Bone Abscess Research Articles

Pathological humerus fracture due to anti-interferon-gamma autoantibodies: A case report

BACKGROUNDVarious etiologies contribute to pathological fractures, including bone infections. Recently, non-tuberculosis Mycobacterium-related bone infections among patients with anti-interferon-gamma autoantibody-induced adult-onset immunodeficiency has raised concerns in Southeast Asia, with the common presentations including osteomyelitis. However, it also rarely manifests as traumatic fractures, as reported in this case.CASE SUMMARYA diabetic female fractured her humerus after a traumatic accident and received fixation surgery. Abnormal necrotic bone tissue and abscess formation were noted, and she was diagnosed with a pathological fracture due to non-tuberculosis Mycobacterium infection. Multiple bone involvement was also revealed in a bone scan. Anti-interferon-gamma autoantibodies were then checked due to an unexplained immunocompromised status and found to be positive. Her humerus fracture and multiple bone infections healed after steroid and anti-non-tuberculosis Mycobacterium medication treatment following fixation surgery.CONCLUSIONComprehensive preoperative evaluations may help identify pathological fractures and guide the treatment course.

Pott’s Puffy Tumor - Overview of case series

Pott’s puffy tumor (PPT) is rare and usually seen as a complication of frontal sinusitis that has been neglected or partially treated, resulting in subperiosteal abscess of the frontal bone with underlying osteomyelitis, which can lead to life-threatening intracranial complications, such as epidural/subdural empyema, cerebral abscess and meningitis. Given this, the purpose of the present study was to gather the most diverse cases reported together to highlight the main treatment methods. Methods: It is a narrative review, starting from the search in the database PubMed, Lilacs and Scielo from 2010 to 2020, which resulted in 34 scientific articles. The search focused on obtaining data on new approaches and treatments established for Pott’s puffy tumor. Results: 34 articles were included which described 58 patients with a swollen Pott tumor, occurring predominantly in male adolescents, with streptococci (26,1%) as the main etiologic agent. Approximately 84% of all patients were male subjects. The most prevalent intracranial complication was an epidural or extradural abscess (84,2%). Regarding PTT therapy, all patients received antibiotic therapy (ATB), and the main empirical antimicrobial scheme used was cephalosporin third generation, with vancomycin and metronidazole. In most cases, surgery was performed using several techniques, mainly an external surgical approach, external drainage (ED) of the subperiosteal abscess associated with endoscopic sinus surgery (ESS). In general, the prognosis is favorable, even if neurological symptoms are present at admission. Conclusion: Based on available literature, PPT is a profoundly serious complication, which can be easily avoided if treated with the ATB, ED and ESS triad immediately, and, if necessary, craniotomy.

A RARE COMPLICATION POTT’S PUFFY TUMOR TREATED WITH FRONTOETHMOIDECTOMY: A CASE REPORT

Untreated or undiagnosed frontal sinusitis develops as a subperiosteal abscess in the frontal bone named Pott’s puffy tumor (PPT). Pott’s puffy tumor is a rare complication that needs surgical excision. In this communication, we report a 50-year-old woman presenting with typical signs and symptoms of PPT. CT-Scan and X-ray imaging are the gold standards to measure the extent of tumor and involvement of structures, if any.

Investigation of the Effect of Pentoxifylline and Tocopherol on Osseous Healing Following Tooth Extraction in Bisphosphonate-Administered Rats

Background: The incidence of medication-related osteonecrosis of the jaw has increased with the widespread use of bisphosphonates. Present study aimed to evaluate the effect of pentoxifylline and/or tocopherol alone or in combination, on bisphosphonate-induced osteonecrosis in tooth extracted rat jaw. Methods: 24 rats were randomly assigned to 4 groups and each animal received intraperitoneal zoledronic acid injection 0.06 mg/ kg/week for 3 weeks. Following the zoledronic acid application, the lower right first molars of the rats were extracted on day 22. Starting from the day of tooth extraction animals received intraperitoneal pentoxifylline and/or tocopherol injections. Fourteen days later all rats were sacrificed. RANKL and osteoprotegerin (OPG) in blood were measured, and mandibles were examined histologically. When the inter-group differences were evaluated, the Kruskal Wallis-H Test and the Chi-square analysis were used. Results: Each groups’ serum RANKL, OPG and RANKL/OPG levels did not reveal any statistically significant differences. There were no statistically significant differences in terms of bone necrosis, abscess formation, inflammation, osteoblastic/osteoclastic activity, bone cellularity and epithelial integrity.Conclusions: Pentoxifylline and/or tocopherol injections alone or in combination did not have any statistically significant effecton the jaw following tooth extraction in bisphosphonate-induced rat animal model.

Haematogenous Klebsiella pneumoniae osteomyelitis.

Klebsiella pneumoniae infection has been associated with alcoholic and diabetic patient populations, especially in Asian populations. K. pneumonia wound infection is common, but K. pneumonia without wound osteomyelitis (OM) is relatively rare. However, the pathogenesis of haematogenous K. pneumonia without open wound OM still unclear until now. In our research, we are trying to collect patients with haematogenous K. pneumonia osteomyelitis (K.p OM) at our hospital and to evaluate their contributing factors. We compiled a retrospective database of haematogenous K. pneumonia osteomyelitis (K.p OM) from 1990 to 2019 at our hospital. Patients' bone cultures without K. pneumonia infection were excluded. Sixteen patients with haematogenous K.p OM were recruited. Patients' basic information, comorbidities, wound history, the biochemical examination of the blood, bacterial blood, bone, urine, and liver abscess cultures, the location of OM, corresponding treatments, and post operation K.p wound infection history were reviewed retrospectively. The collected data were analyzed using SPSS software. Unwounded haematogenous K.p OM had a statistically significant and positive correlation with liver insufficiency (P = .037; OR = 2.200), advanced age (≥ 65years) (P = .037; OR = 2.200) and male gender (P = .03; OR = 1.833). DM, hypertension, steroid usage, GI or GU tract K.p infection, post operation K.p wound infection, hypoalbuminemia, and the location of K.p OM had no significant relationship to outcomes. Male patients of advanced age (> 65years) and patients with liver insufficiency, including liver cirrhosis and hepatitis, have a strong correlation with unwounded haematogenous K.p OM.

Clinical and imaging characteristics of patients with different types of infectious sacroiliitis

To investigate the clinical manifestations and imaging characteristics of patients with different types of infectious sacroiliitis. Clinical data of 40 patients diagnosed with infectious sacroiliitis were retrospectively analyzed. Among the 40 patients, 16 patients were diagnosed as non-brucellar and non-tuberculous infectious sacroiliitis (ISI), 13 with tuberculous infectious sacroiliitis (TSI), and 11 with brucellar sacroiliitis (BSI). In the ISI and TSI group, female patients accounted for 11/16, 12/13, while the proportion of unilateral involvement was 15/16 and 12/13, respectively. Compared with ISI and TSI group, BSI patients were mainly male (8/11) and presented more bilateral involvement (6/11) (P<0.05). Bone erosion was more common in ISI and TSI groups than in BSI group (6/15, 7/11 and 2/10), as well as abscess formation (3/15, 4/11 and 1/10, respectively). Symptoms in all patients relieved 1-2 weeks after administration of antibiotics or anti-tuberculosis treatment, but the resolution of the magnetic resonance imaging findings delayed about 6 (3-9) months. ISI and TSI patients with infectious sacroiliitis should be differentiated from spondyloarthritis, with a characteristic of more female patients, unilateral sacroiliitis, bone erosion, soft tissue involvement and abscess formation. However, BSI patients are mainly male, more bilateral involvement and less bone destruction and abscess formation. Antibiotic therapy demonstrates significant therapeutic effects, but resolution of the magnetic resonance imaging findings responses late.

Ocorrência de Histoplasma capsulatum isolado no período de 2016 a 2019 em um Laboratório Estadual de Saúde Pública do Centro-Oeste Brasileiro

Objetivo: Analisar a ocorrência de Histoplasma capsulatum nas culturas para fungos que deram entrada em um Laboratório Estadual de Saúde Pública do Centro-Oeste brasileiro no período de 2016 a 2019. Metodologia: Trata-se de um estudo transversal, constituído por culturas para pesquisa de fungos que deram entrada no referido laboratório e provenientes de Hospitais de Referência do Estado. As variáveis analisadas foram gênero, faixa etária, número de positividade e negatividade das culturas para Histoplasma capsulatum e espécime clínico utilizado para análise. Resultados: No período analisado, foi dada entrada de um total de 12.476 culturas para fungos, 2.262 foram positivas, das quais 313 identificou-se a presença do Histoplasma capsulatum. A prevalência percentual desse agente entre as amostras positivas correspondeu a 13,84, nas faixas etárias de 31 a 40 anos (19,28), de 41 - 50 anos (16,83) e de 51 a 60 anos (14,60), com maior prevalência no gênero masculino e quanto aos espécimes clínicos oriundas de medula óssea (85,00), linfonodo (64,29), líquido ascítico (42,86), sangue (39,96) e abscesso (33,33). Ao analisar a razão de prevalência verificou possível associação de histoplasmose em amostras de pacientes, cujas principais matrizes biológicas foram o sangue 6,28 (6,04 – 11,89), medula óssea 5,72 (4,52 – 68,12) e linfonodo (3,15 – 28,48). Conclusão: Nota-se frente à prevalência encontrada a relevância da notificação compulsória dessa micose a nível nacional, a fim de melhorar o monitoramento para subsidiar medidas que facilitem o diagnóstico precoce e o tratamento adequado.

MDCT Evaluation of Post-Operative Cranium: Spectrum of Normal Findings &amp; Complications

Imaging plays an essential role in the evaluation of patients after cranial surgery. Postoperative infection and hemorrhage are common complications after cranial surgeries. Life-threatening complications (like tension and paradoxical herniation) must be identified rapidly at imaging to secure a favorable prognosis. This cross-sectional study included 250 patients who underwent neurosurgical operations and were imaged for the developed postoperative complications using Computed Tomography(CT), Magnetic Resonance Imaging(MRI) with and without contrast. We reviewed the common normal and abnormal findings in post-operative neurosurgical patients. The expected postoperative CT and MRI appearances of these procedures are discussed, followed by complications. These include hemorrhage, tension , wound/soft tissue infection, bone flap infection and abscesses. Complications specifically related to include herniation, external brain , paradoxical herniation, and syndrome. In our study165 male; 58 % and 85 female; 42 % were included; age range (6months-69 years), mean age 34.7 ± 2.9 years. 130 patients underwent , infection (23%) was the most dominant complication followed by cranial hemorrhage (19 %). So to conclude;radiologist must know how to recognize postoperative complications and differentiate them from expected normal findings because an early and accurate diagnosis is important for proper postoperative care. tomography is fast, cost effective, and easily accessible for first-line imaging. Magnetic resonance imaging has higher sensitivity for detecting postoperative infection and ischemia.

Interpreting an orthopantomogram.

An orthopantomogram (OPG) is a common radiograph used to identify thehard tissues of the oral cavity and surrounding skeletal structures. It is an extra-oral radiograph that approximates the focal trough of the mandible. Although resolution is not as detailed as intra-oral radiographs for examination of the teeth, gross changes in calcification of the dental structures, and changes in ossification of the underlying mandible and maxilla can aid in identification of dental disease such as caries (decay), periodontal bone loss, and abscess and cyst formation. This article outlines key anatomical features identifiable in an OPG and illustrates some common pathology thatmay be seen. The large amount of data visible on an OPG may appear daunting to the viewer unless a systematic approach is used to examine structures present. Distortion due to flattening of the curve of the mandible and dentition will give an overall view of these structures and requires the viewer to reinterpret these intheir mind for a three-dimensional appreciation of the image.

A Case of Chronic Invasive Rhinocerebral Mucormycosis with Pott’s Puffy Tumor

Mucormycosis is one of the most fatal and rapidly progressive fungal infections in humans; among its many forms. rhinocerebral mucormycosis is the most common. It is known to occur as opportunistic infection in patients with uncontrolled diabetes, metabolic disorders, organ transplantation, or autoimmune disease with prolonged steroid use. Pott’s puffy tumor is the subperiosteal abscess of the frontal bone caused by trauma complication or frontal sinusitis. It is considered as a very rare complication since the dawn of antibiotic treatments. We report a case of chronic rhinocerebral mucormycosis involving Pott’s puffy tumor in a patient receiving immunosuppressive therapy after lung transplantation.

Incidence of Odontogenic Disease in Patients With Pott's Puffy Tumor

Osteomyelitis with subperiosteal abscess of the frontal bone, or Pott's puffy tumor (PPT), is a rare but life-threatening condition. The relationship of concurrent dental disease to PPT has not been well described. This study sought to delineate the incidence of odontogenic disease in PPT, especially in cases where there is no history of facial trauma or prior frontal sinus surgery. A retrospective chart review of patients diagnosed with PPT between 2010 and 2019 was carried out. Demographics, pertinent medical history, surgical procedures performed, and microbial cultures and antibiotics used were extracted for analysis. Maxillofacial computed tomography scans were reviewed for presence of odontogenic disease. A total of 17 patients were identified. Four had documented history of frontal bone trauma; 3 had previous frontal sinus surgery. Seven (41%) had documented odontogenic disease on initial radiology reports; however, upon dentist review, 16 (94%) had various pathology visible on their computed tomography scans. Twelve of these 16 patients had no previous frontal sinus trauma or surgery. Eight patients (47%) had only ipsilateral maxillary or ethmoid inflammation respective to PPT on computed tomography. Seventy-six percent of patients underwent endoscopic sinus surgery. Of 14 patients with cultures collected at the time of surgery, 7 (50%) had polymicrobial growth and 6 (43%) had anaerobic growth. The incidence of odontogenic disease in this population of PPT was 94%. In the absence of a history of frontal bone trauma or frontal sinus surgery, underlying dental origin should be suspected in cases of PPT. Initial radiology reports may not document all identifiable dental pathology. Therefore, patients presenting with PPT should undergo comprehensive evaluation, including an oral cavity and dental examination, and potential referral to dental colleagues.

Tumor inflamatorio de pott. Descripción de un caso

RESUMEN Introducción y objetivo: El tumor inflamatorio de Pott se describe como una inflama-ción en la región frontal debido la formación de un absceso subperióstico y osteo-mielitis del hueso frontal; debido en la mayoría de las ocasiones, a una sinusitis fron-tal. Es más frecuente observarlo en adolescentes. El objetivo de nuestro estudio es presentar un diagnóstico un tanto olvidado y poco frecuente; así como su descrip-ción como entidad en la discusión de los artículos más relevantes de la literatura. Descripción: Presentamos el caso de un varón de 61 años con cefalea punzante a nivel supraciliar derecha, sin insuficiencia respiratoria nasal y con fibroscopia prácti-camente anodina. En la inspección se observa una inflamación, dolorosa a la palpa-ción, del tejido blando con una pequeña fistulización hacia la piel y salida de material purulento. En el TC de senos paranasales se observa una sinusitis crónica frontal derecha. Dicho seno presenta una solución de continuidad en su pared anterior que comunica las partes blandas. Se realiza Draf III del seno frontal derecho guiado con neuronavegador con abordaje combinado externo y vancomicina IV intrahospitalaria. Actualmente el paciente se encuentra asintomático sin clínica infecciosa. Discusión: el tumor inflamatorio de Pott es una complicación rara, pero potencialmente mortal de la sinusitis bacteriana, que consiste en un absceso subperióstico y osteomielitis del hueso frontal. Se diagnostica con tomografía computarizada con contraste o reso-nancia magnética y se trata con antibióticos de amplio espectro, así como interven-ción quirúrgica de forma precoz. Es necesario conocer la fisiopatología y manejo del cuadro; evitando así las posibles complicaciones intracraneales. Conclusiones: el diagnóstico precoz de esta entidad y el tratamiento antibiótico y endoscópico son esenciales para evitar el riesgo de progresión hacia complicaciones neurológicas graves subsidiarias de tratamientos quirúrgicos más agresivos.

Medial Sural Artery Perforator Flap for Leg and Knee Coverage: Extended Skin Paddle With 2 Perforators.

For soft-tissue defect coverage in the lower leg and around the knee joint, the gastrocnemius muscle flap is the most commonly used. Having constant anatomy, a long pedicle, and decreased donor site morbidity, the medial sural artery perforator (MSAP) flap may represent a good reconstructive alternative. The aim of this report was to present the experience of using a dual perforator MSAP pedicled flap. Nineteen patients underwent soft-tissue reconstruction by MSAP flap in the one third of the lower leg and around the knee joint. Eleven patients were injured in traffic accidents. Exposure of a knee prosthesis required flap coverage in 4 cases. The other defect etiologies were a gunshot wound, bone abscess due to a sickle cell anemia, bone exposure due to a full thickness burn, and sarcoma resection. Defect dimensions ranged from 7 × 5 cm to 15 × 8 cm. Seventeen flaps were harvested with 2 perforators. Donor sites were closed primary in 16 of the 19 cases. The sizes of the MSAP flaps ranged from 7 to 22 cm × 5 to 8 cm. The procedure was uneventful in 17 cases. The 2 unsuccessful flaps developed a distal necrosis, for which an excision with direct suture was made secondary. Complete healing was achieved in all cases. The pedicled MSAP flap represents a versatile option in soft-tissue defect coverage of the lower leg and around the knee joint. Inclusion of 2 perforators could render the flap safer and increase its skin paddle, making it suitable for larger defects.

Description of Eikenella halliae sp. nov. and Eikenella longinqua sp. nov., derived from human clinical materials, emendation of Eikenella exigua Stormo et al. 2019 and emendation of the genus Eikenella to include species which are strict anaerobes

The Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella (HACEK) group genus Eikenella contained a single species, Eikenella corrodens, for many years. In November 2019, Eikenella exigua was described after recovery from a brain abscess and blood culture in Norway. Coincidentally, characterization of 22 Gram-negative bacteria resembling Eikenella from 17 Canadian patients had been underway. Seven isolates from five patients were conclusively identifiable as E. corrodens. One (NML 120819) was deemed to represent a species of the genus Eikenella most closely related to E. corrodens. Fourteen isolates had 97.6 to 98.8% similarities to E. corrodens by 16S rRNA gene sequencing, forming three distinct groups by genome analyses. The largest contained ten anaerobic isolates from eight patients recovered from blood, brain, bone and other abscesses; upon re-evaluation, this group was found to be most consistent with E. exigua. A second facultatively anaerobic clade consisted of two ocular isolates from one patient and a sinus isolate from a second patient. The third taxon consisted of a single strictly anaerobic blood culture isolate. The novel taxa, like E. corrodens, were poorly reactive biochemically and difficult to discern from each other phenotypically and chemotaxonomically, including by cellular fatty acids. MALDI-TOF (Bruker) and whole-genome sequencing were used to further characterize isolates. Draft genomes for the strains had similar DNA G+C contents (55.38-58.53 mol%) while sizes varied from 1.82 Mb to 2.54 Mb. We propose here emendations of the genus Eikenella and the species Eikenella exigua, as well as describing Eikenella halliae sp. nov. NML 130454T (=LMG 30894T=NCTC 14180T) and Eikenella longinqua sp. nov. NML 02-A-017T (=LMG 30896T=NCTC 14179T), on the basis of these findings.

Prediction of Adverse Outcomes in Pediatric Acute Hematogenous Osteomyelitis.

Clinicians cannot reliably predict complications of acute hematogenous osteomyelitis (AHO). Consecutive cases of AHO from 2 pediatric centers in the United States were analyzed retrospectively to develop clinical tools from data obtained within 96 hours of hospitalization to predict acute and chronic complications of AHO. Two novel composite prediction scores derived from multivariable logistic regression modeling were compared with a previously published severity of illness (SOI) score, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) using area under the receiver operating characteristic curve analyses. The causative organisms were identified in 73% of 261 cases. Bacteremia (45%), abscesses (38%), and associated suppurative arthritis (23%) were relatively common. Acute or chronic complications occurred in 24% and 11% of patients, respectively. Multivariable logistic regression identified bone abscess (odds ratio [OR], 2.3 [95% confidence interval {CI}, 1.0-5.2]), fever > 48 hours (OR, 2.7 [95% CI, 1.2-6.0]), suppurative arthritis (OR, 3.2 [95% CI, 1.3-7.5]), disseminated disease (OR, 4.6 [95% CI, 1.5-14.3]), and delayed source control (OR, 5.1 [95% CI, 1.4-19.0]) as strong predictors of acute complications. In a separate model, CRP ≥ 100 mg/L at 2-4 days after antibiotics (OR, 2.7 [95% CI, 1.0-7.3]), disseminated disease (OR, 3.3 [95% CI, 1.1-10.0]), and requirement for bone debridement (OR, 6.7 [95% CI, 2.1-21.0]) strongly predicted chronic morbidity. These variables were combined to create weighted composite prediction scores for acute (A-SCORE) and chronic (C-SCORE) osteomyelitis, which were superior to SOI, CRP, and ESR and had negative predictive values > 90%. Two novel composite clinical scores were superior to existing tools to predict complications of pediatric AHO.

A Case of Temporal Bone Abscess in an Immunocompromised Patient

Introduction: Acute otitis media (AOM) is an otological disease that is usually self-limit ing. However, certain AOM complicates with abscess development over the deep neck cavity (Bezold's abscess), occiptal abscess (Citelli's) or beneath the temporal muscle (Luc's abscess). Luc's abscess was described as a more benign form of AOM that seldom require extensive surgical drainage.Case report: We report a case of a subperiosteal temporal bone abscess in an immunocompromised patient, which resolved with local drainage of abscess and cultureoriented antimicrobial.Conclusion: Luc's abscess is a rare form of the complication of otitis media, associated with relatively lower morbidity, better prognosis, and requires a limited surgical intervention. High resolution computed tomography (HRCT) temporal bone is highly recommended to evaluate the extent of the disease and to decide for further treatment strategy. The choice of surgery should also be tailored to the patient's premorbid factor.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 45

852. The Cefazolin Inoculum Effect and Methicillin-Susceptible Staphylococcus aureus Osteoarticular Infections in Children: Does It Matter?

BackgroundSelect methicillin-susceptible Staphylococcus aureus (MSSA) strains may produce β-lactamases with an affinity for first-generation cephalosporins (1GC). In the setting of a high inoculum, these β-lactamases may promote clinically meaningful cleavage of 1GCs, potentially resulting in antibiotic failure, a phenomenon known as the cefazolin inoculum effect (CIE). Acute hematogenous osteoarticular infections (AHOAIs, including osteomyelitis and septic arthritis) are the most common manifestation of invasive S. aureus infection in children. We evaluated the prevalence and potential impact of CIE among MSSA AHOAI isolates at two children’s hospitals.MethodsMSSA AHOAI isolates were obtained through surveillance studies at Texas Children’s and St. Louis Children’s Hospitals from January 2011 to December 2018. Isolates were tested for CIE via a macrobroth dilution assay with an inoculum of 107 CFU/mL; CIE was defined as a cefazolin MIC ≥16 µg/mL. Isolates were characterized by accessary gene regulator group (agr). The subsequent development of chronic osteomyelitis (CO) was regarded as a clinically important outcome.ResultsA total of 287 cases were included and the median patient age was 8.6 years. 14.3% of isolates exhibited CIE; CIE prevalence was similar across study sites. 74.6% of patients received a 1GC as definitive therapy. CIE isolates were more often resistant to clindamycin, belonged to agr III and associated with CO (Figure 1); a numerically higher rate of CO was observed with CIE isolates regardless of definitive antibiotic choice (Figure 2). In multivariable analyses, bone abscesses, agr III, positive blood cultures, multiple surgeries, and delayed source control but not CIE were independently associated with CO (Figure 3); similar results were seen if analyses were restricted to only those receiving 1GC.ConclusionCIE is exhibited by 14.3% of MSSA AHOAI isolates in children. CIE is associated with agr III and clindamycin-resistant strains. agr III strains are independently associated with CO; thus negative outcomes reported with CIE may more accurately reflect strain-dependent virulence factors rather than true antibiotic failure. Further studies are necessary to better understand the clinical significance of these findings. Disclosures All Authors: No reported Disclosures.

Osteoarticular Infections Following Open or Penetrating Trauma in Children in the Post-Community-Acquired Methicillin-resistant Staphylococcus aureus Era: The Impact of Enterobacter cloacae.

Most cases of pediatric osteoarticular infections (OAIs) are hematogenous in nature and caused by Staphylococcus aureus. OAI in children can also occur through direct inoculation of microorganisms secondary to penetrating or open trauma. No studies in the United States have evaluated the microbiology or outcomes of trauma-related OAI (TROAI) in children in the era of community-acquired methicillin-resistant S. aureus (CA-MRSA). Cases were identified from the inpatient infectious diseases consultation database at Texas Children's Hospital from January 2011 to December 2016. TROAI cases were those in which OAI developed following a clear history of penetrating trauma, open fracture, crush injury or traumatic amputation. Only cases with radiographic evidence of bone abscess, gross appearance of infection at the time of surgery and/or positive cultures from bone or joint were included. Complications included recurrence of infection, pathologic fracture or chronic osteomyelitis. During the study period, 692 consultations for OAI were performed, with 34 meeting inclusion criteria. In 68%, at least 1 organism was isolated, and the most commonly isolated organisms were S. aureus (32% overall, 21% MRSA) and Enterobacter cloacae (24%). Polymicrobial infections occurred in 38% of patients. Eighty-five percentage of patients had at least 1 surgical procedure, and 38% underwent ≥ 2 procedures. Eighty-two percentage of patients were discharged on oral therapy. Complications developed in 15% of patients and were more commonly associated with E. cloacae (80% vs. 14%, P = 0.007) and fungi (P = 0.03). TROAI are relatively uncommon in children but cause significant morbidity. While MRSA contributes substantially to TROAI, the highly diverse microbiology emphasizes the importance of obtaining cultures for microbiologic diagnosis and management. Clinicians should be aware of the frequency of E. cloacae in TROAI and its high risk for sequelae.

Suppurative complications of acute hematogenous osteomyelitis in children

We carried out a case-control study in children with acute hematogenous osteomyelitis (AHO) with and without suppurative complications discharged from our institution over an 11-year period to test the hypothesis that abscess formation was associated with a delayed presentation to care. Of 102 children with AHO, 54 abscesses were documented in 46 patients (25 bone, 29 muscle). A delay in presentation was not associated with abscess formation (6.5 vs. 5.0 days, P=0.26). Overall, 78% of all bone abscesses were visible on initial MRI. Consistent use of MRI at presentation may identify children with suppurative complications of AHO.

Orbital Cellulitis And Subperiosteal Abscess Of Frontal Bone Complicating Unilateral Pansinusitis: A Case Report

Objective: The aim of this report is to demonstrate that acute rhino-sinusitis may result in orbital cellulitis and even life threatening complications especially intracranial abscesses in children and young adults. Rare complications such as subperiosteal abscess seen in this patient may also occur Morbidity and mortality can be prevented through early diagnosis and treatment by relevant specialists.&#x0D; Method: We present a case report and literature review on unilateral pansinusitis complicated with orbital cellulitis and subperiosteal abscess of the frontal bone.&#x0D; Results: Following a diagnosis of orbital cellulitis and subperiosteal abscess of the frontal bone from a unilateral pansinusitis, an initial intravenous antibiotic was given for 72 hours, followed by a surgical drainage with subsequent rapid improvement.&#x0D; Conclusion: Acute rhinosinusitis may be complicated by orbital cellulitis and abscess formation. Prompt referral to a tertiary health facility as well as ooperation between the Ophthalmologists and Otorhinolaryngologists is very important to prevent life threatening complications.&#x0D; Key words: Orbital cellulitis, Pansinusitis, Subperiosteal abscess