic encephalitis and SE is underlined by histological findings. The options of technical examinations and biomarkers to diagnose SE are discussed together with established therapeutic options as well as current experimental approaches. Expert commentary: An outlook for clinicians is provided including promising diagnostic approaches by means of new imaging techniques. Clinical trials with drugs already established for other indications such as statins, erythropoietin and minocycline are warranted in the future.

Ewing sarcoma versus osteomyelitis: differential diagnosis with magnetic resonance imaging

International Nuclear Information System (INIS)

Henninger, B.; Glodny, B.; Rudisch, A.; Trieb, T.; Loizides, A.; Judmaier, W.; Schocke, M.F.; Putzer, D.

2013-01-01

To find and evaluate characteristic magnetic resonance imaging (MRI) patterns for the differentiation between Ewing sarcoma and osteomyelitis. We identified 28 consecutive patients referred to our department for MRI (1.5 T) of an unclear bone lesion with clinical symptoms suggestive of Ewing sarcoma or osteomyelitis. MRI scans were re-evaluated by two experienced radiologists, typical MR imaging features were documented and a diagnostic decision between Ewing sarcoma and osteomyelitis was made. Statistical significance of the association between MRI features and the biopsy-based diagnosis was assessed using Fisher's exact test. The most clear-cut pattern for determining the correct diagnosis was the presence of a sharp and defined margin of the bone lesion, which was found in all patients with Ewing sarcoma, but in none of the patients with osteomyelitis (P < 0.0001). Contrast enhancing soft tissue was present in all cases with Ewing sarcoma and absent in 4 patients with osteomyelitis (P = 0.0103). Cortical destruction was found in all patients with Ewing sarcoma, 4 patients with osteomyelitis did not present any cortical reaction (P = 0.0103). Cystic or necrotic areas were identified in 13 patients with Ewing sarcoma and in 1 patient with osteomyelitis (P = 0.004). Interobserver reliability was very good (kappa = 1) in Ewing sarcoma and moderate (kappa = 0.6) in patients with osteomyelitis. A sharp and defined margin, optimally visualized on T1-weighted images in comparison to short tau inversion recovery (STIR) images, is the most significant feature of Ewing sarcoma in differentiating from osteomyelitis. (orig.)

MR Imaging of the Diabetic Foot.

Science.gov (United States)

McCarthy, Eoghan; Morrison, William B; Zoga, Adam C

2017-02-01

Abnormalities of the peripheral nervous, vascular, and immune systems contribute to the development of numerous foot and ankle pathologies in the diabetic population. Although radiographs remain the most practical first-line imaging tool, magnetic resonance (MR) is the tertiary imaging modality of choice, allowing for optimal assessment of bone and soft tissue abnormalities. MR allows for the accurate distinction between osteomyelitis/septic arthritis and neuropathic osteoarthropathy. Furthermore, it provides an excellent presurgical anatomic road map of involved tissues and devitalized skin to ensure successful limited amputations when required. Signal abnormality in the postoperative foot aids in the diagnosis of recurrent infection. Copyright © 2016 Elsevier Inc. All rights reserved.

Osteomyelitis of the proximal sesamoid bone in a horse - a case report

International Nuclear Information System (INIS)

Kofler, J.

1994-01-01

Suppurative osteomyelitis of the lateral proximal sesamoid bone and chronic septic tenosynovitis of the digital flexor tendon sheath of the right hind limb was diagnosed in a 8 year old warmblood mare. Three months earlier the horse had received a puncture wound in the plantar fetlock region, penetrating the plantar annular ligament, tendon sheath and intersesamoidian ligament up to the plantaro-axial surface of the lateral sesamoid bone. The clinical, radiographic and ultrasonographic findings are described. The horse showed grade 2 / 4 right hindlimb lameness, marked thickening of the entire digital flexor tendon sheath area as well as the puncture wound in the middle of the annular ligament region. Radiographs revealed a 10 x 12 mm centro-axial, circular translucent lesion and marked bony proliferation on the abaxial and plantar margins of the lateral proximal sesamoid. Adhesions and marked anechoic areas between the plantar septum of the tendon sheath and the superficial flexor tendon, a thickening of the plantar annular ligament and structural alterations of the deep flexor tendon were demonstrated by sonography. Due to these severe findings a very poor prognosis was given and therefore surgery was not recommended. The horse was euthanized 4 months later as a result of further deterioration. Additional clinical, radiographic and sonographic findings as well as post mortem findings are mentioned. Gross pathology showed a fibrino-purulent tenosynovitis of the digital flexor tendon sheath and tendinitis of both flexor tendons, as well as a fistulous lesion of the intersesamoidian ligament over the lateral proximal sesamoid bone. The patho-histologic examination revealed focal suppurative osteomyelitis of the lateral sesamoid bone with necrotic bone tissue in the osteolytic area and accumulated neutrophils and macrophages [de

Acute Septic Arthritis of the Knee Caused by Kingella kingae in a 5-Year-Old Cameroonian Boy

Directory of Open Access Journals (Sweden)

Nawal El Houmami

2017-11-01

as a potential cause of septic arthritis in children living in sub-Saharan Africa, and hence the burden of K. kingae infection may be not limited to the Western countries. Further studies are required to determine the prevalence of K. kingae infection and carriage in Africa.

Free intra-osseous muscle transfer for treatment of chronic osteomyelitis.

Science.gov (United States)

Lê Thua, Trung-Hau; Boeckx, Willy D; Zirak, Christophe; De Mey, Albert

2015-06-10

Chronic osteomyelitis is still a big reconstructive challenge. Even with standard care, therapeutic failures and recurrences are common. Multiple techniques of tissue transfer have increased the success rate. This study recommends free muscle transfers into the intramedullary bone cavities for treatment of chronic osteomyelitis. The review included 29 patients that were treated for chronic osteomyelitis. Osteomyelitis was located at the femur in four patients, the tibia in 22 patients, and the foot in three patients. Dead bone and scar tissue were replaced with durable free muscle flap with special attention to fill the dead space. The average age of these patients was 48.5 years old (range = 23-70 years old). The average duration of osteomyelitis was 8.2 years (range = 1-45 years). Gracilis was applied in 20 cases (69%), latissimus dorsi was used in five cases (17.2%), and rectus abdominis was performed in four cases (13.8%). There was one flap failure, one partial superficial flap necrosis, two arterial thrombosis, and one venous thrombosis. All the remaining 28 muscle flaps survived. From 1-10 years follow-up, there was one recurrence of the osteomyelitis in the distal end of the intra-medullary cavity of a femur after reconstructing using the gracilis flap. The present study demonstrated that free intramedullary muscle transfers are effective in providing a high rate of success in the treatment of chronic osteomyelitis. The secondary filling of the intramedullary cavity after extensive removal of all infected bony sequesters has proven to give a long-term arrest of chronic osteomyelitis.

Early diagnosis of osteomyelitis occurred in the jaws

International Nuclear Information System (INIS)

Choi, Eun Sook; Na, Seung Mog; Lee, Un Gyeong; Koh, Kwang Joon

1994-01-01

Early diagnosis and treatment of osteomyelitis provide good prognosis and prevent severe complications. Therefore, it is important to early diagnose and treat before the bony changes are observed in conventional radiograms. Authors experienced three cases of early osteomyelitis, and scintigrams were useful to differentiate them from other diseases. The purpose of this report was to aid in the early diagnosis and treatment of osteomyelitis occurred in the jaws. The characteristic features were as follows: 1. In clinical examination, the patients complained mild pain and localized swelling in the jaws. 2. In radiographic findings, the conventional radiograms showed relatively mild bony change in the jaws. 3. The more severe periosteal reactions were observed in radiograms in children than in adult patient. 4. It showed marked increased uptake of radioisotopes in all scintigrams. 5. The three phase bone scanning were helpful to differentiate osteomyelitis from soft tissue diseases.

Osteomyelitis Caused by Candida glabrata in the Distal Phalanx

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Shunichi Toki

2014-01-01

Full Text Available Osteomyelitis caused by Candida glabrata is rare and its optimal treatment is unknown. Here we report a case of osteomyelitis caused by C. glabrata in the distal phalanx in a 54-year-old woman. Despite partial resection of the nail and administering a 1-month course of antibiotics for paronychia, the local swelling remained and an osteolytic lesion was found. C. glabrata osteomyelitis of the distal phalanx was later diagnosed after curettage. Thereafter, the patient was treated with antifungal agents for 3 months. The infection eventually resolved, and radiological healing of the osteolytic lesion was achieved. Antifungal susceptibility testing should be performed in the case of osteomyelitis caused by nonalbicans Candida species, due to their resistance to fluconazole.

Acute Hematogenous Osteomyelitis in a Five-Month-Old Male with Rickets

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Lucia J. Santiago

2017-01-01

Full Text Available Osteomyelitis is defined as an infection of the bone, bone marrow, and the surrounding soft tissues. Most cases of acute hematogenous osteomyelitis in children are caused by Gram-positive bacteria, principally Staphylococcus aureus. We present a case where a 5-month-old male had an acute onset of decreased movement of his left leg and increased irritability and was subsequently diagnosed with rickets and hematogenous osteomyelitis with bacteremia. The case explores a possible association between hematogenous osteomyelitis and rickets.

Aspergillus Osteomyelitis of the Skull.

Science.gov (United States)

Nicholson, Simon; King, Richard; Chumas, Paul; Russell, John; Liddington, Mark

2016-07-01

Osteomyelitis of the craniofacial skeleton is rare, with fungal pathogens least commonly implicated. The authors present 2 patients of osteomyelitis of the skull caused by Aspergillus spp. and discuss the diagnosis, clinicopathological course, and management strategies.Late recurrence seen in this type of infection warrants long-term follow-up and a high index of suspicion for the clinical signs associated with recurrence.Such patients would benefit from their surgical debridement being planned and managed via a specialist craniofacial unit, so as to utilize the most aesthetically sensitive approach and the experience of specialists from several surgical disciplines.

Radiologic study of osteomyelitis of the jaw

International Nuclear Information System (INIS)

Lee, Young Ho; Ahn, Hyung Kyu

1980-01-01

The author studied age and sex distribution, etiology, affected site and several radiographic features of osteomyelitis of the jaw. And radiologic classification of osteomyelitis was also done. The material consisted of 118 males and 96 females examined and/or treated under the diagnosis of osteomyelitis during past 11 years (1970-1980.6) in SNUDH. The obtained results were as followings. 1. The incidence is the highest in teen ages (22.9%) and the lowest in seventies. (2.8%). 2. 199 cases were found in lower jaw, and 15 cases in upper jaw. 30.8% of all cases were located at the posterior portion of mandibular body comprising alveolar region. 3. Radiographic examination of osteolytic lesion revealed that 21.5% of all patients had periapical and alveolar bone rarefaction combined with osteoporotic changes were present at the same time. 4. Sclerotic lesions were seen in 62.2% of all patients and 21.5% of sclerotic lesion were diffuse or homogenous type. 5. Based on the radiologic study, classification of the osteomyelitis of the jaw was made. Localized osteolytic type was the highest in incidence (38.8%) and localized sclerotic type was the lowest (7.0%).

Osteomyelitis associated with Nocardiopsis composta in a dog.

Science.gov (United States)

Salas, Elisa N; Royal, Debra; Kurz, Lance; Loy, J Dustin

2015-05-01

We report the first detection of Nocardiopsis composta in association with osteomyelitis in a young male miniature Australian shepherd dog. Findings included suppurative osteomyelitis containing intralesional Fite's acid fast bacilli, aerobic culture of branching Gram-positive rods, and positive identification via phenotypic analysis and 16S rDNA sequencing.

Concomitant Suppurative Parotitis and Condylar Osteomyelitis.

Science.gov (United States)

Vorrasi, John; Zinberg, Geoffrey

2017-03-01

Parotitis is a common occurrence in the immunocompromised, dehydrated, and malnourished patient as a result of dysfunctional ductal and parotid cells. Inflammation can be acute or chronic based on clinical history, and it can be suppurative based on the presence of micro or macro abscess formation within the substance of the gland. This report presents a case of concomitant condylar osteomyelitis and chronic suppurative parotitis in the setting of previous methicillin-susceptible Staphylococcus aureus foot infection. Ultimately, resection of osteomyelitis, drainage of parotid infection, and intravenous antibiotic therapy led to full resolution of the infection and symptoms. The final pathology of osteomyelitis of the temporomandibular joint and methicillin-resistant S aureus infection is an unusual consequence of chronic parotitis. The patient was restored with a total joint replacement approximately 3 months after resection with no recurrence of infection after 24 months. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Microbiota associated with chronic osteomyelitis of the jaws

Directory of Open Access Journals (Sweden)

Elerson Gaetti-Jardim Júnior

2010-12-01

Full Text Available Chronic osteomyelitis of maxilla and mandible is rare in industrialized countries and its occurrence in developing countries is associated with trauma and surgery, and its microbial etiology has not been studied thoroughly. The aim of this investigation was to evaluate the microbiota associated with osteomyelitis of mandible or maxilla from some Brazilian patients. After clinical and radiographic evaluation, samples of bone sequestra, purulent secretion, and biopsies of granulomatous tissues from twenty-two patients with chronic osteomyelitis of mandible and maxilla were cultivated and submitted for pathogen detection by using a PCR method. Each patient harbored a single lesion. Bacterial isolation was performed on fastidious anaerobe agar supplemented with hemin, menadione and horse blood for anaerobes; and on tryptic soy agar supplemented with yeast extract and horse blood for facultative bacteria and aerobes. Plates were incubated in anaerobiosis and aerobiosis, at 37ºC for 14 and 3 days, respectively. Bacteria were cultivated from twelve patient samples; and genera Actinomyces, Fusobacterium, Parvimonas, and Staphylococcus were the most frequent. By PCR, bacterial DNA was detected from sixteen patient samples. The results suggest that cases of chronic osteomyelitis of the jaws are usually mixed anaerobic infections, reinforcing the concept that osteomyelitis of the jaws are mainly related to microorganisms from the oral environment, and periapical and periodontal infections may act as predisposing factors.

Micro-CT analyses of historical bone samples presenting with osteomyelitis

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Lamm, C.; Pietschmann, P. [Medical University Vienna (MUV), Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Vienna (Austria); Dockner, M.; Weber, G.W. [University of Vienna, Department of Anthropology, Vienna (Austria); University of Vienna, Core Facility for Micro-Computed Tomography, Vienna (Austria); Pospischek, B.; Winter, E.; Patzak, B. [Museum of Natural History (NHM), Collection of Anatomical Pathology in the Madhouse Tower, Vienna (Austria); Pretterklieber, M. [Medical University of Vienna (MUV), Department of Applied Anatomy, Vienna (Austria)

2015-10-15

Osteomyelitis is an inflammation of the bone marrow mainly caused by bacteria such as Staphylococcus aureus. It typically affects long bones, e.g. femora, tibiae and humeri. Recently micro-computed tomography (μCT) techniques offer the opportunity to investigate bone micro-architecture in great detail. Since there is no information on long bone microstructure in osteomyelitis, we studied historic bone samples with osteomyelitis by μCT. We investigated 23 femora of 22 individuals suffering from osteomyelitis provided by the Collection of Anatomical Pathology, Museum of Natural History, Vienna (average age 44 ±19 years); 9 femora from body donors made available by the Department of Applied Anatomy, Medical University of Vienna (age range, 56-102 years) were studied as controls. Bone microstructure was assessed by μCT VISCOM X 8060 II with a minimal resolution of 18 μm. In the osteomyelitic femora, most prominent alterations were seen in the cortical compartment. In 71.4 % of the individuals with osteomyelitis, cortical porosity occurred. 57.1 % of the individuals showed cortical thinning. In 42.9 % trabecularisation of cortical bone was observed. Osteomyelitis is associated with severe alterations of cortical bone structure otherwise typically observed at old age such as cortical porosity and cortical thinning. (orig.)

Effects of Implant-Associated Osteomyelitis on Cefuroxime Bone Pharmacokinetics

DEFF Research Database (Denmark)

Tøttrup, Mikkel; Bue, Mats; Koch, Janne

2016-01-01

Background: The prolonged antibiotic therapy that is often needed for successful management of osteomyelitis may be related to incomplete penetration of antibiotics into the target site. The objective of this study was to assess the effects of implant-associated osteomyelitis on cefuroxime...... cavity up to MICs of 2 mg/L compared with the other tissues, but the time was shorter for higher MICs.  Conclusions: Cefuroxime penetration into infected cancellous bone was incomplete but comparable with that in healthy bone. The destructive bone processes associated with acute osteomyelitis reduced...

Biomaterials approaches to treating implant-associated osteomyelitis.

Science.gov (United States)

Inzana, Jason A; Schwarz, Edward M; Kates, Stephen L; Awad, Hani A

2016-03-01

Orthopaedic devices are the most common surgical devices associated with implant-related infections and Staphylococcus aureus (S. aureus) is the most common causative pathogen in chronic bone infections (osteomyelitis). Treatment of these chronic bone infections often involves combinations of antibiotics given systemically and locally to the affected site via a biomaterial spacer. The gold standard biomaterial for local antibiotic delivery against osteomyelitis, poly(methyl methacrylate) (PMMA) bone cement, bears many limitations. Such shortcomings include limited antibiotic release, incompatibility with many antimicrobial agents, and the need for follow-up surgeries to remove the non-biodegradable cement before surgical reconstruction of the lost bone. Therefore, extensive research pursuits are targeting alternative, biodegradable materials to replace PMMA in osteomyelitis applications. Herein, we provide an overview of the primary clinical treatment strategies and emerging biodegradable materials that may be employed for management of implant-related osteomyelitis. We performed a systematic review of experimental biomaterials systems that have been evaluated for treating established S. aureus osteomyelitis in an animal model. Many experimental biomaterials were not decisively more efficacious for infection management than PMMA when delivering the same antibiotic. However, alternative biomaterials have reduced the number of follow-up surgeries, enhanced the antimicrobial efficacy by delivering agents that are incompatible with PMMA, and regenerated bone in an infected defect. Understanding the advantages, limitations, and potential for clinical translation of each biomaterial, along with the conditions under which it was evaluated (e.g. animal model), is critical for surgeons and researchers to navigate the plethora of options for local antibiotic delivery. Copyright © 2015 Elsevier Ltd. All rights reserved.

Imaging of chronic osteomyelitis; Chronische Infektionen des Skelettsystems. Bildgebende Diagnostik

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Glaser, C.; Matzko, M.; Reiser, M. [Klinikum Grosshadern, Muenchen (Germany). Inst. fuer Radiologische Diagnostik

2000-06-01

The diagnosis of chronic osteomyelitis is made on the basis of clinical, radiologic and histologic findings. The role of imaging in patients with known chronic osteomyelitis is to detect and to delineate areas of active infection. To correctly interpret the imaging findings, it is essential to take both the individual clinical findings and previous imaging studies into account. Reliable signs of active infection are bone marrow abscess, sequestra and sinus tract formation. Only the combined evaluation of bony changes together with alterations of the adjacent soft tissues provides good diagnostic accuracy. Projection radiography gives an overview of the condition of the bone, which provides the basis for follow-up and the selection of further imaging modalities. Computed tomography can be used to evaluate even discrete or complex bony alterations and to guide percutaneous biopsy or drainage. Magnetic resonance imaging achieves the best diagnostic sensitivity and specificity and provides superior contrast as well as anatomical resolution in both bone marrow and soft tissues. In this paper the features and clinical relevance of imaging in primary chronic osteomyelitis, posttraumatic osteomyelitis, tuberculous spondylitis and osteomyelitis of the diabetic foot are reviewed, with particular respect to MRI. (orig.) [German] Die Diagnose der chronischen Osteomyelitis wird durch Klinik, Bildgebung und Histologie gestellt. Bei bekannter chronischer Osteomyelitis soll die Bildgebung einen floriden Prozess und die betroffenen Kompartimente herausarbeiten. Die Klinik des Patienten, seine individuelle Krankheitskonstellation und die Verlaufsbeobachtung sind essentiell fuer die Befundinterpretation. Erst die kombinierte Beurteilung der Veraenderungen am Knochen selbst sowie die der umgebenden Weichteile fuehrt zu einer validen Aussage. Sichere Zeichen einer floriden Osteomyelitis sind lediglich (Knochenmarks)abzess, Sequester und Fistelgang. Die Projektionsradiographie gibt

Appearance of acute gouty arthritis on indium-111-labeled leukocyte scintigraphy

International Nuclear Information System (INIS)

Palestro, C.J.; Vega, A.; Kim, C.K.; Swyer, A.J.; Goldsmith, S.J.

1990-01-01

Indium-111-labeled leukocyte scintigraphy was performed on a 66-yr-old male with polyarticular acute gouty arthritis. Images revealed intense labeled leukocyte accumulation in a pattern indistinguishable from septic arthritis, in both knees and ankles, and the metatarsophalangeal joint of both great toes, all of which were involved in the acute gouty attack. Joint aspirate as well as blood cultures were reported as no growth; the patient was treated with intravenous colchicine and ACTH for 10 days with dramatic improvement noted. Labeled leukocyte imaging, repeated 12 days after the initial study, revealed near total resolution of joint abnormalities, concordant with the patient's clinical improvement. This case demonstrates that while acute gouty arthritis is a potential pitfall in labeled leukocyte imaging, in the presence of known gout, it may provide a simple, objective, noninvasive method of evaluating patient response to therapy

Saksenaea vasiformis osteomyelitis.

OpenAIRE

Pierce, P F; Wood, M B; Roberts, G D; Fitzgerald, R H; Robertson, C; Edson, R S

1987-01-01

A 24-year-old man sustained a crush injury to the tibia, which subsequently became infected with Saksenaea vasiformis. He was treated with debridement and a free myocutaneous flap, but amputation was necessary because of mycotic osteomyelitis. S. vasiformis was recovered and identified on the basis of its characteristic morphology on cornmeal agar.

Approaches to the evaluation of the child with a limp

International Nuclear Information System (INIS)

Poznanski, A.K.

1987-01-01

This course addresses the radiologic approach to evaluating the child with a limp and the integration of various imaging modalities for this purpose, particularly radionuclide bone scans, CT, US, and MR imaging. The use of these modalities in the various abnormalities that cause a limp in children is discussed. These abnormalities include congenital disorders; inflammatory problems such as transient toxic synovitis, septic arthritis, or osteomyelitis; neoplastic entities such as osteoid osteoma, leukemia, and neuroblastoma; trauma, such as may be seen in association with stress fracture, the battered child, cartilagenous or ligamentous injury; and other conditions such as Perthes disease, Gaucher disease, steroid arthropathy, slipped capital femoral epiphyses, the arthritides, reflex sympathetic dystrophy

Bone scintigraphy in drug addiction

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Lopez-Majano, V.; Miskew, D.; Sansi, P.

1981-01-01

In 22 drug addicts, the clinical diagnosis of osteomyelitis and/or septic arthritis was suspected because of symptoms of sepsis and pain in various locations. All patients underwent bone scintigraphy with 17-20 mCi of /sup 99/sup(m)Tc labeling either pyrophosphate or methylene diphosphonate. Whole body and spot scans located the area of disease in most patients. This permitted biopsy of the affected area when the pathogen recurs. One of the two patients whose scintigrams were normal was on adequate treatment before the bone scintigram and the other was on oxacillin. Radiographs of the affected areas were normal, which indicates bone scintigraphy should be preferred to radiography in the early diagnosis of osseous infections.

Bone scintigraphy in drug addiction

International Nuclear Information System (INIS)

Lopez-Majano, V.; Miskew, D.; Sansi, P.

1981-01-01

In 22 drug addicts, the clinical diagnosis of osteomyelitis and/or septic arthritis was suspected because of symptoms of sepsis and pain in various locations. All patients underwent bone scintigraphy with 17-20 mCi of 99 sup(m)Tc labeling either pyrophosphate or methylene diphosphonate. Whole body and spot scans located the area of disease in most patients. This permitted biopsy of the affected area when the pathogen recurs. One of the two patients whose scintigrams were normal was on adequate treatment before the bone scintigram and the other was on oxacillin. Radiographs of the affected areas were normal, which indicates bone scintigraphy should be preferred to radiography in the early diagnosis of osseous infections. (orig.) [de

Distinguishing Osteomyelitis From Ewing Sarcoma on Radiography and MRI

Science.gov (United States)

McCarville, M. Beth; Chen, Jim Y.; Coleman, Jamie L.; Li, Yimei; Li, Xingyu; Adderson, Elisabeth E.; Neel, Mike D.; Gold, Robert E.; Kaufman, Robert A.

2017-01-01

OBJECTIVE The purpose of this study was to determine whether clinical and imaging features can distinguish osteomyelitis from Ewing sarcoma (EWS) and to assess the accuracy of percutaneous biopsy versus open biopsy in the diagnosis of these diseases. MATERIALS AND METHODS Three radiologists reviewed the radiographs and MRI examinations of 32 subjects with osteomyelitis and 31 subjects with EWS to determine the presence of 36 imaging parameters. Information on demographic characteristics, history, physical examination findings, laboratory findings, biopsy type, and biopsy results were recorded. Individual imaging and clinical parameters and combinations of these parameters were tested for correlation with findings from histologic analysis. The diagnostic accuracy of biopsy was also determined. RESULTS On radiography, the presence of joint or metaphyseal involvement, a wide transition zone, a Codman triangle, a periosteal reaction, or a soft-tissue mass, when tested individually, was more likely to be noted in subjects with EWS (p ≤ 0.05) than in subjects with osteomyelitis. On MRI, permeative cortical involvement and soft-tissue mass were more likely in subjects with EWS (p ≤ 0.02), whereas a serpiginous tract was more likely to be seen in subjects with osteomyelitis (p = 0.04). African Americans were more likely to have osteomyelitis than EWS (p = 0). According to the results of multiple regression analysis, only ethnicity and soft-tissue mass remained statistically significant (p ≤ 0.01). The findings from 100% of open biopsies (18/18) and 58% of percutaneous biopsies (7/12) resulted in the diagnosis of osteomyelitis, whereas the findings from 88% of open biopsies (22/25) and 50% of percutaneous biopsies (3/6) resulted in a diagnosis of EWS. CONCLUSION Several imaging features are significantly associated with either EWS or osteomyelitis, but many features are associated with both diseases. Other than ethnicity, no clinical feature improved diagnostic

Periostitis and osteomyelitis in chronic drug addicts

International Nuclear Information System (INIS)

Taylor, C.R.; Lawson, J.P.

1986-01-01

Periostitis and osteomyelitis can occur in drug addicts not only by hematogeneous dissemination of the infecting organisms, but as a result of introduction of bacteria by direct injection into periosteum or injection through infected skin and subcutaneous tissues. A spectrum of examples of osteomyelitis of the bones of the forearm in drug addicts is presented to illustrate this phenomenon. Neglect of these infections and the trauma of continued injections can lead to extensive tissue and bone loss. (orig.)

Acute bacterial sternoclavicular osteomyelitis in a long-term renal transplant recipient.

Science.gov (United States)

Dounousi, Evangelia; Duni, Anila; Xiromeriti, Sofia; Pappas, Charalambos; Siamopoulos, Kostas C

2016-06-24

Kidney transplantation is the treatment of choice for a significant number of patients with end-stage renal disease. Although immunosuppression therapy improves graft and patient's survival, it is a major risk factor for infection following kidney transplantation altering clinical manifestations of the infectious diseases and complicating both the diagnosis and management of renal transplant recipients (RTRs). Existing literature is very limited regarding osteomyelitis in RTRs. Sternoclavicular osteomyelitis is rare and has been mainly reported after contiguous spread of infection or direct traumatic seeding of the bacteria. We present an interesting case of acute, bacterial sternoclavicular osteomyelitis in a long-term RTR. Blood cultures were positive for Streptococcus mitis, while the portal entry site was not identified. Magnetic resonance imaging of the sternoclavicluar region and a three-phase bone scan were positive for sternoclavicular osteomyelitis. Eventually, the patient was successfully treated with Daptomycin as monotherapy. In the presence of immunosuppression, the transplant physician should always remain alert for opportunistic pathogens or unusual location of osteomyelitis.

Computerized tomography of pelvic osteomyelitis in patients with spinal cord injuries

International Nuclear Information System (INIS)

Firooznia, H.; Rafii, M.; Golimbu, C.; Sokolow, J.

1983-01-01

Computerized tomography (CT) was performed in 19 patients with spinal cord injury (SCI) who had large pressure sores and in whom other complications were suspected. CT detected the depth, extent, and degree of undermining of the edges of the pressure sores in 19 of 27 lesions. Conventional radiography detected four cases of pelvic osteomyelitis. CT detected eight additional cases of pelvic osteomyelitis, as well as eight clinically unsuspected peripelvic and intrapelvic abscesses. Technetium-99m bone scanning was not very helpful because of localization in chronic proliferative changes of bone and widespread foci of myositis ossificans, as well as in osteomyelitis. Gallium-67 scanning detected only one of six abscesses. It was not very helpful because of confusion of abscess and osteomyelitis with intense soft tissue swelling and cellulitis, which are often associated with pressure sores in patients with chronic SCI. CT was found to be, by far, the modality of choice for detection of pelvic osteomyelitis and abscess in patients with SCI

Osteomyelitis following extraction of lower third molar during pregnancy

International Nuclear Information System (INIS)

Kim, Sang Bin; Huh, Kyung Hoe; Yi, Won Jin; Lee, Sam Sun; Kim, Mi Ja

2008-01-01

A 27-year-old female was referred to our hospital postpartum due to rapid aggravation of facial swelling. She was diagnosed with osteomyelitis on clinical, radiological, and histopathological examinations, but the possibility of malignancy was not excluded. Clinical signs and symptoms such as facial swelling and discomfort were improved with four months of antibiotics treatment. This is a case of an osteomyelitis progressed from infected extraction socket in a woman with physiological changes of pregnancy. Decreased immunological response, increased sex hormone and calcium regulatory hormones regulate the response of the bone infection. We report this case for helping the diagnosis of unusual form of osteomyelitis in pregnancy and postpartum.

Osteomyelitis following extraction of lower third molar during pregnancy

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Kim, Sang Bin; Huh, Kyung Hoe; Yi, Won Jin; Lee, Sam Sun [Department of Oral and Maxillofacial Radiology, and Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of); Kim, Mi Ja [Department of Dentistry, Hangang Sacred Heart Hospital, Hallym University, Seoul (Korea, Republic of)

2008-09-15

A 27-year-old female was referred to our hospital postpartum due to rapid aggravation of facial swelling. She was diagnosed with osteomyelitis on clinical, radiological, and histopathological examinations, but the possibility of malignancy was not excluded. Clinical signs and symptoms such as facial swelling and discomfort were improved with four months of antibiotics treatment. This is a case of an osteomyelitis progressed from infected extraction socket in a woman with physiological changes of pregnancy. Decreased immunological response, increased sex hormone and calcium regulatory hormones regulate the response of the bone infection. We report this case for helping the diagnosis of unusual form of osteomyelitis in pregnancy and postpartum.

Chronic pyogenic osteomyelitis of long bones at specialized hospital ...

African Journals Online (AJOL)

Introduction: Chronic pyogenic osteomyelitis of long bones is common and difficult to treat. Objectives: The aim of this study was to examine the pattern of presentation and outcome of treatment of chronic osteomyelitis of long bones at specialized hospital in Nigeria. Patients and methods: Case records of patients who were ...

Saksenaea vasiformis osteomyelitis.

Science.gov (United States)

Pierce, P F; Wood, M B; Roberts, G D; Fitzgerald, R H; Robertson, C; Edson, R S

1987-01-01

A 24-year-old man sustained a crush injury to the tibia, which subsequently became infected with Saksenaea vasiformis. He was treated with debridement and a free myocutaneous flap, but amputation was necessary because of mycotic osteomyelitis. S. vasiformis was recovered and identified on the basis of its characteristic morphology on cornmeal agar. Images PMID:3584430

Septic and non-septic olecranon bursitis in the accident and emergency department--an approach to management.

Science.gov (United States)

Stell, I M

1996-01-01

Olecranon bursitis is relatively common. One third of episodes are septic. Most of the remainder are non-septic, with occasional rheumatological causes. Trauma can cause both septic and non-septic olecranon bursitis. Clinical features are helpful in separating septic from non-septic olecranon bursitis, but there may be local erythema in both. Aspiration should be carried out in all cases, and if the presence of infection is still in doubt, microscopy, Gram staining, and culture of the aspirate will resolve the issue. Septic olecranon bursitis should be treated by aspiration, which may need to be repeated, and a long course of antibiotics. Some cases will need admission, and a few will need surgical treatment. Non-septic olecranon bursitis can be managed with aspiration alone. Non-steroidal anti-inflammatory drugs probably hasten symptomatic improvement. Intrabursal corticosteroids produce a rapid resolution but concern remains over their long term local effects. Recovery from septic olecranon bursitis can take months. PMID:8894865

Efficacy of clindamycin in the treatment of Staphylococcus aureus osteomyelitis in dogs

International Nuclear Information System (INIS)

Braden, T.D.; Johnson, C.A.; Wakenell, P.; Tvedten, H.W.; Mostosky, U.V.

1988-01-01

The efficacy of clindamycin in the treatment of experimentally induced, posttraumatic Staphylococcus aureus osteomyelitis was studied in dogs. At the end of the experiment, bacteria could not be isolated from bone marrow of 15 of 16 (93.7%) dogs treated with clindamycin, whereas bacteria could not be isolated from similar specimens obtained from 6 of 13 (46.1%) untreated dogs. None of the 16 dogs treated with clindamycin had histopathologic evidence of osteomyelitis at the end of the experiment. Five of the 13 untreated control dogs had histopathologic evidence of osteomyelitis. The recovery rate was 31% in untreated dogs, whereas 94% of dogs treated with clindamycin recovered from osteomyelitis. Clindamycin, 11 mg/kg of body weight, given orally, q 12 h, for 28 days, was efficacious in the treatment of experimentally induced, posttraumatic S aureus osteomyelitis in dogs

Clinical Application of Antimicrobial Bone Graft Substitute in Osteomyelitis Treatment: A Systematic Review of Different Bone Graft Substitutes Available in Clinical Treatment of Osteomyelitis

Directory of Open Access Journals (Sweden)

T. A. G. van Vugt

2016-01-01

Full Text Available Osteomyelitis is a common occurrence in orthopaedic surgery, which is caused by different bacteria. Treatment of osteomyelitis patients aims to eradicate infection by debridement surgery and local and systemic antibiotic therapy. Local treatment increases success rates and can be performed with different antimicrobial bone graft substitutes. This review is performed to assess the level of evidence of synthetic bone graft substitutes in osteomyelitis treatment. According to the PRISMA statement for reporting systematic reviews, different types of clinical studies concerning treatment of osteomyelitis with bone graft substitutes are included. These studies are assessed on their methodological quality as level of evidence and bias and their clinical outcomes as eradication of infection. In the fifteen included studies, the levels of evidence were weak and in ten out of the fifteen studies there was a moderate to high risk of bias. However, first results of the eradication of infection in these studies showed promising results with their relatively high success rates and low complication rates. Due to the low levels of evidence and high risks of bias of the included studies, these results are inconclusive and no conclusions regarding the performed clinical studies of osteomyelitis treatment with antimicrobial bone graft substitutes can be drawn.

MR imaging of tuberculous vertebral osteomyelitis: pictorial review

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Gouliamos, A.D.; Kehagias, D.T.; Lahanis, S.; Moulopoulou, E.S.; Kalovidouris, A.A.; Trakadas, S.J.; Vlahos, L.j. [Dept. of Radiology, University of Athens (Greece); Athanassopoulou, A.A. [Dept. of Radiology, Asklipiion Hospital, Athens (Greece)

2001-04-01

Vertebral osteomyelitis is one of the most common manifestations of tuberculosis. Magnetic resonance imaging is considered the main imaging modality for the diagnosis, the demonstration of the extent of the disease, and follow-up studies. Vertebral destruction involving two consecutive levels with sparing of the intervertebral disc, disc herniation into the vertebral body, epidural involvement, and paraspinal abscess are the most common MRI findings suggestive of tuberculous vertebral osteomyelitis. (orig.)

SPECT/CT in the Diagnosis of Skull Base Osteomyelitis

International Nuclear Information System (INIS)

Damle, Nishikant Avinash; Kumar, Rakesh; Kumar, Praveen; Jaganthan, Sriram; Patnecha, Manish; Bal, Chandrasekhar; Bandopadhyaya, Gurupad; Malhotra, Arun

2011-01-01

Skull base osteomyelitis is a potentially fatal disease. We demonstrate here the utility of SPECT/CT in diagnosing this entity, which was not obvious on a planar bone scan. A 99mT c MDP bone scan with SPECT/CT was carried out on a patient with clinically suspected skull base osteomyelitis. Findings were correlated with contrast enhanced CT (CECT) and MRI. Planar images were equivocal, but SPECT/CT showed intense uptake in the body of sphenoid and petrous temporal bone as well as the atlas corresponding to irregular bone destruction on CT and MRI. These findings indicate that SPECT/CT may have an additional role beyond planar imaging in the detection of skull base osteomyelitis.

CHRONIC OSTEOMYELITIS: A BACTERIOLOGICAL STUDY WITH SPECIAL REFERENCE TO STAPHYLOCOCCUS AUREUS

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Sanjoy Chakravarty

2015-01-01

Full Text Available Advances in the identification of infections and early diagnosis of Osteomyelitis have led to the improved management of Osteomyelitis. This study was undertaken to determine the bacteriological profile of Osteomyelitis and the antibiotic resistance pattern of various isolates obtained as it is an important cause of morbidity. A total of 50 patients of Osteomyelitis either attending the outpatient department or admitted in the wards of a teaching and tertiary care hospita l in Sikkim from October 2013 to October, 2014 were included in the study. All those patients who were clinically and/ or radiologically suspected of having Osteomyelitis were enrolled as cases. Pus/ pus swabs or sequestrum samples taken aseptically were c ultured aerobically at 37 0 C for 18 - 24 hours in Blood and Mac Conkey agar plates. Culture isolates were identified by a series of standard biochemical reactions. Antibiotic susceptibility was tested on Mueller Hinton agar by Kirby Bauer disc diffusion met hod. Betalactamase production of S. aureus strains were verified by iodometric filter paper and acidometric agar plate methods. S. aureus strains were screened for methicillin resistance by using conventional microbiological methods. S. aureus turned out t o be the most common organism isolated. Other organism isolated were P. Aeruginosa, Proteus spp., Klebsiella spp., E. coli, Enterobacter spp., S. epidermitis, Streptococcus pyogens and Enterococcus spp. Beta - lactamase production and methicillin resistance was seen in S. aureus strains respectively. Multidrug resistance was observed in other strains. Infection caused by Methicillin resistant S. aureus and multidrug resistant organisms are posing a major challenge in the treatment of Osteomyelitis. So, appropriate drug selected by antibiotic sensitivity testing should be used to treat Osteomyelitis

Aspergillus arthritis: analysis of clinical manifestations, diagnosis, and treatment of 31 reported cases.

Science.gov (United States)

Gamaletsou, Maria N; Rammaert, Blandine; Bueno, Marimelle A; Sipsas, Nikolaos V; Moriyama, Brad; Kontoyiannis, Dimitrios P; Roilides, Emmanuel; Zeller, Valerie; Taj-Aldeen, Saad J; Henry, Michael; Petraitis, Vidmantas; Denning, David W; Lortholary, Olivier; Walsh, Thomas J

2017-04-01

Aspergillus arthritis is a debilitating form of invasive aspergillosis. Little is known about its epidemiology, clinical manifestations, laboratory features, treatment, and prognosis. Cases of Aspergillus arthritis were reviewed in the English literature from 1967 through 2015 for variables of arthritis with Aspergillus spp. recovered from joint and/or adjacent bone, underlying conditions, symptoms, signs, inflammatory biomarkers, diagnostic imaging, management, and outcome. Among 31 evaluable cases, 87% were males and 13% pediatric. Median age was 50 y (range 1-83 y). Seventeen (55%) patients were immunosuppressed with such conditions as hematological malignancies (26%), corticosteroids (39%), and/or transplantation (26%). Approximately one-half (52%) of patients had hematogenous seeding of the joint, and more than 80% had de novo infection with no prior antifungal therapy. Oligoarticular infection (2-3 joints) occurred in 45% and contiguous osteomyelitis was present in 61%. Clinical manifestations included pain (87%), edema (26%), and limited function (23%), with knees (35%), intervertebral discs (26%), and hips (16%) being most commonly infected. Aspergillus fumigatus constituted 77% of cases followed by Aspergillus flavus in 13%, Aspergillus niger in 3%, and not specified in 7%. Median ESR was 90 mm/hr and median CRP was 3.6 mg/dl. Median synovial fluid WBC was 17,200/μL (7,300-128,000) with 72% PMNs (range 61-92). Osteolysis occurred in 35%, and soft-tissue extension 47%. Nineteen patients (61%) were managed with combined medical and surgical therapy, 10 (32%) with medical therapy only, and 2 (6%) surgery only. Amphotericin B and itraconazole were the most frequently used agents with median duration of therapy of 219 days (range 30-545). Surgical interventions included debridement in 61%, drainage 19%, and amputation 6%. Complete or partial response was achieved in 71% and relapse occurred in 16%. Medical therapy was reinstituted with successful outcome in

Pasteurella multocida Osteomyelitis: An Unusual Case Presentation

Directory of Open Access Journals (Sweden)

Herbert P von Schroeder

1996-01-01

Full Text Available A healthy male farm employee developed an unusual infection caused by Pasteurella multocida. Atypical features included the chronic nature of the infection, the development of osteomyelitis of the tibia without direct animal inoculation, and lack of fever and leukocytosis. Radiographic appearance of P multocida osteomyelitis may be the result of osteoclast activation and can be confused with musculoskeletal tumour. P multocida infection requires a high degree of suspicion, and should be considered in cases of farm- or animal-related injuries even if there is no history of direct animal contact.

Chronic Recurrent Multifocal Osteomyelitis Causing an Acute Scoliosis

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Alexander Armstrong

2013-01-01

Full Text Available Study Design. A Case Report. Objective. We present a 15-year-old girl with an acute atypical scoliosis secondary to chronic recurrent multifocal osteomyelitis (CRMO. Summary of Background Data. CRMO is a rare nonpyogenic inflammatory bone condition with unclear aetiology. CRMO mainly affects the metaphyses of long bones, the pelvis, shoulder girdle, and less commonly the spine. Methods. Our case presented with a 6-month history of worsening thoracic back pain, asymmetry of her shoulders and abnormal posture. Whole spine radiographs revealed a right atypical thoracic scoliosis. Magnetic Resonance Imaging showed abnormal signal on the short TI inversion recovery (STIR sequences in multiple vertebrae. A bone biopsy demonstrated evidence of fibrosis and chronic inflammatory changes. Interval MRI scans revealed new oedematous lesions and disappearance of old lesions. Symptoms improved. Results. It is important to consider CRMO as an acute cause of atypical scoliosis. Malignancy, pyogenic infections and atypical presentations of juvenile arthritis need excluding. Conclusion. This 24-month follow-up describes a rare cause of an atypical scoliosis and fortifies the small amount of the currently available literature. The case highlights the relapsing and remitting nature of CRMO with new lesions developing and older lesions burning out. We advise close radiological surveillance and symptomatic management.

Case report 834: Chronic sclerosing osteomyelitis of the mandible with long bone periostitis.

Science.gov (United States)

Stewart, A; Carneiro, R; Pollock, L; Shaw, D

1994-04-01

We present the case of a patient with primary chronic osteomyelitis of the mandible, the radiological appearance of which is compatible with a diagnosis of chronic sclerosing osteomyelitis. The accompanying femoral and tibial periosteal reactive new bone formation and the benign clinical course suggest that this presentation may represent a form of chronic multifocal osteomyelitis.

The Septic Shock 3.0 Definition and Trials: A Vasopressin and Septic Shock Trial Experience.

Science.gov (United States)

Russell, James A; Lee, Terry; Singer, Joel; Boyd, John H; Walley, Keith R

2017-06-01

The Septic Shock 3.0 definition could alter treatment comparisons in randomized controlled trials in septic shock. Our first hypothesis was that the vasopressin versus norepinephrine comparison and 28-day mortality of patients with Septic Shock 3.0 definition (lactate > 2 mmol/L) differ from vasopressin versus norepinephrine and mortality in Vasopressin and Septic Shock Trial. Our second hypothesis was that there are differences in plasma cytokine levels in Vasopressin and Septic Shock Trial for lactate less than or equal to 2 versus greater than 2 mmol/L. Retrospective analysis of randomized controlled trial. Multicenter ICUs. We compared vasopressin-to-norepinephrine group 28- and 90-day mortality in Vasopressin and Septic Shock Trial in lactate subgroups. We measured 39 cytokines to compare patients with lactate less than or equal to 2 versus greater than 2 mmol/L. Patients with septic shock with lactate greater than 2 mmol/L or less than or equal to 2 mmol/L, randomized to vasopressin or norepinephrine. Concealed vasopressin (0.03 U/min.) or norepinephrine infusions. The Septic Shock 3.0 definition would have decreased sample size by about half. The 28- and 90-day mortality rates were 10-12 % higher than the original Vasopressin and Septic Shock Trial mortality. There was a significantly (p = 0.028) lower mortality with vasopressin versus norepinephrine in lactate less than or equal to 2 mmol/L but no difference between treatment groups in lactate greater than 2 mmol/L. Nearly all cytokine levels were significantly higher in patients with lactate greater than 2 versus less than or equal to 2 mmol/L. The Septic Shock 3.0 definition decreased sample size by half and increased 28-day mortality rates by about 10%. Vasopressin lowered mortality versus norepinephrine if lactate was less than or equal to 2 mmol/L. Patients had higher plasma cytokines in lactate greater than 2 versus less than or equal to 2 mmol/L, a brisker cytokine response to infection. The Septic

Treatment options for diabetic foot osteomyelitis.

Science.gov (United States)

Senneville, Eric; Robineau, Olivier

2017-06-01

Diabetic foot osteomyelitis therapeutical options are based on antibiotic therapy and surgical resection of the infected bone(s). Surgical and medical approaches of patients suffering from a diabetic foot osteomyelitis do not oppose but are complementary and need to be discussed as a tailored manner. Areas covered: The aim of the present article is to discuss data issued from the most recent guidelines of the Infectious Diseases Society of America and the International Working Group on the Diabetic Foot on the management of the diabetic foot infection and from a search in the current literature using the terms diabetic foot osteomyelitis and treatment/therapy/therapeutical in both PubMed and Medline, restricted to the last five years. Expert opinion: Surgical removal of the entire infected bone(s) has been considered in the past as the standard treatment but medical approach of these patients has now proven efficacy in selected situations. The current emergence of bacteria, especially among Gram negative rods, resistant to almost all the available antibiotics gradually augments the complexity of the management of these patients and is likely to decrease the place of the medical approach and to worsen the outcome of these infections in the next future.

Bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei: a case report and an updated literature review

DEFF Research Database (Denmark)

Kaldau, Niels Christian; Brorson, Stig; Jensen, Poul Einar

2012-01-01

We present a case of bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei, and review the literature on Candida osteomyelitis.......We present a case of bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei, and review the literature on Candida osteomyelitis....

Cat-scratch disease osteomyelitis

International Nuclear Information System (INIS)

Heye, S.; Matthijs, P.; Campenhoudt, M. van; Wallon, J.

2003-01-01

We report on a patient who presented with osteomyelitis of a rib and adjacent abscess as a rare and atypical manifestation of cat-scratch disease. Radiographic findings showed an osteolytic lesion with adjacent mass. Biopsy, serology and polymerase chain reaction technique are essential for the final diagnosis. Prognosis is excellent with full recovery. (orig.)

Combination of Erythromycin and Curcumin Alleviates Staphylococcus aureus Induced Osteomyelitis in Rats

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Zubin Zhou

2017-08-01

Full Text Available Osteomyelitis is commonly caused by Staphylococcus aureus. Both erythromycin and curcumin can suppress S. aureus growth, but their roles in osteomyelitis are barely studied. We aim to explore the activities of erythromycin and curcumin against chronical osteomyelitis induced by methicillin-resistant S. aureus (MRSA. Chronicle implant-induced osteomyelitis was established by MRSA infection in male Wistar rats. Four weeks after bacterial inoculation, rats received no treatment, erythromycin monotherapy, curcumin monotherapy, or erythromycin plus curcumin twice daily for 2 weeks. Bacterial levels, bone infection status, inflammatory signals and side effects were evaluated. Rats tolerated all treatments well, with no death or side effects such as, diarrhea and weight loss. Two days after treatment completion, erythromycin monotherapy did not suppress bacterial growth and had no effect in bone infection, although it reduced serum pro-inflammatory cytokines tumor necrosis factor (TNF-α and interleukin (IL-6. Curcumin monotherapy slightly suppressed bacterial growth, alleviated bone infection and reduced TNF-α and IL-6. Erythromycin and curcumin combined treatment markedly suppressed bacterial growth, substantially alleviated bone infection and reduced TNF-α and IL-6. Combination of erythromycin and curcumin lead a much stronger efficiency against MRSA induced osteomyelitis in rats than monotherapy. Our study suggests that erythromycin and curcumin could be a new combination for treating MRSA induced osteomyelitis.

Osteomyelitis of the Mandible after Dental Implants in an Immunocompetent Patient

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Matthieu Balanger

2017-01-01

Full Text Available Dental implants are now broadly used to replace missing teeth, and the presence of infectious complications is rising. Dental implant therapy as a local risk factor for the onset of osteomyelitis and its management have not been widely explored. Here, we report an unusual case of mandibular suppurative osteomyelitis caused by Streptococcus intermedius in a healthy and immunocompetent patient secondary to mandibular implants. We describe how surgery combined with systemic application of antibiotics allowed conservation of the dental implants in the mandibular bone, discuss the probable source of contamination, and present the follow-up of the osteomyelitis.

Neonatal osteomyelitis in Nigerian infants

Energy Technology Data Exchange (ETDEWEB)

Omene, J.A.; Okolo, A.A.; Odita, J.C.

1984-07-01

Twenty-seven Nigerian infants with osteomyelitis are presented during the first 28 days of life to highlight the severity of the clinical manifestations and the radiological features of this infection. The clinical signs include limitation of movement of the extremities involved and localised swelling. Severe constitutional changes such as fever (>39/sup 0/C) and abdominal distension were common. This contrasts with results from North America and Europe which emphasize the paucity of clinical signs despite involvement of multiple sites. Multiple site involvement was encountered in only eight cases. Staphylococcus aureus, proteus mirabilis and candida albicans were the main pathogens isolated. The long bones were more frequently affected. Aggressive bone destruction was a constant radiological finding peculiar to Staphylococcal osteomyelitis while the formation of Sequestrum, are rare occurrence in the newborn, was present in six patients. The mortality rate was 7.4% and the morbidity rate was equally low.

Neonatal osteomyelitis in Nigerian infants

International Nuclear Information System (INIS)

Omene, J.A.; Okolo, A.A.; Odita, J.C.

1984-01-01

Twenty-seven Nigerian infants with osteomyelitis are presented during the first 28 days of life to highlight the severity of the clinical manifestations and the radiological features of this infection. The clinical signs inlcude limitation of movement of the extremities involved and localised swelling. Severe constitutional changes such as fever (>39 0 C) and abdominal distension were common. This contrasts with results from North America and Europe which emphasize the paucity of clinical signs despite involvement of multiple sites. Multiple site involvement was encountered in only eight cases. Staphylococcus aureus, proteus mirabilis and candida albicans were the main pathogens isolated. The long bones were more frequently affected. Aggressive bone destruction was a constant radiological finding peculiar to Staphylococcal osteomyelitis while the formation of Sequestrum, are rare occurrence in the newborn, was present in six patients. The mortality rate was 7.4% and the morbidity rate was equally low. (orig.)

Sonographic evaluation of acute osteomyelitis in infants

International Nuclear Information System (INIS)

Hwang, Ji Young; Lee, Sun Wha; Kim, Yoo Kyung

2002-01-01

To analyze the related sonographic findings and to determine the value of sonography in establishing the diagnosis of acute osteomyelitis in infants. The sonographic findings of eleven infants aged 10 days-4 months (mean, 45 days) with acute osteomyelitis were retrospectively evaluated. The involved bones were the femur (n=5), humerus (n=2), tibia (n=2), rib(n=1), sternum (n=1), and calcaneus (n=1). Discontinuity or destruction of cortical margins, echotexture of the metaphysis and epiphysis, the presence of subperiosteal hypoechoic lesion, adjacent soft tissue swelling, distension of the joint capsule, the echotexture of joint effusion, and dislocation or subluxation of the involved joint were evaluated. The sonographic findings were compared with the plain radiographic (n=12) and MR (n=5) findings, with special attention to the identification of the metaphyseal or epiphyseal bony lesions and the involvement of adjacent joints. The sonographic findings of osteomyelitis were cortical discontinuity or destruction (n=12), hypoechoic lesions with an echogenic rim in the metaphysis (n=12), subperiosteal hypoechoic lesions (n=8), soft tissue swelling (n=9), a distended hip joint, with echogenic fluid (n=5), ill-demarcated echogenic lesions in the capital femoral epiphysis (n=5), and a subluxated hip joint (n=3). Plain radiographs revealed well or ill-defined osteolytic lesions in the metaphysis, accompanied by cortical destruction (n=8), new periosteal bone formation (n=3) and reactive sclerosis (n=2). Abnormality of the femoral epiphyses and joint involvement were not detected on plain radiographs, and in four cases no abnormality was noted. MR imaging showed that at T1WI, affected bony lesions were of low signal intensity and enhaned, with high signal intensity at T2WI. In all cases, both metaphyseal and epiphyseal lesions were demonstrated at MRI, but in one of the three cases in which an epiphyseal lesion was seen at MRI, this was not detected at US. Sonography is

Sonographic evaluation of acute osteomyelitis in infants

Energy Technology Data Exchange (ETDEWEB)

Hwang, Ji Young; Lee, Sun Wha; Kim, Yoo Kyung [College of Medicine, Ewha Womans Univ., Seoul (Korea, Republic of)

2002-03-01

To analyze the related sonographic findings and to determine the value of sonography in establishing the diagnosis of acute osteomyelitis in infants. The sonographic findings of eleven infants aged 10 days-4 months (mean, 45 days) with acute osteomyelitis were retrospectively evaluated. The involved bones were the femur (n=5), humerus (n=2), tibia (n=2), rib(n=1), sternum (n=1), and calcaneus (n=1). Discontinuity or destruction of cortical margins, echotexture of the metaphysis and epiphysis, the presence of subperiosteal hypoechoic lesion, adjacent soft tissue swelling, distension of the joint capsule, the echotexture of joint effusion, and dislocation or subluxation of the involved joint were evaluated. The sonographic findings were compared with the plain radiographic (n=12) and MR (n=5) findings, with special attention to the identification of the metaphyseal or epiphyseal bony lesions and the involvement of adjacent joints. The sonographic findings of osteomyelitis were cortical discontinuity or destruction (n=12), hypoechoic lesions with an echogenic rim in the metaphysis (n=12), subperiosteal hypoechoic lesions (n=8), soft tissue swelling (n=9), a distended hip joint, with echogenic fluid (n=5), ill-demarcated echogenic lesions in the capital femoral epiphysis (n=5), and a subluxated hip joint (n=3). Plain radiographs revealed well or ill-defined osteolytic lesions in the metaphysis, accompanied by cortical destruction (n=8), new periosteal bone formation (n=3) and reactive sclerosis (n=2). Abnormality of the femoral epiphyses and joint involvement were not detected on plain radiographs, and in four cases no abnormality was noted. MR imaging showed that at T1WI, affected bony lesions were of low signal intensity and enhaned, with high signal intensity at T2WI. In all cases, both metaphyseal and epiphyseal lesions were demonstrated at MRI, but in one of the three cases in which an epiphyseal lesion was seen at MRI, this was not detected at US. Sonography is

Survey of bone pain in patients of infectious section of Labafinejad hospital using radioisotope scanning

International Nuclear Information System (INIS)

Ibrahimie, Farhad

1996-01-01

Skeletal scintigraphy is the first or second most frequently performed imaging procedure in most nuclear medicine departments. The uses of bone scan in orthopedic practice are multiple. Bone scans are often used to localize disease, to identify areas of focal increased physiological activity, and to evaluate pain. Bone scans are particularly useful in depicting and localizing small tumors. Bone scans may clarify the significance of radiographic abnormalities. When pain is poorly localized, a bone scan helps focus attention, particularly when it precisely corresponds to the questionable radiographic lesion. In order to do a survey about role of bone scan for the detection and localizing bone pain, a retrospective study was done about 37 patient who from 1373 to 1374 were admitted to the infectious department of Martyr Labafinejad having bone pain. The results of our studies showed that most common case of bone pain of this patients was due to brucellosis (brucella arthritis) with 19%, and other causes were cellulits with 13.15% osteomyelitis and D.J.D with 11%, septic arthritis, bone metastasis, bone abscesses, discopathy, infectious spondylitis, lymphoma, D.V.T. and reactive traumatic arthritis with 2.7%

The MRI appearances of early vertebral osteomyelitis and discitis

International Nuclear Information System (INIS)

Dunbar, J.A.T.; Sandoe, J.A.T.; Rao, A.S.; Crimmins, D.W.; Baig, W.; Rankine, J.J.

2010-01-01

Aim: To describe the magnetic resonance imaging (MRI) appearances in patients with a clinical history suggestive of vertebral osteomyelitis and discitis who underwent MRI very early in their clinical course. Materials and methods: A retrospective review of the database of spinal infections from a spinal microbiological liaison team was performed over a 2 year period to identify cases with clinical features suggestive of spinal infection and an MRI that did not show features typical of vertebral osteomyelitis and discitis. All patients had positive microbiology and a follow up MRI showing typical features of spinal infection. Results: In four cases the features typical of spinal infection were not evident at the initial MRI. In three cases there was very subtle endplate oedema associated with disc degeneration, which was interpreted as Modic type I degenerative endplate change. Intravenous antibiotic therapy was continued prior to repeat MRI examinations. The mean time to the repeat examination was 17 days with a range of 8-22 days. The second examinations clearly demonstrated vertebral osteomyelitis and discitis. Conclusion: Although MRI is the imaging method of choice for vertebral osteomyelitis and discitis in the early stages, it may show subtle, non-specific endplate subchondral changes; a repeat examination may be required to show the typical features.

A Rare Case of Cranial Osteomyelitis Caused by Proteus Vulgaris

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Hakan Uslu

2011-03-01

Full Text Available Osteomyelitis of the calvarial bones can cause serious complications such as brain abscess, due to the close proximity to adjacent brain structures. Development of the purulent secretion in surgery and traumatic scalp injuries must be considered as a possibility of osteomyelitis possibility. Generally gram positive, rarely gram negative bacteria and mix agents, can be isolated in infection. Especially chronic pyogenic osteomyelitis agents can be isolated from chronic infections such as tuberculosis. In cranial osteomyelitis diagnosis, radiological diagnosis has a very important place together with the clinical diagnosis. However, infection can usually show late findings radiologically. In treatment, antibiotic treatment is absolutely essential as well as removal of the infected part of the bone. Due to antibiotic treatment lasting between 6-12 weeks, organizing the antibiotic protocols according to the results of culture-antibiograms, which were provided from purulent secretions, has the most important role in the success of surgical treatment. In Proteus sp. infections, for choice of suitable treatment, determination of the type of bacteria is important. For exact diagnosis, histopathological examination of the bone tissue must be carried out. In this report, a case with cranial osteomyelitis caused by Proteus vulgaris which is a gram negative bacteria causing anaerobic infections and classified in the Enterobacteriaceae family is presented. The patient was treated with surgery and appropriate antibiotics. Early recognition of this condition, planning the best treatment strategy and taking precautions to prevent complications, is mandatory for a better outcome.

Optimal management of chronic osteomyelitis: current perspectives

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Pande KC

2015-08-01

Full Text Available Ketan C Pande Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BruneiAbstract: Chronic osteomyelitis is a challenging condition to treat. It is seen mostly after open fractures or in implant-related infections following treatment of fractures and prosthetic joint replacements. Recurrence of infection is well known, and successful treatment requires a multidisciplinary team approach with surgical debridement and appropriate antimicrobial therapy as the cornerstone of treatment. Staging of the disease and identification of the causative microorganism is essential before initiation of treatment. Important surgical steps include radical debridement of necrotic and devitalized tissue, removal of implants, management of resultant dead space, soft-tissue coverage, and skeletal stabilization or management of skeletal defects. The route of administration and duration of antimicrobial therapy continues to be debated. The role of biofilm is now clearly established in the chronicity of bone infection, and newer modalities are being developed to address various issues related to biofilm formation. The present review addresses various aspects of chronic osteomyelitis of long bones seen in adults, with a review of recent developments. Keywords: osteomyelitis, infection, biofilm, bone, therapy, treatment

Nocardia brasiliensis vertebral osteomyelitis and epidural abscess.

Science.gov (United States)

Johnson, Philip; Ammar, Hussam

2013-04-11

Nocardia species exist in the environment as a saprophyte; it is found worldwide in soil and decaying plant matter. They often infect patients with underlying immune compromise, pulmonary disease or history of trauma or surgery. The diagnosis of nocardiosis can be easily missed as it mimics many other granulomatous and neoplastic disease. We report a 69-year-old man who presented with chronic back pain and paraparesis. He was found to have Nocardial brasiliensis vertebral osteomyelitis and epidural abscess. Laminectomy and epidural wash out was performed but with no neurological recovery. This is the second reported case of N brasiliensis vertebral osteomyelitis in the literature.

The Role of Poly(ADP-ribose Polymerase-1 in Rheumatoid Arthritis

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Samuel García

2015-01-01

Full Text Available Poly(ADP-ribose polymerase-1 (PARP-1 is a nuclear enzyme with a crucial role in the maintenance of genomic stability. In addition to the role of PARP-1 in DNA repair, multiple studies have also demonstrated its involvement in several inflammatory diseases, such as septic shock, asthma, atherosclerosis, and stroke, as well as in cancer. In these diseases, the pharmacological inhibition of PARP-1 has shown a beneficial effect, suggesting that PARP-1 regulates their inflammatory processes. In recent years, we have studied the role of PARP-1 in rheumatoid arthritis, as have other researchers, and the results have shown that PARP-1 has an important function in the development of this disease. This review summarizes current knowledge on the effects of PARP-1 in rheumatoid arthritis.

Is Vancomycine Still a Choice for Chronic Osteomyelitis Empirical Therapy in Iran?

Science.gov (United States)

Izadi, Morteza; Zamani, Mohammad Mahdi; Mousavi, Seyed Ahmad; Sadat, Seyed Mir Mostafa; Siami, Zeinab; Vais Ahmadi, Noushin; Jonaidi Jafari, Nematollah; Shirvani, Shahram; Majidi Fard, Mojgan; Imani Fooladi, Abbas Ali

2012-01-01

Background Pyogenic bacteria and especially Staphylococcus aurous (S. aurous) are the most common cause of chronic osteomyelitis. Not only treatment protocol of chronic osteomyelitis occasionally is amiss but also this malady responds to treatment difficultly. Objectives This study investigates antibiotic resistance pattern of S. aurous isolated from Iranian patients who suffer from chronic osteomyelitis by two methods: disk diffusion (Kirby bauyer) and E-test (Epsilometer test) to find Vancomycin susceptibility and MIC (Minimum inhibitory concentration). Patients and Methods One hundred and thirty one patients who suffer from chronic osteomyelitis which have been referred to both governmental and private hospitals at 2010 were tried out for culturing of osteomyelitis site (sites). Antibiotic susceptibility and MIC of isolated bacteria were investigated by Kirby bauyer and E-test respectively. Results Samples were collected from bone (73.4%), surrounding tissue (14.6%) and wound discharge (12%). S. aureus was isolated from 49.6% of the samples. According to disc diffusion, methicillin resistance S. aureus (MRSA) was 75% and Vancomycin resistance S. aurous (VRSA) was 0% and based on MIC, MRSA was 68.5% and VRSA was 0%. According to MIC experiments, maximum sensitivity was against to Vancomycin (90.2%) and ciprofloxacin (54.4%) respectively but based on disc diffusion, maximum sensitivity was against to Vancomycin (97.7%) and ciprofloxacin (43.2%), respectively (P = 0.001). E-test (9.8%) in comparison with Disc diffusion (2.3%) showed higher percent of intermediate susceptibility to Vancomycin (P = 0.017). Conclusions Comparison of antibiograms and MICs showed that Kirby bauyer technique especially for detection of VISA strains is not reliable comparison with E-test. Already VRSA strains have not detected in Iranian chronic osteomyelitis, Thus Vancomycin is the first choice for chronic osteomyelitis empirical therapy in Iran yet. PMID:23483042

Should single-phase radionuclide bone imaging be used in suspected osteomyelitis

International Nuclear Information System (INIS)

Fihn, S.D.; Larson, E.B.; Nelp, W.B.; Rudd, T.G.; Gerber, F.H.

1984-01-01

The records of 69 patients who had 86 delayed, static radionuclide bone images for suspected osteomyelitis were studied to determine the effects of this procedure on diagnosis and treatment. Sensitivity, specificity, and positive predictive value were lower than reported in several other studies. When osteomyelitis was unlikely, imaging was either negative or falsely positive and rarely affected treatment. In 46 cases where osteomyelitis was more likely, imaging potentially changed therapy in 19 but was unhelpful or misleading in 15. Static-phase images with ''definite'' interpretations, particularly when negative, are specific, but ''equivocal'' studies may lead to diagnostic and therapeutic errors. When ostemyelitis is improbable, imaging rarely changes diagnosis or therapy

Acute Osteomyelitis as Cause of Late Sepsis in a Nigerian Neonate

African Journals Online (AJOL)

section delivery, significant jaundice, and systemic infections such as pneumonia or meningitis. Some important factors in the pathogenesis of osteomyelitis include the virulence of the .... Current imaging concepts in pediatric osteomyelitis. Eur Radiol 2004;14 Suppl 4:L55‑64. 15. Faust SN, Clark J, Pallett A, Clarke NM.

Chronic recurrent multifocal osteomyelitis (CRMO)

International Nuclear Information System (INIS)

Schilling, F.

1998-01-01

Chronic recurrent multifocal osteomyelitis (CRMO) is an unusual clinical entity. More than 200 cases are described in the literature and it is presented here with special reference to its radiological aspects. It is an acquired disease of the skeleton which occurs predominantly during childhood and adolescence. About ten per cent of cases begin in early or, rarely, in later adult life. This variant is described here for the first time and is discussed as 'adult CRMO'. The underlying pathology is a bland, predominantly lympho-plasma cellular osteomyelitis which is self-limiting and leads to bone sclerosis (Garre). It probably involves an abnormal immune process which follows an infection but remains clinically latent and remains aseptic and sterile. In a quarter of cases there is an association with pustulosis palmo-plantaris and its relationship with psoriatic arthropathy is discussed. The clinical, histopathological and imaging features (radiological and particularly MRT) and the bone changes are described. (orig./AJ) [de

VAC Therapy Direct to the Medullary Cavity for Chronic Tibial Osteomyelitis.

Science.gov (United States)

Miyamura, Satoshi; Tsuji, Shigeyoshi; Iwai, Takao; Hamada, Masayuki

2016-06-01

Vacuum-assisted wound closure (VAC) is useful for difficult wound beds, although sites where bleeding or infection is expected are usually regarded as problematic for this therapy. This report outlines the treatment of chronic tibial osteomyelitis (Cierny- Mader type III) due to mixed infection with Nocardia spp and Bacteroi- des fragilis by postoperative VAC therapy direct to the medullary cavity, followed by wound coverage with a gastrocnemius myocutaneous skin flap. A 64-year-old man developed chronic left tibial os- teomyelitis after a work injury. The nonviable tissues were debrided, including a sequestrum. Nocardia spp and B. fragilis were isolated from surgical bone specimens, and chronic tibial osteomyelitis due to mixed infection was diagnosed. Postoperatively, VAC therapy was performed directly to the open medullary cavity of the tibia and sub- sequently covered the residual soft tissue defect with a gastrocnemius myocutaneous flap. The authors could not find any English literature on VAC therapy direct to the medullary cavity combined with transplantation of a myocutaneous flap for osteomyelitis. Nocardia spp can cause a variety of infections, among which osteomyelitis occupies a relatively small percentage. This case raises the possibil- ity of treating chronic tibial osteomyelitis caused by mixed infection with Nocardia spp and B. fragilis by applying postoperative VAC ther- apy directly to the medullary cavity and covering the residual wound with a gastrocnemius myocutaneous flap.

Results of immunoscintigraphy of osteomyelitis (LeukoScan) trademark

International Nuclear Information System (INIS)

Gratz, S.; Becker, W.

2000-01-01

99mTc-labeled antigranulocyte monoclonal antibody Fab' fragments have shown a high sensitivity and specificity for detecting osteomyelitis in prospective studies. We retrospectively evaluated the use of LeukoScan trademark (Immunomedics, Morris Plains, N.J.) in clinical routine for the detection of bone and soft tissue infections and we want to present the results of our findings as well as some of the more interesting cases in this occasion. Imaging infection can be performed fast and easy with 99m Tc-Fab' fragments due to a fast targeting of infection and good background clearance, which increases in imaging quality. The application of 99m Tc-Fab' fragments gives good results in patients with bone and soft tissue infections of peripheral bones, as well as in patients with infected prostheses and infected arthritis. The use of 99m Tc-Fab' fragments should not be limited to these patients only, since good results can also be achieved in patients with infections of vascular grafts, of appendicitis and of endocarditis as well. A higher number of false-negative results has to be expected in case of subacute/chronic infections instead. Independent of the grade of infection acute/subacute infections of the spine always show 'cold lesions'. If cold lesions are used as guide for diagnosing a pathologic finding, an increase in sensitivity together with a decrease in specificity can be achieved. (orig.) [de

Septic tank additive impacts on microbial populations.

Science.gov (United States)

Pradhan, S; Hoover, M T; Clark, G H; Gumpertz, M; Wollum, A G; Cobb, C; Strock, J

2008-01-01

Environmental health specialists, other onsite wastewater professionals, scientists, and homeowners have questioned the effectiveness of septic tank additives. This paper describes an independent, third-party, field scale, research study of the effects of three liquid bacterial septic tank additives and a control (no additive) on septic tank microbial populations. Microbial populations were measured quarterly in a field study for 12 months in 48 full-size, functioning septic tanks. Bacterial populations in the 48 septic tanks were statistically analyzed with a mixed linear model. Additive effects were assessed for three septic tank maintenance levels (low, intermediate, and high). Dunnett's t-test for tank bacteria (alpha = .05) indicated that none of the treatments were significantly different, overall, from the control at the statistical level tested. In addition, the additives had no significant effects on septic tank bacterial populations at any of the septic tank maintenance levels. Additional controlled, field-based research iswarranted, however, to address additional additives and experimental conditions.

Osteomyelitis: a current challenge

Directory of Open Access Journals (Sweden)

Luciana Souza Jorge

Full Text Available Over the last 30 years, the pathogenesis of osteomyelitis has almost been totally elucidated, and many factors responsible for the persistence of this infection have been identified. Numerous antimicrobial agents with distinct spectrums of action, pharmacokinetics, and pharmacodynamics have been used in its treatment. Surgical techniques, including muscle grafts, the Ilizarov technique, and antibiotic bone cements, have been applied. However, bone infections are still a challenge. Despite the importance of isolation and identification of microorganisms to determine the antimicrobial treatment of bone infections, there are few systematic national studies about the etiological profile of these diseases. This article describes the current knowledge of osteomyelitis and summarizes published national data based on the experience of different Orthopedic and Traumatology Services. In general, S. aureus was described as an important etiological agent; however, the difference in design of national studies makes a comparison between the prevalence of bone infection, the associated risk factors, and the different therapeutic approaches difficult. In conclusion, effort is necessary in order to stimulate systematic national studies in different Orthopedics and Traumatology Services to obtain a better consensus on preventive measures and therapies of bone infections.

Characteristics of claims in the management of septic arthritis in Japan: Retrospective analyses of judicial precedents and closed claims.

Science.gov (United States)

Otaki, Yasuhiro; DaSilva, Makiko Ishida; Saito, Yuichi; Oyama, Yasuaki; Oiso, Giichiro; Yoshida, Tomohiko; Fukuhara, Masakazu; Moriyama, Mitsuru

2018-03-01

Septic arthritis (SA) cases can result in claims or litigation because of poor prognosis even if it is unavoidable. Although these claims or litigation are useful for understanding causes and background factors of medical errors, the characteristics of malpractice claims associated with SA remain undetermined in Japan. This study aimed to increase our understanding of malpractice claims in the clinical management of SA. We analyzed 6 civil precedents and 16 closed claims of SA from 8530 malpractice claims processed between July 2004 and June 2014 by the Tokyo office of Sompo Japan Nipponkoa Insurance, Incorporated. We also studied 5 accident and 21 incident reports of SA based on project data compiled by the Japan Council for Quality Health Care. The rate of negligence was 83.3% in the precedents and 75.0% in closed claims. Two main malpractice claim patterns were revealed: SA in a lower extremity joint following sepsis caused by methicillin-resistant Staphylococcus aureus in newborns and SA in an injection site following joint injection. These two patterns accounted for 83.3% and 56.3% of judicial cases and closed claim cases, respectively. Breakdowns in care process of accident and incident reports were clearly differentiated from judicial cases or closed claim cases (Fisher's exact test, p < 0.001). It is important to pay particular attention to SA following sepsis in newborns and to monitor for any signs of SA after joint injection to ensure early diagnosis. Analysis of both malpractice claims and accident and incident reports is essential to ensure a full understanding of the situation in Japan. Copyright © 2017. Published by Elsevier Taiwan LLC.

Multifocal, chronic osteomyelitis of unknown etiology

International Nuclear Information System (INIS)

Kozlowski, K.; Beluffi, G.; Feltham, C.; James, M.; Nespoli, L.; Tamaela, L.; Pavia Univ.; Municipal Hospital, Nelson; Medical School, Jakarta

1985-01-01

Four cases of multifocal osteomyelitis of unknown origin in childhood are reported. The variable clinical and radiographic appearances of the disease are illustrated and the diagnostic difficulties in the early stages of the disease are stressed. (orig.) [de

Radiation osteomyelitis of the mandible. Report of two cases

Energy Technology Data Exchange (ETDEWEB)

Molla, M.R.; Nishio, Juntaro; Matsuya, Tokuzo; Miyazaki, Tadashi (Osaka Univ. (Japan). School of Dentistry)

1982-12-01

Radiation therapy for the head and neck malignant tumor may often cause osteoradionecrosis of the mandible, leading to radiation osteomyelitis with a source of infection. The present study demonstrates two cases with radiation osteomyelitis of the mandible to discuss the etiology, radiological findings and preventive measure for this type of bone disease. The results indicate that, 1) A higher dose in external radiotherapy may claimed to be a potent factor to cause osteoradionecrosis and post irradiation periodontitis of the tooth associated with pain, may be preliminary symptom of leading radiation osteomyelitis, where a delayed healing of tooth extraction is an accelerating factor responsible for rapid progress of osteomyelitic changes. 2) Once infection sets in post irradiated bone, radio-osteomyelitic change is quite progressive even after various conservative measure. 3) Only radiological change in those cases is a slow formation of sequestrum time ranging from 7 to 10 months, with a gradual separation of dead bone as a large mass.

Spectrum of musculo-skeletal disorders in sickle cell disease in Lagos, Nigeria

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Ogo Chidiebere N

2010-01-01

Full Text Available Abstract Background Sickle cell anemia (SCA is a common genetic disease in Nigeria. Past studies from West Africa focused on isolated aspects of its medical and surgical presentations. To the best of our knowledge, the musculo-skeletal presentations amongst Nigerians with SCA have not been documented in a single all encompassing study. This work aims to prospectively document the musculo-skeletal disease burden among SCA patients. Methods In a prospective study of 318 consecutive patients with genotype-confirmed SCA at the Lagos University Teaching Hospital (LUTH, the musculo-skeletal pathologies, anatomic sites, grade of disease, age at presentation and management outcome were recorded over a one-year period. Data obtained were analyzed using Epi-Info software version 6.0. Data are presented as frequencies (% and mean values (SD as appropriate. Results The HbSS genotype occurred in 296 (93.0%, while 22 (7.0% were HbSC. 100 (31.4% patients with average presenting haemoglobin concentration of 8.2 g/100 ml in the study group, presented with 131 musculo-skeletal pathologies in 118 anatomic sites. Osteomyelitis 31 (31% and septic arthritis 19 (19% were most commonly observed in children less than 10 years. Skin ulcers and avascular necrosis (AVN occurred predominantly in the older age groups, with frequencies of 13 (13.0% and 26 (26.0% respectively. 20 (71.5% of diagnosed cases of AVN presented with radiological grade 4 disease. The lower limbs were involved in 84 (71.1% of sites affected. Lesions involving the spine were rare 11 (0.9%. Multiple presentations occurred in 89 (28.0% of patients; 62 (69.7% of which were children below 10 years. Conclusions Musculo-skeletal complications are common features of sickle cell anaemia seen in 31.4%. Infectious aetiologies predominate with long bones and joints of lower limbs more commonly affected by osteomyelitis and septic arthritis. Healthcare providers managing SCA should be aware of the potential

Jaw Osteomyelitis as a Complication of Sickle Cell Anaemia in Three Omani Patients; Case reports and literature review

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Hilal Al-Ismaili

2017-03-01

Full Text Available Sickle cell anaemia (SCA is a common haemoglobinopathy among people from the Middle East, the Afro-Caribbean region, the Mediterranean and East India. While osteomyelitis of the long bones is a welldocumented complication of SCA, there are few documented cases of SCA patients presenting with jaw osteomyelitis. We report three SCA patients with chronic jaw osteomyelitis who presented to the Department of Oral Health, Sultan Qaboos University Hospital, Muscat, Oman, between 2009 and 2013. Two of the patients had osteomyelitis of the mandible and the third had osteomyelitis of the maxilla. In addition, a brief review of the literature is presented focusing on the clinical presentation, diagnosis and management of jaw osteomyelitis among patients with SCA.

Hip Synovial Fluid Cell Counts in Children From a Lyme Disease Endemic Area.

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Dart, Arianna H; Michelson, Kenneth A; Aronson, Paul L; Garro, Aris C; Lee, Thomas J; Glerum, Kimberly M; Nigrovic, Peter A; Kocher, Mininder S; Bachur, Richard G; Nigrovic, Lise E

2018-05-01

Patients with septic hip arthritis require surgical drainage, but they can be difficult to distinguish from patients with Lyme arthritis. The ability of synovial fluid white blood cell (WBC) counts to help discriminate between septic and Lyme arthritis of the hip has not been investigated. We assembled a retrospective cohort of patients ≤21 years of age with hip monoarticular arthritis and a synovial fluid culture obtained who presented to 1 of 3 emergency departments located in Lyme disease endemic areas. Septic arthritis was defined as a positive synovial fluid culture result or synovial fluid pleocytosis (WBC count ≥50 000 cells per µL) with a positive blood culture result. Lyme arthritis was defined as positive 2-tiered Lyme disease serology results and negative synovial fluid bacterial culture results. All other patients were classified as having other arthritis. We compared median synovial fluid WBC counts by arthritis type. Of the 238 eligible patients, 26 (11%) had septic arthritis, 32 (13%) had Lyme arthritis, and 180 (76%) had other arthritis. Patients with septic arthritis had a higher median synovial fluid WBC count (126 130 cells per µL; interquartile range 83 303-209 332 cells per µL) than patients with Lyme arthritis (53 955 cells per µL; interquartile range 33 789-73 375 cells per µL). Eighteen patients (56%) with Lyme arthritis had synovial fluid WBC counts ≥50 000 cells per µL. Of the 94 patients who underwent surgical drainage, 13 were later diagnosed with Lyme arthritis. In Lyme disease endemic areas, synovial fluid WBC counts cannot always help differentiate septic from Lyme arthritis. Rapid Lyme diagnostics could help avoid unnecessary operative procedures in patients with Lyme arthritis. Copyright © 2018 by the American Academy of Pediatrics.

Gout: radiographic findings mimicking infection

International Nuclear Information System (INIS)

Rousseau, I.; Raymond-Tremblay, D.; Cardinal, E.; Beauregard, C.G.; Braunstein, E.M.; Saint-Pierre, A.

2001-01-01

Objective: To describe radiographic features of gout that may mimic infection. Design and patients: We report five patients with acute bacterial gout who presented with clinical as well as radiological findings mimicking acute bacterial septic arthritis or osteomyelitis. Three patients had delay in the appropriate treatment with the final diagnosis being established after needle aspiration and identification of urate crystals under polarized light microscopy. Two patients underwent digit amputation for not responding to antibiotic treatment and had histological findings confirming the diagnosis of gout. Conclusion: It is important for the radiologist to be aware of the radiological manifestations of acute gout that can resemble infection in order to avoid inappropriate diagnosis and delay in adequate treatment. The definitive diagnosis should rely on needle aspiration and a specific search for urate crystals. (orig.)

The multifaceted presentation of chronic recurrent multifocal osteomyelitis

DEFF Research Database (Denmark)

Girschick, Hermann; Finetti, Martina; Orlando, Francesca

2018-01-01

Objectives: Chronic non-bacterial osteomyelitis (CNO) or chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disorder characterized by sterile bone osteolytic lesions. The aim of this study was to evaluate the demographic data and clinical, instrumental and therapeutic features...... with glucocorticoids, 61 with bisphosphonates, 58 with MTX, 47 with SSZ, 26 with anti-TNF and 4 with anakinra, with a variable response. Conclusion: This is the largest reported case series of CNO patients, showing that the range of associated clinical manifestations is rather heterogeneous. The study confirms...... that the disease usually presents with an early teenage onset, but it may also occur in adults, even in the absence of mucocutaneous manifestations....

A Rare Case of Clavicle Osteomyelitis in a Child and Literature Review

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Elisavet-Anna Chrysochoou

2016-01-01

Full Text Available Acute clavicle osteomyelitis in children is rare representing <3% of osteomyelitis cases. We treated a 12-year-old boy who presented with acute pain in the right clavicle and high fever for 4 days. MRI showed abnormal signal in the right clavicle with periosteal reaction. Staphylococcus aureus isolated from blood was susceptible to methicillin, clindamycin, and macrolides. Clindamycin was given intravenously for 3 wks and orally for another 3 wks with no recurrence. We reviewed clavicle osteomyelitis cases in children searching PubMed English literature. From a total of 89 studies retrieved, only 6 fulfilled the criteria and were analyzed. Sixteen patients (56% female were included with a median age of 9 yrs (range 2 wks–16 yrs. Osteomyelitis was hematogenous in most cases, with S. aureus being the most frequent cause, isolated from either blood or tissue. Symptoms included fever, swelling, and localized bone tenderness. Antimicrobial therapy lasted for 4–12 weeks (median 7.5. Three patients required drainage or curettage. Recurrence occurred in 1/16 cases (6.2% and persistence of symptoms occurred to 2/16 cases (12.5% reported before 90s with unknown antimicrobial susceptibility of the pathogen. Acute clavicle osteomyelitis mainly affects older children and has generally good prognosis. Staphylococcus aureus is most commonly implicated and surgery may be needed.

Magnetic resonance imaging features of hip disorders in an Egyptian pediatric population

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Y. Ragab

2015-09-01

Full Text Available Hip disorders in a pediatric population are a diagnostic challenge. The aim of the study is to assess the role of magnetic resonance imaging (MRI in the evaluation of non-traumatic hip disorders in a series of Egyptian patients and to review the literature on the most common hip conditions. Seventy two consecutive patients [40 males (55.6% and 32 females (44.4] with acute onset of hip complaints unrelated to trauma or falls were recruited. All patients underwent an initial full clinical assessment and blood tests as well as contrast enhanced MRI of both hips. The most common diagnosis in this group of Egyptian patients was transient synovitis in 29 (40.3% cases, followed by seronegative enthesopathy and arthropathy syndrome in 8 (11.1%, septic arthritis in 10 (13.9%, tuberculous arthritis in 4 (5.6%, sickle-cell disease in 7 (9.7%, complicated with septic arthritis in 3 (4.2%, transient bone marrow edema (BME in 3 (4.2%, osteomyelitis in 2 (2.8%, osteosarcoma in 2 (2.8%, sciatic nerve injury in 1 (1.4%, leukemia with BME in 1 (1.4%, coxa vara of both hips and L5/S1 facet joint ankylosis in 1 (1.4%, and a benign bone cyst in 1 (1.4%. MRI studies showed hip effusion in a total of 51 patients (70.8%, joint space narrowing in 9 (12.5%, and BME in 15(20.8%. MRI is a sensitive tool for assessing hip disorders in a pediatric population and can play an important role in both diagnosis and management of different hip disorders, irrespective of the underlying pathology.

Acute Osteomyelitis of the Symphysis Pubis after Inguinal Hernia Surgery

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Recep Tekin

2015-01-01

Full Text Available Osteomyelitis of pubic symphysis is infectious inflammatory condition of the symphysis pubis and rare complication of surgery around inguinal and groin region. It should be kept in mind in the differential diagnosis of lower pelvic pain and should be sought in cases of pelvic insufficiency fractures. Herein, we present a case of a 55-year-old man with osteomyelitis of the symphysis pubis following inguinal hernia surgery for diagnosis and management of this rare condition.

A case of osteomyelitis of mandibular bone in Kimura's disease

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Kinugawa, Hiroshi; Shimada, Fumihiko; Sai, Yoshikazu; Amakata, Yoshikuni; Yoshitake, Kazusada [Shiga Univ. of Medical Science, Otsu (Japan)

1991-07-01

We experienced a case of osteomyelitis of mandibular bone in Kimura's disease. The patient received radiation therapy to head and neck area against the same disease. Bone tissue which received radiation therapy had developed malnutrition as side effect of radiation, and osteomyelitis was induced by infection from the teeth. Even in the benign soft tissue disease like Kimura's disease, especially after radiation therapy, pathologic fracture of bone may happen due to bone damage caused by radiation. (author).

Alterations to Bone Mineral Composition as an Early Indication of Osteomyelitis in the Diabetic Foot

OpenAIRE

Esmonde-White, Karen A.; Esmonde-White, Francis W.L.; Holmes, Crystal M.; Morris, Michael D.; Roessler, Blake J.

2013-01-01

OBJECTIVE Osteomyelitis in the diabetic foot is a major risk factor for amputation, but there is a limited understanding of early-stage infection, impeding limb-preserving diagnoses. We hypothesized that bone composition measurements provide insight into the early pathophysiology of diabetic osteomyelitis. RESEARCH DESIGN AND METHODS Compositional analysis by Raman spectroscopy was performed on bone specimens from patients with a clinical diagnosis of osteomyelitis in the foot requiring surgi...

A case of radiation ulcer of chest wall with osteomyelitis

International Nuclear Information System (INIS)

Baba, Kyoko; Shibata, Hirotatsu; Mouri, Mari; Uchinuma, Eiju

2005-01-01

We report a case of anterior chest skin ulcer with rib and sternum osteomyelitis following radiation therapy for post operative mammary carcinoma. Operation was performed six times including debridement with sternum and rib resection reconstruction and skin grafting. It took about one and a half years after first operation to heal the ulcer with osteomyelitis. Principle of treatment for radiation ulcer accompanied by osteomyelitis is complete resection of the damaged lesion. However, it is difficult to evaluate the exact area of the damaged lesion. Therefore it is not rare to repeat its recurrence and have trouble with its treatment. In this case, it was considered that the resected area was insufficient on the initial operation. In order to treat for radiation ulcers accompanied by osteomyelitis, enough resection of the damaged lesion in the initial operation is necessary. Ultimately, in our case, the resection of all sternum, part of the right second to fifth rib and part of left second to seventh rib was necessary. It is generally said that reconstructing bone structure is required in the case of wide defect of chest wall. Though, we did not perform reconstruction of the bone structures, there is no problem in the condition of respiratory system. The surrounding soft tissues changed to hard enough to avoid paradoxical breathing. (author)

Congenital multifocal osteomyelitis at 24 weeks' gestation

International Nuclear Information System (INIS)

Raupp, Peter; Shubbar, Adil; Baichoo, Vijaymani; Samson, Gregory

2007-01-01

We report an extremely rare case of congenital nonsyphilitic osteomyelitis in a very preterm infant, providing a unique illustration of the radiological appearances at birth, which may serve as a reference to facilitate diagnosis. (orig.)

Salmonella osteomyelitis by sickle cell anemia

International Nuclear Information System (INIS)

Rausch, H.; Tran, V.T.; Boeckmann, U.; Duesseldorf Univ.

1985-01-01

Case report of a 28 year old black sickle cell anemia patient with salmonella osteomyelitis of the radius. Aside from sickle cell anemia patients this skeletal complication of enteric salmonellosis is an extreme rarity. Description of the typical roentgenological features includes intracortical fissures and sequestration. (orig.) [de

Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline

International Nuclear Information System (INIS)

Newman, L.G.; Waller, J.; Palestro, C.J.; Schwartz, M.; Klein, M.J.; Hermann, G.; Harrington, E.; Harrington, M.; Roman, S.H.; Stagnaro-Green, A.

1991-01-01

The prevalence of osteomyelitis in diabetic foot ulcers is unknown. Early diagnosis of this infection is critical, as prompt antibiotic treatment decreases the rate of amputation. The authors therefore assessed the prevalence of osteomyelitis in 35 diabetic patients with 41 foot ulcers. They compared results of roentgenograms, leukocyte scans with indium In 111 oxyquinoline, and bone scans with the diagnostic criterion standards of bone histologic and culture findings. Leukocyte scans were repeated at 2- to 3-week intervals during antibiotic treatment. Consecutive samples were obtained from 54 diabetic patients. Thirty-five patients with 41 foot ulcers were included. As determined by bone biopsy and culture, osteomyelitis was found to underlie 28 (68%) of 41 diabetic foot ulcers. Only nine (32%) of the 28 cases were diagnosed clinically by the referring physician. Underscoring the clinically silent nature of osteomyelitis in these ulcers, 19 (68%) of 28 occurred in outpatients, 19 (68%) of 28 occurred in ulcers not exposing bone, and 18 (64%) of 28 had no evidence of inflammation on physical examination. All patients with ulcers that exposed bone had osteomyelitis. Of the imaging tests, the leukocyte scan had the highest sensitivity, 89%. In patients with osteomyelitis, the leukocyte scan image intensity decreased by 16 to 34 days of antibiotic treatment and normalized by 36 to 54 days. The majority of diabetic foot ulcers have an underlying osteomyelitis that is clinically unsuspected. Leukocyte scans are highly sensitive for diagnosing osteomyelitis in diabetic foot ulcers and may be useful for monitoring the efficacy of antibiotic treatment. The recommend that diabetic patients with foot ulcers that expose bone should be treated for osteomyelitis

Prevotella osteomyelitis after dental capping procedure

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Alexander Williams

2017-01-01

Full Text Available We present a 49 year old man who presented to the emergency department with severe lower back pain of 5 days duration. One week prior he had been diagnosed with a right psoas muscle abscess and was discharged with a 28 day course of moxifloxacin after the preliminary culture from the psoas grew an anaerobic organism. MRI of the lumbar spine showed marrow edema in the L2 body, occupying most of the anterior two thirds of the body, with cortical erosion at the anteroinferior aspect of L1. Blood cultures were negative and bone biopsy of L2 showed neutrophilic invasion and reactive changes. Cultures grew Prevotella oralis. Hematogenous spread from a composite bonding procedure for exposed teeth roots is thought to be the source for the vertebral osteomyelitis. This is a plausible spread of infection in our case because it was thought that the osteomyelitis occurred first and spread to the psoas muscle.

Actinomycetes as the causative organism of osteomyelitis in sickle cell disease

International Nuclear Information System (INIS)

Barter, S.J.; Hennessy, O.

1984-01-01

The case of a 17-year-old girl with sickle cell anaemia who presented with extensive osteomyelitis due to actinomycetes is reported. Osteomyelitis in the long bones due to actinomycosis is extremely rare. A review of the literature reveals only six cases in which actinomycetes have been isolated from lesions affecting a long bone. The occurence of this condition in sickle cell haemoglobinopathy has not been previously reported. (orig.)

Maxillary Chronic Osteomyelitis Caused by Domestic Violence: A Diagnostic Challenge

Science.gov (United States)

Oliveira, Tamyris Inácio; de Carli, Marina Lara; Ribeiro Junior, Noé Vital; Pereira, Alessandro Antônio Costa; Tatakis, Dimitris N.; Hanemann, João Adolfo Costa

2014-01-01

Maxillary osteomyelitis is a rare condition defined as inflammation of the bone primarily caused by odontogenic bacteria, with trauma being the second leading cause. The present report documents a rare case of maxillary osteomyelitis in a 38-year-old female who was the victim of domestic violence approximately a year prior to presentation. Intraoral examination revealed a lesion appearing as exposed bony sequestrum, with significant destruction of gingiva and alveolar mucosa in the maxillary right quadrant, accompanied by significant pain, local edema, and continued purulence. Teeth numbers 11, 12, 13, 14, and 15 were mobile, not responsive to percussion, and nonvital. Treatment included antibiotic therapy for seven days followed by total enucleation of the necrotic bone tissue and extraction of the involved teeth. Microscopic findings confirmed the clinical diagnosis of chronic suppurative osteomyelitis. Six months postoperatively, the treated area presented complete healing and there was no sign of recurrence of the lesion. PMID:25610667

Maxillary Chronic Osteomyelitis Caused by Domestic Violence: A Diagnostic Challenge

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Tamyris Inácio Oliveira

2014-01-01

Full Text Available Maxillary osteomyelitis is a rare condition defined as inflammation of the bone primarily caused by odontogenic bacteria, with trauma being the second leading cause. The present report documents a rare case of maxillary osteomyelitis in a 38-year-old female who was the victim of domestic violence approximately a year prior to presentation. Intraoral examination revealed a lesion appearing as exposed bony sequestrum, with significant destruction of gingiva and alveolar mucosa in the maxillary right quadrant, accompanied by significant pain, local edema, and continued purulence. Teeth numbers 11, 12, 13, 14, and 15 were mobile, not responsive to percussion, and nonvital. Treatment included antibiotic therapy for seven days followed by total enucleation of the necrotic bone tissue and extraction of the involved teeth. Microscopic findings confirmed the clinical diagnosis of chronic suppurative osteomyelitis. Six months postoperatively, the treated area presented complete healing and there was no sign of recurrence of the lesion.

Septic trochanteric bursitis in an adolescent.

Science.gov (United States)

Makki, Daoud; Watson, Alex James

2010-01-01

Trochanteric bursitis, whether septic or inflammatory in origin, is a condition that affects middle-aged patients. Here we report the rare case of an adolescent with septic trochanteric bursitis (treated successfully with intravenous antibiotics), review the available literature on septic bursitis, illustrate the importance of prompt recognition and treatment of this condition in any age group, and describe the clinical presentation and the radiologic findings.

MR findings of squamous cell carcinoma arising from chronic osteomyelitis of the tibia: A case report

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Han, Dong Hwa; Lee, Ji Hae; Cho, Woo Ho; Kim, Jae Hyung; Jeong, Myeong Ja; Kim, Soung Hee; Kim, Ji Young; Kim, Soo Hyun; Kang, Mi Jin; Bae, Kyung Eun [Dept. of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

2016-05-15

Malignant transformation is a rare and late complication of untreated chronic osteomyelitis. Known radiographic findings of the malignant transformation of chronic osteomyelitis are osteolytic or mixed sclerotic and osteolytic lesions with or without soft tissue mass. But its magnetic resonance (MR) imaging findings are rarely described in the literature. We experienced a case of an 82-year-old man diagnosed with squamous cell carcinoma arising from long standing chronic osteomyelitis of the tibia. Our case indicates that radiologists should consider the possibility of malignant transformation in patients with untreated chronic osteomyelitis, with enhancing soft tissue mass invading and extending through underlying bone cortex and medulla on MR imaging.

FDG PET/CT imaging in the diagnosis of osteomyelitis in the diabetic foot

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Kagna, Olga; Keidar, Zohar [Rambam Health Care Campus, Department of Nuclear Medicine, POB 9602, Haifa (Israel); Srour, Saher; Militianu, Daniela [Rambam Health Care Campus, Department of Diagnostic Imaging, Haifa (Israel); Melamed, Eyal [Rambam Health Care Campus, Department of Orthopedics, Haifa (Israel)

2012-10-15

Osteomyelitis, the most serious complication of the diabetic foot, occurs in about 20 % of patients. Early diagnosis is crucial. Appropriate treatment will avoid or decrease the likelihood of amputation. The objective of this study was to assess the value of FDG PET/CT in diabetic patients with clinically suspected osteomyelitis. Enrolled in this prospective study were 39 consecutive diabetic patients (29 men and 10 women, mean age 57 years, range 28-71 years) with 46 suspected sites of foot infection. Of these 39 patients, 38 had type 2 and 1 type 1 diabetes for 4-25 years, and 28 were receiving treatment with insulin. FDG PET/CT was interpreted for the presence, intensity (SUVmax) and localization of increased FDG foci. Final diagnosis was based on histopathology and bacteriology of surgical samples, or clinical and imaging follow-up. Osteomyelitis was correctly diagnosed in 18 and excluded in 21 sites. Of 20 lesions with focal bone FDG uptake, 2 were false-positive with no further evidence of osteomyelitis. Five sites of diffuse FDG uptake involving more than one bone on CT were correctly diagnosed as diabetic osteoarthropathy. FDG PET/CT had a sensitivity, specificity and accuracy of 100 %, 92 % and 95 % in a patient-based analysis and 100 %, 93 % and 96 % in a lesion-based analysis, respectively, for the diagnosis of osteomyelitis in the diabetic foot. FDG PET/CT was found to have high performance indices for evaluation of the diabetic foot. The PET component identified FDG-avid foci in sites of acute infection which were precisely localized on fused PET/CT images allowing correct differentiation between osteomyelitis and soft-tissue infection. (orig.)

FDG PET/CT imaging in the diagnosis of osteomyelitis in the diabetic foot

International Nuclear Information System (INIS)

Kagna, Olga; Keidar, Zohar; Srour, Saher; Militianu, Daniela; Melamed, Eyal

2012-01-01

Osteomyelitis, the most serious complication of the diabetic foot, occurs in about 20 % of patients. Early diagnosis is crucial. Appropriate treatment will avoid or decrease the likelihood of amputation. The objective of this study was to assess the value of FDG PET/CT in diabetic patients with clinically suspected osteomyelitis. Enrolled in this prospective study were 39 consecutive diabetic patients (29 men and 10 women, mean age 57 years, range 28-71 years) with 46 suspected sites of foot infection. Of these 39 patients, 38 had type 2 and 1 type 1 diabetes for 4-25 years, and 28 were receiving treatment with insulin. FDG PET/CT was interpreted for the presence, intensity (SUVmax) and localization of increased FDG foci. Final diagnosis was based on histopathology and bacteriology of surgical samples, or clinical and imaging follow-up. Osteomyelitis was correctly diagnosed in 18 and excluded in 21 sites. Of 20 lesions with focal bone FDG uptake, 2 were false-positive with no further evidence of osteomyelitis. Five sites of diffuse FDG uptake involving more than one bone on CT were correctly diagnosed as diabetic osteoarthropathy. FDG PET/CT had a sensitivity, specificity and accuracy of 100 %, 92 % and 95 % in a patient-based analysis and 100 %, 93 % and 96 % in a lesion-based analysis, respectively, for the diagnosis of osteomyelitis in the diabetic foot. FDG PET/CT was found to have high performance indices for evaluation of the diabetic foot. The PET component identified FDG-avid foci in sites of acute infection which were precisely localized on fused PET/CT images allowing correct differentiation between osteomyelitis and soft-tissue infection. (orig.)

Temporal Bone Osteomyelitis: The Relationship with Malignant Otitis Externa, the Diagnostic Dilemma, and Changing Trends

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Jia-Cheng Chen

2014-01-01

Full Text Available Fifty-five patients hospitalized for osteomyelitis of the temporal bone between 1990 and 2011 were divided into two study groups: group 1 was patients collected from 1990 to 2001 and group 2 was composed of patients between 2002 and 2011. Clinical diagnostic criteria and epidemiologic data were analyzed to illustrate the altering features of osteomyelitis of the temporal bone. Group 1 patients were characterized by high prevalence of diabetes and more commonly suffered from otalgia, otitis externa and granulation tissue in the external auditory canal and higher positive culture for Pseudomonas aeruginosa. Noticeable changing trends were found between both groups, including declining prevalence of diabetes, fewer patients complaining of pain or presenting with otitis externa, and canal granulation, and increased variety of pathogens in group 2. We should highlight the index of clinical suspicion for osteomyelitis of the temporal bone, even in nondiabetic or immunocompetent patients. Painless otorrhea patients were also at risk of osteomyelitis of the temporal bone, especially patients with previous otologic operation. Increased multiplicity of pathogens amplified the difficulty of diagnosis for osteomyelitis of the temporal bone.

Septic bursitis in immunocompromised patients.

Science.gov (United States)

Roschmann, R A; Bell, C L

1987-10-01

A retrospective analysis of 29 patients with septic bursitis was undertaken to ascertain if immunocompromised patients differed in their clinical presentations, type of organisms cultured, and outcome when compared with their non-immunocompromised cohorts. Thirty episodes of septic bursitis occurred in 29 patients, 43 percent of which occurred in immunocompromised patients. Despite similar clinical presentations, the bursae of immunocompromised patients took three times longer to sterilize and had a much higher bursal white blood cell count when compared with the bursae of non-immunocompromised patients. The bacteriologic spectrum was essentially identical in both groups; there were no cases in which gram-negative organisms were recovered from infected bursae. No cases of septic bursitis were seen in neutropenic patients. The most common factors contributing to an immunocompromised state were alcoholism or steroid therapy. A successful resolution of septic bursitis was seen in all the patients in the immunocompromised groups.

Study on the hard tissue changes in osteomyelitis of the jaws using CT image

International Nuclear Information System (INIS)

An, Chang Hyeon; Choi, Bo Ram; Huh, Kyung Hoe; Yi, Won Jin; Lee, Sam Sun; Choi, Soon Chul

2009-01-01

To assess the clinical findings and hard tissue changes of osteomyelitis of the jaws using computed tomographic (CT) image analysis. We reviewed and interpreted the CT images of 163 patients (64 males and 99 females, age range from 10 to 87 years) who visited the Seoul National University Dental Hospital from April 23, 2006 to December 31, 2008 and were diagnosed as osteomyelitis of the jaws through clinical, radiologic, and histopathologic examination. Each CT findings was investigated for frequency, correlation with age and gender. Of the 163 patients, 31 (19.0%) were affected on the maxilla, 135 (82.8%) were affected on the mandible, and 3 (1.8%) were affected on the both jaws simultaneously. The mean age of the patients who were affected on the maxilla was 61.0 years and that of the patients who were affected on the mandible was 56.2 years. On the maxilla, the most frequent site of disease was the posterior area (83.9%) and on the mandible, mandibular body (83.0%), followed by angle (48.1%), ramus (38.5%), condyle (13.3%), incisal area (9.6%), and coronoid process (3.0%). Among the 31 maxillary osteomyelitis, defect in the trabecular bone was observed in 28 (90.3%), osteosclerosis 20 (64.5%), defect in the cortical bone 27 (87.1%), sequestrum 17 (54.8%), and periosteal reaction 2 (6.5%). Among the 135 mandibular osteomyelitis, defect in the trabecular bone was observed in 100 (74.1%), osteosclerosis 104 (77.0%), defect in the cortical bone 116 (85.9%), sequestrum 36 (26.7%), and periosteal reaction 67 (49.6%). Of our cases, the maxillary osteomyelitis was visibly observed more frequently in females than males. The incidence is the highest in seventies (28.8%) and the lowest in teens (3.1%). The osteomyelitis of the jaws was observed more frequently in males than females before the age of 50, and observed more frequently in females after the age of 50. The most noticeable point was that the sequestrum was observed more often on maxillary osteomyelitis and the

Medical Imaging in Differentiating the Diabetic Charcot Foot from Osteomyelitis.

Science.gov (United States)

Short, Daniel J; Zgonis, Thomas

2017-01-01

Diabetic Charcot neuroarthropathy (DCN) poses a great challenge to diagnose in the early stages and when plain radiographs do not depict any initial signs of osseous fragmentation or dislocation in a setting of a high clinical index of suspicion. Medical imaging, including magnetic resonance imaging, computed tomography, and advanced bone scintigraphy, has its own unique clinical indications when treating the DCN with or without concomitant osteomyelitis. This article reviews different clinical case scenarios for choosing the most accurate medical imaging in differentiating DCN from osteomyelitis. Copyright © 2016 Elsevier Inc. All rights reserved.

Non-Bacterial Chronic Recurrent Osteomyelitis of the Clavicle

Directory of Open Access Journals (Sweden)

KL Pan

2012-03-01

Full Text Available This report details the case of a 12-year-old girl with a painful, progressive swelling of the medial portion of the clavicle with no history of trauma or other constitutional symptoms. All laboratory investigations were normal except for an elevated erythrocyte sedimentation rate (ESR. Initial plain radiographs showed a destructive lesion with magnetic resonance imaging showing features of malignancy. Biopsies revealed osteomyelitis, but with negative bacterial cultures and no evidence of malignancy. Treatment with antibiotics did not result in a favourable response. Over time, the swelling increased in size with episodic exacerbations of pain. Follow-up radiographs showed sclerosis and hyperostosis. After five years, this was recognized as non-bacterial chronic recurrent osteomyelitis of the clavicle.

Alterations of blood serum parameters in patients with chronic hematogenous osteomyelitis

Institute of Scientific and Technical Information of China (English)

Sadrudin Magomedov; Larisa Polishchuk

2015-01-01

Objective:To examine metabolic disorders of major components of organic basis of bone tissue in patients with chronic hematogenous osteomyelitis and response to surgical treatment. Methods: The cubital vein puncture was conducted to take blood for analysis in patients with chronic hematogenous osteomyelitis. The activity of collagenase and hyaluronidase, elastin, elastase and total content of glycosaminoglycans were measured in blood serum. Results: The study revealed an enhancement of catabolic phase of metabolism of the main components in bone organic matrix during the relapse of inflammation. It was evidenced by indicators reflecting the synthetic and catabolic phases of the main components of the connective tissue collagen and glycosaminoglycans. The effective therapeutic treatments led to the reduction and normalization of studied compounds. Conclusions: The initial development of hematogenous osteomyelitis happens in a background of metabolic disorders of the main components of organic matrix of bone tissue, and normalizes upon effective therapy.

Osteomyelitis of sternum and rib after breast prosthesis implantation: A rare or underestimated infection?

Directory of Open Access Journals (Sweden)

Piseth Seng

2015-01-01

Full Text Available Sternum and rib osteomyelitis complicated from breast implant infection is rare. We report a case of early sternum and rib osteomyelitis occurred during breast implant infection managed in an inter-regional referral center for bone/joint infections in the south of France.

Cryptococcal osteomyelitis: a report of 5 cases and a review of the recent literature.

Science.gov (United States)

Medaris, Leigh Ann; Ponce, Brent; Hyde, Zane; Delgado, Dennis; Ennis, David; Lapidus, William; Larrison, Matthew; Pappas, Peter G

2016-06-01

Cryptococcus neoformans is a fungal pathogen associated with advanced HIV disease and other disorders associated with immune dysfunction. The pulmonary and the central nervous system are the most common manifestations of the disease. Localised osteomyelitis as the sole manifestation of extrapulmonary disease is rare. Herein, we present five cases of Cryptococcus osteomyelitis as the only manifestation of extrapulmonary disease. We also identified 84 additional cases of isolated cryptococcal osteomyelitis in the literature. Using these data, we have made some general recommendations regarding an approach to treatment of this uncommon clinical entity. © 2016 Blackwell Verlag GmbH.

A Case of Invasive Pneumococcal Infection with Septic Shock and Rare Complications

Directory of Open Access Journals (Sweden)

John R. Woytanowski

2017-01-01

Full Text Available Invasive pneumococcus is a serious illness with potentially devastating outcomes. A 64-year-old female with a medical history of psoriatic arthritis and diabetes was transferred from an outside hospital for ventilator dependent respiratory failure and altered mental status. She initially presented with worsening back pain and was found to have leukocytosis with bandemia and acute renal failure but she was in septic shock upon arrival to our tertiary care center. Her blood cultures grew Streptococcus pneumoniae and MRI of the brain revealed pus within the posterior lateral ventricles and multiple infarcts. MRI of the spine revealed a psoas abscess. Transesophageal echocardiogram revealed mitral valve vegetation and her right eye developed endogenous endophthalmitis. She was treated with intravenous and intravitreal antibiotics and underwent drainage of the abscess with no improvement in mental status. Repeat imaging revealed multiple new thalamic, basal ganglia, and parietal lobe infarcts likely from septic emboli. After a protracted ICU stay, the patient’s family opted for comfort care. The incidence of invasive pneumococcal infections has declined rapidly since the advent of antibiotics and vaccines. With the growing incidence of antibiotic resistance as well as the emergence of new immunomodulating drugs for various pathologies, there is a concern that invasive infections will reemerge. Ventriculitis and endogenous endophthalmitis are very rare complications of pneumococcal bacteremia.

Skull Base Osteomyelitis from Otitis Media Presenting as the Collet-Sicard Syndrome

Directory of Open Access Journals (Sweden)

Wong-Kein Low

2018-01-01

Full Text Available Skull base osteomyelitis can involve the jugular foramen and its associated cranial nerves resulting in specific clinical syndromes. The Collet-Sicard syndrome describes the clinical manifestations of palsies involving cranial nerves IX, X, XI, and XII. We present a rare atypical case of skull base osteomyelitis originating from infection of the middle ear and causing the Collet-Sicard syndrome. Caused by Pseudomonas aeruginosa and Klebsiella pneumoniae, this occurred in an elderly diabetic man subsequent to retention of a cotton swab in an ear with chronic suppurative otitis media. This case report illustrates the possibility of retained cotton swabs contributing to the development of otitis media, skull base osteomyelitis, and ultimately the Collet-Sicard syndrome in the ears of immune-compromised patients with chronically perforated eardrums.

Osteomyelitis in burn patients requiring skeletal fixation

NARCIS (Netherlands)

Barret, JP; Desai, MH; Herndon, DN

Deep and severe burns often present with the exposure of musculoskeletal structures and severe deformities. Skeletal fixation, suspension and/or traction are part of their comprehensive treatment. Several factors put burn patients at risk for osteomyelitis, osteosynthesis material being one of them.

Radiography of pressure ulcers

International Nuclear Information System (INIS)

Borgstroem, P.S.; Ekberg, O.; Lasson, A.

1988-01-01

In patients with longstanding and/or deep pressure ulcers radiology is usually consulted. Survey radiography and sinography in 14 patients with pressure ulcers (6 over the tuber ischii and 8 over the femoral trochanter) were evaluated. Osteomyelitic involvement of adjacent bone was revealed in 9 patients on survey radiography. However, it was usually impossible to assess whether or not bony involvement represents healed or active osteomyelitis. Sinography did not contribute to the assessment of whether or not adjacent cortical bone was involved. However, when a fistulation to an adjacent joint was revealed this contributed substantially to the preoperative planning of resection. We therefore recommend that survey radiography and sinography should be included in the evaluation of these patients but that the results from such examinations are critically evaluated. Joint involvement should be taken seriously as progression of septic arthritis usually occurs rapidly. (orig.)

An unusual osteomyelitis caused by Moraxella osloensis: A case report

Directory of Open Access Journals (Sweden)

Nidal J. Alkhatib

Full Text Available Introduction: Moraxella osloensis is a gram-negative coccobacillus, that is saprophytic on skin and mucosa, and rarely causing human infections. Reported cases of human infections usually occur in immunocompromised patients. Presentation of case: We report the second case of M. osloensis-caused-osteomyelitis in literature, occurring in a young healthy man. The organism was identified by sequencing analysis of the 16S ribosomal RNA gene. Our patient was treated successfully with surgical debridement and intravenous third-generation cephalosporins. Discussion: M. osloensis has been rarely reported to cause local or invasive infections. Our case report is the second case in literature and it is different from the previously reported case in that our patient has no chronic medical problems, no history of trauma, with unique presentation and features on the MRI and intraoperative finding. Conclusion: Proper diagnosis is essential for appropriate treatment of osteomyelitis. RNA gene sequence analysis is the primary method of M. osloensis diagnosis. M. osloensis is usually susceptible to simple antibiotics. Keywords: Moraxella osloensis, Osteomyelitis, Case report

Sternoclavicular Osteomyelitis in an Immunosuppressed Patient: A Case Report and Review of the Literature.

Science.gov (United States)

Khan, Kamran; Wozniak, Susan E; Mehrabi, Erfan; Giannone, Anna Lucia; Dave, Mitul

2015-12-28

BACKGROUND Sternoclavicular osteomyelitis is a rare disease, with less than 250 cases identified in the past 50 years. We present a rare case of sternoclavicular osteomyelitis in an immunosuppressed patient that developed from a conservatively treated dislocation. CASE REPORT A 62-year-old white man with a history of metastatic renal cell carcinoma presented to the emergency department (ED) with a dislocated left sternoclavicular joint. He was managed conservatively and subsequently discharged. However, over subsequent days he began to experience pain, fever, chills, and night sweats. He presented to the ED again and imaging revealed osteomyelitis. In the operating room, the wound was aggressively debrided and a wound vac (vacuum-assisted closure) was placed. He was diagnosed with sternoclavicular osteomyelitis and placed on a 6-week course of intravenous Nafcillin. CONCLUSIONS Chemotherapy patients who sustain joint trauma normally associated with a low risk of infection should be monitored thoroughly, and the option to discontinue immunosuppressive therapy should be considered if signs of infection develop.

Systematic approach to treat chronic osteomyelitis through localized drug delivery system: Bench to bed side

Energy Technology Data Exchange (ETDEWEB)

Bhattacharya, Rupnarayan [Department of Plastic Surgery, R. G. Kar Medical College and Hospital (RGKMCH), Kolkata 700004 (India); Kundu, Biswanath, E-mail: biswa_kundu@rediffmail.com [Biocermics and Coating Division, CSIR — Central Glass and Ceramic Research Institute (CSIR-CGCRI), Kolkata 700032 (India); Nandi, Samit Kumar, E-mail: samitnandi1967@gmail.com [Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences (WBUAFS), Kolkata 700037 (India); Basu, Debabrata [Biocermics and Coating Division, CSIR — Central Glass and Ceramic Research Institute (CSIR-CGCRI), Kolkata 700032 (India)

2013-10-15

Chronic osteomyelitis is a challenging setback to the orthopedic surgeons in deciding an optimal therapeutic strategy. Conversely, patients feel frustrated of the therapeutic outcomes and development of adverse drug effects, if any. Present investigation deals with extensive approach incorporating in vivo animal experimentation and human application to treat chronic osteomyelitis, using antibiotic loaded porous hydroxyapatite scaffolds. Micro- to macro-porous hydroxyapatite scaffolds impregnated with antibiotic ceftriaxone–sulbactam sodium (CFS) were fabricated and subsequently evaluated by in vivo animal model after developing osteomyelitis in rabbit tibia. Finally 10 nos. of human osteomyelitis patients involving long bone and mandible were studied for histopathology, radiology, pus culture, 3D CT etc. up to 8–18 months post-operatively. It was established up to animal trial stage that 50N50H samples [with 50–55% porosity, average pore size 110 μm, higher interconnectivity (10–100 μm), and moderately high drug adsorption efficiency (50%)] showed efficient drug release up to 42 days than parenteral group based on infection eradication and new bone formation. In vivo human bone showed gradual evidence of new bone formation and fracture union with organized callus without recurrence of infection even after 8 months. This may be a new, alternative, cost effective and ideal therapeutic strategy for chronic osteomyelitis treatment in human patients. - Highlights: • Chronic osteomyelitis is challenging setback to decide optimal therapeutic strategy. • Micro- to macro-porous antibiotic CFS impregnated HAp scaffolds were fabricated. • Complete in vivo animal trial done after developing osteomyelitis in rabbit tibia. • Clinical trial showed fracture union without recurrence of infection after 8 months. • This may be a new, alternative, cost effective and ideal therapeutic strategy.

Bone scan in diagnosis of infectious osteoarthritis

International Nuclear Information System (INIS)

Marandian, M.H.; Mortazavi, H.; Behvad, A.; Haghigat, H.; Lessani, M.; Youssefian, B.

1979-01-01

Bone scan with Technetium 99m is harmless method of evaluation of skeletal lesions. It is safe in pediatrics age group and it can be used in early diagnosis of infectious osteoarthritis. Bone scan differentiate osteomyelitis from cellulitis, and also it may help in diagnosis of subclinical involvement of rheumatoid arthritis, benign and malignant bone tumors, stress fractures and periostitis. We report results of bone scan in 30 pediatrics patients as follow: osteomyelitis 9 cases, cellulitis 4 cases, infectious arthritis 7 cases, tuberculous osteoarthritis 2 cases, rheumatoid arthritis 2 cases, and other different diseases 9 cases [fr

Hematogenous osteomyelitis in children

DEFF Research Database (Denmark)

Rud, B; Halken, S; Damholt, V

1986-01-01

approach. At follow-up after 5 (1-12) years, 3 neonates had developed severe growth disturbances despite optimal initial treatment. Acceptable results were obtained with antibiotic therapy for 6 weeks or more. We recommend ampicillin and a penicillinase-resistant penicillin, unless bacterial resistance......In a 10-year period, 31 children, including 9 infants, were treated for hematogenous osteomyelitis. Fifteen children were treated closed and 16 open. Thirteen of 14 positive cultures were Staphylococcus aureus. Three recurrences could possibly have been prevented by a more aggressive primary...

Three Phase Bone Scintigraphy in Active and Inactive Osteomyelitis

International Nuclear Information System (INIS)

Yang, Woo Jin; Chung, Soo Kyo; Ha, Hyun Kwon; Bahk, Yong Whee

1988-01-01

To Appreciate the value of bone scintigraphy in determination of the bony infection, we performed three phase bone scintigraphy in 34 cases of osteomyelitis of extremities prospectively. They were clinically inactive in 11 and active in 23 cases. We confirmed the active osteomyelitis by operation or aspiration within one week after scintigraphy. Perfusion, blood pool and delayed images were analyzed respectively and compared with the plain roentgenograms. All 23 active lesions showed diffusely increased perfusion in affected limbs. The areas of the increased activities on blood pool images were larger than or similar to those on delayed images in 17 cases (73.9%) with active osteomyelitis and smaller in 6 cases (26.1%). 5 of the latter 6 cases showed definite soft tissue activities on blood pool images. In inactive cases bone scintigrams were completely normal in 4 cases. Two of those were normal on plain films and remaining two showed mild focal bony sclerosis. Among 7 inactive lesions, perfusion was normal in 2 cases, diffusely increased in 4 cases and diffusely decreased in 1 case. 6 of these 7 cases showed increased activities both on blood pool and delayed images and the areas of increased activities on blood pool images didn't exceed those on delayed images. Bony sclerosis was noted on plain films in those 7 inactive lesions and the extent of the sclerosis correlated well to delayed images. Large blood pool activity was characteristics of active osteomyelitis. Normal three phase bone scintigram may indicate the time to terminate the treatment, but increased activity on perfusion and blood pool scans is not absolute indication of active lesion if the extent of the lesion on the blood pool image is smaller than that on delayed image and if no definite soft tissue activity is noted on perfusion and blood pool images in clinically inactive patient.

Diabetic charcot neuroarthropathy of the foot and ankle with osteomyelitis.

Science.gov (United States)

Ramanujam, Crystal L; Stapleton, John J; Zgonis, Thomas

2014-10-01

One of the most devastating foot and/or ankle complications in the diabetic population with peripheral neuropathy is the presence of Charcot neuroarthropathy (CN). In recent years, diabetic limb salvage has been attempted more frequently as opposed to major lower extremity amputation for CN of the foot and ankle with ulceration and/or deep infection. Treatment strategies for osteomyelitis in the diabetic population have evolved. This article reviews some of the most common surgical strategies recommended for the diabetic patient with CN of the foot and/or ankle and concomitant osteomyelitis. Copyright © 2014 Elsevier Inc. All rights reserved.

MRI findings of post-traumatic osteomyelitis of distal phalanx following neglected open fracture

Energy Technology Data Exchange (ETDEWEB)

Kim, Dong Eon; Lee, Ji Hee; Bae, Kung Eun; Kang, Min Jin; Kim, Jea Hyung; Cho, Woo Ho; Jeong, Myeong Ja; Kim, Soung Hee; Kim, Ji Young; Kim, Soo Hyun [Dept. of Radiology, Inje University Sanggye Paik Hospital, Seoul (Korea, Republic of)

2017-07-15

Careful radiologic examination of the osteolytic lesion is important for patients with fracture. Differential diagnosis includes osteonecrosis, neoplasm and infections. In this report, we presented MRI findings of post-traumatic osteomyelitis following neglected open fracture of 3rd distal phalanx with open wound. Early suspicion and imaging of wound or soft tissue inflammation around osteolytic lesion could be helpful for diagnosis of osteomyelitis.

Case report 558: Multicentric Klebsiella pneumoniae (Friedlaenders bacillus) osteomyelitis in sickle cell anemia

International Nuclear Information System (INIS)

Malpani, A.R.; Sundaram, M.; Ramani, S.K.

1989-01-01

This patient represents a unique combination of multicentric osteomyelitis due to Klebsiella pneumoniae, lesions in the skull, pathological fracture of a long bone and no evidence of pulmonary disease. That Klebsiella pneumoniae osteomyelitis can occur in sickle cell anemia should be considered when such bone changes are seen. The remarkable resolution on conservative management also needs to be noted. (orig./GDG)

Enhanced sludge reduction in septic tanks by increasing temperature.

Science.gov (United States)

Pussayanavin, Tatchai; Koottatep, Thammarat; Eamrat, Rawintra; Polprasert, Chongrak

2015-01-01

Septic tanks in most developing countries are constructed without drainage trenches or leaching fields to treat toilet wastewater and /or grey water. Due to the short hydraulic retention time, effluents of these septic tanks are still highly polluted, and there is usually high accumulation of septic tank sludge or septage containing high levels of organics and pathogens that requires frequent desludging and subsequent treatment. This study aimed to reduce sludge accumulation in septic tanks by increasing temperatures of the septic tank content. An experimental study employing two laboratory-scale septic tanks fed with diluted septage and operating at temperatures of 40 and 30°C was conducted. At steady-state conditions, there were more methanogenic activities occurring in the sludge layer of the septic tank operating at the temperature of 40°C, resulting in less total volatile solids (TVS) or sludge accumulation and more methane (CH4) production than in the unit operating at 30°C. Molecular analysis found more abundance and diversity of methanogenic microorganisms in the septic tank sludge operating at 40°C than at 30°C. The reduced TVS accumulation in the 40°C septic tank would lengthen the period of septage removal, resulting in a cost-saving in desluging and septage treatment. Cost-benefit analysis of increasing temperatures in septic tanks was discussed.

Childhood Pyogenic Osteomyelitis in Abakaliki, South East Nigeria

African Journals Online (AJOL)

2018-04-20

Apr 20, 2018 ... study of all the children aged 18 years and under seen with pyogenic osteomyelitis ... Staphylococcus aureus was ... Poverty is also a limiting factor in its definitive ... type and virulence of causative organism, host immune.

Diagnostic value of MRI signs in differentiating Ewing sarcoma from osteomyelitis.

Science.gov (United States)

Kasalak, Ömer; Overbosch, Jelle; Adams, Hugo Ja; Dammann, Amelie; Dierckx, Rudi Ajo; Jutte, Paul C; Kwee, Thomas C

2018-01-01

Background The value of magnetic resonance imaging (MRI) signs in differentiating Ewing sarcoma from osteomyelitis has not be thoroughly investigated. Purpose To investigate the value of various MRI signs in differentiating Ewing sarcoma from osteomyelitis. Material and Methods Forty-one patients who underwent MRI because of a bone lesion of unknown nature with a differential diagnosis that included both Ewing sarcoma and osteomyelitis were included. Two observers assessed several MRI signs, including the transition zone of the bone lesion, the presence of a soft-tissue mass, intramedullary and extramedullary fat globules, and the penumbra sign. Results Diagnostic accuracies for discriminating Ewing sarcoma from osteomyelitis were 82.4% and 79.4% for the presence of a soft-tissue mass, and 64.7% and 58.8% for a sharp transition zone of the bone lesion, for readers 1 and 2 respectively. Inter-observer agreement with regard to the presence of a soft-tissue mass and the transition zone of the bone lesion were moderate (κ = 0.470) and fair (κ = 0.307), respectively. Areas under the receiver operating characteristic curve of the diameter of the soft-tissue mass (if present) were 0.829 and 0.833, for readers 1 and 2 respectively. Mean inter-observer difference in soft-tissue mass diameter measurement ± limits of agreement was 35.0 ± 75.0 mm. Diagnostic accuracies of all other MRI signs were all value in this setting.

Diagnosis of pedal osteomyelitis in diabetic patients using current scintigraphic techniques

International Nuclear Information System (INIS)

Keenan, A.M.; Tindel, N.L.; Alavi, A.

1989-01-01

Seventy-seven diabetic patients with suspected osteomyelitis of the foot were evaluated by three-phase bone scintigraphy (TPBS), indium 111-labeled white blood cell scintigraphy (WBCS), roentgenography, or some combination thereof. Retrospective analysis after clinical and pathologic follow-up indicated that the sensitivity of TPBS alone in the diagnosis of osteomyelitis was 100%, with a specificity of only 38% and an accuracy of 63%; the sensitivity of WBCS alone was 100%, with a specificity of 78% and an accuracy of 87%; and the combination of TPBS and WBCS yielded a sensitivity of 100%, with a specificity of 79% and an accuracy of 87%. Roentgenography yielded a sensitivity of 69%, with a specificity of 82% and an accuracy of 76%. The results of this study demonstrate that WBCS is superior to TPBS in the diagnosis of osteomyelitis in the diabetic foot, and TPBS adds little when viewed in conjunction with WBCS. Based on our observations and because of the high prevalence of neuropathic joint disease and other causes of false-positive bone scans, we believe that WBCS alone is adequate for evaluation of suspected pedal osteomyelitis in diabetic patients, particularly when the suspected lesion is located in the tarsometatarsal region in contrast to the toe region (7% vs 44% specificity and 28% vs 69% accuracy, respectively, for TPBS in these two regions, compared with 100% vs 68% specificity and 100% vs 80% accuracy, respectively, for WBCS in the same two regions)

Surgical management of maxillary and premaxillary osteomyelitis in a reticulated python (Python reticulatus).

Science.gov (United States)

Latney, La'Toya V; McDermott, Colin; Scott, Gregory; Soltero-Rivera, Maria M; Beguesse, Kyla; Sánchez, Melissa D; Lewis, John R

2016-05-01

CASE DESCRIPTION A 1-year-old reticulated python (Python reticulatus) was evaluated because of a 2-week history of wheezing and hissing. CLINICAL FINDINGS Rostral facial cellulitis and deep gingival pockets associated with missing rostral maxillary teeth were evident. Tissues of the nares were swollen, resulting in an audible wheeze during respiration. Multiple scars and superficial facial wounds attributed to biting by live prey were apparent. Radiographic examination revealed bilateral, focal, rostral maxillary osteomyelitis. TREATMENT AND OUTCOME Wound irrigation, antimicrobials, and anti-inflammatory drug treatment resulted in reduced cellulitis. A 3-week regimen that included empirical antimicrobial treatment and improved husbandry resulted in resolution of the respiratory sounds and partial healing of bite wounds, but radiographic evaluation revealed progressive maxillary osteomyelitis. Microbial culture of blood yielded scant gram-positive cocci and Bacillus spp, which were suspected sample contaminants. Bilateral partial maxillectomies were performed; microbial culture and histologic examination of resected bone confirmed osteomyelitis with gram-positive cocci. Treatment with trimethoprim-sulfamethoxazole was initiated on the basis of microbial susceptibility tests. Four months later, follow-up radiography revealed premaxillary osteomyelitis; surgery was declined, and treatment with trimethoprim-sulfamethoxazole was reinstituted. Eight months after surgery, the patient was reevaluated because of recurrent clinical signs; premaxillectomy was performed, and treatment with trimethoprim-sulfamethoxazole was prescribed on the basis of microbial culture of bone and microbial susceptibility testing. Resolution of osteomyelitis was confirmed by CT 11 months after the initial surgery. CONCLUSIONS AND CLINICAL RELEVANCE Focal maxillectomies and premaxillectomy were successfully performed in a large python. Surgical management and appropriate antimicrobial treatment

A NEW CLASSIFICATION OF OSTEOMYELITIS FOR DEVELOPING ...

African Journals Online (AJOL)

Kateee

2003-07-01

Jul 1, 2003 ... Background : The term osteomyelitis (OSM) was first coined by Nelaton in 1844. Waldvogel et al, Cierny-Mader, May et al classifications of OSM from developed countries and Meier et al's from Nigeria have been described. Objective:This new classification was developed to highlight significant pathology ...

Is there a simple, definitive, and cost-effective way to diagnose osteomyelitis in the pressure ulcer patient?

Science.gov (United States)

Larson, David L; Gilstrap, Jarom; Simonelic, Kevin; Carrera, Guillermo F

2011-02-01

Despite advances in managing pressure ulcers, there is still no definitive way to diagnose bone infection (osteomyelitis) short of open biopsy. An effective, less invasive diagnostic method might result in cost savings and improved care; however, needle aspiration, computed tomography scan, magnetic resonance imaging, ultrasound, and bone scans have proven unsatisfactory in predicting osteomyelitis. The authors reviewed preoperative radiologic studies of stage IV pressure ulcer patients and their bone biopsy results to determine which radiologic studies are most diagnostic for osteomyelitis. Patients (n = 44) having surgical débridement of stage IV ulcers with open bone biopsy after prior radiographic imaging (plain films, ultrasound, computed tomography, magnetic resonance imaging, and/or nuclear bone scans) were included. Studies were interpreted by a single musculoskeletal radiologist blinded to information from the medical record and following standard radiologic criteria for the diagnosis of osteomyelitis. The percentage of patients with biopsy-proven osteomyelitis identified with imaging was 50 percent using a computed tomography scan and 88 percent using a plain film of the bony area of involvement. The overall sensitivity of either radiologic study was 61 percent. The percentage of patients without osteomyelitis identified as not having the condition by imaging was 85 percent for the computed tomography scan and 32 percent for the plain film. Overall specificity of both studies was 69 percent. Preoperative radiologic studies for osteomyelitis in a pressure ulcer are far from definitive; however, if a radiologic study is used to make that diagnosis in a stage IV pressure ulcer, it would appear that a plain film would suffice.

Osteomyelitis diagnosis by 99mTc radiolabeled aptamers

International Nuclear Information System (INIS)

Santos, S.R.; Ferreira, I.M.; Andrade, A.S.R.; Barros, A.L.B.; Cardoso, V.N.; Diniz, O.F.

2015-01-01

Osteomyelitis, which is characterized by progressive inflammatory destruction and new opposition of bone, is still a difficult infection to treat. The clinical diagnosis in late stages is achieved easily, but an early diagnosis is more challenging. Staphylococcus aureus is a common agent found in osteomyelitis and bone prostheses infection. Diagnosis by scintigraphy has advantages because it is a non-invasive procedure and is able to perform an early diagnosis even before anatomic changes. Thus, nuclear medicine could contribute to an accurate diagnosis since specific radiopharmaceuticals were developed. In this study, aptamers selected to Staphylococcus aureus were labeled with 99m Tc and used for bacteria identification in an osteomyelitis experimental model. The aptamers selected to S. aureus were directly labelled with 99m Tc and were evaluated by biodistribution studies. Wistar rats with intraosseous infection in the right paw were used. A random aptamer labelled with 99m Tc was as control. Six animals were used in each group. The aptamers labeled with 99m Tc were able to identify the infection foci caused by S. aureus displaying a target/non-target ratio of 2,23 ± 0,20, after 3 h. The control group presented a target/non-target ratio 1,08 ± 0.23. The results indicated that the radiolabeled aptamers were able to identify specifically the infection foci and they should be further explored for infection diagnosis by scintigraphy. (author)

Diagnosing pelvic osteomyelitis beneath pressure ulcers in spinal cord injured patients: a prospective study.

Science.gov (United States)

Brunel, A-S; Lamy, B; Cyteval, C; Perrochia, H; Téot, L; Masson, R; Bertet, H; Bourdon, A; Morquin, D; Reynes, J; Le Moing, V

2016-03-01

There is no consensus on a diagnostic strategy for osteomyelitis underlying pressure ulcers. We conducted a prospective study to assess the accuracy of multiple bone biopsies and imaging to diagnose pelvic osteomyelitis. Patients with clinically suspected osteomyelitis beneath pelvic pressure ulcers were enrolled. Bone magnetic resonance imaging (MRI) and surgical bone biopsies (three or more for microbiology and one for histology per ulcer) were performed. Bacterial osteomyelitis diagnosis relied upon the association of positive histology and microbiology (at least one positive culture for non-commensal microorganisms or three or more for commensal microorganisms of the skin). From 2011 to 2014, 34 patients with 44 pressure ulcers were included. Bacterial osteomyelitis was diagnosed for 28 (82.3%) patients and 35 (79.5%) ulcers according to the composite criterion. Discrepancy was observed between histology and microbiology for 5 (11.4%) ulcers. Most common isolates were Staphylococcus aureus (77.1%), Peptostreptococcus (48.6%) and Bacteroides (40%), cultured in three or more samples in 42.9% of ulcers for S. aureus and ≥20% for anaerobes. Only 2.8% of ulcers had three or more positive specimens with coagulase-negative staphylococci, group B Streptococcus, and nil with enterococci and Pseudomonas aeruginosa. Staphylococcus aureus, Proteus and group milleri Streptococcus were recovered from one sample in 22.8%, 11.4% and 11.4% of ulcers, respectively. Agreement was poor between biopsies and MRI (κ 0.2). Sensitivity of MRI was 94.3% and specificity was 22.2%. The diagnosis of pelvic osteomyelitis relies on multiple surgical bone biopsies with microbiological and histological analyses. At least three bone samples allows the detection of pathogens and exclusion of contaminants. MRI is not routinely useful for diagnosis. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Parenteral and oral antibiotic duration for treatment of pediatric osteomyelitis: a systematic review protocol

Science.gov (United States)

2013-01-01

Background Pediatric osteomyelitis is a bacterial infection of bones requiring prolonged antibiotic treatment using parenteral followed by enteral agents. Major complications of pediatric osteomyelitis include transition to chronic osteomyelitis, formation of subperiosteal abscesses, extension of infection into the joint, and permanent bony deformity or limb shortening. Historically, osteomyelitis has been treated with long durations of antibiotics to avoid these complications. However, with improvements in management and antibiotic treatment, standard of care is moving towards short durations of intravenous antibiotics prior to enteral antibiotics. Methods/Design The authors will perform a systematic review based on PRISMA guidelines in order to evaluate the literature, looking for evidence to support the optimal duration of parenteral and enteral therapy. The main goals are to see if literature supports shorter durations of either parenteral antibiotics and/or enteral antibiotics. Multiple databases will be investigated using a thorough search strategy. Databases include Medline, Cochrane, EMBASE, SCOPUS, Dissertation Abstracts, CINAHL, Web of Science, African Index Medicus and LILACS. Search stream will include medical subject heading for pediatric patients with osteomyelitis and antibiotic therapy. We will search for published or unpublished randomized and quasi-randomized controlled trials. Two authors will independently select articles, extract data and assess risk of bias by standard Cochrane methodologies. We will analyze comparisons between dichotomous outcomes using risk ratios and continuous outcomes using mean differences. 95% confidence intervals will be computed. Discussion One of the major dilemmas of management of this disease is the duration of parenteral therapy. Long parenteral therapy has increased risk of serious complications and the necessity for long therapy has been called into question. Our study aims to review the currently available

Septic-embolic and septic-metabolic brain abscess; Septisch-embolischer und septisch-metastatischer Hirnabszess

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Weber, W.; Henkes, H.; Kuehne, D. [Alfried-Krupp-Krankenhaus Essen (Germany). Klinik fuer Radiologie und Neuroradiologie; Felber, S. [Universitaetsklinik Innsbruck (Austria). Klinische Abt. der Radiologie I; Jaenisch, W. [Freie Univ. Berlin (Germany). Inst. fuer Neuropathologie; Woitalla, D. [Bochum Univ. (Germany). St. Josef-Hospital

2000-11-01

The hematogeneous spread of bacteria, fungi and protozoa may also reach the brain vessels, which happens mostly through septic emboli. >From such an embolus a metastatic focal encephalitis and later a septic-embolic brain abscess may arise. The most frequently underlying infections that may cause septic emboli are bacterial endocarditis as well as bacterial infections of artificial heart valve prostheses. Congenital heart malformations with a right-to-left shunt also play here a certain role. Basically, however, all septic conditions and bacteriemias may cause septic-embolic brain abscesses. They occur frequently as multiple lesions. MRI is superior to CT in depicting the different stages of evolution from focal encephalitis, through the hardly encapsulated early abscess, to the formation of a membrane and later a dense fibrous capsule. The medical treatment of a brain abscess requires properly performed CT or MRI follow-up examinations in order to realize early enough a possible growing of such a lesion. (orig.) [German] Die haemoatogene Ausbreitung von Bakterien, Pilzen oder Protozoen bis in die Hirngefaesse erfolgt meist durch eine septische Embolie. Es entstehen eine metastatische Herdenzephalitis und im weiteren Verlauf daraus ein septisch-embolischer Hirnabszess. Die haeufigste Grunderkrankung die zu septischen Embolien fuehrt, ist die bakterielle Endokarditis sowie die bakterielle Infektion von Herzklappenprothesen. Eine besondere Bedeutung kommt hier den angeborenen kardialen Fehlbildungen mit Rechts-Links-Shunt zu. Grundsaetzlich koennen jedoch alle Bakteriaemien zu septisch-embolischen Hirnabszessen fuehren. Septisch-embolische Hirnabszesse treten aufgrund ihres Entstehungsmechanismus haeufig multipel auf. Die CT und besser noch die MRT erlauben die Darstellung aller Entwicklungsstadien von der Herdenzephalitis ueber den kaum abgegrenzten Abszess, die Membranbildung bis zur Entstehung einer dicken, die eitergefuellte Hoehle allseits umgebenden

Repurposing the Nonsteroidal Anti-inflammatory Drug Diflunisal as an Osteoprotective, Antivirulence Therapy for Staphylococcus aureus Osteomyelitis.

Science.gov (United States)

Hendrix, Andrew S; Spoonmore, Thomas J; Wilde, Aimee D; Putnam, Nicole E; Hammer, Neal D; Snyder, Daniel J; Guelcher, Scott A; Skaar, Eric P; Cassat, James E

2016-09-01

Staphylococcus aureus osteomyelitis is a common and debilitating invasive infection of bone. Treatment of osteomyelitis is confounded by widespread antimicrobial resistance and the propensity of bacteria to trigger pathological changes in bone remodeling that limit antimicrobial penetration to the infectious focus. Adjunctive therapies that limit pathogen-induced bone destruction could therefore limit morbidity and enhance traditional antimicrobial therapies. In this study, we evaluate the efficacy of the U.S. Food and Drug Administration-approved, nonsteroidal anti-inflammatory (NSAID) compound diflunisal in limiting S. aureus cytotoxicity toward skeletal cells and in preventing bone destruction during staphylococcal osteomyelitis. Diflunisal is known to inhibit S. aureus virulence factor production by the accessory gene regulator (agr) locus, and we have previously demonstrated that the Agr system plays a substantial role in pathological bone remodeling during staphylococcal osteomyelitis. Consistent with these observations, we find that diflunisal potently inhibits osteoblast cytotoxicity caused by S. aureus secreted toxins independently of effects on bacterial growth. Compared to commonly used NSAIDs, diflunisal is uniquely potent in the inhibition of skeletal cell death in vitro Moreover, local delivery of diflunisal by means of a drug-eluting, bioresorbable foam significantly limits bone destruction during S. aureus osteomyelitis in vivo Collectively, these data demonstrate that diflunisal potently inhibits skeletal cell death and bone destruction associated with S. aureus infection and may therefore be a useful adjunctive therapy for osteomyelitis. Copyright © 2016, American Society for Microbiology. All Rights Reserved.

Acute Osteomyelitis in the Hand Due to Dog Bite Injury: A Report of 3 Cases

Directory of Open Access Journals (Sweden)

Ryun Lee

2017-09-01

Full Text Available As many people keep small dogs as pets, dog bites are common injuries, accounting for approximately 80%–90% of all animal bite injuries. These injuries usually occur on the upper extremities, most commonly on the fingers. Most of these injuries appear as simple lacerations or abrasions of the skin. Common symptoms include inflammatory reactions of the soft tissue, such as pain, swelling, erythema, and cellulitis. However, the complications of small dog bites may include joint or cartilage injuries, including acute osteomyelitis. Once osteomyelitis develops, it is difficult to diagnose since it has a latency period of approximately 2 weeks. Plain radiography, magnetic resonance imaging, and 3-phase bone scans should be performed when acute osteomyelitis is suspected, and broad-spectrum empiric antibiotic treatment should be administered for approximately 8–12 weeks. We report 3 very rare cases of acute osteomyelitis that occurred after a dog bite injury.

Role of radionuclide imaging in the diagnosis of acute osteomyelitis

International Nuclear Information System (INIS)

Demopulos, G.A.; Bleck, E.E.; McDougall, I.R.

1988-01-01

Over the last decade, the role of nuclear medicine studies in the diagnosis of acute osteomyelitis has been discussed in depth in the literature. Yet, the respective roles played in this setting by each of the commonly used radionuclide studies often are confusing. In an attempt to develop a cogent diagnostic strategy, we reviewed the literature published within the last 12 years pertaining to the use of radiophosphate bone scintigraphy as well as gallium and indium WBC imaging in the diagnosis of this condition. Based on our findings, we propose an alternative approach to the evaluation of a patient with suspected acute osteomyelitis. 63 references

Chronic suppurative osteomyelitis of subcondylar region: a case report.

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Kumar, G Ravi; Syed, Basheer Ahmed; Prasad, N; Praveen, Sp

2013-05-01

Chronic suppurative osteomyelitis (CSO) of the maxillofacial region is primarily caused by infections of odontogenic microorganisms. It may also arise as a complication of dental extractions, maxillofacial trauma, inadequate treatment of a fracture and irradiation to the mandible. This condition is characterized by areas of devitalized bone (sequestra) which serves as a nidus for recurrent episodes of infection. This case report describes a case of CSO in an untreated right subcondylar fracture of the mandible which was successfully treated with a combination of antibiotic therapy and surgical debridement in an 8-year-old boy. How to cite this article: Kumar GR, Syed BA, Prasad N, Praveen SP. Chronic Suppurative Osteomyelitis of Subcondylar Region: A Case Report. Int J Clin Pediatr Dent 2013;6(2): 119-123.

An interesting septic embolism

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Funda Uluorman

2014-01-01

Full Text Available Septic pulmonary embolism is a rare disease but mortality and morbidity of it is high. Septic pulmonary emboli comes from infected heart valves, thrombophlebitis, and pulmonary artery catheter or infected pacemaker wires as many sources [1,2]. In recent years, pacemaker is a common treatment of the bradiarrhythmia that is persisted in the etiology of septic embolism, its applications has started to pick up [3]. There is the growing number of patients with pacemaker, according to this the frequency of pacemaker lead infection and the number of patients at risk for right-sided endocarditis increase [4]. The patients don't have specific clinical and radiological features because of this it is very difficult to define, so the diagnosis is often delayed [5]. A detailed medical history, a detailed physical examination in diagnosis and evaluation of good additional imaging methods is very important. Early diagnosis and proper treatment, the implementation of the management, can provide good results.

Skin rash and arthritis a simplified appraisal of less common associations.

Science.gov (United States)

Cozzi, A; Doria, A; Gisondi, P; Girolomoni, G

2014-06-01

Skin and joint manifestations are part of the clinical spectrum of many disorders. Well-known associations include psoriatic arthritis and arthritis associated with autoimmune connective tissue diseases. This review focuses on less common associations where skin lesions can provide easily accessible and valuable diagnostic clues, and directly lead to the specific diagnosis or limit the list of possibilities. This may also affect health care resources as diagnostic tests are often low-specific, highly expensive and poorly available. This group of diseases can be divided into two subsets, based on the presence/absence of fever, and then further classified according to elementary skin lesions (macular, urticarial, maculo-papular, vesico-bullous, pustular, petechial and nodular). In most instances joint involvement occurs as peripheral migrating polyarthritis. Erythematosus macular or urticarial rashes occur in most febrile disorders such as monogenic autoinflammatory syndromes, Schnitzler's syndrome, Still's disease and rheumatic fever and afebrile diseases as urticarial vasculitis. Pustular rash may be observed in chronic recurrent multifocal osteomyelitis (CRMO) and pyogenic arthritis with pyoderma gangrenosum and acne (PAPA) syndrome (both febrile) as well as in Behcet's disease and Synovitis, acne, pustulosis, hyperostosis and osteitis syndrome (both non-febrile). Papular lesions are typical of secondary syphilis, sarcoidosis, interstitial granulomatous dermatitis, papular petechial of cutaneous small-vessel vasculitis and nodular lesions of polyarteritis nodosa and multicentric reticulohistiocytosis all of which are afebrile. Differential diagnosis includes infections and drug reactions which may mimic several of these conditions. To biopsy the right skin lesion at the right time it is essential to obtain relevant histological information. © 2013 European Academy of Dermatology and Venereology.

Evaluation of the inflammatory activity in chronic osteomyelitis. Contribution of the scintigraphy with polyclonal antibodies

International Nuclear Information System (INIS)

Sapienza, Marcelo Tatit

1996-01-01

Active chronic osteomyelitis or complicating osteomyelitis (superimposed on diseases that changes the normal bone structure fractures, post-surgery, prosthesis) can be difficult to diagnose by anatomic radiological imaging modalities, like plain radiograph and CT. These diseases frequently cause also increased bone remodeling, leading to nonspecific uptake of Tc-99m-bone scan agents and gallium-67. New radiopharmaceuticals with greater inflammation/infection avidity and specificity are being developed, including the nonspecific polyclonal immunoglobulin (IgG) labeled with technetium-99. Tc-99m-IgG may be available as a ready to use kit, with no reported side effects, low patient absorbed radiation dose and low cost. The mechanism of IgG uptake at the inflammation site has not been fully elucidated yet. Specific (receptor linking, physico-chemical immunoglobulin properties) and nonspecific mechanisms (enhanced vascular permeability and macromolecular exudate) has been suggested. IgG scintigraphy results are affected by the isotope, labeling procedure adopted and characteristics of the inflammatory focus. Nineteen patients with suspected osteomyelitis (active chronic osteomyelitis or violated bone osteomyelitis) were studied by Tc-99m-IgG scintigraphy (directly labeled polyclonal immunoglobulin, Sandoglobuilina - Sandoz). All patients also underwent standard three-phase bone scintigraphy using methylene diphosphonate (Tc-99m-MDP), gallium-67 scintigraphy and plain radiographs. Infection was found in 8 sites. Sensitivity and specificity for Tc-99m-MDP, gallium-67 and Tc 99m-IgG scintigraphy were, respectively, 88 and 36%, 75 and 73%,88 and 82%. All patients with false positive IgG scintigraphies had previous surgery. Other current scintigraphic procedures used in the diagnosis of osteomyelitis are also reviewed. (author)

Conservative management of diabetic foot osteomyelitis.

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Acharya, S; Soliman, M; Egun, A; Rajbhandari, S M

2013-09-01

In this retrospective study, 130 patients with diabetic foot osteomyelitis were analysed. 66.9% of these healed with antibiotic treatment alone and 13.9% needed amputation, of which 1.5% were major. Presence of MRSA was associated with adverse outcome (53.3% vs 21.1%, p=0.04) which was defined as death, amputation and failure to heal. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Domestic wells have high probability of pumping septic tank leachate

Science.gov (United States)

Bremer, J. E.; Harter, T.

2012-08-01

Onsite wastewater treatment systems are common in rural and semi-rural areas around the world; in the US, about 25-30% of households are served by a septic (onsite) wastewater treatment system, and many property owners also operate their own domestic well nearby. Site-specific conditions and local groundwater flow are often ignored when installing septic systems and wells. In areas with small lots (thus high spatial septic system densities), shallow domestic wells are prone to contamination by septic system leachate. Mass balance approaches have been used to determine a maximum septic system density that would prevent contamination of groundwater resources. In this study, a source area model based on detailed groundwater flow and transport modeling is applied for a stochastic analysis of domestic well contamination by septic leachate. Specifically, we determine the probability that a source area overlaps with a septic system drainfield as a function of aquifer properties, septic system density and drainfield size. We show that high spatial septic system density poses a high probability of pumping septic system leachate. The hydraulic conductivity of the aquifer has a strong influence on the intersection probability. We find that mass balance calculations applied on a regional scale underestimate the contamination risk of individual drinking water wells by septic systems. This is particularly relevant for contaminants released at high concentrations, for substances that experience limited attenuation, and those that are harmful even at low concentrations (e.g., pathogens).

Domestic wells have high probability of pumping septic tank leachate

Directory of Open Access Journals (Sweden)

J. E. Bremer

2012-08-01

Full Text Available Onsite wastewater treatment systems are common in rural and semi-rural areas around the world; in the US, about 25–30% of households are served by a septic (onsite wastewater treatment system, and many property owners also operate their own domestic well nearby. Site-specific conditions and local groundwater flow are often ignored when installing septic systems and wells. In areas with small lots (thus high spatial septic system densities, shallow domestic wells are prone to contamination by septic system leachate. Mass balance approaches have been used to determine a maximum septic system density that would prevent contamination of groundwater resources. In this study, a source area model based on detailed groundwater flow and transport modeling is applied for a stochastic analysis of domestic well contamination by septic leachate. Specifically, we determine the probability that a source area overlaps with a septic system drainfield as a function of aquifer properties, septic system density and drainfield size. We show that high spatial septic system density poses a high probability of pumping septic system leachate. The hydraulic conductivity of the aquifer has a strong influence on the intersection probability. We find that mass balance calculations applied on a regional scale underestimate the contamination risk of individual drinking water wells by septic systems. This is particularly relevant for contaminants released at high concentrations, for substances that experience limited attenuation, and those that are harmful even at low concentrations (e.g., pathogens.

Two cases of Pseudomonas aeruginosa epidural abscesses and cervical osteomyelitis after dental extractions.

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Walters, Heather L; Measley, Robert

2008-04-20

Case report. To report 2 unusual cases of Pseudomonas aeruginosa epidural abscesses and cervical osteomyelitis after routine dental extractions and to review relevant literature. Pseudomonas aeruginosa is a rare cause of cervical osteomyelitis in patients after dental extractions. Only 1 prior case could be found in the literature. The cases of an 18-year-old male and a 23-year-old female are presented. PubMed was used to search for relevant literature. Our 2 patients presented with excruciating neck pain within 24 hours of routine dental extractions and, by imaging were found to have cervical epidural abscesses and osteomyelitis. Both patients were taken to the operating room for drainage and corpectomy and treated with prolonged courses of intravenous antibiotics. When seen in follow up 3 months later, neither patient demonstrated any neurologic sequelae. Pseudomonas aeruginosa epidural abscesses and osteomyelitis of the cervical spine have only rarely been reported in healthy patients after dental extractions. To our knowledge, the 2 patients reported here are only the second 2 such cases reported in the literature. Unfortunately, as in prior cases, these 2 patients had a significant delay in diagnosis. Therefore, a strong suspicion must be maintained for all patients presenting with neck pain after a recent dental extraction and appropriate imaging must be obtained urgently.

The Impact of the Sepsis-3 Septic Shock Definition on Previously Defined Septic Shock Patients.

Science.gov (United States)

Sterling, Sarah A; Puskarich, Michael A; Glass, Andrew F; Guirgis, Faheem; Jones, Alan E

2017-09-01

The Third International Consensus Definitions Task Force (Sepsis-3) recently recommended changes to the definitions of sepsis. The impact of these changes remains unclear. Our objective was to determine the outcomes of patients meeting Sepsis-3 septic shock criteria versus patients meeting the "old" (1991) criteria of septic shock only. Secondary analysis of two clinical trials of early septic shock resuscitation. Large academic emergency departments in the United States. Patients with suspected infection, more than or equal to two systemic inflammatory response syndrome criteria, and systolic blood pressure less than 90 mm Hg after fluid resuscitation. Patients were further categorized as Sepsis-3 septic shock if they demonstrated hypotension, received vasopressors, and exhibited a lactate greater than 2 mmol/L. We compared in-hospital mortality in patients who met the old definition only with those who met the Sepsis-3 criteria. Four hundred seventy patients were included in the present analysis. Two hundred (42.5%) met Sepsis-3 criteria, whereas 270 (57.4%) met only the old definition. Patients meeting Sepsis-3 criteria demonstrated higher severity of illness by Sequential Organ Failure Assessment score (9 vs 5; p definition demonstrated significant mortality benefit following implementation of a quantitative resuscitation protocol (35% vs 10%; p = 0.006). In this analysis, 57% of patients meeting old definition for septic shock did not meet Sepsis-3 criteria. Although Sepsis-3 criteria identified a group of patients with increased organ failure and higher mortality, those patients who met the old criteria and not Sepsis-3 criteria still demonstrated significant organ failure and 14% mortality rate.

Significance of bone marrow edema in pathogenesis of rheumatoid arthritis

International Nuclear Information System (INIS)

Sudoł-Szopińska, Iwona; Kontny, Ewa; Maśliński, Włodzimierz; Prochorec-Sobieszek, Monika; Warczyńska, Agnieszka; Kwiatkowska, Brygida

2013-01-01

Assessing the pathology of the synovium, its thickening and increased vascularity through ultrasound and magnetic resonance examinations (more often an ultrasound study alone) is still considered a sensitive parameter in the diagnosis of rheumatoid arthritis and in monitoring of treatment efficacy. Magnetic resonance studies showed that, aside from the joint pannus, the subchondral bone tissue constitutes an essential element in the development of rheumatoid arthritis. Bone marrow edema correlates with inflammation severity, joint destruction, clinical signs and symptoms of rheumatoid arthritis, and thus is considered a predictor of rapid radiological progression of the disease. The newest studies reveal that bone marrow edema may be a more sensitive indicator of the response to therapy than appearance of the synovium. Bone marrow edema presents with increased signal in T2-weighted images, being most visible in fat saturation or IR sequences (STIR, TIRM). On the other hand, it is hypointense and less evident in T1-weighted images. It becomes enhanced (hyperintense) after contrast administration. Histopathological studies confirmed that it is a result of bone inflammation (osteitis/osteomyelitis), i.e. replacememt of bone marrow fat by inflammatory infiltrates containing macrophages, T lymphocytes, B lymphocytes, plasma cells and osteoclasts. Bone marrow edema appears after a few weeks from occurrence of symptoms and therefore is considered an early marker of inflammation. It correlates with clinical assessment of disease activity and elevated markers of acute inflammatory phase, i.e. ESR and CRP. It is a reversible phenomenon and may become attenuated due to biological treatment. It is considered a “herald” of erosions, as the risk of their formation is 6-fold higher in sites where BME was previously noted

Infection imaging with radiopharmaceuticals in the 21st century

Energy Technology Data Exchange (ETDEWEB)

Das, Satya S.; Wareham, David W. [St. Bartholomew' s Hospital, London (United Kingdom). Dept. of Medical Microbiology; Britton, Keith E. [St. Bartholomew' s Hospital, London (United Kingdom). Dept. of Nuclear Medicine; Hall, Anne V. [Harefield Hospital, Middlesex (United Kingdom). Microbiology Dept.

2002-09-01

Infection continues to be a major cause of morbidity and mortality worldwide. Nuclear medicine has an important role in aiding the diagnosis of particularly deep-seated infections such as abscesses, osteomyelitis, septic arthritis, endocarditis, and infections of prosthetic devices. Established techniques such as radiolabelled leucocytes are sensitive and specific for inflammation but do not distinguish between infective and non-infective inflammation. The challenge for Nuclear Medicine in infection imaging in the 21st century is to build on the recent trend towards the development of more infection specific radiopharmaceuticals, such as radiolabelled anti-infectives (e.g. 99 m Tc ciprofloxacin). In addition to aiding early diagnosis of infection, through serial imaging these agents might prove very useful in monitoring the response to and determining the optimum duration of anti-infective therapy. This article reviews the current approach to infection imaging with radiopharmaceuticals nd the future direction it might take. (author)

Infection imaging with radiopharmaceuticals in the 21st century

International Nuclear Information System (INIS)

Das, Satya S.; Wareham, David W.; Britton, Keith E.; Hall, Anne V.

2002-01-01

Infection continues to be a major cause of morbidity and mortality worldwide. Nuclear medicine has an important role in aiding the diagnosis of particularly deep-seated infections such as abscesses, osteomyelitis, septic arthritis, endocarditis, and infections of prosthetic devices. Established techniques such as radiolabelled leucocytes are sensitive and specific for inflammation but do not distinguish between infective and non-infective inflammation. The challenge for Nuclear Medicine in infection imaging in the 21st century is to build on the recent trend towards the development of more infection specific radiopharmaceuticals, such as radiolabelled anti-infectives (e.g. 99 m Tc ciprofloxacin). In addition to aiding early diagnosis of infection, through serial imaging these agents might prove very useful in monitoring the response to and determining the optimum duration of anti-infective therapy. This article reviews the current approach to infection imaging with radiopharmaceuticals nd the future direction it might take. (author)

Skull base osteomyelitis: current microbiology and management.

Science.gov (United States)

Spielmann, P M; Yu, R; Neeff, M

2013-01-01

Skull base osteomyelitis typically presents in an immunocompromised patient with severe otalgia and otorrhoea. Pseudomonas aeruginosa is the commonest pathogenic micro-organism, and reports of resistance to fluoroquinolones are now emerging, complicating management. We reviewed our experience of this condition, and of the local pathogenic organisms. A retrospective review from 2004 to 2011 was performed. Patients were identified by their admission diagnostic code, and computerised records examined. Twenty patients were identified. A facial palsy was present in 12 patients (60 per cent). Blood cultures were uniformly negative, and culture of ear canal granulations was non-diagnostic in 71 per cent of cases. Pseudomonas aeruginosa was isolated in only 10 (50 per cent) cases; one strain was resistant to ciprofloxacin but all were sensitive to ceftazidime. Two cases of fungal skull base osteomyelitis were identified. The mortality rate was 15 per cent. The patients' treatment algorithm is presented. Our treatment algorithm reflects the need for multidisciplinary input, early microbial culture of specimens, appropriate imaging, and prolonged and systemic antimicrobial treatment. Resolution of infection must be confirmed by close follow up and imaging.

Prediction of the course of acute odontogenic pathology with pronounced osteomyelitis by immunoglobulin and cytokin evaluation

Directory of Open Access Journals (Sweden)

A. I. Yaremenko

2013-01-01

Full Text Available The aim of our trial was detection of the most significant clinico-laboratory factors in the saliva and blood samples of the patients with odontogenic osteomyelitis in order to predict severity of the clinical course of osteomyelitis and to choose the optimal treatment tactics.

Gentamicin coating of plasma chemical oxidized titanium alloy prevents implant-related osteomyelitis in rats.

Science.gov (United States)

Diefenbeck, M; Schrader, C; Gras, F; Mückley, T; Schmidt, J; Zankovych, S; Bossert, J; Jandt, K D; Völpel, A; Sigusch, B W; Schubert, H; Bischoff, S; Pfister, W; Edel, B; Faucon, M; Finger, U

2016-09-01

Implant related infection is one of the most feared and devastating complication associated with the use of orthopaedic implant devices. Development of anti-infective surfaces is the main strategy to prevent implant contamination, biofilm formation and implant related osteomyelitis. A second concern in orthopaedics is insufficient osseointegration of uncemented implant devices. Recently, we reported on a macroporous titanium-oxide surface (bioactive TiOB) which increases osseointegration and implant fixation. To combine enhanced osseointegration and antibacterial function, the TiOB surfaces were, in addition, modified with a gentamicin coating. A rat osteomyelitis model with bilateral placement of titanium alloy implants was employed to analyse the prophylactic effect of gentamicin-sodiumdodecylsulfate (SDS) and gentamicin-tannic acid coatings in vivo. 20 rats were randomly assigned to four groups: (A) titanium alloy; PBS inoculum (negative control), (B) titanium alloy, Staphylococcus aureus inoculum (positive control), (C) bioactive TiOB with gentamicin-SDS and (D) bioactive TiOB plus gentamicin-tannic acid coating. Contamination of implants, bacterial load of bone powder and radiographic as well as histological signs of implant-related osteomyelitis were evaluated after four weeks. Gentamicin-SDS coating prevented implant contamination in 10 of 10 tibiae and gentamicin-tannic acid coating in 9 of 10 tibiae (infection prophylaxis rate 100% and 90% of cases, respectively). In Group (D) one implant showed colonisation of bacteria (swab of entry point and roll-out test positive for S. aureus). The interobserver reliability showed no difference in the histologic and radiographic osteomyelitis scores. In both gentamicin coated groups, a significant reduction of the histological osteomyelitis score (geometric mean values: C = 0.111 ± 0.023; D = 0.056 ± 0.006) compared to the positive control group (B: 0.244 ± 0.015; p < 0.05) was observed. The

Treatment of osteomyelitis defects by a vancomycin-loaded gelatin/β-tricalcium phosphate composite scaffold

Science.gov (United States)

Zhou, J.; Zhou, X. G.; Wang, J. W.; Zhou, H.; Dong, J.

2018-01-01

Objective In the present study, we aimed to assess whether gelatin/β-tricalcium phosphate (β-TCP) composite porous scaffolds could be used as a local controlled release system for vancomycin. We also investigated the efficiency of the scaffolds in eliminating infections and repairing osteomyelitis defects in rabbits. Methods The gelatin scaffolds containing differing amounts of of β-TCP (0%, 10%, 30% and 50%) were prepared for controlled release of vancomycin and were labelled G-TCP0, G-TCP1, G-TCP3 and G-TCP5, respectively. The Kirby-Bauer method was used to examine the release profile. Chronic osteomyelitis models of rabbits were established. After thorough debridement, the osteomyelitis defects were implanted with the scaffolds. Radiographs and histological examinations were carried out to investigate the efficiency of eliminating infections and repairing bone defects. Results The prepared gelatin/β-TCP scaffolds exhibited a homogeneously interconnected 3D porous structure. The G-TCP0 scaffold exhibited the longest duration of vancomycin release with a release duration of eight weeks. With the increase of β-TCP contents, the release duration of the β-TCP-containing composite scaffolds was decreased. The complete release of vancomycin from the G-TCP5 scaffold was achieved within three weeks. In the treatment of osteomyelitis defects in rabbits, the G-TCP3 scaffold showed the most efficacious performance in eliminating infections and repairing bone defects. Conclusions The composite scaffolds could achieve local therapeutic drug levels over an extended duration. The G-TCP3 scaffold possessed the optimal porosity, interconnection and controlled release performance. Therefore, this scaffold could potentially be used in the treatment of chronic osteomyelitis defects. Cite this article: J. Zhou, X. G. Zhou, J. W. Wang, H. Zhou, J. Dong. Treatment of osteomyelitis defects by a vancomycin-loaded gelatin/β-tricalcium phosphate composite scaffold. Bone Joint Res

Effect of temperature increments in septic tank efficiency

International Nuclear Information System (INIS)

Chi-Tec, M.; Caballero-Arzapalo, N.; Giacoman Vallejo, G.; Mendez-Novelo, R.; Quintal-Franco, C.

2009-01-01

Septic tanks are the main sewage disposal system used in Yucatan, Mexico. Septic tank content is stabilized under anaerobic conditions and is considered the temperature has a significant effect on the efficiency. This work was developed in order asses the feasibility to improve communal septic tanks efficiency by increasing content temperature. Temperatures inside the tank were increased using a hybrid heater system (solar and electricity). (Author)

MR imaging findings of acute gouty arthritis

International Nuclear Information System (INIS)

Lee, Gyung Kyu; Lee, Jee Young; Suh, Jin Suck

2006-01-01

The purpose of this study was to describe the clinical and MR imaging features of acute gouty arthritis and to define the characteristic findings that would be helpful for differentiating acute gouty arthritis from septic arthritis. The authors retrospectively studied seven patients who suffered from acute gouty arthritis. The MR imaging findings were analyzed by two musculoskeletal radiologists who focused on joint effusion, subchondral bone erosion, bone marrow edema, synovial thickening (regular and even, or irregular and nodular), and the soft tissue changes (edema or abscess). The clinical records of the patients were reviewed with regard to age and gender, the clinical presentation and the laboratory findings (serum uric acid, WBC, erythrocyte sedimentation rate, C-reactive protein and synovial fluid culture). The patients consisted of six men and one woman whose mean age was 41 years (age range:24-65 years). The joints involved were the knee (n=6), and ankle (n=1). Two patients had medical histories of gouty attacks that involved the first metatarsophalangeal joint. In six cases, the serum uric acid level during acute attacks was elevated. In all the patients, the affected joint became swollen, hot, erythematous and extremely tender, and this was accompanied by a high ESR and a high C-reactive protein level at the time of presentation. The results of Gram stain and culture of the synovial fluid were negative. In all patients, the MR images showed large amounts of joint effusion, thick irregular and nodular synovial thickening and soft tissue edema without subchondral bone erosions and soft tissue abscess. In one case, subchondral bone marrow edema of the medial femoral condyle was present. In five cases, there were multiple low signal foci in the joint on the spin-echo T2-weighted MR image. Even though the MR imaging findings of acute gouty arthritis are nonspecific, it should be considered as a possible diagnosis when a large amount of joint effusion

Clinical characteristics and outcomes of septic bursitis.

Science.gov (United States)

Lieber, Sarah B; Fowler, Mary Louise; Zhu, Clara; Moore, Andrew; Shmerling, Robert H; Paz, Ziv

2017-12-01

Limited data guide practice in evaluation and treatment of septic bursitis. We aimed to characterize clinical characteristics, microbiology, and outcomes of patients with septic bursitis stratified by bursal involvement, presence of trauma, and management type. We conducted a retrospective cohort study of adult patients admitted to a single center from 1998 to 2015 with culture-proven olecranon and patellar septic bursitis. Baseline characteristics, clinical features, microbial profiles, operative interventions, hospitalization lengths, and 60-day readmission rates were determined. Patients were stratified by bursitis site, presence or absence of trauma, and operative or non-operative management. Of 44 cases of septic bursitis, patients with olecranon and patellar bursitis were similar with respect to age, male predominance, and frequency of bursal trauma; patients managed operatively were younger (p = 0.05). Clinical features at presentation and comorbidities were similar despite bursitis site, history of trauma, or management. The most common organism isolated from bursal fluid was Staphylococcus aureus. Patients managed operatively were discharged to rehabilitation less frequently (p = 0.04). This study of septic bursitis is among the largest reported. We were unable to identify presenting clinical features that differentiated patients treated surgically from those treated conservatively. There was no clear relationship between preceding trauma or bursitis site and clinical course, management, or outcomes. Patients with bursitis treated surgically were younger. Additional study is needed to identify patients who would benefit from early surgical intervention for septic bursitis.

Diagnosis of osteomyelitis of the foot in diabetic patients: Value of 111In-leukocyte scintigraphy

International Nuclear Information System (INIS)

Larcos, G.; Brown, M.L.; Sutton, R.T.

1991-01-01

The noninvasive diagnosis of osteomyelitis of the foot in diabetic patients with currently available radiologic and radionuclide imaging techniques is often difficult. Recently, 111In-labeled leukocyte scintigraphy has been proposed as an attractive alternative. Accordingly, the authors retrospectively reviewed 51 111In-labeled leukocyte scans, 49 technetium-99m bone scans, and 49 plain radiographs obtained in 51 adults with diabetes in whom osteomyelitis of the foot was suspected. The sensitivity and specificity of these techniques were evaluated in all patients, as well as in a subgroup of 11 patients with neuroarthropathy. Results with 111In-labeled leukocyte scans were also examined in subsets of patients with soft-tissue ulcers (n = 35) and those receiving antibiotics during investigation (n = 20). Confirmation or exclusion of osteomyelitis was made surgically in 28 patients and clinically in 23. Fourteen patients had osteomyelitis. Bone scans were most sensitive (93%) but least specific (43%); plain radiographs were most specific (83%) but least sensitive (43%). 111In-labeled leukocyte scans were both sensitive (79%) and specific (78%), and remained useful in patients with neuroarthropathy, soft-tissue ulcers, and antibiotic treatment. Poor spatial resolution contributed to the false-negative and false-positive 111In-labeled leukocyte scans, suggesting that this technique should not be interpreted independent of other tests. 111In-labeled leukocyte scans are a valuable diagnostic tool for the diagnosis of pedal osteomyelitis in diabetic patients

Antibiotic-eluting hydrophilized PMMA bone cement with prolonged bactericidal effect for the treatment of osteomyelitis.

Science.gov (United States)

Oh, Eun Jo; Oh, Se Heang; Lee, In Soo; Kwon, Oh Soo; Lee, Jin Ho

2016-05-01

Osteomyelitis is still considered to be one of the major challenges for orthopedic surgeons despite advanced antiseptic surgical procedures and pharmaceutical therapeutics. In this study, hydrophilized poly(methyl methacrylate) (PMMA) bone cements containing Pluronic F68 (EG79PG28EG79) as a hydrophilic additive and vancomycin (F68-VAcements) were prepared to allow the sustained release of the antibiotic for adequate periods of time without any significant loss of mechanical properties. The compressive strengths of the bone cements with Pluronic F68 compositions less than 7 wt% were not significantly different compared with the control vancomycin-loaded bone cement (VAcement). TheF68 (7 wt%)-VAcement showed sustained release of the antibiotic for up to 11 weeks and almost 100% release from the bone cement. It also prohibited the growth ofS. aureus(zone of inhibition) over six weeks (the required period to treat osteomyelitis), and it did not show any notable cytotoxicity. From an animal study using a femoral osteomyelitis rat model, it was observed that theF68 (7 wt%)-VAcement was effective for the treatment of osteomyelitis, probably as a result of the prolonged release of antibiotic from the PMMA bone cement. On the basis of these findings, it can be suggested that the use of Pluronic F68 as a hydrophilic additive for antibiotic-eluting PMMA bone cement can be a promising strategy for the treatment of osteomyelitis. © The Author(s) 2016.

Testing the efficacy of antimicrobial peptides in the topical treatment of induced osteomyelitis in rats.

Science.gov (United States)

Melicherčík, Pavel; Čeřovský, Václav; Nešuta, Ondřej; Jahoda, David; Landor, Ivan; Ballay, Rastislav; Fulín, Petr

2018-01-01

Joint replacement infections and osteomyelitis are among the most serious complications in orthopaedics and traumatology. The risk factors for these infections are often bacterial resistance to antimicrobials. One of the few solutions available to control bacterial resistance involves antimicrobials, which have a different mechanism of action from traditional antibiotics. Antimicrobial peptides (AMP) appear to be highly promising candidates in the treatment of resistant infections. We have identified several AMP in the venom of various wild bees and designed analogues that show potent antimicrobial activity and low toxicity against eukaryotic cells. The aim of the present study was to test the efficacy of one of those synthetic peptide analogues for the treatment of acute osteomyelitis invoked in laboratory rats. Femoral cavities of 20 laboratory Wistar rats were infected with Staphylococcus aureus. After 1 week, eight rats received an injectable calcium phosphate carrier alone, another eight rats were treated with a calcium phosphate mixed with AMP, and four rats were left without any further treatment. After another week, all rats were euthanized and radiographs were made of both the operated and healthy limbs. The animals with the carrier alone exhibited more severe acute osteomyelitis on radiographs in comparison to the recipients of the calcium phosphate carrier loaded AMP and untreated infected individuals. Based on the results of the above mentioned experiment, it was concluded that when injected directly into the site of femoral acute osteomyelitis, the calcium phosphate carrier mixed with AMP reduced osteomyelitis signs visible on radiographs.

Fungal osteomyelitis with vertebral re-ossification.

Science.gov (United States)

O Guinn, Devon J; Serletis, Demitre; Kazemi, Noojan

2016-01-01

We present a rare case of thoracic vertebral osteomyelitis secondary to pulmonary Blastomyces dermatitides. A 27-year-old male presented with three months of chest pains and non-productive cough. Examination revealed diminished breath sounds on the right. CT/MR imaging confirmed a right-sided pre-/paravertebral soft tissue mass and destructive lytic lesions from T2 to T6. CT-guided needle biopsy confirmed granulomatous pulmonary Blastomycosis. Conservative management with antifungal therapy was initiated. Neurosurgical review confirmed no clinical or profound radiographic instability, and the patient was stabilized with TLSO bracing. Serial imaging 3 months later revealed near-resolution of the thoracic soft tissue mass, with vertebral re-ossification from T2 to T6. Fungal osteomyelitis presents a rare entity in the spectrum of spinal infections. In such cases, lytic spinal lesions are classically seen in association with a large paraspinous mass. Fungal infections of the spinal column may be treated conservatively, with surgical intervention reserved for progressive cases manifesting with neurological compromise and/or spinal column instability. Here, we found unexpected evidence for vertebral re-ossification across the affected thoracic levels (T2-6) in response to IV antibiotic therapy and conservative bracing, nearly 3 months later. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Imaging osteomyelitis and the diabetic foot

International Nuclear Information System (INIS)

Becker, W.

1999-01-01

The clinical diagnosis of osteomyelitis and the diabetic foot is in most of the patients not possible without imaging the bone. The clinical problem is to diagnose infection as early, as reliable and as cheap as possible to prevent the possible longstanding and life-threatening complications. For imaging a lot of different radiological and nuclear medicine methods are available. This article focuses on the possible results of conventional plain radiography and tomography, computed tomography and magnetic resonance imaging as radiological and on bone scan, autologous white blood cell scintigraphy with 111 In-oxin or 99m Tc-HMPAO, antigranulocyte antibodies, 99m Tc/ 111 In-human immunoglobulin, 67 Ga-citrate and 99m Tc-nanocelloids. Different methods after different answers. Radiological methods give detailed pathological answers, nuclear medicine methods answer questions of specificity such as leukocyte infiltration. If osteomyelitis is suspected, plain radiography should be the first, three phase bone scintigraphy the second and infection specific radiopharmaceuticals the third step of examination. Only in negative images with high clinical suspicion CT or MRI should be the final imaging procedure. In the diabetic foot imaging cascade should also start with plain radiography, followed by three phase bone scintigraphy or MRI. If clinically neuropathy is present specific nuclear medicine imaging should be performed

Osteomyelitis diagnosis by {sup 99m}Tc radiolabeled aptamers

Energy Technology Data Exchange (ETDEWEB)

Santos, S.R.; Ferreira, I.M.; Andrade, A.S.R., E-mail: sararoberta7@hotmail.com, E-mail: imendesf@yahoo.com.br, E-mail: antero@cdtn.br [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil); Barros, A.L.B.; Cardoso, V.N.; Diniz, O.F., E-mail: brancodebarros@yahoo.com.br, E-mail: valbertcardoso@yahoo.com.br, E-mail: simoneodilia@yahoo.com.br [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Farmacia. Departamento de Analises Clinicas e Toxicologicas

2015-07-01

Osteomyelitis, which is characterized by progressive inflammatory destruction and new opposition of bone, is still a difficult infection to treat. The clinical diagnosis in late stages is achieved easily, but an early diagnosis is more challenging. Staphylococcus aureus is a common agent found in osteomyelitis and bone prostheses infection. Diagnosis by scintigraphy has advantages because it is a non-invasive procedure and is able to perform an early diagnosis even before anatomic changes. Thus, nuclear medicine could contribute to an accurate diagnosis since specific radiopharmaceuticals were developed. In this study, aptamers selected to Staphylococcus aureus were labeled with {sup 99m}Tc and used for bacteria identification in an osteomyelitis experimental model. The aptamers selected to S. aureus were directly labelled with {sup 99m}Tc and were evaluated by biodistribution studies. Wistar rats with intraosseous infection in the right paw were used. A random aptamer labelled with {sup 99m}Tc was as control. Six animals were used in each group. The aptamers labeled with {sup 99m}Tc were able to identify the infection foci caused by S. aureus displaying a target/non-target ratio of 2,23 ± 0,20, after 3 h. The control group presented a target/non-target ratio 1,08 ± 0.23. The results indicated that the radiolabeled aptamers were able to identify specifically the infection foci and they should be further explored for infection diagnosis by scintigraphy. (author)

Pathology and biofilm formation in a porcine model of staphylococcal osteomyelitis

DEFF Research Database (Denmark)

Johansen, L K; Koch, J; Frees, D

2012-01-01

A porcine model was used to examine the potential of human and porcine Staphylococcus aureus isolates to induce haematogenously spread osteomyelitis. Pigs were inoculated in the right femoral artery with one of the following S. aureus strains: S54F9 (from a porcine lung abscess; n = 3 animals), N...... dependent on the strain of bacteria inoculated and on the formation of a biofilm....... with colonies of S. aureus as demonstrated immunohistochemically. By peptide nucleic acid fluorescence in situ hybridization bacterial aggregates were demonstrated to be embedded in an opaque matrix, indicating that the bacteria had formed a biofilm. Development of experimental osteomyelitis was therefore...

Radionuclide uptake during the evolution of experimental acute osteomyelitis

International Nuclear Information System (INIS)

Norris, S.H.; Watt, I.

1981-01-01

The findings of technetium 99m MDP and gallium 67 citrate scintigraphy are described in the first four days following experimental acute osteomyelitis of the tibia of rabbits. On the day of inoculation, defects in activity are observed in both the perfusion and bone phases of technetium scintigraphy. Similar defects are achieved by saline injection. On subsequent days technetium scintigraphy reveals an increased activity in the perfusion stage but a persisting defect of activity in the bone phase. Gallium activity is increased throughout the period of the study in inoculated animals but not in those injected with saline. It is concluded that 99 Tcsup(m) MDP, in its perfusion phase, and 67 Ga citrate are highly sensitive indicators of bone inflammation and that early osteomyelitis is characterized by increased activity with these agents together with a technetium bone scan defect. (author)

Amyloid goitre following chronic osteomyelitis: case report and ...

African Journals Online (AJOL)

Amyloid goitre following chronic osteomyelitis: case report and review of literature. AZ Mohammed, ST Edino, O Ochicha. Abstract. Amyloid Goitre is a rare clinical entity associated with systemic amyloidosis. It poses a significant diagnostic and therapeutic challenge and may be confused with a neoplastic goiter. We present ...

Streptobacillus hongkongensis sp. nov., isolated from patients with quinsy and septic arthritis, and emended descriptions of the genus Streptobacillus and Streptobacillus moniliformis.

Science.gov (United States)

Woo, Patrick C Y; Wu, Alan K L; Tsang, Chi-Ching; Leung, Kit-Wah; Ngan, Antonio H Y; Curreem, Shirly O T; Lam, Kwok-Wai; Chen, Jonathan H K; Chan, Jasper F W; Lau, Susanna K P

2014-09-01

Two bacterial strains, HKU33(T) and HKU34, were isolated in Hong Kong from the pus aspirated from the right peritonsillar abscess of a patient with quinsy and the left elbow joint fluid of another patient with tophaceous gout and left elbow septic arthritis, respectively. The bacteria were Gram-stain-negative, non-motile, non-spore-forming, non-haemolytic pleomorphic bacilli. They grew best on Columbia agar with 5 % defibrinated sheep blood in an anaerobic environment or aerobic environment with 5 % CO2. They also grew on chocolate agar but not on MacConkey agar. They were catalase- and cytochrome oxidase-negative. They showed a unique profile of enzyme activities distinguishable from their closely related species. Phylogenetic analysis of the complete 16S rRNA gene, and partial groEL, gyrB and recA gene sequences showed the two isolates formed a distinct branch within the family Leptotrichiaceae, being related most closely to Streptobacillus moniliformis. Hierarchical cluster analysis of mass spectra of whole-cell protein contents showed that strains HKU33(T) and HKU34 were closely related to each other, but were distinct from Streptobacillus moniliformis, Sneathia sanguinegens and 'Leptotrichia amnionii'. The DNA G+C content of strain HKU33(T) was 26.0±2.1 mol% (mean±sd; n = 3). DNA-DNA hybridization demonstrated ≤45.02 % DNA relatedness between the two isolates and Streptobacillus moniliformis CCUG 13453(T). A novel species, Streptobacillus hongkongensis sp. nov., is proposed to accommodate strains HKU33(T) and HKU34, with HKU33(T) ( = JCM 18691(T) = NCTC 13659(T) = DSM 26322(T)) designated the type strain. Emended descriptions of the genus Streptobacillus and Streptobacillus moniliformis are also given. © 2014 IUMS.

Osteomyelitis of the mandible in the patient with plasmocytoma – case report

Directory of Open Access Journals (Sweden)

Wioletta Anna Bal

2017-12-01

Full Text Available Osteomyelitis is an infection of bone which may be caused by infection carried to the bone via the bloodstream or from surrounding tissue. Treatment of osteomyelitis of the mandible is extremely difficult because of oral environment and teeth presence. Management often involves both debridement and antibiotic selection. Despite this, aggressive surgical interventions and conservative therapy are most important aspects of treatment. Medication-related osteonecrosis of the jaw (MRONJ is an avascular necrosis related to osteomyelitis and characterized by necrotic bone in the maxillofacial region. The prevalence of this is associated with treatment with high-potency bisphosphonates or denosumab and it seems to be getting increasingly frequent. Due to lack of prospective studies with long-term follow-up there are no recommendation for treatment of MRNOJ. The main aim of treatment of patients with MRNOJ is to continue and to support oncological treatment as well as to provide patient education, comfort to life, control of pain and to prevent from secondary infection and development of new areas of necrosis.

Biomimetic 3D in vitro model of biofilm triggered osteomyelitis for investigating hematopoiesis during bone marrow infections.

Science.gov (United States)

Raic, Annamarija; Riedel, Sophie; Kemmling, Elena; Bieback, Karen; Overhage, Joerg; Lee-Thedieck, Cornelia

2018-04-18

In this work, we define the requirements for a human-based osteomyelitis model which overcomes the limitations of state of the art animal models. Osteomyelitis is a severe and difficult to treat infection of the bone that develops rapidly, making it difficult to study in humans. We have developed a 3D in vitro model of the bone marrow, comprising a macroporous material, human hematopoietic stem and progenitor cells (HSPCs) and mesenchymal stromal cells (MSCs). Inclusion of biofilms grown on an implant into the model system allowed us to study the effects of postoperative osteomyelitis-inducing bacteria on the bone marrow. The bacteria influenced the myeloid differentiation of HSPCs as well as MSC cytokine expression and the MSC ability to support HSPC maintenance. In conclusion, we provide a new 3D in vitro model which meets all the requirements for investigating the impact of osteomyelitis. Implant associated-osteomyelitis is a persistent bacterial infection of the bone which occurs in many implant patients and can result in functional impairments or even entire loss of the extremity. Nevertheless, surprisingly little is known on the triangle interaction between implant material, bacterial biofilm and affected bone tissue. Closing this gap of knowledge would be crucial for the fundamental understanding of the disease and the development of novel treatment strategies. For this purpose, we developed the first biomaterial-based system that is able to mimic implant-associated osteomyelitis outside of the body, thus, opening the avenue to study this fatal disease in the laboratory. Copyright © 2018 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Osteomyelitis and infarction in sickle cell hemoglobinopathies: differentiation by combined technetium and gallium scintigraphy

International Nuclear Information System (INIS)

Amundsen, T.R.; Siegel, M.J.; Siegel, B.A.

1984-01-01

Clinical records and scintigrams were reviewed of 18 patients with sickle cell hemoglobinophaties who had undergone combined technetium and gallium scintigraphy during 22 separate episodes of suspected osseous infection. The combined scintigrams were correctly interpreted as indicating osteomyelitis in four studies. Of 18 studies in patients with infarction, the combined scintigrams were correctly interpreted in 16 and showed either no local accumulation of Ga-67 or less accumulation than that of Tc-99m MDP at symptomatic sites. In the other two studies, the scintigrams were falsely interpreted as indicating osteomyelitis and showed congruent, increased accumulation of both Tc-99, MDP and Ga-67. This pattern must be considered indeterminate. Overall, the results indicate that the combination of technetium and gallium scintigraphy is an effective means to distinguish osteomyelitis from infarction in patients with sickle cell hemoglobinopathies

Acute postoperative osteomyelitis in femur fracture: contribution of bone scintilography (case report)

Energy Technology Data Exchange (ETDEWEB)

Borges, Natalie Ferreira; Rezende, Cleuza Maria de Faria; Sanchez-Ucros, Natalia; Laguardia, Priscilla [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Escola de Veterinaria; Diniz, Simone Odilia Fernandes; Cardoso, Valbert Nascimento [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Farmacia; Rodrigues, Carlos Jorge Simal [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Santos, Raquel Gouvea dos [Centro de Desenvolcimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil). Lab. de Radiobiologia

2009-07-01

The treatment of bone fractures is aimed at consolidating and returns of function as soon as possible and can be performed by different methods. Treatment with the plate in fractures of the femur in bridge aims not to address the location of fracture and stabilize it, maintaining the anatomical axis by the fixation of proximal and distal segments. Postoperative follow-up of the fracture is necessary to evaluate the irrigation of the bone structure and the effect of the method. The scintigraphy is a method capable of assessing the degree of bone remodeling and the presence or absence of local bone homeostasis. The objective of this report is to present the case of a rabbit, male, which was subjected to osteotomy and fixation of the femoral diaphysis by means of the plate in the bridge. After 10 days the animal was subjected to scintigraphic and radiographic evaluations. The animal came to death and an autopsy was performed on the same when it was observed macroscopy consistent with acute osteomyelitis due to contamination postoperative time. Radiographic evaluation in acute osteomyelitis is unclear. The methods assist in the scintigraphic diagnosis of osteomyelitis by allowing the detection of functional changes in this infectious process. The bone scintigraphy with diphosphonates labeled with technetium-99m shows increased bone turnover in the infected area and its high sensitivity, even in an early stage makes it the method of choice in the diagnosis of acute osteomyelitis in patients without prior bone disease and bone radiologically normal. (author)

Acute postoperative osteomyelitis in femur fracture: contribution of bone scintilography (case report)

International Nuclear Information System (INIS)

Borges, Natalie Ferreira; Rezende, Cleuza Maria de Faria; Sanchez-Ucros, Natalia; Laguardia, Priscilla; Diniz, Simone Odilia Fernandes; Cardoso, Valbert Nascimento; Rodrigues, Carlos Jorge Simal; Santos, Raquel Gouvea dos

2009-01-01

The treatment of bone fractures is aimed at consolidating and returns of function as soon as possible and can be performed by different methods. Treatment with the plate in fractures of the femur in bridge aims not to address the location of fracture and stabilize it, maintaining the anatomical axis by the fixation of proximal and distal segments. Postoperative follow-up of the fracture is necessary to evaluate the irrigation of the bone structure and the effect of the method. The scintigraphy is a method capable of assessing the degree of bone remodeling and the presence or absence of local bone homeostasis. The objective of this report is to present the case of a rabbit, male, which was subjected to osteotomy and fixation of the femoral diaphysis by means of the plate in the bridge. After 10 days the animal was subjected to scintigraphic and radiographic evaluations. The animal came to death and an autopsy was performed on the same when it was observed macroscopy consistent with acute osteomyelitis due to contamination postoperative time. Radiographic evaluation in acute osteomyelitis is unclear. The methods assist in the scintigraphic diagnosis of osteomyelitis by allowing the detection of functional changes in this infectious process. The bone scintigraphy with diphosphonates labeled with technetium-99m shows increased bone turnover in the infected area and its high sensitivity, even in an early stage makes it the method of choice in the diagnosis of acute osteomyelitis in patients without prior bone disease and bone radiologically normal. (author)

Childhood Pyogenic Osteomyelitis in Abakaliki, South East Nigeria

African Journals Online (AJOL)

2018-04-20

Apr 20, 2018 ... [3] In general, growing children are the most vulnerable to pyogenic bone infection. However, in a recent published report, the relatively higher risk of osteomyelitis among Polynesians and Maori children compared to European children in New Zealand[2] indicates ethnicity bias in the risk of childhood bone.

Skull-base Osteomyelitis: a Dreaded Complication after Trivial Fall and Inadequate Management

Directory of Open Access Journals (Sweden)

Kundan Mittal

2015-10-01

Full Text Available Introduction: Skull-based osteomyelitis is bony infection which generally originates from inadequately treated chronic infection, adjoining tissue infection or after trauma.Case: 11 month female child had a trivial fall while standing near a bucket. The child developed fracture of right clavicle and left orbital swelling which was inadequately treated. This resulted in in spread of infection to adjoining tissues, skull bones, sinuses and brain.Conclusion: Cranial base osteomyelitis is rare but dreaded condition which requires early diagnosis and prompt treatment to avoid mortality and morbidity in form of neurological deficits and permanent disability

Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease -- can it differentiate bone infarcts from acute osteomyelitis?

Science.gov (United States)

Delgado, Jorge; Bedoya, Maria A; Green, Abby M; Jaramillo, Diego; Ho-Fung, Victor

2015-12-01

Children with sickle cell disease (SCD) are at risk of bone infarcts and acute osteomyelitis. The clinical differentiation between a bone infarct and acute osteomyelitis is a diagnostic challenge. Unenhanced T1-W fat-saturated MR images have been proposed as a potential tool to differentiate bone infarcts from osteomyelitis. To evaluate the reliability of unenhanced T1-W fat-saturated MRI for differentiation between bone infarcts and acute osteomyelitis in children with SCD. We retrospectively reviewed the records of 31 children (20 boys, 11 girls; mean age 10.6 years, range 1.1-17.9 years) with SCD and acute bone pain who underwent MR imaging including unenhanced T1-W fat-saturated images from 2005 to 2010. Complete clinical charts were reviewed by a pediatric hematologist with training in infectious diseases to determine a clinical standard to define the presence or absence of osteomyelitis. A pediatric radiologist reviewed all MR imaging and was blinded to clinical information. Based on the signal intensity in T1-W fat-saturated images, the children were further classified as positive for osteomyelitis (low bone marrow signal intensity) or positive for bone infarct (high bone marrow signal intensity). Based on the clinical standard, 5 children were classified as positive for osteomyelitis and 26 children as positive for bone infarct (negative for osteomyelitis). The bone marrow signal intensity on T1-W fat-saturated imaging was not significant for the differentiation between bone infarct and osteomyelitis (P = 0.56). None of the additional evaluated imaging parameters on unenhanced MRI proved reliable in differentiating these diagnoses. The bone marrow signal intensity on unenhanced T1-W fat-saturated MR images is not a reliable criterion to differentiate bone infarcts from osteomyelitis in children.

Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease - can it differentiate bone infarcts from acute osteomyelitis?

International Nuclear Information System (INIS)

Delgado, Jorge; Bedoya, Maria A.; Green, Abby M.; Jaramillo, Diego; Ho-Fung, Victor

2015-01-01

Children with sickle cell disease (SCD) are at risk of bone infarcts and acute osteomyelitis. The clinical differentiation between a bone infarct and acute osteomyelitis is a diagnostic challenge. Unenhanced T1-W fat-saturated MR images have been proposed as a potential tool to differentiate bone infarcts from osteomyelitis. To evaluate the reliability of unenhanced T1-W fat-saturated MRI for differentiation between bone infarcts and acute osteomyelitis in children with SCD. We retrospectively reviewed the records of 31 children (20 boys, 11 girls; mean age 10.6 years, range 1.1-17.9 years) with SCD and acute bone pain who underwent MR imaging including unenhanced T1-W fat-saturated images from 2005 to 2010. Complete clinical charts were reviewed by a pediatric hematologist with training in infectious diseases to determine a clinical standard to define the presence or absence of osteomyelitis. A pediatric radiologist reviewed all MR imaging and was blinded to clinical information. Based on the signal intensity in T1-W fat-saturated images, the children were further classified as positive for osteomyelitis (low bone marrow signal intensity) or positive for bone infarct (high bone marrow signal intensity). Based on the clinical standard, 5 children were classified as positive for osteomyelitis and 26 children as positive for bone infarct (negative for osteomyelitis). The bone marrow signal intensity on T1-W fat-saturated imaging was not significant for the differentiation between bone infarct and osteomyelitis (P = 0.56). None of the additional evaluated imaging parameters on unenhanced MRI proved reliable in differentiating these diagnoses. The bone marrow signal intensity on unenhanced T1-W fat-saturated MR images is not a reliable criterion to differentiate bone infarcts from osteomyelitis in children. (orig.)

Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease - can it differentiate bone infarcts from acute osteomyelitis?

Energy Technology Data Exchange (ETDEWEB)

Delgado, Jorge; Bedoya, Maria A. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Green, Abby M. [The Children' s Hospital of Philadelphia, Division of Oncology, Philadelphia, PA (United States); Jaramillo, Diego; Ho-Fung, Victor [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (United States)

2015-12-15

Children with sickle cell disease (SCD) are at risk of bone infarcts and acute osteomyelitis. The clinical differentiation between a bone infarct and acute osteomyelitis is a diagnostic challenge. Unenhanced T1-W fat-saturated MR images have been proposed as a potential tool to differentiate bone infarcts from osteomyelitis. To evaluate the reliability of unenhanced T1-W fat-saturated MRI for differentiation between bone infarcts and acute osteomyelitis in children with SCD. We retrospectively reviewed the records of 31 children (20 boys, 11 girls; mean age 10.6 years, range 1.1-17.9 years) with SCD and acute bone pain who underwent MR imaging including unenhanced T1-W fat-saturated images from 2005 to 2010. Complete clinical charts were reviewed by a pediatric hematologist with training in infectious diseases to determine a clinical standard to define the presence or absence of osteomyelitis. A pediatric radiologist reviewed all MR imaging and was blinded to clinical information. Based on the signal intensity in T1-W fat-saturated images, the children were further classified as positive for osteomyelitis (low bone marrow signal intensity) or positive for bone infarct (high bone marrow signal intensity). Based on the clinical standard, 5 children were classified as positive for osteomyelitis and 26 children as positive for bone infarct (negative for osteomyelitis). The bone marrow signal intensity on T1-W fat-saturated imaging was not significant for the differentiation between bone infarct and osteomyelitis (P = 0.56). None of the additional evaluated imaging parameters on unenhanced MRI proved reliable in differentiating these diagnoses. The bone marrow signal intensity on unenhanced T1-W fat-saturated MR images is not a reliable criterion to differentiate bone infarcts from osteomyelitis in children. (orig.)

Salmonella pyomyositis with concurrent sacroiliac osteomyelitis presenting as piriformis syndrome: A rare case

Directory of Open Access Journals (Sweden)

P S Phadke

2017-01-01

Full Text Available A-21-year old male admitted with fever and piriformis syndrome, typically associated with gluteal region pain radiating down the thigh, was evaluated and found to have pyomyositis involving piriformis and osteomyelitis with sacroiliac joint affection on radiological imaging. Salmonella serotype typhi was isolated from blood culture. He was treated with intravenous Ceftriaxone for 6 weeks with signs of recovery documented clinically as well as on imaging studies. Salmonella pyomyositis with osteomyelitis in an immunocompetent patient with no previous hematological or endocrine disorder makes this case an unusual presentation.

Pulmonary nocardiosis with osteomyelitis

International Nuclear Information System (INIS)

Bechet, R.; Granier, P.; Mourad, M.; Dufranc, A.; Adoue, D.

2007-01-01

We report a case of a 49-year-old female who developed a bronchopneumonia associated with atelectasis of the upper right lobe and back pain of bone origin. Bronchoscopy revealed an endobronchial mass at the origin of the right upper lobe bronchus. Scintigraphy showed three paravertebral spots of the seventh and eighth thoracic vertebrae, without any radiological modification. Culture of lung tissue obtained by trans-parietal punction under CT scan control became positive to Nocardia belonging to the pneumoniae complex. Positive diagnosis of pulmonary nocardiosis associated with two rare localizations was set, one was an endobronchial mass, the other was osteomyelitis of the posterior chest wall. The patient was treated with Trimethoprim ulfamethoxazole and recovered completely. (author)

[Maggot therapy for gangrene and osteomyelitis].

Science.gov (United States)

Mumcuoglu, K Y; Lipo, M; Ioffe-Uspensky, I; Miller, J; Galun, R

1997-03-02

5 patients with diabetic-foot were treated by maggot therapy. The most serious case was in a 75-year-old man who had gangrene and osteomyelitis of the right foot. Proteus mirabilis, Enterococcus sp., Providencia stuartii and Staphylococcus spec. (coagulase positive) were isolated from lesions which did not respond to antibiotic therapy. The patient had twice refused amputation but agreed to maggot therapy. Larvae of the sheep blowfly Phoenicia (Lucilia) sericata were used for twice-weekly treatment over a period of 7 months. Sterile larvae were applied to the wound and replaced every 3-4 days. After 4 months of treatment, the necrotic tissue around the toes and on the sole of the foot detached from the healthy tissue. During the last 3 months of treatment the larvae removed the remaining infected tissue. As therapy progressed, new layers of healthy tissue covered the wound. The offensive odor associated with the necrotic tissue and the intense pain in the foot decreased significantly. At the end of therapy, during which there were no complaints of discomfort, he was able to walk. In the 4 other patients who had relatively superficial gangrene, the maggots debrided the wounds within 2-4 weeks. Thereafter treatment was continued with antibiotics. Maggot therapy can be recommended in cases of intractable gangrene and osteomyelitis, when treatment with antibiotics and surgical debridement have failed.

Imaging osteomyelitis and the diabetic foot

Energy Technology Data Exchange (ETDEWEB)

Becker, W. (Gottingen Univ. (Germany). Dep. of Nuclear Medicine)

1999-03-01

The clinical diagnosis of osteomyelitis and the diabetic foot is in most of the patients not possible without imaging the bone. The clinical problem is to diagnose infection as early, as reliable and as cheap as possible to prevent the possible longstanding and life-threatening complications. For imaging a lot of different radiological and nuclear medicine methods are available. This article focuses on the possible results of conventional plain radiography and tomography, computed tomography and magnetic resonance imaging as radiological and on bone scan, autologous white blood cell scintigraphy with [sup 111]In-oxin or [sup 99m]Tc-HMPAO, antigranulocyte antibodies, [sup 99m]Tc/[sup 111]In-human immunoglobulin,[sup 67] Ga-citrate and [sup 99m]Tc-nanocelloids. Different methods after different answers. Radiological methods give detailed pathological answers, nuclear medicine methods answer questions of specificity such as leukocyte infiltration. If osteomyelitis is suspected, plain radiography should be the first, three phase bone scintigraphy the second and infection specific radiopharmaceuticals the third step of examination. Only in negative images with high clinical suspicion CT or MRI should be the final imaging procedure. In the diabetic foot imaging cascade should also start with plain radiography, followed by three phase bone scintigraphy or MRI. If clinically neuropathy is present specific nuclear medicine imaging should be performed.

Technetium-99m hexamethylpropylene amine oxime leucocyte scintigraphy for the diagnosis of bone and joint infections: a retrospective study in 116 patients

International Nuclear Information System (INIS)

Devillers, A.; Moisan, A.; Jean, S.; Arvieux, C.; Bourguet, P.

1995-01-01

The aim of this study was to evaluate the diagnostic value of technetium-99m hexamethylpropylene amine oxime leucocyte scintigraphy (HMPAO-LS) by means of a retrospective review of 116 patients divided into three groups of bone and joint infection. One hundred and thirty-one LS examinations were performed, and 143 sites analysed. The final diagnosis of infection was based on surgical, histological and bacteriological data and follow-up. Ninety-four suspected localizations were examined in group 1, which included 74 patients with an infection suspected to involve orthopaedic implants. In this group, there were 38 true-positives, 1 false-negative, 49 true-negatives and 6 false-positives. Surgical confirmation was obtained in 34 cases. In group 2 (24 patients with suspected osteomyelitis), there were 27 localizations of which 14 were true-positives and 13 were true-negatives (including seven surgical confirmations). In group 3 (18 patients suspected of septic arthritis) there were eight true-positives, two false-negatives, ten true-negatives and two false-positives. Overall sensitivity of 99m Tc-HMPAO-LS for the detection of bone and joint infection was 95%, with a specificity of 90% (group 1: sensitivity 97%, specificity 89%; group 2: 100% and 100%; group 3: 80% and 83%). It may be concluded that HMPAO-LS is an effective tool for the diagnosis of both bone infection involving implants and chronic osteomyelitis. (orig.)

Unilateral Osteomyelitis of the Clavicle in Childhood:A Case Report

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Arezou Hemmati

2017-08-01

Full Text Available Infection of clavicle is a rare complication in children that is difficult to diagnose. The exact incidence is unknown. We report a case of osteomyelitis of the clavicle without any long term disability.

In-111 WBC imaging in musculoskeletal sepsis

International Nuclear Information System (INIS)

Thompson, L.; Ouzounian, T.J.; Webber, M.M.; Amstutz, H.C.

1984-01-01

This study evaluated the accuracy and utility of the In-111 labeled WBC imaging in a series of patients who were suspected of having musculoskeletal sepsis. The labeling of the WBCs was patterned after a method previously described, in which the WBCs are labeled with In-111 oxine in plasma. The WBCs from 100 ml of blood are separated and incubated with In-111 oxine complex, and then 500 μCi. of the labeled cells were reinjected into the patient. Images of the areas in question were obtained at 24 hrs. In some instances, 48 hour images were also obtained. Images were interpreted using consistent criteria. Forty imaging procedures were done on 39 patients. These included 39 total joint protheses, and 17 other images to evaluate possible osteomyelitis, septic arthritis or deep abscesses. Of these studies, 15 were positive, and 42 negative. The findings were then correlated with operative culture and pathology in 21, aspiration cultures and gram stains in 14, and with clinical findings in the remaining 21. This correlation showed 41 true negatives, 12 true positives, 1 false negative, and 2 false positives. The sensitivity was 92.9% and the specificity was 95.2%l. The false negative occurred in a patient on chronic suppressive antibiotic therapy for an infected total hip replacement. The false positive images occurred in a patient with active rheumatoid arthritis and in a patient imaged one month post operative placement of the prosthesis. These images were very useful in several septic patients who had many possible sites of infection. The authors conclude that In-III imaging is an accurate and useful non-invasive method of evaluating musculoskeletal sepsis

Treatment of Osteomyelitis: A Case for Disruption of the Affected Adjacent Periosteum.

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Hudson, John W; Daly, Austin P; Foster, Michael

2017-10-01

To evaluate the response of mandibular osteomyelitis treated by surgical decortication with disruption of the affected adjacent periosteum in concert with long-term targeted antibiotic therapy. The hypothesis is that, by removing the buccal cortical plate and disrupting the hypertrophically inflamed adjacent periosteum, the medullary bone will be brought in contact with bleeding tissue and circulating immunologic factors and antibiotics, which will promote definitive resolution. A retrospective review was conducted of 7 patient charts with associated radiographs from November 2010 to August 2016 treated by the first author at the University of Tennessee Medical Center (Knoxville, TN). Patients with chronic suppurative or nonsuppurative osteomyelitis of the mandible without condylar involvement or pathologic fracture were selected and treated with decortication with periosteal disruption in combination with long-term targeted antibiotic therapy. Seven patients (3 women and 4 men; mean age, 60 yr) underwent decortication with periosteal disruption of the affected area and received at least 6 weeks of targeted intravenous antibiotics. Computed tomography was performed preoperatively and a repeat study was performed after completion of antibiotics. In each case, post-treatment imaging showed definitive resolution after treatment with decortication in concert with disruption of the inflamed hypertrophic periosteum and intravenous antibiotics. Debridement of the infected cortical bone with restoration of the blood supply through disruption of the adjacent periosteum provided definitive resolution of mandibular osteomyelitis in the 7 patients treated. The hypothesis is that disruption of the affected adjacent periosteum reintroduces an immune-mediated response in concert with improved antibiotic delivery to and penetrance of the diseased mandible, aiding in definitive resolution. Decortication with periosteal disruption allows for preservation of the inferior alveolar

Hand infections: anatomy, types and spread of infection, imaging findings, and treatment options.

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Patel, Dakshesh B; Emmanuel, Neelmini B; Stevanovic, Milan V; Matcuk, George R; Gottsegen, Christopher J; Forrester, Deborah M; White, Eric A

2014-01-01

Infections of the hand are common, particularly in immunocompromised patients, and can lead to significant morbidity, including amputation, if not treated properly. Hand infection can spread far and wide from the original site of inoculation through interconnections between the synovium-lined and nonsynovial potential spaces. Because surgery is the mainstay of treatment, knowledge of the pertinent anatomy is imperative for accurately describing the presence, location, and extent of infection. The authors review the pertinent anatomy of the spaces of the hand and describe different types of infection-including cellulitis, necrotizing fasciitis, paronychia, felon, pyogenic flexor tenosynovitis, deep space infections, septic arthritis, and osteomyelitis-and common causative organisms of these infections. They also describe various modes of spread; the common radiologic appearances of hand infections, with emphasis on findings at magnetic resonance imaging and ultrasonography; and the role of radiology in the management of these infections, along with a brief overview of treatment options. ©RSNA, 2014.

Clinical significance of the isolation of Staphylococcus epidermidis from bone biopsy in diabetic foot osteomyelitis

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Javier Aragón-Sánchez

2010-08-01

Full Text Available Introduction: Coagulase-negative staphylococci are considered as microorganisms with little virulence and usually as contaminants. In order to establish the role of Staphylococcus epidermidis as a pathogen in diabetic foot osteomyelitis, in addition to the isolation of the sole bacterium from the bone it will be necessary to demonstrate the histopathological changes caused by the infection. Methods: A consecutive series of 222 diabetic patients with foot osteomyelitis treated surgically in the Diabetic Foot Unit at La Paloma Hospital (Las Palmas de Gran Canaria, Canary Islands, Spain between 1 October 2002 and 31 October 2008. From the entire series including 213 bone cultures with 241 isolated organisms, we have analyzed only the 139 cases where Staphylococci were found. We analyzed several variables between the two groups: Staphylococcus aureus versus Staphylococcus epidermidis. Results: Of the 134 patients included in this study, Staphlylococcus epidermidis was found as the sole bacterium isolated in 11 cases and accompanied by other bacteria in 12 cases. Staphlylococcus aureus was found as the sole bacterium isolated in 72 cases and accompanied by other bacteria in 39 cases. Histopathological changes were found in the cases of osteomyelitis where Staphylococcus epidermidis was the sole bacterium isolated. Acute osteomyelitis was found to a lesser extent when Staphylococcus epidermidis was the sole bacterium isolated but without significant differences with the cases where Staphylococcus aureus was the sole bacterium isolated. Conclusion: Staphylococcus epidermidis should be considered as a real pathogen, not only a contaminant, in diabetic patients with foot osteomyelitis when the bacterium is isolated from the bone. No differences in the outcomes of surgical treatment have been found with cases which Staphlylococcus aureus was isolated.

Legionella Bozemanae, a New Cause of Septic Arthritis diagnosed by 16S PCR followed by specific culture

DEFF Research Database (Denmark)

Just, Søren Andreas; Bonde Knudsen, John; Skov, Marianne Nielsine

This is the first report ever to demonstrate that L. Bozemanae can colonize synovial joints leading to infectious arthritis. L. Bozemanae is a rare Legionella species, earlier described as a cause of cavitating lung infections with up to 40% mortality (2). L. Bozemanae is missed by standard...

Septic systems as hot-spots of pollutants in the environment: Fate and mass balance of micropollutants in septic drainfields.

Science.gov (United States)

Yang, Yun-Ya; Toor, Gurpal S; Wilson, P Chris; Williams, Clinton F

2016-10-01

Septic systems, a common type of onsite wastewater treatment systems, can be an important source of micropollutants in the environment. We investigated the fate and mass balance of 17 micropollutants, including wastewater markers, hormones, pharmaceuticals and personal care products (PPCPs) in the drainfield of a septic system. Drainfields were replicated in lysimeters (1.5m length, 0.9m width, 0.9m height) and managed similar to the field practice. In each lysimeter, a drip line dispersed 9L of septic tank effluent (STE) per day (equivalent to 32.29L/m(2) per day). Fourteen micropollutants in the STE and 12 in the leachate from drainfields were detected over eight months. Concentrations of most micropollutants in the leachate were low (85% of the added micropollutants except for sucralose were attenuated in the drainfield. We discovered that sorption was the key mechanism for retention of carbamazepine and partially for sulfamethoxazole, whereas microbial degradation likely attenuated acetaminophen in the drainfield. This data suggests that sorption and microbial degradation limited transport of micropollutants from the drainfields. However, the leaching of small amounts of micropollutants indicate that septic systems are hot-spots of micropollutants in the environment and a better understanding of micropollutants in septic systems is needed to protect groundwater quality. Copyright © 2016 Elsevier B.V. All rights reserved.

[Streptococcus milleri: An unusual cause of skull extensive osteomyelitis in an immunocompetent patient].

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Duquenne, C; Dernis, E; Zehrouni, A; Bizon, A; Duquenne, M

2017-09-01

Streptococcus milleri (Streptococcus anginosus, intermedius and constellatus) are commensal organisms, which can become pathogenic and cause infection with frequent abscess formation, local or metastatic extension. Osteomyelitis of the skull has been rarely reported in this type of infection. Skull osteomyelitis due to Streptococcus milleri is reported in a 61-year-old immunocompetent man without any medical history, occurring 10 months after a head injury without any wound or complication at initial presentation. A progressive right parieto-occipital headache with worsening and increased acute phase reactants evoked a giant cell arteritis. After few days of corticosteroid therapy (0.5 mg/kg/day), diagnosis of subcutaneous abscess associated to an extensive osteomyelitis of the skull due to Streptococcus milleri was diagnosed. The outcome was favorable after drainage of one liter of pus, irrigation, debridement and antibiotherapy by amoxicillin for 8 weeks. It is necessary to discuss the differential diagnosis of giant cell arteritis particularly when symptoms are unusual. Even a short-term corticosteroid therapy may dramatically exacerbate an undetected infection. Copyright © 2017. Published by Elsevier SAS.

Scintigraphic evaluation of diabetic osteomyelitis: concise communication

International Nuclear Information System (INIS)

Park, H.M.; Wheat, L.J.; Siddiqui, A.R.; Burt, R.W.; Robb, J.A.; Ransburg, R.C.; Kernek, C.B.

1982-01-01

Researchers have reviewed the three-phase bone scans, radiographs, and histologic findings of 39 diabetic patients with serious foot problems. The sensitivity and specificity of bone scans were 83% and 75%, respectively, for osteomyelitis of the small bones of the foot. The positive and negative predictive values were 87% and 69%, respectively. The radiographs were less sensitive (62%) and less specific (69%), with predictive values of 80% (positive) and 47%

Maxillary Necrosis: A Sequelae of Fungal Osteomyelitis

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K Anbarasi

2010-01-01

Full Text Available Osteomyelitis is designated to a variety of bone diseases having inflammation as a common denominator. Persistent infection progresses to inflammation of marrow space, haversian system and periostium of affected region. Thrombosis of endothelial vessels cause necrosis and sequestrum formation. Both pyogenic and nonpyogenic infections of jaw lead to this condition. Immunosuppressed patients are more prone to mycelial infections, whereas their occurrence in immunocompetent individuals are highly unusual.

Gram-negative diabetic foot osteomyelitis: risk factors and clinical presentation.

Science.gov (United States)

Aragón-Sánchez, Javier; Lipsky, Benjamin A; Lázaro-Martínez, Jose L

2013-03-01

Osteomyelitis frequently complicates infections in the feet of patients with diabetes. Gram-positive cocci, especially Staphylococcus aureus, are the most commonly isolated pathogens, but gram-negative bacteria also cause some cases of diabetic foot osteomyelitis (DFO). These gram-negatives require different antibiotic regimens than those commonly directed at gram-positives. There are, however, few data on factors related to their presence and how they influence the clinical picture. We conducted a retrospective study to determine the variables associated with the isolation of gram-negative bacteria from bone samples in cases of DFO and the clinical presentation of these infections. Among 341 cases of DFO, 150 had a gram-negative isolate (alone or combined with a gram-positive isolate) comprising 44.0% of all patients and 50.8% of those with a positive bone culture. Compared with gram-positive infections, wounds with gram-negative organisms more often had a fetid odor, necrotic tissue, signs of soft tissue infection accompanying osteomyelitis, and clinically severe infection. By multivariate analysis, the predictive variables related to an increased likelihood of isolating gram-negatives from bone samples were glycated hemoglobin gram-negatives had a statistically significantly higher prevalence of leukocytosis and higher white blood cell counts than those without gram-negatives. In conclusion, gram-negative organisms were isolated in nearly half of our cases of DFO and were associated with more severe infections, higher white blood cell counts, lower glycated hemoglobin levels, and wounds of traumatic etiology.

Vacuum-Assisted Closure Combined with a Myocutaneous Flap in the Management of Osteomyelitis in a Dog

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Jeremy L. Shomper

2013-01-01

Full Text Available Case Description. A 2.5-year-old female spayed mixed breed dog presented to the Teaching Hospital for draining tracts on the left medial aspect of the tibia. Two years prior to presentation, the patient sustained a left tibial fracture, which was repaired with an intramedullary (IM pin and two cerclage wires. Multiple antimicrobials were utilized during this time. Clinical Findings. Radiographs were consistent with left tibial osteomyelitis. The implant was removed and the wound was debrided. Treatment and Outcome. A bone window on the medial aspect of the tibia was created in order to facilitate implant removal. The wound and associated bone window were treated with vacuum assisted closure (VAC in preparation for reconstructive surgery. Adjunctive VAC therapy was utilized following the caudal sartorius myocutaneous flap. Complications following this surgery included distal flap necrosis and donor site dehiscence. Clinical Relevance. This presents a difficult case of canine osteomyelitis with subsequent wound care in which VAC and a myocutaneous flap were useful adjunctive treatments for osteomyelitis. This is the first report of VAC in the management of canine osteomyelitis and management with a myocutaneous flap.

Clostridium difficile bacteremia and meningitis as a complication of prolonged cephalosporin therapy in a case of staphylococcal pyogenic arthritis

Institute of Scientific and Technical Information of China (English)

Abhrajit Ganguly; Saibal Das; Jayanta Kumar Dey; Somnath Mondal

2012-01-01

With increasing incidence of Clostridium difficile (C. difficile) associated diarrhea and pseudomembranous colitis, several extra-intestinal manifestations of the organism have been unmasked which include-bacteremia, brain abscess, pericarditis etc. We report a rare and interesting case of C. difficile bacteremia and subsequent meningitis in a 10 year old child. The child was immune competent, which further raises the question about the virulent possibilities of the organism and its implications in the near future. The condition resulted from a prolonged treatment with intravenous (I.V.) cefotaxime for staphylococcal pyogenic arthritis. The child recovered from the septic arthritis but on the 7th day post-admission developed features of bacteremia. The child was later treated with intravenous metronidazole and vancomycin and he was discharged on the 21st day post-admission. No recurrence of symptoms was noted.

Single-Stage Treatment of Osteomyelitis for Digital Salvage by Using an Antibiotic-Eluting, Methylmethacrylate Joint-Spanning Spacer.

Science.gov (United States)

Aimé, Victoria L; Kidwell, John T; Webb, Leland H

2017-06-01

Osteomyelitis of the digit is a challenging problem that can result in amputation. We describe 13 cases of osteomyelitis involving bones of the hand managed with a novel technique. We reviewed records of 12 patients (13 digits) who had joint-spanning, antibiotic-eluting (tobramycin or vancomycin), methylmethacrylate spacers placed as definitive, single-stage treatment for digital osteomyelitis. The primary outcome was digit salvage. Secondary outcomes were infection eradication (no recurrence at 3 months) and spacer removal. Patients were followed up until the infection resolved (ie, no cutaneous signs of infection, including pain, erythema, or swelling). At a mean of 24 months, 10 of 13 infections had successful one-stage treatment. One patient required a second operation to revise a soft tissue flap but the spacer remained in place. Two spacers were removed because of malalignment. An antibiotic-eluting methylmethacrylate spacer is an innovative treatment for digital osteomyelitis. In 12 consecutive patients (13 digits), we successfully salvaged the digit. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Modern tactics of observation the postpartum purulent-septic complications

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O. M. Slinko

2014-04-01

Full Text Available Introduction. Postpartum purulent-septic diseases remain an urgent problem of modern obstetrics and are one of the important causes of maternal mortality. The presence of lethal proceeds from septic complications in the postpartum period is above all due to late diagnosis of this complication, delayed acceptance decision on the need and extent of surgery, inadequate capacity of syndromic and intensive care. The aim of research. The clinical analysis of different methods of diagnosis and treatment of patients with postpartum purulent-septic complications, obtained during the period from January 2011 to June 2013, based on work of gynecological department of Zaporozhye Regional Clinical Hospital. Materials and methods. During the period from January 2011 to June 2013 in the gynecological department of Zaporozhye Regional Clinical Hospital specialized medical care of 30 patients with purulent-septic complications in the postpartum period have been provided. 5 women in labor (16.67% were transferred from the maternity homes of Zaporozhye city and the rest (83.33% from different regions. Results. All patients admitted to gynecology department of Zaporozhye Regional Clinical Hospital were conducted massive antibiotic, syndromic therapy. 11 additional patients had an operation vacuum aspiration contents of the uterus, and 5 mothers had absolute indications for surgery: hysterectomy with uterine tube (2 patients diagnosed - septic condition, 3 cases - failure scar on the uterus after cesarean. Conclusion. 1. Delivery by cesarean section surgery significantly increases the risk of developing pyo-septic complications. Prompt delivery should be made according to strict indications, using modern sutures , intraoperative blood loss objective assessment (if necessary with timely appointment of replacement therapy and anti-anemic , with mandatory drainage of the abdominal cavity with repeated cesarean operations . 2. Using the entire set of clinical

The use of differential scintigraphy in the clinical diagnosis of osseous and soft tissue changes affecting the diabetic foot

International Nuclear Information System (INIS)

Visser, H.J.; Jacobs, A.M.; Oloff, L.; Drago, J.J.

1984-01-01

Prompt recognition of cellulitis, osteomyelitis, diabetic osteolysis, Charcot neuroarthropathy, septic synovitis, and deep plantar abscesses in the diabetic foot is essential because the therapy is drastically different. Differential diagnosis has been greatly facilitated by recently developed scanning techniques

Septic Systems Case Studies

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A collection of septic systems case studies to help community planners, elected officials, health department staff, state officials, and interested citizens explore alternatives for managing their decentralized wastewater treatment systems.

Arthritis - resources

Science.gov (United States)

Resources - arthritis ... The following organizations provide more information on arthritis : American Academy of Orthopaedic Surgeons -- orthoinfo.aaos.org/menus/arthritis.cfm Arthritis Foundation -- www.arthritis.org Centers for Disease Control and Prevention -- www. ...

Probiotics improve survival of septic rats by suppressing conditioned pathogens in ascites

Science.gov (United States)

Liu, Da-Quan; Gao, Qiao-Ying; Liu, Hong-Bin; Li, Dong-Hua; Wu, Shang-Wei

2013-01-01

AIM: To investigate the benefits of probiotics treatment in septic rats. METHODS: The septic rats were induced by cecal ligation and puncture. The animals of control, septic model and probiotics treated groups were treated with vehicle and mixed probiotics, respectively. The mixture of probiotics included Bifidobacterium longum, Lactobacillus bulgaricus and Streptococcus thermophilus. We observed the survival of septic rats using different amounts of mixed probiotics. We also detected the bacterial population in ascites and blood of experimental sepsis using cultivation and real-time polymerase chain reaction. The severity of mucosal inflammation in colonic tissues was determined. RESULTS: Probiotics treatment improved survival of the rats significantly and this effect was dose dependent. The survival rate was 30% for vehicle-treated septic model group. However, 1 and 1/4 doses of probiotics treatment increased survival rate significantly compared with septic model group (80% and 55% vs 30%, P probiotics treated group compared with septic model group (5.20 ± 0.57 vs 9.81 ± 0.67, P probiotics treated group compared with septic model group (33.3% vs 100.0%, P probiotics treated group were decreased significantly compared with that of septic model group (3.93 ± 0.73 vs 8.80 ± 0.83, P probiotics treatment, there was a decrease in the scores of inflammatory cell infiltration into the intestinal mucosa in septic animals (1.50 ± 0.25 vs 2.88 ± 0.14, P Probiotics improve survival of septic rats by suppressing these conditioned pathogens. PMID:23840152

Prospective evaluation of bone and leukocyte scintigraphy for diagnosis of chronic osteomyelitis in patients with coexistent soft-tissue pathology

International Nuclear Information System (INIS)

Jacobson, A.F.; Harley, J.D.; Lipsky, B.A.; Pecoraro, R.E.

1989-01-01

This paper reports on a study involving twenty-four patients with soft-tissue infections or wounds and radiographic abnormalities in contiguous bones possibly representing osteomyelitis who underwent three-phase T c -99 m methylene diphosphonate (MDP) bone scanning, followed by In-111 leukocyte scintigraphy (22 patients) and bone biopsy (21 patients). Chronic osteomyelitis was confirmed in 12 patients by means of biopsy cultures and in one by means of histologic findings following amputation. Four patterns of leukocyte uptake in bone were identified: definitely increased, possibly increased, normal, and decreased. The prevalence of osteomyelitis for these four leukocyte scan patterns was as follows: 89% (eight of nine patients), 40% (two of five), 20% (one of five), and 67% (two of three), respectively. A definite increase in bone uptake of In-111-labeled leukocytes usually reflects osteomyelitis, but bone biopsy may be necessary to establish the diagnosis when other scan patterns are present

Retainment of the antimicrobial agent triclosan in a septic tank

DEFF Research Database (Denmark)

Kirjanova, Ala; Rimeika, Mindaugas; Vollertsen, Jes

2014-01-01

Laboratory experiments were conducted to investigate the fate of the antimicrobial agent triclosan (TCS) in a conventional septic tank. The main mechanism of TCS removal from wastewater was identified to be rapid TCS sorption to suspended particles followed by settling of these particles...... to the bottom of the septic tank. Sorption to particles was completed within minutes while the settling took several days. Therefore, in a septic tank the removal of TCS from wastewater is mainly determined by the removal of suspended particles by sedimentation. Over 5 days of hydraulic residence time...... subsequent sorption onto the septic sludge....

Carpal intra-articular blastomycosis in a Labrador retriever.

Science.gov (United States)

Woods, Katharine S; Barry, Maureen; Richardson, Danielle

2013-02-01

A 6-month-old male castrated Labrador retriever was presented for coughing and forelimb lameness. Blastomyces dermatitidis was identified in cytology of sputum and synovial fluid. Repeat arthrocentesis 7 months later revealed resolution of septic arthritis. Fungal septic arthritis should be considered for cases of monoarthritis and may respond to oral itraconazole treatment.

Carpal intra-articular blastomycosis in a Labrador retriever

OpenAIRE

Woods, Katharine S.; Barry, Maureen; Richardson, Danielle

2013-01-01

A 6-month-old male castrated Labrador retriever was presented for coughing and forelimb lameness. Blastomyces dermatitidis was identified in cytology of sputum and synovial fluid. Repeat arthrocentesis 7 months later revealed resolution of septic arthritis. Fungal septic arthritis should be considered for cases of monoarthritis and may respond to oral itraconazole treatment.

Actinomycotic Osteomyelitis of Maxilla Presenting as Oroantral Fistula: A Rare Case Report

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Ashalata Gannepalli

2015-01-01

Full Text Available Actinomycosis is a chronic granulomatous infection caused by Actinomyces species which may involve only soft tissue or bone or the two together. Actinomycotic osteomyelitis of maxilla is relatively rare when compared to mandible. These are normal commensals and become pathogens when they gain entry into tissue layers and bone where they establish and maintain an anaerobic environment with extensive sclerosis and fibrosis. This infection spreads contiguously, frequently ignoring tissue planes and surrounding tissues or organ. The portal of entry may be pulpal, periodontal infection, and so forth which may lead to involvement of adjacent structures as pharynx, larynx, tonsils, and paranasal sinuses and has the propensity to damage extensively. Diagnosis is often delayed and is usually based on histopathology as they are cultured in fewer cases. The chronic clinical course without regional lymphadenopathy may be essential in diagnosis. The management of actinomycotic osteomyelitis is surgical debridement of necrotic tissue combined with antibiotics for 3–6 months. The primary actinomycosis arising within the maxilla with contiguous involvement of paranasal sinus with formation of oroantral fistula is rare. Hence, we present a 50-year-old female patient with chronic sclerosing osteomyelitis of maxilla which presented as oroantral fistula with suppurative and sclerotic features.

Osteomyelitis of the calcaneus in horses: 28 cases (1972-1987)

International Nuclear Information System (INIS)

MacDonald, M.H.; Honnas, C.M.; Meagher, D.M.

1989-01-01

Medical records of 28 horses with osteomyelitis of the calcaneus were reviewed to evaluate signalment, history, diagnostic and treatment methods, outcome, and long-term follow-up information. Trauma was the most commonly reported cause (24). Physical examination revealed lameness in 27 horses, and 22 (79%) had a wound or draining tract over the plantar aspect of the calcaneus. Radiography of all horses was done prior to the initiation of treatment, and follow-up radiography was done on 20 horses. The most common radiographic findings were soft tissue swelling (25), bony lysis of the calcaneus (17), bone fragments or sequestra from the tuber calcis (13), and periosteal new bone production or bony lysis of the sustentaculum tali (5). Association could not be found between initial radiographic findings and eventual outcome of the case. Positive bacterial cultures were obtained from 13 horses. A wide variety of gram-positive, gram-negative, and anaerobic organisms were isolated. Fourteen of the 15 isolates, for which susceptibilities were reported, were susceptible to penicillin, gentamicin, or trimethoprim sulfamethoxazole. Twenty-six of the 28 horses diagnosed as having osteomyelitis of the calcaneus were treated; 16 horses were treated with surgical debridement in addition to antimicrobial treatment, and 10 horses were treated with antimicrobial agents, anti-inflammatory drugs, or supportive wound care. There was no significant difference in survival rate of horses treated surgically and those treated conservatively. Six horses that were treated were later euthanatized for problems associated with chronic osteomyelitis, and 2 horses died or were euthanatized for unrelated problems. Eighteen horses (64%) were alive at last follow-up

Dopamine versus noradrenaline in septic shock

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Bo Xu

2011-10-01

Full Text Available BackgroundThe ‘Surviving Sepsis’ Campaign guidelines recommend theuse of dopamine or noradrenaline as the first vasopressor inseptic shock. However, information that guides clinicians inchoosing between dopamine and noradrenaline as the firstvasopressor in patients with septic shock is limited.ObjectiveThis article presents a review of the literature regarding theuse of dopamine versus noradrenaline in patients with septicshock.ResultsTwo randomised controlled trials (RCT and two largeprospective cohort studies were analysed. RCT data showeddopamine was associated with increased arrhythmic events.One cohort study found dopamine was associated with higher30-day mortality. The other cohort study found noradrenalinewas associated with higher 28-day mortality.DiscussionData on the use of dopamine versus noradrenaline in patientswith septic shock is limited. Following the recent SOAP IIstudy, there is now strong evidence that the use of dopaminein septic shock is associated with significantly morecardiovascular adverse events, compared tonoradrenaline.ConclusionNoradrenaline should be used as the initial vasopressor inseptic shock to avoid the arrhythmic events associatedwith dopamine.

Differentiation of osteomyelitis and infarction in sickle-cell hemoglobinopathies using combined bone-marrow and gallium scanning

International Nuclear Information System (INIS)

Hatfield, M.K.; Kahn, C.E.; Ryan, J.W.; Martin, W.B.

1986-01-01

The clinical records and scintigrams of patients with sickle cell hemoglobinopathies in whom acute symptoms developed suggestive of possible osteomyelitis and who had undergone sequential Tc-99m bone marrow scans and gallium scintigraphy of the affected sites were reviewed. Osteomyelitis was correctly diagnosed in six of 18 cases when gallium was focally increased relative to a site of decreased or absent bone marrow activity. Of 12 episodes of infarction, both studies showed focally decreased activity in a concordant manner in 11. The remaining, false-positive study indicated slightly increased gallium in 11. The remaining, false-positive indicated slightly increased gallium concentration at a site of decreased bone marrow activity. Overall, a protocol of sequential Tc-99m bone marrow scans and gallium scintigraphy is an effective means of distinguishing osteomyelitis from infarction in patients with sickle cell hemoglobinopathies

Vertebral Osteomyelitis Caused by Mycobacterium abscessus Surgically Treated Using Antibacterial Iodine-Supported Instrumentation

Directory of Open Access Journals (Sweden)

Satoshi Kato

2014-01-01

Full Text Available Mycobacterium abscessus infections rarely develop in healthy individuals, and mostly they occur in immunocompromised hosts. Vertebral osteomyelitis due to Mycobacterium abscessus is very rare and only three previous cases of spinal infection caused by Mycobacterium abscessus have been reported. Mycobacterium abscessus isolates are uniformly resistant to antituberculous agents and can display a virulent biofilm-forming phenotype. The patient was a 67-year-old woman with vertebral osteomyelitis of the L1-2. She was healthy without immune-suppressed condition, history of trauma, or intravenous drug use. The smear examination of the specimen harvested by CT-guided puncture of the paravertebral abscess revealed Mycobacterium abscessus. Her disease condition did not abate with conservative treatment using antimicrobial chemotherapy. Radical debridement of the vertebral osteomyelitis and anterior reconstruction from T12 to L2 using antibacterial iodine-supported instrumentation were performed. Chemotherapy using clarithromycin, amikacin, and imipenem was applied for 6 months after surgery as these antibiotics had been proven to be effective to Mycobacterium abscessus after surgery. Two years after surgery, the infected anterior site healed and bony fusion was successfully achieved without a recurrence of infection.

Disturbance of growth of the vertebral bodies in children and adolescents with hematogenous osteomyelitis of the vertebral column

International Nuclear Information System (INIS)

Sizov, V.A.

1987-01-01

Clinicoroentgenological changes were studied over time in 72 children and adolescents with localized hematogenous osteomyelitis of the lumbar spine. The duration of clinicoroengenological observation ranged from 1 year to 15 years. The dynamic roentgenological followup of a course of hematogenous osteomyelitis developing in the period of growth, made it possible to reveal and describe for the first time an increase in the height of the vertebral bodies which hitherto was regarded in literature as a pathognomonic sign of tuberculous spondylitis. Unlike tuberculosis, in hematogenous osteomyelitis there was an increase in the height not only of the adjacent unaffected but also of the affected vertebrae in case of their superficial or localized focal involvement

[Osteomyelitis of the temporomaxillary joint (author's transl)].

Science.gov (United States)

Winiker-Blanck, E; Wittstock, C; Braun, L; Biedermann, F

1978-01-01

Although osteomyelitis of the inferior maxilla is still relatively frequently diagnosed, manifestation of the disease in the temporomaxillary joint is a rare occurrence. The symptomatology, diagnosis, and therapy of this particular arthropathy is discussed by reference to three cases treated in recent years at the Berlin Clinic of Maxillofacial Surgery. The importance of an early diagnosis and therapy is directed attention to because of the danger of serious subsequent diseases that may result in the loss of vital functions.

Sepsis and Septic Shock Strategies.

Science.gov (United States)

Armstrong, Bracken A; Betzold, Richard D; May, Addison K

2017-12-01

Three therapeutic principles most substantially improve organ dysfunction and survival in sepsis: early, appropriate antimicrobial therapy; restoration of adequate cellular perfusion; timely source control. The new definitions of sepsis and septic shock reflect the inadequate sensitivity, specify, and lack of prognostication of systemic inflammatory response syndrome criteria. Sequential (sepsis-related) organ failure assessment more effectively prognosticates in sepsis and critical illness. Inadequate cellular perfusion accelerates injury and reestablishing perfusion limits injury. Multiple organ systems are affected by sepsis and septic shock and an evidence-based multipronged approach to systems-based therapy in critical illness results in improve outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Chronic multifocal non-bacterial osteomyelitis in hypophosphatasia mimicking malignancy

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Warmuth-Metz Monika

2007-01-01

Full Text Available Abstract Background Hypophosphatasia (HP is characterized by a genetic defect in the tissue-nonspecific alkaline phosphatase (TNSALP gene and predominantly an autosomal recessive trait. HP patients suffer from reduced bone mineralization. Biochemically, elevated concentrations of substrates of TNSALP, including pyridoxal-5'-phosphate and inorganic pyrophosphate occur in serum, tissues and urine. The latter has been associated with chronic inflammation and hyperprostaglandinism. Case presentation We report on 2 affected children presenting with multifocal inflammatory bone lesions mimicking malignancy: A 6 years old girl with short stature had been treated with human growth hormone since 6 months. Then she started to complain about a painful swelling of her left cheek. MRI suggested a malignant bone lesion. Bone biopsy, however, revealed chronic inflammation. A bone scan showed a second rib lesion. Since biopsy was sterile, the descriptive diagnosis of chronic non-bacterial osteomyelitis (CNO was established. The diagnostic tests related to growth failure were repeated and subsequent analyses demonstrated a molecular defect in the TNSALP gene. The second girl (10 years old complained about back pain after she had fallen from her bike. X rays of her spine revealed compressions of 2 thoracic vertebrae. At first these were considered trauma related, however a bone scan did show an additional lesion in the right 4th rib. A biopsy of this rib revealed a sterile lympho- plasmocytoid osteomyelitis suggesting multifocal CNO. Further analyses did show a decreased TNSALP in leukocytes and elevated pyridoxal phosphate in plasma, suggesting a heterozygous carrier status of HP. Conclusion Chronic bone oedema in adult HP and chronic hyper-prostaglandinism in childhood HP do suggest that in some HP patients bone inflammation is present in conjunction with the metabolic defect. Sterile multifocal osteomyelitis could be demonstrated. Non-steroidal anti

Evaluation of Coagulation Profiles in Dogs with Septic Shock

OpenAIRE

YILMAZ, Zeki; YALÇIN, Ebru

2002-01-01

The aim of the this study was to observe possible changes in coagulation profiles in dogs with septic shock. A total of 30 dogs (control group n=10, test group n=20) were used as materials in this study. Although different diseases leading to septic shock were diagnosed in dogs in the test group, dogs were selected on the basis of septic shock criteria such as fever or hypothermia, hypotension, leukopenia or leukocytosis and thrombocytopenia. In addition to the results of rutine clinical and...

Chronic multifocal osteomyelitis: Is infectious causation a moot point?

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Nevio Cimolai

2011-09-01

Full Text Available Summary: Chronic multifocal osteomyelitis (CMO is an uncommon disease entity with descriptions possibly emanating from the medical literature over one century ago, and there are numerous disease entities which have been historically detailed and which are probably synonymous. The illness is one of chronicity with exacerbating and remitting focal bony lesions. The differential diagnosis for a bony lesion which ultimately proves to be CMO is initially quite broad. There is no absolute pathognomonic clinical finding, and the diagnosis is highly dependent on clinical course, histopathology, and an absence of microbial infection. Recent studies have focused on immune dysfunction or dysregulation, and there are now many other diseases which are inflammatory in nature and which have been diagnosed among patients with CMO. Despite the aforementioned, the potential for direct infectious causation or indirect causation by infectious stimulation of immunity cannot be entirely excluded. Infection as a mechanism for pathogenesis must continue to be entertained. Multi-centre studies are key to future research. Key words: Osteomyelitis, Infection, SAPHO, Immunity

Bone infection in patients suspected of complicating osteomyelitis: the diagnostic value of dual isotope bone-granulocyte scintigraphy

DEFF Research Database (Denmark)

Buhl, Thora; Stentzer, Kim; Hede, Adam

2005-01-01

: Simultaneous dual isotope bone-granulocyte scintigraphic images were obtained in 42 consecutive patients in whom conventional X-ray, erythrocyte sedimentation rate, and C-reactive protein were also available. 99mTc MDP bone and 111In labelled granulocyte imaging was obtained simultaneously. The images were...... interpreted as positive for osteomyelitis if regions of interests of pathologic 111In granulocyte accumulation included 99mTc MDP activity on the bone images (except in the spine). RESULTS: The sensitivity, specificity, and accuracy were 84, 71 and 79%, respectively, for simultaneous, dual isotope bone......AIM: The purpose of this study was to evaluate the diagnostic value of dual isotope bone-granulocyte scintigraphy in patients with known bone pathology clinically suspected of osteomyelitis, i.e. complicating osteomyelitis, using per-operative bacterial culture from bone as reference. METHODS...

Non-infectious osteomyelitis of the mandible in a young woman

DEFF Research Database (Denmark)

Rasmussen, Anne Q; Andersen, Ulrik B; Jørgensen, Niklas R

2014-01-01

after 12 months. The bone pain was significantly reduced six months after treatment and had disappeared 24 months after treatment. CONCLUSION: We report an unusual localization of non-infectious osteomyelitis of the jaw in a young woman. Even though the presentation was in the jaw, her condition...

Granulomatous salmonella osteomyelitis associated with anti-tumor necrosis factor therapy in a non-sickle cell patient: a case report

Energy Technology Data Exchange (ETDEWEB)

Gould, Elaine S.; Gilet, Anthony G. [State University of New York at Stony Brook, Department of Radiology, Stony Brook, NY (United States); Vigorita, Vincent J. [SUNY Health Sciences Center Brooklyn, Department of Pathology and Orthopedics, Brooklyn, NY (United States)

2010-08-15

Salmonella osteomyelitis is seen most commonly in patients with sickle cell disease and in those with compromised immune systems. We report on the clinical, histological and imaging findings of salmonella osteomyelitis with intraosseous abscess formation occurring in a non-sickle cell patient receiving anti-tumor necrosis factor (TNF) alpha therapy. (orig.)

Granulomatous salmonella osteomyelitis associated with anti-tumor necrosis factor therapy in a non-sickle cell patient: a case report

International Nuclear Information System (INIS)

Gould, Elaine S.; Gilet, Anthony G.; Vigorita, Vincent J.

2010-01-01

Salmonella osteomyelitis is seen most commonly in patients with sickle cell disease and in those with compromised immune systems. We report on the clinical, histological and imaging findings of salmonella osteomyelitis with intraosseous abscess formation occurring in a non-sickle cell patient receiving anti-tumor necrosis factor (TNF) alpha therapy. (orig.)

Caloric requirement of the critically ill septic patient

International Nuclear Information System (INIS)

Shizgal, H.M.; Martin, M.F.

1988-01-01

The caloric requirement of the critically ill septic patient was determined by measuring body composition, by multiple isotope dilution, before and at 2-wk intervals while receiving total parenteral nutrition (TPN) in 86 septic and 57 nonseptic malnourished patients. All patients received a TPN solution containing 25% dextrose and 2.75% crystalline amino acids. The body composition of the nonseptic patients, who received 51.9 +/- 1.5 kcal/kg.day, improved significantly, while that of the septic patients, receiving 46.8 +/- 1.1 kcal/kg.day was only maintained. The relationship between caloric intake and the restoration of a malnourished body cell mass (BCM) was determined for each group by correlating, using multiple linear regression, the mean daily change in the BCM with the caloric intake and the nutritional state, as determined by body composition. According to the resultant regressions, an intake of 35.1 and 50.7 kcal/kg.day was required to maintain the BCM of the septic and nonseptic patients, respectively. To restore a depleted BCM, caloric intakes in excess of this amount are required

Control groups in recent septic shock trials

DEFF Research Database (Denmark)

Pettilä, Ville; Hjortrup, Peter B; Jakob, Stephan M

2016-01-01

PURPOSE: The interpretation of septic shock trial data is profoundly affected by patients, control intervention, co-interventions and selected outcome measures. We evaluated the reporting of control groups in recent septic shock trials. METHODS: We searched for original articles presenting......, and mortality outcomes, and calculated a data completeness score to provide an overall view of quality of reporting. RESULTS: A total of 24 RCTs were included (mean n = 287 patients and 71 % of eligible patients were randomized). Of the 24 studies, 14 (58 %) presented baseline data on vasopressors and 58...... % the proportion of patients with elevated lactate values. Five studies (21 %) provided data to estimate the proportion of septic shock patients fulfilling the Sepsis-3 definition. The mean data completeness score was 19 out of 36 (range 8-32). Of 18 predefined control group characteristics, a mean of 8 (range 2...

[Treatment of pubic osteomyelitis secondary to pressure sores].

Science.gov (United States)

Brunel, Anne-Sophie; Téot, Luc; Lamy, Brigitte; Masson, Raphaël; Morquin, David; Reynes, Jacques; Le Moing, Vincent

2014-01-01

There is no consensus regarding the diagnostic and therapeutic strategy for pubic osteomyelitis secondary to pelvic pressure sores. Diagnosis is often difficult and bone biopsies with microbiological and anatomical-pathological examination remain the gold standard. The rate of cicatrisation of pressure sores is low. Cleansing and negative pressure treatment are key elements of the treatment. Optimising the care management with medical-surgical collaboration is being studied in the Ostear protocol.

Successful treatment of Pseudomonas aeruginosa osteomyelitis with antibiotic monotherapy of limited duration.

Science.gov (United States)

Laghmouche, Nadir; Compain, Fabrice; Jannot, Anne-Sophie; Guigui, Pierre; Mainardi, Jean-Luc; Lonjon, Guillaume; Bouyer, Benjamin; Fernandez-Gerlinger, Marie-Paule

2017-09-01

The aim of this study was to present a 15-year experience and provide a comprehensive analysis of a large cohort of patients with Pseudomonas aeruginosa osteomyelitis. We reviewed the medical records of patients admitted to a large French university hospital for P. aeruginosa osteomyelitis over a 15-year period. Patient outcome was assessed at follow-up after at least six months. Sixty-seven patients were included, comprising 57% with chronic osteomyelitis. Polymicrobial infection was predominant (63%), and an infected device was involved in 39% patients. The overall treatment success rate was 79.1%. All but one patient were treated with a combination of surgery and antibiotic therapy. The antibiotic treatment had a mean duration of 45 days (range, 21-90 days). Single-antibiotic therapy was preferred in nearly all cases. Treatment failure was reported for 14 (21%) patients and was due to the persistence of P. aeruginosa in four cases. No significant risk factor for treatment failure was identified, especially when treatment strategies were compared. We advocate optimal surgical debridement combined with initial parenteral antibiotics for a maximum of 15 days, followed by an oral fluoroquinolone. Total treatment duration should not exceed six weeks, and antibiotic treatment with two-drug combinations does not seem necessary. Copyright © 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Preliminary characterization of abandoned septic tank systems. Volume 1

International Nuclear Information System (INIS)

1995-12-01

This report documents the activities and findings of the Phase I Preliminary Characterization of Abandoned Septic Tank Systems. The purpose of the preliminary characterization activity was to investigate the Tiger Team abandoned septic systems (tanks and associated leachfields) for the purpose of identifying waste streams for closure at a later date. The work performed was not to fully characterize or remediate the sites. The abandoned systems potentially received wastes or effluent from buildings which could have discharged non-domestic, petroleum hydrocarbons, hazardous, radioactive and/or mixed wastes. A total of 20 sites were investigated for the preliminary characterization of identified abandoned septic systems. Of the 20 sites, 19 were located and characterized through samples collected from each tank(s) and, where applicable, associated leachfields. The abandoned septic tank systems are located in Areas 5, 12, 15, 25, and 26 on the Nevada Test Site

The Relationship Between Osteomyelitis Complication and Drug-Resistant Infection Risk in Diabetic Foot Ulcer: A Meta-analysis.

Science.gov (United States)

Chen, Yin; Ding, Hui; Wu, Hua; Chen, Hong-Lin

2017-09-01

In this study, we aimed to investigate the relationship between osteomyelitis complications and drug-resistant infection risk in diabetic foot ulcer. Searches of MEDLINE and ISI databases were performed for the studies. Odds ratios (ORs) for drug-resistant infection incidence were calculated for diabetic foot ulcer patients with or without osteomyelitis complications. Eleven studies (12 cohorts) with 1526 patients were included in this study. Meta-analysis showed that the summary OR was 3.343 (95% CI = 2.355-4.745; Z = 6.75, P analysis by only pooled the adjusted ORs showed that the result was robust (the summary OR = 4.081, 95% CI = 2.471-6.739). Subgroup analysis by drug-resistant type showed that the summary OR was 4.391 (95% CI = 2.287-8.394) for methicillin-resistant infection subgroup, and 2.693 (95% CI = 1.882-3.851) for multidrug-resistant infection subgroup. The meta-regression showed that drug-resistant incidence ( t = -0.90, P = .389) and published year ( t = -0.11, P = .913) were not related with the OR changes. In conclusion, our meta-analysis indicates that osteomyelitis complications are related with drug-resistant infection risk in diabetic foot ulcer. We suggest bone culture-based narrow-spectrum antibiotic therapy for osteomyelitis for prevention drug-resistant infection in diabetic foot ulcer.

[Surgical intensive care medicine. Current therapy concepts for septic diseases].

Science.gov (United States)

Niederbichler, A D; Ipaktchi, K; Jokuszies, A; Hirsch, T; Altintas, M A; Handschin, A E; Busch, K H; Gellert, M; Steinau, H-U; Vogt, P M; Steinsträsser, L

2009-10-01

The clinical appearance of septic disorders is characterized by an enormous dynamic. The sepsis-induced dysbalance of the immune system necessitates immediate and aggressive therapeutic interventions to prevent further damage progression of the disease to septic shock and multiple organ failure. This includes supportive therapy to normalize and maintain organ and tissue perfusion as well as the identification of the infection focus. In cases where an infectious focus is identified, surgical source control frequently is a key element of the treatment strategy besides pharmacologic and supportive measures. The integrative approach of the management of septic patients requires rapid communication between the involved medical disciplines and the nursing personnel. Therefore, this article outlines current therapeutic concepts of septic diseases as well as central nursing aspects.

Relationship between the clinical characteristics of osteomyelitis and the finding of extraosseous fat on MRI in pediatric patients

Energy Technology Data Exchange (ETDEWEB)

Mattis, Tod A. [Spectrum Health Helen Devos Children' s Hospital, Grand Rapids, MI (United States); Michigan State University, College of Human Medicine, Radiology, Grand Rapids, MI (United States); Grand Rapids Medical Education Partners, Grand Rapids, MI (United States); Borders, Heather L.; Ellinger, Doug M.; Junewick, Joseph J. [Spectrum Health Helen Devos Children' s Hospital, Grand Rapids, MI (United States); Michigan State University, College of Human Medicine, Radiology, Grand Rapids, MI (United States); Advanced Radiology Services, Grand Rapids, MI (United States)

2011-10-15

MRI is frequently utilized to evaluate patients for osteomyelitis. The findings of intramedullary and extramedullary fat globules as well as extramedullary fat-fluid levels can help improve the specificity of MRI for this diagnosis. To correlate these MRI findings with the clinical characteristics in children with osteomyelitis. A retrospective electronic medical record search for pediatric patient charts from March 2004 to November 2009 that contained the word ''osteomyelitis'' in the ''principal diagnosis'' portion of the international classification of disease (ICD) billing code. Each electronic chart was reviewed. MRI examinations of selected children were reviewed by a pediatric radiologist, a general radiologist and a transitional year resident. A total of 10 patients/11 MRI studies were included. Five of the 11 had the MRI finding of extramedullary globular fat signal. There was a significantly increased likelihood of seeing this finding in children of pubertal or postpubertal age compared to those of prepubertal age (p < 0.05). This study provides evidence that the MRI finding of extramedullary fat globules in children with acute osteomyelitis is associated with the clinical characteristic of being within or above the age range for puberty. (orig.)

Psoriatic arthritis

International Nuclear Information System (INIS)

Gerber, L.H.; Espinoza, L.R.

1985-01-01

This book contains 11 chapters. Some of the titles are: The history and epidemiologic definition of psoriatic arthritis as a distinct entity; Psoriatic arthritis: Further epidemiologic and genetic considerations; The radiologic features of psoriatic arthritis; and Laboratory findings and pathology of psoriatic arthritis

Juvenile Arthritis

Science.gov (United States)

Juvenile arthritis (JA) is arthritis that happens in children. It causes joint swelling, pain, stiffness, and loss of motion. It can affect any joint, but ... of JA that children get is juvenile idiopathic arthritis. There are several other forms of arthritis affecting ...

Radiologic findings of cerebral septic embolism

Energy Technology Data Exchange (ETDEWEB)

Lee, Jee Young; Kim, Sang Joon; Kim Tae Hoon; Kim, Seung Chul; Kim, Jae Seung; Pai, Hyun Joo [Dankook Univ., Seoul (Korea, Republic of). Coll. of Medicine; Kim, Dong Ik [Yonsei Univ., Seoul (Korea, Republic of). Coll. of Medicine; Chang, Kee Hyun [Seoul National Univ. (Korea, Republic of). Coll. of Medicine; Choi, Woo Suk [Kyung Hee Univ., Seoul (Korea, Republic of). Coll. of Medicine

1998-01-01

To determine the MR and CT findings which differentiate cerebral septic embolism from thrombotic infarction. Cerebral septic embolism was confirmed by blood culture in six patients and autopsy in two. The number, size, distribution, contrast enhancement, and hemorrhage of the lesions, as seen on MR and CT, were retrospectively analyzed, and four patients were followed up for between one week and seven months. In a total of eight patients, infective endocarditis (n=5) and sepsis (n=3) caused cerebral septic embolism. The number, of lesions was 3 {approx} 7 in six patients, over 10 in one, and innumerable in one: these varied in size from punctate to 6 cm and were distributed in various areas of the brain. Gyral infarction was noted in five patients: non-enhancing patchy lesions involving the basal ganglia or white matter were found in five, tiny isolated nodular or ring-enhancing small lesions involving the cortex and white matter in three, peripheral rim-enhancing large lesions in one, and numerous enhancing nodules disseminated in the cortex in one. Hemorrhage had occurred in six. follow-up studies in four patients showed that initial lesions had enlarged in two and regressed in two: new lesions had appeared in two. Multiple lesions of different sizes and various patterns which include gyral infarction, patchy or nodular lesion in the cortex, white mater of basal ganglia, and isolated small ring-like or nodular enhancement or frequent hemorrhage are findings which could be helpful in the radiologic diagnosis of cerebral septic embolism. (author). 8 refs., 5 figs.

Radiologic findings of cerebral septic embolism

International Nuclear Information System (INIS)

Lee, Jee Young; Kim, Sang Joon; Kim Tae Hoon; Kim, Seung Chul; Kim, Jae Seung; Pai, Hyun Joo; Kim, Dong Ik; Chang, Kee Hyun; Choi, Woo Suk

1998-01-01

To determine the MR and CT findings which differentiate cerebral septic embolism from thrombotic infarction. Cerebral septic embolism was confirmed by blood culture in six patients and autopsy in two. The number, size, distribution, contrast enhancement, and hemorrhage of the lesions, as seen on MR and CT, were retrospectively analyzed, and four patients were followed up for between one week and seven months. In a total of eight patients, infective endocarditis (n=5) and sepsis (n=3) caused cerebral septic embolism. The number, of lesions was 3 ∼ 7 in six patients, over 10 in one, and innumerable in one: these varied in size from punctate to 6 cm and were distributed in various areas of the brain. Gyral infarction was noted in five patients: non-enhancing patchy lesions involving the basal ganglia or white matter were found in five, tiny isolated nodular or ring-enhancing small lesions involving the cortex and white matter in three, peripheral rim-enhancing large lesions in one, and numerous enhancing nodules disseminated in the cortex in one. Hemorrhage had occurred in six. follow-up studies in four patients showed that initial lesions had enlarged in two and regressed in two: new lesions had appeared in two. Multiple lesions of different sizes and various patterns which include gyral infarction, patchy or nodular lesion in the cortex, white mater of basal ganglia, and isolated small ring-like or nodular enhancement or frequent hemorrhage are findings which could be helpful in the radiologic diagnosis of cerebral septic embolism. (author). 8 refs., 5 figs

Osteomyelitis of the maxilla in a patient with Malignant Infantile Osteopetrosis

Directory of Open Access Journals (Sweden)

Artur Aburad de Carvalhosa

2016-04-01

Full Text Available Osteopetrosis is characterized by a considerable increase in bone density resulting in defective remodeling, caused by failure in the normal function of osteoclasts, and varies in severity. It is usually subdivided into three types: benign autosomal dominant osteopetrosis; intermediate autosomal recessive osteopetrosis; and malignant autosomal recessive infantile osteopetrosis, considered the most serious type. The authors describe a case of chronic osteomyelitis in the maxilla of a 6-year-old patient with Malignant Infantile Osteopetrosis. The treatment plan included pre-maxilla sequestrectomy and extraction of erupted upper teeth. No surgical procedure was shown to be the best to prevent the progression of oral infection. Taking into account the patient's general condition, if the patient develops severe symptomatic and refractory osteomyelitis surgery should be considered. The patient and his family are aware of the risks and benefits of surgery and its possible complications.

Pets and Pasteurella Infections

Science.gov (United States)

... present in some children, including an infection of the joints ( arthritis ), bones (osteomyelitis), and tendons (tenosynovitis). Less frequently, youngsters may have pneumonia , urinary tract ...

ASPERGILLOSIS OF MANDIBLE : A RARE CASE OF OSTEOMYELITIS

OpenAIRE

ÖZTÜRK, Nurdan; ERSOY, Burak; SÖNMEZ, Ahmet; ÇELEBİLER, Özhan; NUMANOĞLU, Ayhan

2007-01-01

Aspergillus species are saprophyticus fungi which may be the cause of infection predominantly in immunocompromised hosts. Aspergillosis is usually manifested in the respiratory system and bone involvement is rarely encountered. Osteomyelitis of the mandible with aspergillus species has been reported in only two cases in the literature. Treatment mainly consists of antimicrobial therapy in combination with surgery. We report a case of aspergillosis of the mandible in a patient who was under im...

Atypical Focal Osteomyelitis as Initial Manifestation of AIDS

OpenAIRE

A. Akiki; Y. Bilde

2011-01-01

Persistent pain development after a skeletal contusion rarely poses the diagnosis of osteomyelitis. We report the case of a fibular head contusion as an initial manifestation of a focal abscess development in a healthy young patient. The traditional treatment of surgical drainage revealed the presence of an atypical Mycobacterium haemophilum isolates in the abscess. This lead to further investigations that concluded and established the diagnosis of AIDS. Conclusion. Isolation of an atypical M...

Enhancement of a UASB-septic tank performance for decentralised treatment of strong domestic sewage.

Science.gov (United States)

Mahmoud, Nidal; van Lier, Jules B

2011-01-01

The possibility of enhancing the process performance of the UASB-septic tank for treating strong sewage in Palestine by means of inoculating the reactor with well adapted anaerobic sludge and/or adding a packing media to the upper part of the reactor, creating an anaerobic hybrid (AH)-septic tank, was investigated. To achieve these objectives, two community onsite UASB-septic tank and AH-septic tank were operated in parallel at 2 days HRT for around 8 months overlapping the cold and hot periods of the year in Palestine. The achieved removal efficiencies of CODtot in the UASB-septic tank and AH-septic tank during the first months of operation, coinciding with the cold period and the subsequent hot period, were respectively 50 (+/- 15)% and 48 (+/- 15)% and 66 (+/- 8)% and 55 (+/- 8)%. This shows that the UASB-septic tank performed significantly better (p septic tank after rather long periods of operation. The difference in the CODtot removal efficiency was mainly due to the better CODss removal efficiencies in the UASB-septic tank. The removal efficiencies over the last 50 days of operation for CODtot, CODsus, CODcol and CODdis were 70, 72, 77 and 55% and 53, 54, 78 and 45% for the UASB-septic tank and AH-septic tank, respectively. Comparing the here achieved COD removal efficiencies with previously reported efficiencies of UASB-septic tanks operated in Palestine shows that the reactor performance in terms of COD removal and conversion, during the first 8 months of operation, has improved substantially by being started with well adapted anaerobic sludge, simulating and predicting long-term performance. Adding packing media did not lead to an improvement.

Arthritis in Children

Science.gov (United States)

... Issues Listen Español Text Size Email Print Share Arthritis Page Content Article Body Arthritis is an inflammation ... with antibiotics, even if arthritis develops. Juvenile Idiopathic Arthritis (JIA) Juvenile idiopathic arthritis (JIA) has previously been ...

Gadolinium-DTPA enhanced MRI in neonatal osteomyelitis of the cervical-spine

NARCIS (Netherlands)

Martijn, A; van der Vliet, AM; van Waarde, WM; van Aalderen, WMC

Although the radiographic features of neonatal osteomyelitis are well described, spinal localizations are very rare and occur in about 2–4%. Clinical presentation with paresis and paralysis occurs in less than 1% (Resnick & Niwayama, 1988). In the neonate negative bone scintigraphy in the presence

Treatment of infectious arthritis of the radiocarpal joint of cattle with gentamicin-impregnated collagen sponges

International Nuclear Information System (INIS)

Hirsbrunner, G.; Steiner, A.

1998-01-01

Gentamicin-impregnated collagen sponges were used successfully in the treatment of chronic septic arthritis of the radiocarpal joint in two cattle. Both animals were moderately to severely lame and refractory to systemic antibiotics, and one of them was refractory to joint lavage and local antibiotics. The clinical diagnosis was confirmed by radiography and arthrocentesis. Arthroscopy was performed under general anaesthesia and, after debridement and lavage of the joint, gentamicin-impregnated collagen sponges were placed intra-articularly. Synovial fluid was sampled at 10 and 20 days after surgery and radiographs were taken three months (case 1) and two months (case 2) after surgery. The infection was eliminated from both animals and they recovered without residual lameness

Therapeutical effect on blood-flow in three-phase scanning in primary malignant tumours and acute osteomyelitis

Energy Technology Data Exchange (ETDEWEB)

Kovacic, K; Kusic, Z [Clinical Hospital Sestre Milosrdnice, Zagreb (Croatia). Dept. of Oncology and Nuclear Medicine; Cepulic, M [Children` s Hospital, Zagreb (Croatia)

1994-10-01

In the studies where the bone scan was limited only to the late static image, the main disadvantage was its nonspecifity. With three-phase bone scan the number of false positive findings was reduced by some peculiar diseases; for instance, acute hematogenous osteomyelitis. It is well known that various diseases, such as nonunion of the fracture, some surgical interventions, avascular necrosis... can imitate acute osteomyelitis on the static image. These diseases can only be differentiated from inflammation by blood-flow. Therefore, in all patients with the diagnosis of primary bone disease tumor, inflammation, trauma, aseptic necrosis... three-phase bone scintigraphy is performed. Here, only the patients with acute osteomyelitis and primary malignant bone tumors will be presented: the basic scintigram was done before the therapy started, and the second one as a part of the follow-up - in some patients during the therapy and in some after its ending. We noticed that the most reliable part of three-phase bone scan responding to the therapy is angioscintigraphy (blood-flow) and in some cases early static (blood-pool) image. These two phases, especially the first one, are in good correlation with the clinic, in contrast to the third phase which is delayed. From the presented cases it could be concluded that in acute osteomyelitis and primary malignant tumors, blood-flow and blood-pool images are unavoidable phases of the bone scanning when we want to correctly evaluate the effects of the therapy. (author).

Uncommon mandibular osteomyelitis in a cat caused by Nocardia africana.

Science.gov (United States)

de Farias, Marconi Rodrigues; Werner, Juliana; Ribeiro, Márcio Garcia; Rodigheri, Sabrina Marin; Cavalcante, Carolina Zaghi; Chi, Kung Darh; Condas, Larissa Anuska Zeni; Gonoi, Tohru; Matsuzama, Tetsuhiro; Yazama, Katsukiyo

2012-12-06

Nocardiosis is an unusual infection in companion animals characterized by suppurative to pyogranulomatous lesions, localized or disseminated. Cutaneous-subcutaneous, pulmonary and systemic signs are observed in feline nocardiosis. However, osteomyelitis is a rare clinical manifestation in cats. Nocardia cyriacigeorgica (formerly N. asteroides sensu stricto), Nocardia brasiliensis, Nocardia otitidiscaviarum, and Nocardia nova are the most common pathogenic species identified in cats, based on recent molecular classification (16S rRNA gene). The present report is, to our knowledge, the first case of mandibular osteomyelitis in a cat caused by Nocardia africana, diagnosed based upon a combination of methods, including molecular techniques. A one-year-old non-neutered female cat, raised in a rural area, was admitted to the Companion Animal Hospital-PUCPR, São José dos Pinhais, State of Paraná, Brazil, with a history a progressive facial lesion, difficulty apprehending food, loss of appetite, apathy and emaciation. Clinical examination showed fever, submandibular lymphadenitis, and a painless, 8 cm diameter mass, which was irregularly-shaped, of firm consistency, and located in the region of the left mandible. The skin around the lesion was friable, with diffuse inflammation (cellulitis), multiple draining sinuses, and exudation of serosanguinous material containing whitish "sulfur" granules.Diagnosis was based initially in clinical signs, microbiological culture, cytological, and histopathological findings, and radiographic images. Molecular sequencing of 16S rRNA of isolate allowed diagnosis of Nocardia africana. Despite supportive care and antimicrobial therapy based on in vitro susceptibility testing the animal died. The present report describes a rare clinical case of feline osteomyelitis caused by Nocardia africana, diagnosed based upon a combination of clinical signs, microbiological culture, cytological and histopathological findings, radiographic images, and

Dynamic bone scanning in the diagnosis and management of osteomyelitis

International Nuclear Information System (INIS)

Gandsman, E.J.; Deutsch, S.D.; Tyson, I.B.

1982-01-01

The procedure using 99m Tc-MDP (Methylene Diphosphonate) was divided into two parts: a dynamic portion designed to obtain data to calculate the blood flow to the specific bones or joints being evaluated and a static portion that consisted of a routine bone scan. This method was applied to 30 patients with osteomyelitis of various bones. The dynamic study showed a pronounced increase in flow on the affected side. This was accompanied always by a significant increase in flow in the areas proximal and distal to the area of involvement. Ten patients had sequential scans during the course of antibiotic treatment. In all ten patients the flow became more symmetrical during the course of the treatment indicating the effect of the antibiotics. In seven of these patients the flow became completely symmetrical at the end of the therapy. The static bone images remained unchanged during the antibiotic treatment and did not reflect its effect. The method of dynamic bone scanning in osteomyelitis thus provides a way to determine the effectiveness of antibiotic therapy

Acute hematogenous osteomyelitis in young children - clinical and radiological features

International Nuclear Information System (INIS)

Penushliev, T.; Brankov, O.; Georgiev, Tz.; Stoilov, S.; Panov, M.; Totev, M.

2007-01-01

Acute hematogenous osteomyelitis is a bacterial infectious disease which mainly affects the paediatrics age group. The incidence seems to decline through the last decade. The authors analyzed the clinical, bacteriological and radiological features of acute hematogenous osteomyelitis in 49 young children. Their age ranged from 12 days to 2.9 years (19 new-born and 30 babies). The most affected locus was the femur (46.9 %), followed by the humerus (40.9 %) and tibia (6.2 %). The adjacent joint was involved in 38.8 %. Up to the third day after onset of symptoms were admitted 32 children (65.3 %). A bacteriological diagnosis has been achieved in only 19 cases (38.8 %) which underwent different surgical procedures. Staphylococcus aureus (9 children; 64.3 %) was the most common causative microbe. Radiological characteristic showed mainly widening of joints, destruction of cartilage, bone destruction and osteoporosis. The median duration of antibiotic therapy was 31 days. Nine children underwent needle aspiration while another 10 required locus incision or open surgery with debridement or sequestrectomy. Definitive clinical restoration was observed in 42 cases (85.7%). (authors)

Chronic bacterial osteomyelitis: prospective comparison of 18F-FDG imaging with a dual-head coincidence camera and 111In-labelled autologous leucocyte scintigraphy

International Nuclear Information System (INIS)

Meller, J.; Siefker, U.; Lehmann, K.; Meyer, I.; Schreiber, K.; Altenvoerde, G.; Becker, W.; Liersch, T.

2002-01-01

Indium-111-labelled white blood cells ( 111 In-WBCs) are currently considered the tracer of choice in the diagnostic work-up of suspected active chronic osteomyelitis (COM). Previous studies in a limited number of patients, performed with dedicated PET systems, have shown that [ 18 F]2'-deoxy-2-fluoro-D-glucose (FDG) imaging may offer at least similar diagnostic accuracy. The aim of this prospective study was to compare FDG imaging with a dual-head coincidence camera (DHCC) and 111 In-WBC imaging in patients with suspected COM. Thirty consecutive non-diabetic patients with possible COM underwent combined skeletal scintigraphy (30/30 patients), 111 In-WBC imaging (28/30 patients) and FDG-PET with a DHCC (30/30 patients). During diagnostic work-up, COM was proven in 11/36 regions of suspected skeletal infection and subsequently excluded in 25/36 regions. In addition, soft tissue infection was present in five patients and septic arthritis in three. 111 In-WBC imaging in 28 patients was true positive in 2/11 regions with proven COM and true negative in 21/23 regions without further evidence of COM. False-positive results occurred in two regions and false-negative results in nine regions suspected for COM. Most of the false-negative results (7/9) occurred in the central skeleton. If the analysis was restricted to the 18 regions with available histology (n=17) or culture (n=1), 111 In-WBC imaging was true positive in 2/18 regions, true negative in 8/18 regions, false negative in 7/18 regions and false positive in 1/18 regions. FDG-DHCC imaging was true positive in 11/11 regions with proven COM and true negative in 23/25 regions without further evidence of COM. False-positive results occurred in two regions. If the analysis was restricted to the 19 regions with available histology (n=18) or culture (n=1), FDG-DHCC imaging was true positive in 9/9 regions with proven COM and true negative in 10/10 regions without further evidence of COM. It is concluded that FDG

Septic wastewater treatment using recycled rubber particles as biofiltration media.

Science.gov (United States)

Oh, Jin Hwan; Park, Jaeyoung; Ellis, Timothy G

2014-01-01

Performance of the laboratory-scale recycled rubber particles (RRP) biofilter was compared to a conventional gravel system and a peat biofilter for treatment of septic tank effluent. During the study, the RRP biofilter provided similar or better performance than other systems in terms of organic removal and hydraulic capacity. After the start-up period, RRP biofilter achieved removal efficiencies for BOD5, total suspended solids (TSS), ammonia nitrogen of 96%, 93%, and 90%, respectively, over the range of hydraulic loading rates of 57-204 L/m2/d. On the other hand, the peat biofilter failed hydraulically and the gravel system showed high TSS concentrations in the effluent. RRP provided high surface area and sufficient time for biological treatment. In addition, RRP was observed to provide ammonia adsorption capacity. The results showed that RRP has the potential to be used as substitutes for natural aggregate such as gravel in septic system drainfields. The RRP biofilter can be used as alternative septic systems for the sites where an existing septic system has failed or site conditions, such as high groundwater table or small lot size, are not suitable for the installation of conventional septic systems.

Fusarium falciforme vertebral abscess and osteomyelitis: case report and molecular classification

Science.gov (United States)

Fusarium is a ubiquitous filamentous mold that rarely causes disease in immunocompetent humans but can be fatal in immunocompromised hosts. We report an unusual case of vertebral abscess and osteomyelitis in a patient with an autoimmune disorder who was on long term glucocorticoids. Multilocus DNA s...

Nonabsorbable-Suture-Induced Osteomyelitis: A Case Report and Review of the Literature

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Cheng Hong Yeo

2012-01-01

Full Text Available We are reporting a case of nonabsorbable suture-induced osteomyelitis in patient who had an open rotator cuff repair with nonabsorbable Ethibond anchor suture. Patient in this case presented with very subtle clinical features of osteomyelitis of the left proximal humerus 15 years after initial rotator cuff repair surgery. Literature had shown that deep infection following rotator cuff repairs, although rare, can be easily missed and can cause severe complications. Absorbable suture had been demonstrated to be more superior, in terms of rate of deep infection, as compared to nonabsorbable suture when used in rotator cuff repair surgery. Both absorbable and nonabsorbable suture had been demonstrated to have similar mechanical properties by several different studies. The case demonstrated that initial presentation of deep infection can be subtle and easily missed by clinicians and leads to further complications.

The diagnostic value of 18F-FDG-PET/CT and MRI in suspected vertebral osteomyelitis - a prospective study.

Science.gov (United States)

Kouijzer, Ilse J E; Scheper, Henk; de Rooy, Jacky W J; Bloem, Johan L; Janssen, Marcel J R; van den Hoven, Leon; Hosman, Allard J F; Visser, Leo G; Oyen, Wim J G; Bleeker-Rovers, Chantal P; de Geus-Oei, Lioe-Fee

2018-05-01

The aim of this study was to determine the diagnostic value of 18 F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) and magnetic resonance imaging (MRI) in diagnosing vertebral osteomyelitis. From November 2015 until December 2016, 32 patients with suspected vertebral osteomyelitis were prospectively included. All patients underwent both 18 F-FDG-PET/CT and MRI within 48 h. All images were independently reevaluated by two radiologists and two nuclear medicine physicians who were blinded to each others' image interpretation. 18 F-FDG-PET/CT and MRI were compared to the clinical diagnosis according to international guidelines. For 18 F-FDG-PET/CT, sensitivity, specificity, PPV, and NPV in diagnosing vertebral osteomyelitis were 100%, 83.3%, 90.9%, and 100%, respectively. For MRI, sensitivity, specificity, PPV, and NPV were 100%, 91.7%, 95.2%, and 100%, respectively. MRI detected more epidural/spinal abscesses. An important advantage of 18 F-FDG-PET/CT is the detection of metastatic infection (16 patients, 50.0%). 18 F-FDG-PET/CT and MRI are both necessary techniques in diagnosing vertebral osteomyelitis. An important advantage of 18 F-FDG-PET/CT is the visualization of metastatic infection, especially in patients with bacteremia. MRI is more sensitive in detection of small epidural abscesses.

A hot, swollen joint in a cirrhotic patient

Science.gov (United States)

Omakobia, E; Hossain, J; Nash, J; Uhuegbu, C

2010-01-01

Septic arthritis in the elderly carries a high mortality. Underlying risk factors, such as diabetes, malignancy, chronic renal failure, rheumatoid arthritis, hepatobiliary disease and AIDS, should be assessed. Rare causative organisms are occasionally encountered. Here, we describe a case of an 80-year-old diabetic patient with liver cirrhosis who developed Klebsiella pneumoniae septic arthritis, which is a rare cause of joint infection. We postulate that this case supports the notion that the patient's knee effusion seeded during a primary K pneumoniae bacteraemia of intestinal origin and related to liver cirrhosis. PMID:22798443

Outcomes in diabetic foot ulcer patients with isolated T2 marrow signal abnormality in the underlying bone: should the diagnosis of ''osteitis'' be changed to ''early osteomyelitis''?

International Nuclear Information System (INIS)

Duryea, Dennis; Bernard, Stephanie; Flemming, Donald; Walker, Eric; French, Cristy

2017-01-01

To evaluate the variability of clinical treatment and outcomes based on reporting of diabetic foot ulcer MRI findings of adjacent marrow T2 hyperintensity with normal T1 signal. A retrospective review was conducted of 46 MRI examinations evaluating diabetic foot ulcers that demonstrated normal T1 marrow signal, but T2 marrow hyperintensity deep to the ulcer. The cohort was divided based on MRI report impressions into three groups; ''osteitis without osteomyelitis'' (OW), ''osteitis but cannot exclude early osteomyelitis'' (OCEO) and ''early osteomyelitis'' (EO). Patient demographics (age, gender) and accessory MRI findings of ulcer and sinus tract depth were recorded. Initial clinical assessment and medical treatment (route and duration of antibiotics), healing versus disease progression and histology or microbiology results were recorded. The isolated marrow T2 signal hyperintensity was reported as OW in 12 patients, OCEO in 18, and EO in 16. No statistical difference in clinical assessment was demonstrated between the OW, OCEO, and EO groups. Pathological condition was available in 15 patients within 0-7 days (mean 2.4 days) of the MRI examination, with 14 (93%) of these positive for osteomyelitis by histopathology or positive cultures. Initial diagnosis of or progression to osteomyelitis was shown in 28 patients (61%). Treatment of suspected osteomyelitis is heavily determined by clinical factors. Patients who initially demonstrate only T2 marrow signal abnormality under a diabetic ulcer are eventually diagnosed as osteomyelitis in 61% of cases and deserve aggressive treatment as early osteomyelitis when meeting clinical parameters. (orig.)

Evaluation of 61 Secondary Amyloidosis Patients: A Single-Center Experience from Turkey

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Can Huzmeli

2016-09-01

Full Text Available Aim: To evaluate demographic,clinical and laboratory characteristics, causes, MEFV gene mutations, and mortality rates of patients with secondary amyloidosis. Material and Method: 61 patients who had been diagnosed with secondary amyloidosis by renal and rectal biopsy between 2007 and 2013 in the nephrology clinic of Cumhuriyet University, Faculty of Medicine, were included in the study. Demographic characteristics, causes of secondary amyloidosis, MEFV gene mutations, end-stage renal failure (ESRF, renal transplantation, and mortality rates were examined retrospectively. Results: In etiological terms, Familial Mediterranean Fever (FMF occurrence was 62.2% (38, bronchiectasis and emphysema 9.8% (6, tuberculosis 4.9% (3, coexistence of FMF and ankylosing spondylitis 3.2% (2, coexistence of FMF and rheumatoid arthritis 1.6% (1, coexistence of FMF and systemic lupus erythematosus (SLE 1.6% (1, osteomyelitis 1.6% (1, septic arthritis 1.6% (1, Crohn%u2019s disease 1.6% (1, colon cancer 1.6% (1, coexistence of bronchiectasis and tuberculosis 1.6% (1, rheumatoid arthritis 1.6% (1, and idiopathic cases 6.5% (4. Proteinuria was determined at nephrotic level among 68% (32 of 47 patients who had secondary amyloidosis. MEFV gene mutation of 45 patients with secondary amyloidosis was assessed. Most patients had M694V gene mutation. Surprisingly, we detected heterozygous E148Q mutation in 3 cases. 12 cases died; of these, 9 had ESRF. Five cases with ESRF underwent renal transplantation. Discussion: We found FMF as the most common cause for secondary AA amyloidosis in this study. Further studies should be done with larger or multicenter cohorts.

Osteomyelitis following Domestic Animal Bites to the Hand: Two Case Reports and Practical Guidelines

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Jung Soo Lim

2016-11-01

Full Text Available Recently, the number of cases of animal bite wounds has increased significantly in concordance with an increase in the pet population around the world. The authors report two rare cases of osteomyelitis of the phalanx following cat and dog bites. On initial physical examination, signs of a severe infection were observed. Radiographs of both patients showed the presence of osteomyelitis, and in one of the patients, the diagnosis was confirmed with a bone biopsy. After use of empirical antibiotics, intravenous antibiotic therapy that matched the identified bacterium's sensitivity was initiated, and at the same time, secure dressing including debridement was performed to induce secondary healing. In addition, the patients were closely monitored with serial X-rays, and culture and blood test follow-up. One patient fully recovered without sequelae, but the other patient suffered a loss of distal interphalangeal joint motion. When dealing with bite wounds located on the hand, it is important to visit the hospital as soon as possible and receive the appropriate treatment early. Moreover, to prevent severe complications such as osteomyelitis, it is important to administer antibiotic therapy to which the cultured bacteria are sensitive, along with proper wound management and prophylactic antibiotic treatment.

Higher vs. lower haemoglobin threshold for transfusion in septic shock

DEFF Research Database (Denmark)

Rygård, S L; Holst, L B; Wetterslev, J

2017-01-01

. a lower haemoglobin threshold. METHODS: In post-hoc analyses of the full trial population of 998 patients from the Transfusion Requirements in Septic Shock (TRISS) trial, we investigated the intervention effect on 90-day mortality in patients with severe comorbidity (chronic lung disease, haematological......BACKGROUND: Using a restrictive transfusion strategy appears to be safe in sepsis, but there may be subgroups of patients who benefit from transfusion at a higher haemoglobin level. We explored if subgroups of patients with septic shock and anaemia had better outcome when transfused at a higher vs.......51), in those who had undergone surgery (P = 0.99) or in patients with septic shock by the new definition (P = 0.20). CONCLUSION: In exploratory analyses of a randomized trial in patients with septic shock and anaemia, we observed no survival benefit in any subgroups of transfusion at a haemoglobin threshold...

[The application of laser therapy for the medical rehabilitation of the children presenting with chronic osteomyelitis].

Science.gov (United States)

Trunova, O V; Mashkov, A E; Khan, M A; Prikuls, V F; Nazarenko, N N; Supova, M V; Smirnova, S N; Larionov, K S

2015-01-01

The objective of the present study was to develop a scientifically sound rationale for the application of infrared laser radiation (IRLR) either separately or in the combination with fluctuation magnetic therapy in the medical rehabilitation of the children presenting with chronic hematogenous osteomyelitis. Another objective was to evaluate the clinical effectiveness of this therapeutic modality. Two achieve these goals, the clinical observations and special research studies were conducted in two directions with the participation of 95 patients at the age varying from 1 to 15 years. The study has demonstrated the effectiveness of the inclusion of IRLR in the medical rehabilitation program for the children with chronic hematogenous osteomyelitis in different periods of the disease. It was shown that the transcutaneous infrared irradiation of the affected area during the exacerbation of chronic osteomyelitis had a well apparent immunostimulatory effect and reduced the activity of the inflammatory process. The application of IRLR in combination with fluctuation magnetic therapy during the period of partial remission, had a more pronounced influence on the microcirculation and stimulated the regenerative and trophic processes.

Simple deterministic model of the hydraulic buffer effect in septic tanks

OpenAIRE

Forquet, N.; Dufresne, M.

2015-01-01

Septic tanks are widely used in on-site wastewater treatment systems. In addition to anaerobic pre-treatment, hydraulic buffering is one of the roles attributed to septic tanks. However there is still no tool for assessing it, especially in dynamic conditions. For gravity fed system, it could help both researchers and system designers. This technical note reports a simple mechanistic model based on the assumption of flow transition between the septic tank and the outflow pipe. The only parame...

Primary multifocal tuberculous osteomyelitis with involvement of the ribs

Energy Technology Data Exchange (ETDEWEB)

Chang, D.S. [New York University School of Medicine, New York, New York (United States); Rafii, M.; McGuinness, G. [Department of Radiology, NYU Medical Center, New York, NY (United States); Jagirdar, J.S. [Department of Pathology, NYU Medical Center, New York, New York (United States)

1998-11-01

Two cases of primary multifocal tuberculous osteomyelitis with involvement of the rib cage are presented. The lungs were normal and the appearance of the skeletal lesions did not suggest tuberculosis. These lesions were predominantly lytic, with minimal soft tissue involvement. Tuberculosis should be high in the differential diagnosis of multiple destructive bone lesions, especially in patients from regions where tuberculosis is endemic. (orig.) With 5 figs., 21 refs.

Treatment of domestic wastewater using conventional and baffled septic tanks.

Science.gov (United States)

Nasr, Fayza Aly; Mikhaeil, Basem

2013-01-01

The main theme of the study was a comparative study of domestic wastewater treatment using conventional and baffled septic tanks. The septic tanks were fed continuously with domestic wastewater at three different hydraulic retention times (HRTs). The HRTs chosen were 24, 48 and 72 h with corresponding organic loads of 0.321, 0.436 and 0.885 kg chemical oxygen demand (COD) per m3 per day, respectively. The performance of the septic tanks at the three HRTs gave satisfactory results. For the conventional septic tank, COD removal was 53.4%, 56% and 65.3%, at an HRT of 24, 48 and 72 h, respectively, with residual COD of 412, 380 and 334mg/l, respectively. At HRTs of 72, 48 and 24 h, the following percentages removals were realized for: biochemical oxygen demand (BOD), 68.4%, 57, 53.5%; total suspended solid (TSS), 65.3%, 58.3, 55%; phosphorus, 29.3%, 26.9, 25.6%; total Kjeldahl nitrogen 26.8%, 20.8, 17.7%, respectively. On the contrary, ammonia concentrations increased by 7.1%, 5.2 and 4.2% under the same conditions. Consequently, the results showed that the removal of fecal coliform at all HRTs was less than one log. The two baffled septic tanks exhibited superior results at HRTs of 72, 48 and 24 h. Comparing the treated domestic wastewater quality produced by the two types of septic tanks in terms of physico-chemical and biological characteristics, better results were obtained using the two baffles type.

N-terminal-pro-brain natriuretic peptide elevations in the course of septic and non-septic shock reflect systolic left ventricular dysfunction assessed by transpulmonary thermodilution

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A.B. Johan Groeneveld

2016-03-01

Conclusions: In septic and non-septic shock, NT-proBNP elevations reflect systolic left ventricular dysfunction and are associated with a poor outcome. They may help recognition of cardiac dysfunction in shock and its management when invasive hemodynamic monitoring is not yet instituted.

Red blood cell transfusion during septic shock in the ICU

DEFF Research Database (Denmark)

Perner, A; Smith, S H; Carlsen, S

2012-01-01

Transfusion of red blood cells (RBCs) remains controversial in patients with septic shock, but current practice is unknown. Our aim was to evaluate RBC transfusion practice in septic shock in the intensive care unit (ICU), and patient characteristics and outcome associated with RBC transfusion....

Lateral gastrocnemius myocutaneous flap transposition to the midlateral femur: extending the arc of rotation.

Science.gov (United States)

Agarwal, Rishi Raj; Broder, Kevin; Kulidjian, Anna; Bodor, Richard

2014-05-01

We report the successful use of an extended lateral gastrocnemius myocutaneous flap for coverage of the midlateral femur using successive delayed elevations. A 62-year-old man underwent wide resection of a liposarcoma of the right anterior thigh with free flap reconstruction and subsequent radiation therapy 10 years before. Four years later, the patient fractured his irradiated femur and was treated with a retrograde intramedullary nail, which subsequently became infected, causing osteomyelitis of the distal femur, septic arthritis of the knee joint, and nonunion of his pathologic fracture. Although advised by numerous surgeons to undergo above-knee amputation, we offered our motivated patient a multidisciplinary approach to clear his infection and pathology; implanted new orthopedic hardware; performed delayed flap reconstruction; and rehabilitated him back to painless, unassisted ambulation. The extended lateral gastrocnemius myocutaneous flap used provided perfused soft tissues and durable coverage for the patient's exposed orthopedic hardware of the midlateral femur, 14 cm above the joint line of the knee. By using this flap to cover a femur defect well above published heights, our patient avoided amputation after years of worsening incapacitation.

TWO-STAGE REOSTEOSYNTHESIS OF TIBIA IN THE PATIENT WITH FRACTURE NON-UNION COMPLICATED BY POSTOPERATIVE OSTEOMYELITIS

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I. M. Efremov

2018-01-01

Full Text Available The authors present a case report of a patient with pseudarthrosis of the right tibia complicated by chronic postoperative osteomyelitis. The development of the osteomyelitis process is caused by locked intramedullary fixation of the right tibia by a retrograde nail. Unstable fixation led to the development of acute periimplant infection and osteomyelitis.A radical surgical debridement of the focus site of chronic infection was performed by removing locking screws and nail, removal of necrotic bone tissues by handling the tibial medullary cavity by special reamers. The authors used the pulse lavage with active removal of the solution for an additional sterilization of the surgical wound and medullary cavity. A reinforced spacer impregnated with vancomycin and polyvalent bacteriophage was placed in the medullary cavity to ensure local prolonged antimicrobial therapy. Instead of the removed monomer the polyvalent bacteriophage was introduced into the polymer composition including phages against the main infectious agents in patients of traumatology and orthopedics clinic.Three months after the first stage of treatment and stabilization of laboratory parameters the patient was readmitted to the clinic. The second stage of procedure included removal of spacer, closed antegrade locked internal fixation of the right tibia and talus by a nail with an antimicrobial coating of bone cement impregnated with vancomycin and a polyvalent bacteriophage. Antimicrobial coating of the nail was made intraoperatively using an original mold.Two stage procedure allowed to achieve a stable remission of chronic osteomyelitis and stable internal fixation of tibia pseudarthrosis with preservation of the supporting function of the lower limb.

Frequency and spectrum of abnormalities in the bone marrow of the wrist: MR imaging findings

International Nuclear Information System (INIS)

Alam, F.; Schweitzer, M.E.; Malat, J.; Hussain, S.M.; Rijksuniversiteit Leiden

1999-01-01

Objective. To describe the frequency of marrow abnormalities on wrist MR imaging and the MR findings of these various abnormalities.Design and patients. Five hundred and nineteen patients were studied at 1.5 T. Two observers recorded the presence and location of avascular necrosis, occult fractures and arthritic edema [focal osteoarthritis, ulnolunate abutment, rheumatoid arthritis, septic arthritis, gouty arthritis and scapholunate advanced collapse (SLAC)].Results and conclusion. One hundred and eighty-seven (36%) patients demonstrated marrow abnormalities in the wrist, of which 101 were diagnosed as arthritis [64 (34%) as focal osteoarthritis, 17 (9%) as ulnolunate abutment, 15 (8%) as rheumatoid arthritis, 2 as septic arthritis, 2 as SLAC, and 1 as gouty arthritis]. Seventy-two patients had occult fractures and in 27 patients avascular necrosis was seen. MR imaging can reveal various abnormalities in bone marrow of the wrist when findings on radiography are normal or equivocal. (orig.)

Psoriatic arthritis

International Nuclear Information System (INIS)

Espinoza, L.R.

1985-01-01

In the past 10 years, a number of well-controlled surveys of psoriatic patients selective for the presence of arthritis have been conducted. A Canadian group reported that of 100 patients admitted to the hospital for treatment of psoriasis, 32 had clinical or radiologic evidence of psoriatic arthritis, and 17 had both types of evidence. Eighty patients with radiologic evidence of spinal or sacroiliac involvement were asymptomatic, and seven had clinical evidence of peripheral arthritis but without radiologic evidence. The authors concluded that psoriatic arthritis is a common event in patients with severe psoriasis and that it is associated with more extensive skin disease than is found in patients without arthritis. The information gathered from these epidemiologic studies coupled with clinical, radiologic, and serologic characteristics have provided the basis for the current belief that psoriatic arthritis is indeed a distinct entity

Pediatric chronic nonbacterial osteomyelitis.

Science.gov (United States)

Borzutzky, Arturo; Stern, Sara; Reiff, Andreas; Zurakowski, David; Steinberg, Evan A; Dedeoglu, Fatma; Sundel, Robert P

2012-11-01

Little information is available concerning the natural history and optimal treatment of chronic nonbacterial osteomyelitis (CNO). We conducted a retrospective review to assess the clinical characteristics and treatment responses of a large cohort of pediatric CNO patients. Children diagnosed with CNO at 3 tertiary care centers in the United States between 1985 and 2009 were identified. Their charts were reviewed, and clinical, laboratory, histopathologic, and radiologic data were extracted. Seventy children with CNO (67% female patients) were identified. Median age at onset was 9.6 years (range 3-17), and median follow-up was 1.8 years (range 0-13). Half of the patients had comorbid autoimmune diseases, and 49% had a family history of autoimmunity. Patients with comorbid autoimmune diseases had more bone lesions (P coexisting autoimmunity was a risk factor for multifocal involvement and treatment with immunosuppressive agents. Disease-modifying antirheumatic drugs and biologics were more likely to lead to clinical improvement than NSAIDs.

Retainment of the antimicrobial agent triclosan in a septic tank.

Science.gov (United States)

Kirjanova, Ala; Rimeika, Mindaugas; Vollertsen, Jes; Nielsen, Asbjørn Haaning

2014-01-01

Laboratory experiments were conducted to investigate the fate of the antimicrobial agent triclosan (TCS) in a conventional septic tank. The main mechanism of TCS removal from wastewater was identified to be rapid TCS sorption to suspended particles followed by settling of these particles to the bottom of the septic tank. Sorption to particles was completed within minutes while the settling took several days. Therefore, in a septic tank the removal of TCS from wastewater is mainly determined by the removal of suspended particles by sedimentation. Over 5 days of hydraulic residence time the initial dissolved TCS concentration of 100 μg L(-1) was reduced by 87 ± 8%. During the first 24 hours, 66-86% of all removed TCS was retained, whereas during the remainder of the experiment a slight but steady decrease in TCS concentration was observed. This was most likely caused by TCS diffusion and its subsequent sorption onto the septic sludge.

The diagnostic value of [18F]FDG PET for the detection of chronic osteomyelitis and implant-associated infection

International Nuclear Information System (INIS)

Wenter, Vera; Albert, Nathalie L.; Lehner, Sebastian; Fendler, Wolfgang P.; Bartenstein, Peter; Mueller, Jan-Phillip; Friederichs, Jan; Militz, Matthias; Hungerer, Sven; Cyran, Clemens C.; Hacker, Marcus

2016-01-01

The diagnosis of osteomyelitis and implant-associated infections in patients with nonspecific laboratory or radiological findings is often unsatisfactory. We retrospectively evaluated the contributions of [ 18 F]FDG PET and [ 18 F]FDG PET/CT to the diagnosis of osteomyelitis and implant-associated infections, enabling timely and appropriate decision-making for further therapy options. [ 18 F]FDG PET or PET/CT was performed in 215 patients with suspected osteomyelitis or implant-associated infections between 2000 and 2013. We assessed the diagnostic accuracy of both modalities together and separately with reference to intraoperative microbial findings, with a mean clinical follow-up of 69 ± 49 months. Infections were diagnosed clinically in 101 of the 215 patients. PET and PET/CT scans revealed 87 true-positive, 76 true-negative, 38 false-positive, and 14 false-negative results, indicating a sensitivity of 86 %, a specificity of 67 %, a positive predictive value (PPV) of 70 %, a negative predictive value (NPV) of 84 % and an accuracy of 76 %. The sensitivity of PET/CT was 88 %, but specificity, PPV, NPV and accuracy (76 %, 76 %, 89 % and 82 %, respectively) were higher than those of stand-alone PET. [ 18 F]FDG PET is able to identify with high sensitivity the presence of osteomyelitis in orthopaedic surgery patients with nonspecific clinical symptoms of infection. (orig.)

The septic versus nonseptic inflamed joint: MRI characteristics

International Nuclear Information System (INIS)

Graif, M.; Schweitzer, M.E.; Deely, D.; Matteucci, T.

1999-01-01

Objective. To differentiate the MR features of septic versus nonseptic inflamed joints.Design and patients. Thirty patients were referred for MRI with inflamed joints (19 were subsequently found to be septic and 11 nonseptic). At 1.5 T enhanced MRI five groups of signs related to joint space, synovium, cartilage, bone and peri-articular soft tissue respectively were assessed and compared between the septic and nonseptic groups.Results. The prevalence of MRI findings in septic versus nonseptic joints (respectively) was as follows: effusion (79% vs 82%), fluid outpouching (79% vs 73%), fluid heterogeneity (21% vs 27%), synovial thickening (68% vs 55%), synovial periedema (63% vs 55%), synovial enhancement (94% vs 88%), cartilage loss (53% vs 30%), bone erosions (79% vs 38%), bone erosions enhancement (77% vs 43%), bone marrow edema (74% vs 38%), bone marrow enhancement (67% vs 50%), soft tissue edema (63% vs 78%), soft tissue enhancement (67% vs 71%), periosteal edema (11% vs. 10%). The presence of bone erosions appeared to be an indicator for an infected joint (P=0.072); coexistence of bone marrow edema slightly improves the significance (0.068). A similar trend was obtained when combining bone erosions with either synovial thickening, synovial periedema, bone marrow enhancement or soft tissue edema (P=0.075).Conclusions. The combination of bone erosions with marrow edema is highly suggestive for a septic articulation; the additional coexistence of synovial thickening, synovial edema, soft tissue edema or bone marrow enhancement increases the above level of confidence. Similar to conventional radiography, the single sign that appeared to show a significant trend was the presence of bone erosions. However, no single sign or combination could either be considered pathognomonic or exclude the presence of a joint infection. (orig.)

Microbial Load in Septic and Aseptic Procedure Rooms.

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Harnoss, Julian-Camill; Assadian, Ojan; Diener, Markus Karl; Müller, Thomas; Baguhl, Romy; Dettenkofer, Markus; Scheerer, Lukas; Kohlmann, Thomas; Heidecke, Claus-Dieter; Gessner, Stephan; Büchler, Markus Wolfgang; Kramer, Axel

2017-07-10

Highly effective measures to prevent surgical wound infections have been established over the last two decades. We studied whether the strict separation of septic and aseptic procedure rooms is still necessary. In an exploratory, prospective observational study, the microbial concentration in an operating room without a room ventilating system (RVS) was analyzed during 16 septic and 14 aseptic operations with the aid of an air sampler (50 cm and 1 m from the operative field) and sedimentation plates (1 m from the operative field, and contact culture on the walls). The means and standard deviations of the microbial loads were compared with the aid of GEE models (generalized estimation equations). In the comparison of septic and aseptic operations, no relevant differences were found with respect to the overall microbial concentration in the room air (401.7 ± 176.3 versus 388.2 ± 178.3 CFU/m 3 ; p = 0.692 [CFU, colony-forming units]) or sedimentation 1 m from the operative field (45.3 ± 22.0 versus 48.7 ± 18.5 CFU/m 2 /min; p = 0.603) and on the walls (35.7 ± 43.7 versus 29.0 ± 49.4 CFU/m 2 /min; p = 0.685). The only relevant differences between the microbial spectra associated with the two types of procedure were a small amount of sedimentation of Escherichia coli and Enterococcus faecalis in septic operations, and of staphylococcus aureus and pseudomonas stutzeri in aseptic operations, up to 30 minutes after the end of the procedure. These data do not suggest that septic and aseptic procedure rooms need to be separated. In interpreting the findings, one should recall that the study was not planned as an equivalence or non-inferiority study. Wherever patient safety is concerned, high-level safety concepts should only be demoted to lower levels if new and convincing evidence becomes available.

Reactive Arthritis

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Eren Erken

2013-06-01

Full Text Available Reactive arthritis is an acute, sterile, non-suppurative and inflammatory arthropaty which has occured as a result of an infectious processes, mostly after gastrointestinal and genitourinary tract infections. Reiter syndrome is a frequent type of reactive arthritis. Both reactive arthritis and Reiter syndrome belong to the group of seronegative spondyloarthropathies, associated with HLA-B27 positivity and characterized by ongoing inflammation after an infectious episode. The classical triad of Reiter syndrome is defined as arthritis, conjuctivitis and urethritis and is seen only in one third of patients with Reiter syndrome. Recently, seronegative asymmetric arthritis and typical extraarticular involvement are thought to be adequate for the diagnosis. However, there is no established criteria for the diagnosis of reactive arthritis and the number of randomized and controlled studies about the therapy is not enough. [Archives Medical Review Journal 2013; 22(3.000: 283-299

Anaerobic treatment of domestic sewage in modified septic tanks at low temperature.

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Chen, Zhiqiang; Wen, Qinxue; Guan, Huabin; Bakke, Rune; Ren, Nanqi

2014-01-01

Three laboratory-scale septic tanks, an anaerobic baffled reactor (ABR)-septic tank (R1), a Yuhuan drawing three-dimensional-carrier-septic tank (R2) and a conventional septic tank (R3), were operated in parallel over half a year under hydraulic retention times (HRTs) of 36, 24 and 12 h, with a sewage temperature of 16 degrees C. The removal efficiencies of total chemical oxygen demand (CODtot) achieved in R1 and R2 increased by 14%, 21% and 12% and 18%, 3% and 16%, respectively, under three different HRTs, as compared to those in R3. The total nitrogen and phosphorus removal efficiencies were negligible. R1 sludges had a higher specific methane production rate as compared to that of R2 and R3 sludges. The results indicated that the two modified septic tanks can improve the performance in terms of COD and total solids removal, both were suitable technologies for domestic sewage (pre) treatment at low temperature in northern China.

Quantitative assessment of the microcirculation in healthy volunteers and in patients with septic shock

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Edul, Vanina S. Kanoore; Enrico, Carolina; Laviolle, Bruno; Vazquez, Alejandro Risso; Ince, Can; Dubin, Arnaldo

2012-01-01

The microcirculation of septic patients has been characterized only semiquantitatively. Our goal was to characterize the sublingual microcirculation in healthy volunteers and patients with septic shock quantitatively. Our hypotheses were that 1) hyperdynamic blood flow is absent in septic shock; 2)

Arthritis Foundation

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Osteomyelitis in Cat-Scratch Disease: A Never-Ending Dilemma—A Case Report and Literature Review

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D. Donà

2018-01-01

Full Text Available Background. We performed a review of published case studies of osteomyelitis associated with cat-scratch disease to consolidate existing information on clinical presentation, diagnostic tools, therapy, and outcome, as well as presenting a case of disseminated cat-scratch disease in a 12-year-old female with skull osteomyelitis and spleen involvement. Methods. A search for articles indexed in PubMed, Embase, and Google Scholar was performed with the search terms “Bartonella,” “bone,” “osteomyelitis,” “osteolytic,” and “cat-scratch disease” limited to the immunocompetent pediatric population and articles in English. Results. 51 cases were identified. The average age was 7.8 years with equal sex distribution. Fever (84.3%, often with a prolonged course (64.7%, and osteoarticular pain (88.2% were the most common clinical findings. Lymphadenopathy was present in 64.7% of patients. Vertebral body was mainly involved (51.9%. MRI (50% and bone scintigraphy (48.1% were favored to confirm osteomyelitis, while serology was the preferred microbiological diagnostic. Various antibiotics were prescribed in combined or sequential regimens, with median duration of therapy of 23 days. About 12.5% of patients did not receive any treatment. Most patients had excellent prognosis; in particular, all patients not receiving any therapy showed complete recovery and no recurrence of symptoms. Conclusions. Bartonella henselae should be considered in differential diagnosis of localized lymphadentitis. Osteoarticular pain or limitation during cat-scratch disease in children should always be investigated for bone spreading. Owing to good prognosis, invasive procedures to obtain the bone material should be avoided. Serology is the gold standard diagnostic tool and MRI is the best radiographic technique to define bone and surrounding tissue involvement. Treatment represents a never-ending dilemma: surgical intervention or use of antibiotics is still

Challenges in managing paediatric osteomyelitis in the developing world: Analysis of cases presenting to a tertiary referral centre in Tanzania

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Adam M Ali

2014-01-01

Full Text Available Background: The literature on paediatric osteomyelitis in the developing world is scarce, and there have been calls for further characterisation of its epidemiology and the identification of factors that limit effective management in order to guide local service delivery. Our centre is a hospital serving a population of 11 million people in Tanzania. Materials and Methods: We identified patients 3 months. Twelve out of 13 with a time from symptom onset to presentation of <2 months did not develop recurrence. Conclusions: This is, to the best of our knowledge, the second largest study of paediatric osteomyelitis in the developing world. Major challenges facing this centre include a lack of availability of bacterial cultures and failure to attend follow-up. Delayed presentation of osteomyelitis to our centre is associated with recurrence of infection.

A New Type of Biphasic Calcium Phosphate Cement as a Gentamicin Carrier for Osteomyelitis

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Wen-Yu Su

2013-01-01

Full Text Available Osteomyelitis therapy is a long-term and inconvenient procedure for a patient. Antibiotic-loaded bone cements are both a complementary and alternative treatment option to intravenous antibiotic therapy for the treatment of osteomyelitis. In the current study, the biphasic calcium phosphate cement (CPC, called α-TCP/HAP (α-tricalcium phosphate/hydroxyapatite biphasic cement, was prepared as an antibiotics carrier for osteomyelitis. The developed biphasic cement with a microstructure of α-TCP surrounding the HAP has a fast setting time which will fulfill the clinical demand. The X-ray diffraction and Fourier transform infrared spectrometry analyses showed the final phase to be HAP, the basic bone mineral, after setting for a period of time. Scanning electron microscopy revealed a porous structure with particle sizes of a few micrometers. The addition of gentamicin in α-TCP/HAP would delay the transition of α-TCP but would not change the final-phase HAP. The gentamicin-loaded α-TCP/HAP supplies high doses of the antibiotic during the initial 24 hours when they are soaked in phosphate buffer solution (PBS. Thereafter, a slower drug release is produced, supplying minimum inhibitory concentration until the end of the experiment (30 days. Studies of growth inhibition of Staphylococcus aureus and Pseudomonas aeruginosa in culture indicated that gentamicin released after 30 days from α-TCP/HAP biphasic cement retained antibacterial activity.

Current data on extremities chronic osteomyelitis in southwest China: epidemiology, microbiology and therapeutic consequences.

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Wang, Xiaohua; Yu, Shengpeng; Sun, Dong; Fu, Jingshu; Wang, Shulin; Huang, Ke; Xie, Zhao

2017-11-24

The current study was designed to explore the epidemiology of extremities chronic osteomyelitis, its prognosis and the complications of the treatment methods being used in southwest China. The data from osteomyelitis patients treated at the Department of Orthopaedics, Southwest Hospital, China between May 2011 and September 2016 were collected and analysed. The study comprised 503 admitted patients, of which 416 males and 87 were females, with an average age of 40.15 ± 5.64 years. Approximately 356 cases were followed for more than 18 months; the average bone union time was 6.24 ± 0.76 months in 94.1% (335) patients, and infections were almost controlled in 93.8% patients. The rate of infection control with the induced membrane technique was higher than with the I-stage free bone graft. Iliac infection was the main complication of the induced membrane technique, and impaired joint activity was the main complication of I-stage free bone grafts. In southwest China, the incidence of haematogenous osteomyelitis, caused mainly by Staphylococcus aureus, remains very high. The speed of bone defect repair and the rate of infection control with the induced membrane technique were superior to those of I-stage free bone grafts. Internal fixation should be given priority because it offers reduced complications with no increase in the recurrence of infection.

Micropollutants in groundwater from septic systems: Transformations, transport mechanisms, and human health risk assessment.

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Yang, Yun-Ya; Toor, Gurpal S; Wilson, P Chris; Williams, Clinton F

2017-10-15

Septic systems may contribute micropollutants to shallow groundwater and surface water. We constructed two in situ conventional drainfields (drip dispersal and gravel trench) and an advanced drainfield of septic systems to investigate the fate and transport of micropollutants to shallow groundwater. Unsaturated soil-water and groundwater samples were collected, over 32 sampling events (January 2013 to June 2014), from the drainfields (0.31-1.07 m deep) and piezometers (3.1-3.4 m deep). In addition to soil-water and groundwater, effluent samples collected from the septic tank were also analyzed for 20 selected micropollutants, including wastewater markers, hormones, pharmaceuticals and personal care products (PPCPs), a plasticizer, and their transformation products. The removal efficiencies of micropollutants from septic tank effluent to groundwater were similar among three septic systems and were 51-89% for sucralose and 53->99% for other micropollutants. Even with high removal rates within the drainfields, six PPCPs and sucralose with concentrations ranging from septic systems to ecosystem and human health is warranted for the long-term sustainability of septic systems. Copyright © 2017 Elsevier Ltd. All rights reserved.

Osteomielitis crónica esclerosante difusa Chronic diffuse sclerosing osteomyelitis

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M. Paula Aparicio M

2008-12-01

Full Text Available La osteomielitis esclerosante difusa se considera como una osteomielitis crónica primaria consistente en un proceso inflamatorio, doloroso y prolongado en el tiempo. Afecta solo a la mandíbula y es generalmente unilateral, compromete hueso basal y alveolar, y se localiza al nivel de cuerpo, ángulo, rama e incluso cóndilo. La causa es aún controversial, ya que algunos le atribuyen un origen infeccioso, mientras otros lo consideran una condición no infecciosa, como producto de sobrecargas o asociado con síndrome SAPHO (sinovitis, acné, pustulosis, hiperostosis y osteítis, pero la literatura no es concluyente. Con respecto al tratamiento, al igual que su causa, no está totalmente esclarecido y se describen a lo largo del tiempo distintas alternativas, que van desde lo conservador a lo más radical. Se presenta el seguimiento y tratamiento durante 7 meses de una paciente afectada por osteomielitis esclerosante difusa con 18 años de evolución aproximadamente, que ha sido refractaria a las alternativas terapéuticas convencionales.Diffuse sclerosing osteomyelitis is considered a chronic primary osteomyelitis consisting in an inflammatory, painful and prolonged process. It only affects the mandible and it is generally unilateral. It involves the basal and alveolar bone and it is located at the level of body, angle, branch and even condyle. The cause is more controversial, since some attribute an infectious origin to it, whereas others consider it as a non-infectious condition resulting from the overloads or associated with SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis, but literature is not concluding. Treatment as well as its cause are not totally clear. Different alternatives are described that go from the conservative to the most radical position. The 7-month follow-up and treatment of a female patient suffering from diffuse sclerosing osteomyelitis with approximately18 years of evolution that has been refractory

Uncommon mandibular osteomyelitis in a cat caused by Nocardia africana

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de Farias Marconi

2012-12-01

Full Text Available Abstract Background Nocardiosis is an unusual infection in companion animals characterized by suppurative to pyogranulomatous lesions, localized or disseminated. Cutaneous-subcutaneous, pulmonary and systemic signs are observed in feline nocardiosis. However, osteomyelitis is a rare clinical manifestation in cats. Nocardia cyriacigeorgica (formerly N. asteroides sensu stricto, Nocardia brasiliensis, Nocardia otitidiscaviarum, and Nocardia nova are the most common pathogenic species identified in cats, based on recent molecular classification (16S rRNA gene. The present report is, to our knowledge, the first case of mandibular osteomyelitis in a cat caused by Nocardia africana, diagnosed based upon a combination of methods, including molecular techniques. Case presentation A one-year-old non-neutered female cat, raised in a rural area, was admitted to the Companion Animal Hospital-PUCPR, São José dos Pinhais, State of Paraná, Brazil, with a history a progressive facial lesion, difficulty apprehending food, loss of appetite, apathy and emaciation. Clinical examination showed fever, submandibular lymphadenitis, and a painless, 8 cm diameter mass, which was irregularly-shaped, of firm consistency, and located in the region of the left mandible. The skin around the lesion was friable, with diffuse inflammation (cellulitis, multiple draining sinuses, and exudation of serosanguinous material containing whitish “sulfur” granules. Diagnosis was based initially in clinical signs, microbiological culture, cytological, and histopathological findings, and radiographic images. Molecular sequencing of 16S rRNA of isolate allowed diagnosis of Nocardia africana. Despite supportive care and antimicrobial therapy based on in vitro susceptibility testing the animal died. Conclusion The present report describes a rare clinical case of feline osteomyelitis caused by Nocardia africana, diagnosed based upon a combination of clinical signs, microbiological

Efficacy of magnetic resonance imaging in diagnosing diabetic foot osteomyelitis in the presence of ischemia.

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Fujii, Miki; Armstrong, David G; Armsrong, David G; Terashi, Hiroto

2013-01-01

Magnetic resonance imaging (MRI) has been recognized as the most accurate imaging modality for the detection of diabetic foot osteomyelitis. However, how accurately MRI displays the extent of diabetic foot osteomyelitis in the presence of ischemia is still unclear. We retrospectively compared the preoperative MRI findings with the results of histopathologic examinations of resected bones and studied the efficacy of MRI in the diagnosis of diabetic foot osteomyelitis of different etiologies. A total 104 bones from 18 foot ulcers in 16 diabetic patients (10 men and 6 women; age range 42 to 84 years) treated by surgical intervention from 2008 to 2012 was examined. In 8 neuropathic ulcers, 29 bones were accurately diagnosed in detail using MRI, even those with severe soft tissue infection. Of 75 bones in 10 ischemic ulcers, only 7 bones evaluated by MRI after revascularization were diagnosed accurately; the other 68 could not be diagnosed because of unclear or equivocal MRI findings. On histopathologic examination, all the bones were found to be infected through the bone cortex by the surrounding infected soft tissue, not directly by articulation. Overall, preoperative MRI is effective in the diagnosis of neuropathic ulcers, but less so of ischemic ones. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Rare Case of Aspergillus ochraceus Osteomyelitis of Calcaneus Bone in a Patient with Diabetic Foot Ulcers

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Farhang Babamahmoodi

2015-01-01

Full Text Available Diabetes is the most common metabolic disease in humans. One of the major complications of the disease is foot ulcer that is prone to infection. The most common causes of infection which have been reported in these patients are bacteria and fungi such as Candida, Aspergillus, and Rhizopus species. We report one such rare case with calcaneal osteomyelitis caused by Aspergillus ochraceus in a patient with diabetic foot osteomyelitis. The case was a 68-year-old male with a history of type II diabetes for 2 years. The patient had two ulcers on the right heel bones for the past 6 months with no significant improvement. One of the most important predisposing factors to infectious diseases, especially opportunistic fungal infection, is diabetes mellitus. Aspergillus species can involve bony tissue through vascular system, direct infection, and trauma. Proper and early diagnosis and treatment of diabetic foot infection can reduce or prevent complications, such as osteomyelitis and amputation. The annual examination of feet for skin and nail lesion, sensation, anatomical changes, and vascular circulation can be useful for prevention and control of infection.

Frequency and spectrum of abnormalities in the bone marrow of the wrist: MR imaging findings

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Alam, F.; Schweitzer, M.E. (Thomas Jefferson Univ., Philadelphia, PA (United States). Dept. of Radiology); Li Xiaoxian (Dept. of Radiology, Tangshan Gongren Hospital, Tangshan (China)); Malat, J. (Department of Radiology, Naples Radiologists, Naples (Italy)); Hussain, S.M. (Thomas Jefferson Univ., Philadelphia, PA (United States). Dept. of Radiology Rijksuniversiteit Leiden (Netherlands). Dept. of Diagnostic Radiology)

1999-06-01

Objective. To describe the frequency of marrow abnormalities on wrist MR imaging and the MR findings of these various abnormalities.Design and patients. Five hundred and nineteen patients were studied at 1.5 T. Two observers recorded the presence and location of avascular necrosis, occult fractures and arthritic edema [focal osteoarthritis, ulnolunate abutment, rheumatoid arthritis, septic arthritis, gouty arthritis and scapholunate advanced collapse (SLAC)].Results and conclusion. One hundred and eighty-seven (36%) patients demonstrated marrow abnormalities in the wrist, of which 101 were diagnosed as arthritis [64 (34%) as focal osteoarthritis, 17 (9%) as ulnolunate abutment, 15 (8%) as rheumatoid arthritis, 2 as septic arthritis, 2 as SLAC, and 1 as gouty arthritis]. Seventy-two patients had occult fractures and in 27 patients avascular necrosis was seen. MR imaging can reveal various abnormalities in bone marrow of the wrist when findings on radiography are normal or equivocal. (orig.) With 17 figs., 13 refs.

Successful treatment of chronic recurrent multifocal osteomyelitis using low-dose radiotherapy. A case report

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Dietzel, Christian T.; Vordermark, Dirk [Klinikum der Martin-Luther-Universitaet Halle-Wittenberg, Universitaetslinik und Poliklinik fuer Strahlentherapie, Halle (Saale) (Germany); Schaefer, Christoph [Klinikum der Martin-Luther-Universitaet Halle-Wittenberg, Universitaetsklinik und Poliklinik fuer Innere Medizin II, Halle (Saale) (Germany)

2017-03-15

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory disease, which lacks an infectious genesis and predominantly involves the metaphysis of long bones. Common treatments range from nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids at first onset of disease, to immunosuppressive drugs and bisphosphonates in cases of insufficient remission. The therapeutic use of low-dose radiotherapy for CRMO constitutes a novelty. A 67-year-old female patient presented with radiologically proven CRMO affecting the right tibia/talus and no response to immunosuppressive therapy. Two treatment series of radiation therapy were applied with an interval of 6 weeks. Each series contained six fractions (three fractions per week) with single doses of 0.5 Gy, thus the total applied dose was 6 Gy. Ten months later, pain and symptoms of osteomyelitis had completely vanished. Radiotherapy seems to be an efficient and feasible complementary treatment option for conventional treatment refractory CRMO in adulthood. The application of low doses per fraction is justified by the inflammatory pathomechanism of disease. (orig.) [German] Die chronisch rekurrierende multifokale Osteomyelitis (CRMO) ist eine seltene autoimmunologische Erkrankung und befaellt vorzugsweise die Metaphysen der langen Roehrenknochen. Die Therapie umfasst nichtsteroidale Antirheumatika (NSAIDs) und Kortikosteroide bei Erstbefall und reicht bis hin zu Immunsuppressiva und Bisphosphonaten bei insuffizientem Ansprechen. Die Anwendung einer niedrigdosierten Radiatio stellt ein therapeutisches Novum dar. Eine 67-jaehrige Patientin stellte sich mit einem radiologisch gesicherten Befall im Sinne einer CRMO im Bereich des rechten Talus und der Tibia vor. Eine initiale Behandlung mit Immunsuppressiva verblieb erfolglos. Wir fuehrten zwei Bestrahlungsserien im Intervall von 6 Wochen durch. Jede Serie bestand aus 6 Fraktionen (3 Fraktionen/Woche), mit einer Einzeldosis von jeweils 0,5 Gy. Die

Aggregatibacter actinomycetemcomitans osteomyelitis in a 12 year old boy: case report emphasizing the importance of tissue culture, and review of literature.

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Sharma, Ketaki; Mudgil, Poonam; Whitehall, John S; Gosbell, Iain

2017-03-14

Aggregatibacter actinomycetemcomitans most commonly causes periodontitis but has been reported to infect heart valves, soft tissue, brain and lungs, and distal bones. Osteomyelitis distal to the jaw is rarely described. We report an unusual and rare case of chronic osteomyelitis caused by A. actinomycetemcomitans in the toe of a paediatric patient, and review the available literature. The infection was managed with intravenous antibiotics followed by oral antibiotics. This is an unusual presentation of A. actinomycetemcomitans causing chronic osteomyelitis presumed due to nidation in a minimally damaged bone, associated with bacteraemia of an oral commensal. It occurred in the toe, without obvious dental predisposition; associated with minimal clinical disturbance and with muted immune response.

Early fluid loading for septic patients: Any safety limit needed?

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Gong, Yi-Chun; Liu, Jing-Tao; Ma, Peng-Lin

2018-02-01

Early adequate fluid loading was the corner stone of hemodynamic optimization for sepsis and septic shock. Meanwhile, recent recommended protocol for fluid resuscitation was increasingly debated on hemodynamic stability vs risk of overloading. In recent publications, it was found that a priority was often given to hemodynamic stability rather than organ function alternation in the early fluid resuscitation of sepsis. However, no safety limits were used at all in most of these reports. In this article, the rationality and safety of early aggressive fluid loading for septic patients were discussed. It was concluded that early aggressive fluid loading improved hemodynamics transitorily, but was probably traded off with a follow-up organ function impairment, such as worsening oxygenation by reduction of lung aeration, in a part of septic patients at least. Thus, a safeguard is needed against unnecessary excessive fluids in early aggressive fluid loading for septic patients. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

Mycotic aneurysm of the superior mesenteric artery after septic embolism

International Nuclear Information System (INIS)

Schmidt, F.; Dinkel, H.P.

2002-01-01

Mycotic aneurysms of the aorta and the visceral arteries are life-threatening diseases, due to potential rupture and organ or limb ischemia. They occur in endocarditis, immunodeficiency, bacteremia and fungemia, and have a poor prognosis.We report on a case of a 54-year-old male patient suffering from abdominal angina after mitral valve replacement for septic mycotic endocarditis. In presence of a mycotic-embolic occlusion of the left popliteal artery and multiple septic organ infarctions a mycotic aneurysm of the superior mesenteric artery was found in abdominal spiral-CT.Based on sequential spiral-CT examinations, this case demonstrates the development of a septic aneurysm of the superior mesenteric artery. (orig.) [de

Acute bone crises in sickle cell disease: the T1 fat-saturated sequence in differentiation of acute bone infarcts from acute osteomyelitis

International Nuclear Information System (INIS)

Jain, R.; Sawhney, S.; Rizvi, S.G.

2008-01-01

Aim: To prove the hypothesis that acute bone infarcts in sickle cell disease are caused by sequestration of red blood cells (RBCs) in bone marrow, and to evaluate the unenhanced T1 fat-saturated (fs) sequence in the differentiation of acute bone infarction from acute osteomyelitis in patients with sickle-cell disease. Materials and methods: Two studies were undertaken: an experimental study using in-vitro packed red blood cells and normal volunteers, and a retrospective clinical study of 86 magnetic resonance imaging (MRI) studies. For the experimental study containers of packed RBCs were placed between the knees of four healthy volunteers with a saline bag under the containers as an additional control, and were scanned with the pre-contrast T1-fs sequence. Signal intensity (SI) ratios were obtained for packed RBCs:skeletal muscle and packed RBCs:saline. For the clinical study, the SIs of normal bone marrow, packed RBCs, bone and/or soft-tissue lesions, and normal skeletal muscle of 74 patients (86 MRI studies) were measured using unenhanced, T1 fat-saturated MRI. The ratios of the above SIs to normal skeletal muscle were calculated and subjected to statistical analysis. Results: Fifty-one of 86 MRI studies were included in the final analysis. The ratios of SIs for normal bone marrow, packed red cells, bone infarction, acute osteomyelitis, and soft-tissue lesions associated with bone infarct, compared with normal skeletal muscle were (mean ± SD) 0.9 ± 0.2, 2.1 ± 0.7, 1.7 ± 0.5, 1.0 ± 0.3, and 2.2 ± 0.7, respectively. The difference in the ratio of SIs of bone infarcts and osteomyelitis was significant (p = 0.003). The final diagnoses were bone infarction (n = 50), acute osteomyelitis (n = 1), and co-existent bone infarction and osteomyelitis (n = 2). Seven patients who had suspected osteomyelitis underwent image-guided aspiration. Conclusion: Acute bone infarcts in sickle cell disease are caused by sequestration of red blood cells in the bone marrow. The

Use of Leukocyte Platelet (L-PRF Rich Fibrin in Diabetic Foot Ulcer with Osteomyelitis (Three Clinical Cases Report

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Alessandro Crisci

2018-04-01

Full Text Available In this study, the use of fibrin rich in leukocytes and platelets (L-PRF was explored to heal osteomyelitis ulcers in a diabetic foot. The goal was to standardize the utilization of L-PRF in patients with osteomyelitis to direct it for healing. L-PRF was obtained autologously from the peripheral blood of the diabetic patients (n = 3 having osteomyelitis and skin lesions for at least six months. The L-PRF and supernatant serum were inserted into the skin lesion to the bone after a surgical debridement. The evolution of lesions over time was analyzed. All three patients showed positivity to the Probe-to-Bone test and Nuclear Magnetic Resonance detected cortico-periosteal thickening and/or outbreaks of spongy cortical osteolysis in adjacency of the ulcer. The infections were caused by Cocci Gram-positive bacteria, such as S. Aureus, S. β-hemolytic, S. Viridans and Bacilli; and Gram-negative such as Pseudomonas, Proteus, Enterobacter; and yeast, Candida. The blood count did not show any significant alterations. To date, all three patients have healed skin lesions (in a patient for about two years with no evidence of infection. These preliminary results showed that L-PRF membranes could be a new method of therapy in such problematic diseases. Overall, the L-PRF treatment in osteomyelitis of a diabetic foot seems to be easy and cost-effective by regenerative therapy of chronic skin lesions. In addition, it will improve our understanding of wound healing.

Erysipelothrix Rhusiopathiae Endocarditis and Presumed Osteomyelitis

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Marc Romney

2001-01-01

Full Text Available Erysipelothrix rhusiopathiae is known to cause infections in humans following exposure to decaying organic matter or animals colonized with the organism, such as swine and fish. Invasive infections with this organism are unusual and are manifested primarily as infective endocarditis. The present report is believed to be the first to report a case of E rhusiopathiae endocarditis and presumptive osteomyelitis. E rhusiopathiae appears to have intrinsic resistance to vancomycin. Because vancomycin is often used empirically for the treatment of endocarditis, rapid differentiation of E rhusiopathiae> from other Gram-positive organisms is critical. In patients with endocarditis caused by a Gram-positive bacillus and epidemiological risk factors for E rhusiopathiae exposure, empirical treatment with vancomycin should be reconsidered.

Effluent migration from septic tank systems in two different lithologies, Broward County, Florida

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Waller, B.G.; Howie, Barbara; Causaras, C.R.

1987-01-01

Two septic tank test sites, one in sand and one in limestone, in Broward County, Florida, were analyzed for effluent migration. Groundwater from shallow wells, both in background areas and hydraulically down-gradient of the septic tank system, was sampled during a 16-month period from April 1983 through August 1984. Water quality indicators were used to determine the effluent affected zone near the septic tank systems. Specific conductance levels and concentrations of chloride, sulfate, ammonium, and nitrate indicated effluent movement primarily in a vertical direction with abrupt dilution as it moved down-gradient. Effluent was detected in the sand to a depth more than 20 ft below the septic tank outlet, but was diluted to near background conditions 50 ft down-gradient from the tank. Effluent in the limestone was detected in all three observation wells to depths exceeding 25 ft below the septic tank outlet and was diluted, but still detectable, 40 ft down-gradient. The primary controls on effluent movement from septic tank systems in Broward County are the lithology and layering of the geologic materials, hydraulic gradients, and the volume and type of use the system receives. (Author 's abstract)

Inhibition of skeletal muscle protein synthesis in septic intra-abdominal abscess

International Nuclear Information System (INIS)

Vary, T.C.; Siegel, J.H.; Tall, B.D.; Morris, J.G.; Smith, J.A.

1988-01-01

Chronic sepsis is always associated with profound wasting leading to increased release of amino acids from skeletal muscle. Net protein catabolism may be due to decreased rate of synthesis, increased rate of degradation, or both. To determine whether protein synthesis is altered in chronic sepsis, the rate of protein synthesis in vivo was estimated by measuring the incorporation of [ 3 H]-phenylalanine in skeletal muscle protein in a chronic (5-day) septic rat model induced by creation of a stable intra-abdominal abscess using an E. coli + B. fragilis-infected sterile fecal-agar pellet as foreign body nidus. Septic rats failed to gain weight at rates similar to control animals, therefore control animals were weight matched to the septic animals. The skeletal muscle protein content in septic animals was significantly reduced relative to control animals (0.18 +/- 0.01 vs. 0.21 +/- 0.01 mg protein/gm wet wt; p less than 0.02). The rate of incorporation of [ 3 H]-phenylalanine into skeletal muscle protein from control animals was 39 +/- 4 nmole/gm wet wt/hr or a fractional synthetic rate of 5.2 +/- 0.5%/day. In contrast to control animals, the fractional synthetic rate in septic animals (2.6 +/- 0.2%/day) was reduced by 50% compared to control animals (p less than 0.005). The decreased rate of protein synthesis in sepsis was not due to an energy deficit, as high-energy phosphates and ATP/ADP ratio were not altered. This decrease in protein synthesis occurred even though septic animals consumed as much food as control animals

[Septic pylephlebitis associated with Enterobacter cloacae septicemia].

Science.gov (United States)

Amezyane, T; Abouzahir, A; El Kharrass, A; Bassou, D; Fatihi, J; Hammi, S; Mahassin, F; Ghafir, D; Ohayon, V

2010-02-01

Septic pylephlebitis or purulent thrombosis of the portal venous system generally results from a progressive extension of suppurated thrombophlebitis, secondary to an intrabdominal infection. Germs most often found are Escherichia coli and Streptococcus, isolation of Enterobacter cloacae is unusual. We report a particular observation of septic pylephlebitis associated with E. cloacae bacteremia, without biliary, digestive or pancreatic lesion on the CT-scan. The antibiotic sensitivity pattern of the isolated germ and the negative epidemiologic investigation pled in favour of community acquired infection. The infection resolved with antibiotics and anticoagulation, followed by total repermeation of the portal system. Copyright 2009 Elsevier Masson SAS. All rights reserved.

The diagnostic value of [{sup 18}F]FDG PET for the detection of chronic osteomyelitis and implant-associated infection

Energy Technology Data Exchange (ETDEWEB)

Wenter, Vera; Albert, Nathalie L.; Lehner, Sebastian; Fendler, Wolfgang P.; Bartenstein, Peter [University of Munich, Department of Nuclear Medicine, Munich (Germany); Mueller, Jan-Phillip; Friederichs, Jan; Militz, Matthias; Hungerer, Sven [BG Trauma Center Murnau, Murnau (Germany); PMU Salzburg, Salzburg (Austria); Cyran, Clemens C. [University of Munich, Institute for Clinical Radiology, Munich (Germany); Hacker, Marcus [University of Vienna, Department of Nuclear Medicine, Vienna (Austria); Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria)

2016-04-15

The diagnosis of osteomyelitis and implant-associated infections in patients with nonspecific laboratory or radiological findings is often unsatisfactory. We retrospectively evaluated the contributions of [{sup 18}F]FDG PET and [{sup 18}F]FDG PET/CT to the diagnosis of osteomyelitis and implant-associated infections, enabling timely and appropriate decision-making for further therapy options. [{sup 18}F]FDG PET or PET/CT was performed in 215 patients with suspected osteomyelitis or implant-associated infections between 2000 and 2013. We assessed the diagnostic accuracy of both modalities together and separately with reference to intraoperative microbial findings, with a mean clinical follow-up of 69 ± 49 months. Infections were diagnosed clinically in 101 of the 215 patients. PET and PET/CT scans revealed 87 true-positive, 76 true-negative, 38 false-positive, and 14 false-negative results, indicating a sensitivity of 86 %, a specificity of 67 %, a positive predictive value (PPV) of 70 %, a negative predictive value (NPV) of 84 % and an accuracy of 76 %. The sensitivity of PET/CT was 88 %, but specificity, PPV, NPV and accuracy (76 %, 76 %, 89 % and 82 %, respectively) were higher than those of stand-alone PET. [{sup 18}F]FDG PET is able to identify with high sensitivity the presence of osteomyelitis in orthopaedic surgery patients with nonspecific clinical symptoms of infection. (orig.)

Skull base osteomyelitis: role of three phase and hybrid SPECT/CT bone scintigraphy

International Nuclear Information System (INIS)

Chakraborty, D.; Bhattacharaya, A.; Kamaleshwaran, K.K.; Mittal, B.R.; Aggarwal, K.; Singh, B.; Bhoil, A.

2010-01-01

Full text: Skull base osteomyelitis is the infection that has spread to the skull base, beyond the external auditory canal and seen in advanced stage of malignant otitis externa. Early diagnosis of this condition includes the use of bone scintigraphy since clinical assessment alone cannot differentiate the skull base osteomyelitis from the severe type of otitis externa in which there is no extension to the adjacent bone. Objective: To determine the role of three phase bone scintigraphy and delayed SPECT/CT in detection of skull base osteomyelitis in patients with malignant otitis externa. Material and Methods: Clinical records of 20 patients (14 Males and 6 Females; mean age 72 yrs) of otitis externa with suspected skull base involvement referred for bone scintigraphies were analyzed retrospectively. Three phase bone scintigraphy was acquired under dual detector gamma camera after intravenous injection of 20 mCi (740 MBq) 99m Tc-MDP followed by SPECT/CT of the skull. Scintigraphic findings were compared with clinical symptoms, signs and diagnostic CT scan findings. Results: All the patients except one were diabetic and having elevated ESR. 18 patients presented with bilateral symptoms and rest unilateral. Cranial nerves were involved in 8 patients (40%). Ear discharge culture sensitivity report was found in three patients; it was positive for Pseudomonas aeruginosa for two patients and in Diptheroids for one. In 9 patients (45%) increased flow of tracer and 10 patients (50%) increased blood pool phase in the temporal region was found. Delayed phase images showed increased uptake in skull bone in 19 patients (95%). Hybrid SPECT/CT of the skull localized areas of increased tracer uptake to the mastoid part in 15 patients (75%), petrous part in 11 patients (55%), sphenoid in 3 patients (15%) and zygomatic bone in one patient (5%) with CT showing destructive changes in 5 patients (25%) which were corroborated with diagnostic CT findings. SPECT/CT along with three phase

Sickle cell disease in Sierra Leone: a neglected problem | Roberts ...

African Journals Online (AJOL)

Eleven (2.4%) were Sickle Cell-HbC disease, median age 14 years. Patients demonstrated many of the typical features of SCD. The most common reason for hospital admission was bone pain crisis associated with an infection, followed by severe anemia. Aseptic necrosis of the femoral head, leg ulcers, septic osteomyelitis ...

Glucose utilisation in the lungs of septic rats

International Nuclear Information System (INIS)

Hansson, L.; Jeppsson, B.; Ohlsson, T.; Sandell, A.; Valind, S.; Luts, A.; Wollmer, P.

1999-01-01

Sequestration and degranulation of leucocytes in the pulmonary microcirculation is considered to be a key event in the development of acute respiratory distress syndrome in patients with sepsis. Glucose serves as the main source of energy in activated leucocytes. The aim of this study was to assess whether glucose utilisation in the lungs can be used as an indicator of pulmonary leucocyte accumulation in an experimental model of sepsis of intra-abdominal origin. Sepsis was induced in rats by abdominal implantation of a gelatine capsule containing bacteria and rat colonic contents. Empty gelatine capsules were implanted in control animals. Animals were studied 6 and 12 h after sepsis induction. Glucose utilisation was measured as the tissue uptake of fluorine-18-fluorodeoxyglucose ( 18 FDG) 1 h after intravenous injection of the tracer. Micro-autoradiography was also performed after injection of tritiated deoxyglucose. We found increased uptake of 18 FDG in the lungs of septic animals. The uptake also increased with time after sepsis induction. 18 FDG uptake in circulating leucocytes was increased in septic animals compared with controls, and micro-autoradiography showed intense accumulation of deoxyglucose in leucocytes in the lungs of septic animals. We conclude that glucose utilisation is increased in the lungs of septic rats. Measurements of pulmonary glucose utilisation as an index of leucocyte metabolic activity may open new possibilities for studies of the pathophysiology of sepsis and for evaluation of therapeutic interventions. (orig.)

IL-1B rs16944 polymorphism is related to septic shock and death.

Science.gov (United States)

Jiménez-Sousa, María Ángeles; Medrano, Luz M; Liu, Pilar; Almansa, Raquel; Fernández-Rodríguez, Amanda; Gómez-Sánchez, Esther; Rico, Lucía; Heredia-Rodríguez, María; Gómez-Pesquera, Estefanía; Tamayo, Eduardo; Resino, Salvador

2017-01-01

IL-1β is a primary mediator of systemic inflammatory response syndrome (SIRS) and it may lead to shock septic. Our aim was to analyse whether IL-1B rs16944 polymorphism is associated with the onset of septic shock and death after major surgery. We performed a case-control study on 467 patients who underwent major cardiac or abdominal surgery. Of them, 205 patients developed septic shock (cases, SS group) and 262 patients developed SIRS (controls, SIRS group). The primary outcome variables were the development of septic shock and death within 90 days after diagnosis of septic shock. The IL-1B rs16944 polymorphism was genotyped by Sequenom's MassARRAY platform. The association analysis was performed under a recessive genetic model (AA vs. GG/GC). The frequency of septic shock was higher in patients with IL-1B rs16944 AA genotype than in patients with IL-1B rs16944 GG/AG genotype when all patients were taken into account (63·6% vs. 41·8%; P = 0·006), cardiac surgery (52·2% vs. 33·3%; P = 0·072) and abdominal surgery (76·2% vs. 50·2%; P = 0·023). However, the IL-1B rs16944 AA genotype was only associated with higher likelihood of septic shock in the analysis of all population [adjusted odds ratio (aOR) = 2·26 (95%CI = 1·03; 4·97; P = 0·042], but not when it was stratified by cardiac surgery (P = 0·175) or abdominal surgery (P = 0·467). Similarly, IL-1B rs16944 AA genotype was also associated with higher likelihood of septic shock-related death in all population [aOR = 2·67 (95%CI = 1·07; 4·97); P = 0·035]. IL-1B rs16944 AA genotype seems to be related to the onset of septic shock and death in patients who underwent major surgery. © 2016 Stichting European Society for Clinical Investigation Journal Foundation.

Experience of Soviet Medicine in a Great Patriotic War, 1941-1945. Volume 16, Section 4.

Science.gov (United States)

1980-10-22

suppurative arthritis . (11). osteomyelitis. (12). combination of reasons indicated. (13). Shoulder. (14). During primary processing. (15). In another time...the injury. Page t87. The number of imputations apropos of suppurative arthritis and oste~myelitis was comparatively small; o.vidently, as direct...the solutions of antibiotics. As great achievement should be noted the wide and general/universal use/application of physiotherapy , therapeutic

Transfusion requirements in septic shock (TRISS) trial - comparing the effects and safety of liberal versus restrictive red blood cell transfusion in septic shock patients in the ICU

DEFF Research Database (Denmark)

Holst, Lars B; Haase, Nicolai; Wetterslev, Jørn

2013-01-01

Requirements in Septic Shock (TRISS) trial is a multicenter trial with assessor-blinded outcome assessment, randomising 1,000 patients with septic shock in 30 Scandinavian ICUs to receive transfusion with pre-storage leuko-depleted RBC suspended in saline-adenine-glucose and mannitol (SAGM) at haemoglobin...

Deep wound cultures correlate well with bone biopsy culture in diabetic foot osteomyelitis.

Science.gov (United States)

Malone, M; Bowling, F L; Gannass, A; Jude, E B; Boulton, A J M

2013-10-01

Osteomyelitis is a major complication in patients with diabetic foot ulceration. Accurate pathogenic identification of organisms can aid the clinician to a specific antibiotic therapy thereby preventing the need for amputation. All diabetic patients with bone biopsy-confirmed osteomyelitis were included into the study: biopsies were performed either during surgical removal of infected bone or percutaneously under guided fluoroscopy through non-infected tissue. The depth and extent of the ulcer was assessed using a sterile blunt metal probe. Deep wound cultures were taken from the wound base after sharp debridement. Of 66 cases of suspected osteomyelitis in 102 joints, 34 patients had both bone biopsies and deep wound cultures over the study period. Thirty two of 34 (94%), had a history of preceding foot ulceration, and in 25 of the cases a positive probe to bone test was recorded. In a high proportion of patients, at least one similar organism was isolated from both the deep wound culture and bone biopsy procedures (25 of 34 cases, 73.5%, p<0.001). When organisms were isolated from both wound cultures and bone biopsies, the identical strain was identified in both procedures in a significant proportion of cases (16 of 25 cases, 64%, p<0.001, total sample analysis in 16 of 34 cases, 47%). Deep wound cultures correlate well with osseous cultures and provide a sensitive method in assessing and targeting likely pathogens that cause osseous infections. This will help aid the clinician in guiding antibiotic therapy in centers where bone biopsies may not be readily available. Copyright © 2013 John Wiley & Sons, Ltd.

Rheumatoid Arthritis Educational Video Series

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Full Text Available ... Arthritis Managing Your Arthritis Managing Chronic Pain and Depression in Arthritis Nutrition & Rheumatoid Arthritis Arthritis and Health- ... on this website. Copyright Johns Hopkins Arthritis Center © 2018 Patient Privacy Johns Hopkins Rheumatology

Rheumatoid Arthritis Educational Video Series

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Full Text Available ... Managing Your Arthritis Managing Your Arthritis Managing Chronic Pain and Depression in Arthritis Nutrition & Rheumatoid Arthritis Arthritis and Health-related Quality of Life Rehabilitation Management for Rheumatoid Arthritis Patients Rehabilitation of Older Adult ...

Changes in muscle tissue oxygenation during stagnant ischemia in septic patients.

Science.gov (United States)

Pareznik, Roman; Knezevic, Rajko; Voga, Gorazd; Podbregar, Matej

2006-01-01

To determine changes in the rate of thenar muscles tissue deoxygenation during stagnant ischemia in patients with severe sepsis and septic shock. Prospective observational study in the medical ICU of a general hospital. Consecutive patients admitted to ICU with septic shock (n=6), severe sepsis (n=6), localized infection (n=3), and healthy volunteers (n=15). Upper limb ischemia was induced by rapid automatic pneumatic cuff inflation around upper arm. Thenar muscle tissue oxygen saturation (StO2) was measured continuously by near-infrared spectroscopy before and during upper limb ischemia. StO(2) before intervention was comparable in patients with septic shock, severe sepsis, or localized infection and healthy volunteers (89 [65, 92]% vs. 82 [72, 91]% vs. 87 [85, 92]% vs. 83 [79, 93]%, respectively; p>0.1). The rate of StO(2) decrease during stagnant ischemia after initial hemodynamic stabilization was slower in septic shock patients than in those with severe sepsis or localized infection and in controls (-7.0 [-3.6, -11.0] %/min vs. -10.4 [-7.8, -13.3] %/min vs. -19.5 [-12.3, -23.3] vs. -37.4 [-27.3, -56.2] %/min, respectively; p=0.041). At ICU discharge the rate of StO2 decrease did not differ between the septic shock, severe sepsis, and localized infection groups (-17.0 [-9.3, -28.9] %/min vs. -19.9 [-13.3, -23.6] %/min vs. -23.1 [-20.7, -26.2] %/min, respectively), but remained slower than in controls (p<0.01). The rate of StO2 decrease was correlated with Sequential Organ Failure Assessment (SOFA) score (r=0.739, p<0.001). After hemodynamic stabilization thenar muscle tissue oxygen saturation during stagnant ischemia decreases slower in septic shock patients than in patients with severe sepsis or localized infection and in healthy volunteers. During ICU stay and improvement of sepsis the muscle tissue deoxygenation rate increases in survivors of both septic shock and severe sepsis and was correlated with SOFA score.

Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

Science.gov (United States)

Kasch, Richard; Merk, Sebastian; Assmann, Grit; Lahm, Andreas; Napp, Matthias; Merk, Harry; Flessa, Steffen

2017-01-01

Background The most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involves a greater financial burden. Little concrete data about direct costs for aseptic and two-stage septic knee revisions with an in depth-analysis of septic explantation and implantation is available. Questions/Purposes A retrospective consecutive analysis of the major partial costs involved in revision TKA for aseptic and septic failure was undertaken to compare 1) demographic and clinical characteristics, and 2) variable direct costs (from a hospital department’s perspective) between patients who underwent single-stage aseptic and two-stage septic revision of TKA in a hospital providing maximum care. We separately analyze the explantation and implantation procedures in septic revision cases and identify the major cost drivers of knee revision operations. Methods A total of 106 consecutive patients (71 aseptic and 35 septic) was included. All direct costs of diagnosis, surgery, and treatment from the hospital department’s perspective were calculated as real purchase prices. Personnel involvement was calculated in units of minutes. Results Aseptic versus septic revisions differed significantly in terms of length of hospital stay (15.2 vs. 39.9 days), number of reported secondary diagnoses (6.3 vs. 9.8) and incision-suture time (108.3 min vs. 193.2 min). The management of septic revision TKA was significantly more expensive than that of aseptic failure ($12,223.79 vs. $6,749.43) (p costs of explantation stage ($4,540.46) were lower than aseptic revision TKA ($6,749.43) which were again lower than those of the septic implantation stage ($7,683.33). All mean costs of stays were not comparable as they differ significantly (p cost drivers were the cost of the implant and

Rheumatoid Arthritis Educational Video Series

Science.gov (United States)

... Corner / Patient Webcasts / Rheumatoid Arthritis Educational Video Series Rheumatoid Arthritis Educational Video Series This series of five videos ... Your Arthritis Managing Chronic Pain and Depression in Arthritis Nutrition & Rheumatoid Arthritis Arthritis and Health-related Quality of Life ...

Whole body MRI in the diagnosis of chronic recurrent multifocal osteomyelitis.

LENUS (Irish Health Repository)

Kennedy, M T

2012-06-01

Chronic recurrent multifocal osteomyelitis (CRMO) is a diagnosis of exclusion primarily in children and adolescents. As part of the essential criteria for the diagnosis of CRMO, multifocal lesions must be identified. We present the case of an 11-year-old boy with CRMO, whose diagnosis was facilitated by the use of whole body magnetic resonance imaging (WBMR), but not isotope bone scanning.