Subacute Osteomyelitis Research Articles

Subacute hematogenous osteomyelitis of the fibula.

A ten years old patient consulted us for lower right limb pain and fever (38.2°C). There were inflammatory signs and palpation pain in relation to the right fibula. Biology was disturbed with white blood cells at 17.470 el/mm³, a sedimentation rate at 50 mm/1 hour and a C-reactive protein at 20 mg/l. X-ray shows periostal reaction, partial lysis and bone interruption of the fibula (Figure 1 A). Anatomopathological study shows a sclerotic bone and fibrous tissue with altered neutrophils. The diagnosis of subacute osteomyelitis was retained, the patient was put on an oral antibiotic for 21 days and immobilized by a Plaster. X-ray of the fibula after 3 months follow-up shows a bone repair ad-integrum (Figure 1 B). In recent years the face of osteomyelitis has changed considerably. The clinic as well as biology are becoming less noisy, probably in relation to the abusive use of antibiotics. The pain was a constant sign, the symptomatology can sometimes be summed up with a refusal of support on the algic part of the skeleton as it was the case for our patient. Local inflammatory signs are sometimes noted. The absence of general signs of infection is constant. It must be evoked before a non-specific radiographic image often metaphyseal, integrated with clinical and biological data.

Pretibial varicose veins with anomalous intraosseous venous drainage: A rare disease entity

We present a case of pretibial varicose veins with intraosseous perforating vein incompetence, which manifested as swelling and tenderness over the shaft of tibia. It was misdiagnosed by referring clinicians as a case of subacute osteomyelitis based on clinical findings and X-ray film. Further investigations were done which included magnetic resonance imaging, computed tomography scan, and color Doppler.

Moraxella lacunata Subacute Osteomyelitis in a Child.

Moraxella lacunata is a rare coccobacillus associated with eye and upper respiratory tract infections. It may also have an affinity for bone and joint tissue. We report on 1 case of subacute osteomyelitis of the patella due to M. lacunata that presented as an osteolytic bone lesion in a child.

Brodie's Abscesses Can Stimulate the Growth Plate in Children.

Introduction: We present a series of children with lower limb Brodie's abscesses (subacute osteomyelitis) with subsequent deformities.Method: A retrospective examination of the paediatric bone and joint infection database from 2014-2017 was performed. All children have MRI scans and blood tests including full blood count, ESR and CRP. MRI identified collections were drained surgically.Results: There were 68 children with bone and joint infections, and 6 had a Brodie's abscess. 4 Brodie's abscesses were adjacent to a growth plate, all these had resultant growth deformities. Some deformities develop up to 3 years after initial presentation.Discussion: We recommend long-term vigilance for growth deformity after a Brodie's abscess. In particular we demonstrate that infection can result in stimulation of the physis, as opposed to growth retardation as generally accepted.

Brodie Abscess: Case Series of 15 Pediatric Patients Treated Surgically

BACKGROUND:Brodie abscess is a form of circumscribed sub-acute osteomyelitis. Benjamin Brodie, a British surgeon first described subacute osteomyelitis in 1832 with a pus-filled cavity, vascularized wall and hard sclerotic surrounding bone. In 1951, Wiles suggested Brodie abscesses as a particular form of osteomyelitis that follows an acute attack, when the virulence of the pathogen and the resistance of the host are evenly balanced. Kirkaldy-Willis from East-Africa classified it radiologically and subsequently modified by Roberts in 1973. Non-specific pain and swelling, lack of inciting trauma and systemic symptoms makes it difficult to diagnose in pediatric population. Though several case reports have been reported, there are no case …

Brodie Abscess in Children: A 10-Year Single Institution Retrospective Review.

Brodie abscess is a subacute hematogenous osteomyelitis characterized by intraosseous abscess formation. Treatment recommendations and clinical outcomes for this unusual infection are not well established. We report 15 cases of Brodie abscess in a 10-year retrospective review of pediatric patients at Texas Children's Hospital and describe their clinical presentation and outcomes.

Acute exacerbation of chronic osteomyelitis triggered by aggravation of type 2 diabetes mellitus: a case report

BackgroundOsteomyelitis is an infection in a bone. Acute osteomyelitis is observed mainly in the long leg bones of children and is usually treated with antibiotics. On the other hand, in adults, subacute or chronic osteomyelitis is more common. Antibiotics therapy is not necessarily effective for chronic osteomyelitis, and sometimes a surgical operation is performed for its remission. Furthermore, in classification of osteomyelitis by cause, type 2 diabetes mellitus is one of most common conditions associated with osteomyelitis. It isCase presentation well known that a variety of complications are induced in patients with type 2 diabetes mellitus due to chronic hyperglycemia, inflammatory reaction, and immunodeficiency, especially when glycemic control is poor.Case presentationA 58-year-old Japanese man had acute exacerbation of chronic osteomyelitis triggered by aggravation of type 2 diabetes mellitus. He had acute osteomyelitis in his right lower leg in his babyhood. After this episode, he did not experience any pain in his leg for approximately 50 years; he felt acute pain in his right lower leg at the age of 50 when his glycemic control was very poor. He then started undergoing medical therapy for type 2 diabetes mellitus and, after an improvement in glycemic control, his pain was gradually mitigated. However, he did not take medicine for approximately 8 months at the age of 58. After the interruption, glycemic control became very poor and he felt the similar acute pain again in the same area. After improving glycemic control, his pain was gradually mitigated again as observed at the age of 50.ConclusionsHere we report a case of chronic osteomyelitis under poorly controlled diabetic conditions. Interestingly, chronic osteomyelitis was observed at the same position where acute osteomyelitis was observed in his babyhood. In addition, chronic osteomyelitis was repeatedly observed, and it seemed that its acute exacerbation was closely associated with aggravation of type 2 diabetes mellitus. We should bear in mind that type 2 diabetes mellitus is one of the major risk factors of osteomyelitis and that acute exacerbation of chronic osteomyelitis could be triggered by a disturbance of glycemic control in patients with type 2 diabetes mellitus.

Subacute osteomyelitis in index by human bite: a case report

Contiguous infections and systemic dissemination of pathogens are the most frequent causes of osteomyelitis, being the S aureus the major causal agent in both cases. Osteomyelitis secondary to human bite is a rare and severe complication of this wound mechanism. This lesions is difficult to diagnose in the emergency department, both for its infrequently as the lack of information about the origin of the lesion on the part of the patient, for fear of the medical-legal consequences. In addition, due to the variety of aerobic and anaerobic pathogens, constitute a true therapeutic challenge. We present the case of an osteomyelitis secondary to human bite, which presents all of the clinical and radiographic signs that should make us suspect this pathology and begin the management quickly, as it represents the main prognostic factor. The wound by human bite should be suspected and treated properly in the emergency epartment, since the first 24 hours are crucial for the later forecast. The cooperation between specialists reduces the risk of complications, being the emergency department the most important factor to its diagnosis

Osteomyelitis in adults: A prospective study of 60 cases

Introduction: The exact definition of osteomyelitis is inflammation of bone or bone marrow or both, but for all practical purposes this inflammation invariably is the result of infection. Various factors responsible for osteomyelitis include vascular insufficiency due to any cause, hematogenous spread of infection from a distant focus and surgery or trauma. Acute Osteomyelitis usually presents with fever, chills, pain or irritability. The classic signs of inflammation, including swelling, or redness and limited joint movement may also occur. Chronic osteomyelitis may present with bone destruction and sequestrum formation and is a difficult form of osteomyelitis to treat. Aims and Objectives: To study demographic details, organisms involved and outcome of treatment in patients with osteomyelitis. Materials and Methods: After obtaining approval from institutional ethical committee we conducted a prospective study of 60 patients diagnosed with either acute, subacute or chronic osteomyelitis on the basis of imaging and culture and sensitivity. Patients were included in this study on the basis of predefined inclusion criteria and were treated by antibiotics and when necessary surgical intervention was done. In cases of skeletal tuberculosis appropriate antikochs treatment was given. Outcome of treatment was studied over a follow up period of 1 year. The data was tabulated and analyzed using SPSS 16.0 version software. Results: Out of 60 cases of either acute, subacute or chronic osteomyelitis there were 38 males (63.33%) and 22 females (36.66%) with a M:F ratio of 1:0.57. Most common age group affected was found to be between 51-60 (36.66%) years. Acute, subacute and chronic osteomyelitis was seen in 71.66%, 11.66% and 16.66% patients respectively. Most common bones involved were Tibia (20%) and Femur (18.33%) followed by iliac bones (15%) fibula (11.66%) and vertebrae (11.66%). In most of the cases (36/60) contagious spread or trauma was the mechanism of infection. Comorbidities like hypertension, diabetes, chemotherapeutic agents or steroid intake and immunosuppression was present in 32 (53.33%) patients. S. Aureus (25/60) followed by Pseudomonas (7/60) and enterococci (7/60) were commonly isolated organisms. Atypical mycobacterial infection was seen in 1 patient who was immunocompromised. 40 patients were completely cured while remaining 10 patients had some or the other problem associated with chronic osteomyelitis. Amputations was done in 4 cases and septic arthritis developed in other 2 cases. 4 patients died during study period due to causes unrelated to osteomyelitis. Conclusion: Diagnosis as well as management of osteomyelitis is a challenge for treating orthopaedician. Knowledge of predisposing factors, presenting complaints, possible complications and proper management is essential for successful management of acute as well as chronic osteomyelitis.

Risk factors associated with complications/sequelae of acute and subacute haematogenous osteomyelitis: an Italian multicenter study

ABSTRACTBackground: Acute/subacute haematogenous osteomyelitis (AHOM/SAHOM) are potentially devastating diseases. Updated information about the epidemiology, management and outcome of AHOM/SAHOM is needed to minimize the risk of complications and sequelae.Methods: A multicenter study was performed to evaluate retrospectively the management and outcome of AHOM/SAHOM in Italy. Data from children aged >1 month, and hospitalized between 2010 and 2016, in 19 pediatric centers, were analyzed.Results: 300 children with AHOM and 98 with SAHOM were included. Median age was 6.0 years (IQR: 2.0–11.0). No clinical difference was observed with the exception of fever at onset (63.0% vs. 42.9%; P < 0.0001), and a more common spinal involvement in SAHOM (6.7% vs 20.4%; P < 0.001). Fifty-Eight Staphylococcus aureus strains were isolated; 5 (8.6%) were MRSA. No Kingella kingae infection was documented. No different risk for complication/sequela was observed between AHOM and SAHOM (38.3% vs. 34.7%; OR:0.85; 95%CI: 0.53–1.38; P = 0.518). Duration and type of antibiotic therapy were not associated with risk of complication/sequelae.Conclusion: AHOM and SAHOM displayed some differences, however occurrence and risk factors for complications and sequelae are similar, and the same empiric treatment might be recommended.

Childhood Pyogenic Osteomyelitis in Abakaliki, South East Nigeria.

Background:Pyogenic osteomyelitis is an important child health problem in developing countries. It is a one-disease state with a spectrum of pathological features and clinical forms ranging from acute to chronic presentation. Its pattern of presentation varies from and within subregions. The aim of this study was to determine the pattern and outcome of childhood pyogenic osteomyelitis in a low-resource environment.Materials and Methods:This was a retrospective study of all the children aged 18 years and under seen with pyogenic osteomyelitis in Federal Teaching Hospital Abakaliki between January 2005 and December 2015.Results:In 76 patients, there was pyogenic osteomyelitis involving 85 bones. Female-to-male ratio was 1:1.7, and the mean age was 9.9 ± 5.1 years. The clinical forms of presentation were acute in 16 (21.1%), subacute in 10 (13.2%), and chronic in 50 (65.8%) patients. Acute osteomyelitis was the more likely form of presentation among infants (P < 0.001) and urban children (P < 0.011) whereas subacute and chronic osteomyelitis were more likely among the older children (P < 0.001) and rural residents (P < 0.011). Staphylococcus aureus was the most common isolated pathogen. Anemia, septic arthritis, and pathological fractures were the three top complications observed. Fifty patients (65.8%) recovered and adjudged cured, 9 (11.8%) were lost to follow-up, and 17 (22.4%) were unable to afford the financial cost of the treatment.Conclusion:In our environment, chronic pyogenic osteomyelitis sequel to acute hematogenous bone infection in childhood is common. Poverty is also a limiting factor in its definitive treatment. These calls for a policy response aimed at improved care and preventive strategies based on the observed pattern.

Primary subacute osteomyelitis of the talus in a child

Primary subacute osteomyelitis of the talus is very rare in healthy children, and the diagnosis can be delayed or even missed, because of its uncommon presentation. Only a few cases of primary subacute osteomyelitis of the talus have been reported in the literature. In this article, we report a case of primary subacute osteomyelitis of the talus in a child and describe its symptoms, signs, radiographic appearance, and the outcome of the surgical management along with a short course of antibiotics coverage. We present this rare case report and its management to increase the awareness for the possibility of this pathology, and to avoid misdiagnosis.

Osteomyelitis and Arthritis by Atypical Mycobacteria in Children: Three Cases

Introduction Osteoarticular infections caused by atypical mycobacteria are uncommon, with osteitis being more common and arthritis being rare. We describe two cases of subacute osteomyelitis and one of chronic osteomyelitis with arthritis. Case Reports Three boys, aged between 7 and 20 months. Clinical presentations: case 1—swelling of right forearm; case 2—limping and swelling of right hallux; case 3—pain and restriction of motion of right lower limb with effusion. None had fever. All had received Bacillus Calmette–Guérin (BCG) and none had contact with tuberculosis. All had thrombocytosis, and erythrocyte sedimentation rate was between 17 and 44 mm/1st hour. All had osteolytic lesions on X-ray with a sclerotic halo and swelling of the surrounding soft tissues, and invasion of the metaphysis and/or epiphysis. Bone histopathological studies revealed granulomatous inflammation or epithelioid cells in all cases. Microbiological identification was positive by culture in one case (Mycobacterium bovis) and by polymerase chain reaction in two cases (Mycobacterium spp. and M. avium). Immunodeficiency screening was negative in all cases. All were treated with antituberculous agents and made good clinical and radiological recoveries. Discussion Osteolytic lesions should raise suspicion of mycobacterial infection, including BCG vaccine, particularly in the presence of granulomatous inflammation. The prognosis was favorable in all patients. Although immune deficits were not identified in any of our three patients, it should be routinely tested for in such cases.

Osteomyelitis of the lower extremity: pathophysiology, imaging, and classification, with an emphasis on diabetic foot infection.

Osteomyelitis is inflammation of the bone caused by an infectious organism, and is a difficult clinical problem. The pathophysiology, imaging, and classification of osteomyelitis are challenging, varying with the age of the patient (child versus adult), the chronicity of the infection (acute versus chronic), and the route of spread (hematogenous versus contiguous focus), as well as the immune and vascular status of the patient and affected region. The two most common classification schemes are those of Lew and Waldvogel, and Cierny and Mader. Brodie's abscess is seen in subacute osteomyelitis, while sequestrum, involucrum, and cloaca are inter-related entities of chronic osteomyelitis. Imaging workup of suspected osteomyelitis should begin with radiographs, although MRI is the most accurate imaging test. Three patterns of T1 signal change have been described in the setting of suspected osteomyelitis including confluent intramedullary, hazy reticular, and subcortical. The confluent intramedullary pattern is most associated with osteomyelitis, while hazy reticular is rarely associated with hematogenous osteomyelitis, and subcortical is not associated with osteomyelitis. It can be challenging to differentiate neuropathic arthropathy from osteomyelitis. Osteomyelitis tends to involve a single bone subjacent to an ulcer or sinus tract. In contrast, neuropathic arthropathy tends to involve multiple bones of the midfoot. Subchondral cystic change, thin rim enhancement of a joint effusion, and the presence of intra-articular bodies are more indicative of a neuropathic joint without infection. Biopsy can play an important role in diagnosis and treatment of osteomyelitis.

The Spectrum of Pediatric Osteoarticular Infections: A Comparative Study

Background There is a paucity of data relating to pediatric subacute or chronic hematogenous osteomyelitis (SCHO), non-hematogenous osteoarticular infections (NHO), and osteoarticular hardware infections (HI). A comparative analysis of the entire spectrum of pediatric osteoarticular infections was conducted to identify distinguishing clinical features and biological markers.Methods Using ICD9/10 code searches, we identified pediatric patients ≤18 years of age at Hasbro Children’s Hospital (2006–2016) and Nationwide Children’s Hospital (2015–2016) with osteoarticular infections. Cases of Lyme arthritis or ENT-related infections were excluded. Eligibility criteria were confirmed by reviewing medical records and clinical and laboratory data were collected systematically.Results428 children met inclusion criteria: 211 (49%) had acute hematogenous osteomyelitis (AHO), 61 (14%) suppurative arthritis (SA), 42 (10%) SCHO, 60 (14%) NHO, and 54 (13%) HI. The age distribution differed significantly across the five infection types: AHO (median, 9.2 years), SA (5.0), SCHO (10.2), NHO (11.5), and HI (14.5); P < 0.001. Median initial CRP values were significantly higher (P < 0.001) in AHO (65 mg/dl) and SA (44) compared with SCHO (15), NHO (15) and HI (24). An ESR >19 mm/hours at presentation was more sensitive than a CRP >8.0 mg/dl in identifying SCHO (80% vs. 64%; P = 0.035). Bacteremia occurred more frequently in AHO (42%) and SA (25%) compared with SCHO (7%), NHOI (5%) and OHI (4%); P < 0.001. Patients with HI had significantly more complications as reflected by more ICU admissions (33% vs. ≤3% for other groups), and longer antibiotic treatment durations (median, 65 vs. ≤37 days for other groups); P < 0.001 for each comparison. S. aureus was the most common organism isolated for all infections, but the proportion of other Gram- and Gram-negative pathogens was significantly higher in SCHO, NHO, and HI compared with AHO and SA (P < 0.001). The ratio of MSSA to MRSA among isolates was 3:1, and did not differ significantly across the infection types.Conclusion SCHO, NHO, and HI commonly present with minimal evidence of inflammation, and differ in the spectrum of causative pathogens compared with AHO and SA. Further studies are required to optimize the diagnosis and management of non-acute, non-hematogenous osteoarticular infections.Disclosures All authors: No reported disclosures.

Brodie abscess of the jaw: An unusual presentation of a rare complication of subacute osteomyelitis

Background: A Brodie abscess is a rare subtype of subacute osteomyelitis which can be acquired from local trauma or hematogenous spread secondary to transient bacteremia. However, to date there have been no reports of the presence of a Brodie abscess in the mandible.Case representation: Here we report a case of a 51-year-old female who presented to the emergency department with a 4-day history of left sided facial pain and trismus after recent dental manipulation. A computed tomography (CT) scan showed the presence of osteomyelitis with a Brodie abscess in the mandibular condyle. Empiric treatment was initiated with ampicillinsulbactam. After seven days of treatment, the antibiotics were switched to ceftriaxone and metronidazole on discharge. Five days later the patient returned to the hospital with the same symptoms that she initially presented with, indicating a failure of treatment. Follow-up CT scan showed the persistence of the Brodie abscess. Subsequently, IV ertapenem was initiated for a duration of eight weeks and the patient was instructed to obtain an oral surgery evaluation as an outpatient.Conclusions: This case highlights a unique presentation of a Brodie abscess, which has been previously exclusively found in long bones, and raises awareness of such a complication in patients whose facial erythema, pain, and swelling may not improve with first line therapy for a simple dental infection. Additionally, we highlight that the unique location of the mandibular condyle poses a treatment challenge and surgical replacement of the jaw appears to be the lone curative modality.

Subacute Acetabular Osteomyelitis Caused by Proteus Mirabilis. A Case Study

Subacute acetabular osteomyelitis is a rare disease of bone. Deep location of the infection site sometimes may delay diagnosis. The most common cause is Staphylococcus aureus, whereas Proteus organisms are very rare etiologic agents. The aim of this case report is to present an unusual case of subacute acetabular osteomyelitis caused by Proteus mirabilis in a 12-year-old boy. Subacute acetabular osteomyelitis can be induced by Proteus mirabilis in the absence of previous trauma, predisposing conditions or disease. The patient was successfully treated with antibiotics. Local biopsy was essential in diagnosing this infection. Antibiotics should be given only after clinical sampling and susceptibility tests.

Study of Osteomyelitis in paediatric patients

Introduction: Osteomyelitis is defined as inflammation of bone. Though the main culprits are bacteria occasionally fungi may also be involved. Prognosis of untreated or delayed treatment onset osteomyelitis is often bad and leads to adverse outcomes. Very few cases of osteomyelitis are reported from India as compared to other infectious conditions. In this study we aim to study the number of patients, male: female ratio, type of osteomyelitis and the bacterial profile associated with osteomyelitis. Methods: After obtaining Institutional Ethics approval, the present study was conducted from 1st January 2016 - 31st December 2016 at KVG Medical College, Sullia. Blood and sample like fluid aspirate or discharge collected was subjected to microscopy and culture. Antibiotic susceptibility testing was done using disk diffusion methods. Radiological data of the patients was also collected. Results: Bacteria were isolated from 32 cases. The most affected age group was of 6-10 years of age (46.87%). Males were more affected as compared to females and male: female ratio was 3:1. Maximum number of patients were of acute osteomyelitis (87.5%) followed by subacute osteomyelitis (9.38%) and chronic osteomyelitis was found in just a single patient (3.12%). Long bones like tibia (56.25%), femur (18.75%), humerus (12.5%) were mostly affected. Blood culture was positive in 65.62% cases. Methicillin Sensitive Staphylococcus Aureus (MSSA) was the most common isolate (56.25%) followed by, Methicillin Resistant Staphylococcus Aureus (MRSA), Acinetobacter, Coagulase Negative Staphylococcus (CONS), Streptococcus pyogens, E.coli and Pseudomonas. Conclusion: Thus, S. aureus was the most common cause of acute bacterial osteomyelitis and mostly affected school age group children.

Arthroscopically Assisted Evacuation of Brodie’s Abscess of Distal Femur

Brodie’s abscess is a type of subacute osteomyelitis. Opinions differ as to whether treatment should be surgical or medical for these classic lesions. Failure of symptoms to resolve after six weeks of antibiotics or worsening of the condition during treatment should be followed by surgical treatment. Clinical signs of subperiosteal pus or synovitis indicate that the subacute infection has transformed into an acute component, and it must be drained surgically. Surgical treatment is comprised of evacuation and curettage for small lesions and evacuation, packing with cancellous bone chips, for large cavities. When clinical signs of synovitis are present, with a possibility of pus within a joint, arthrotomy is performed. Arthroscopically assisted evacuation of Brodie’s abscess from the distal femur has never been reported in the literature.We report a case of a 23-year-old female who presented with pain and swelling over the left knee for four months. There was diffuse swelling in the knee; tenderness was present over medial femoral condyle and range of motion (ROM) of the knee was five to 45 degrees at the time of presentation. X-ray and magnetic resonance imaging (MRI) revealed Brodie’s abscess on the lateral aspect of the medial femoral condyle. The patient was treated with the evacuation of pus and curettage of the cavity using an arthroscope. After two weeks, the patient had mild pain with knee ROM from zero to 45 degrees, and at the one-month follow-up, the knee ROM improved to zero to 90 degrees. At the two-year follow-up, the patient had no pain, with knee ROM from zero to 120 degrees.

Primary subacute epiphyseal osteomyelitis caused by Mycobacterium species in young children: a modern diagnostic approach.

Primary epiphyseal subacute osteomyelitis (PESAO) caused by Mycobacterium species in young children is poorly recognized. We aimed to define the spectrum of this uncommon condition and to propose a novel diagnostic approach. We performed a systematic review of the literature on the PubMed website by selecting all reports of isolated infantile PESAO caused by Mycobacterium species since 1975. We identified 350 citations, of which 174 were assessed for eligibility based on title and abstract. The full text of 81 eligible citations was screened, and relevant data of 15 children under 4years of age with mycobacterial PESAO were extracted. These data were pooled with those from our Institution. Data from 16 children were reviewed. The median age was 16 ± 7months and the male:female ratio 1.7. The knee was the most common infection site (94%). The diagnosis of mycobacterial disease was delayed in all cases (range, 2weeks to 6months), and initially presumed by histology in 15 children (94%). Microbiologically proven diagnosis was confirmed by bone cultures in 8 of the 15 children (53%), and by specific PCR in 2 of the 3 culture-negative bone specimens (67%). Three children experienced long-term orthopedic complications despite surgical drainage and prolonged antimycobacterial regimens. All recently reported cases came from high-burden tuberculosis areas. Mycobacterium species contribute to the burden of infantile PESAO in endemic tuberculosis areas and may cause growth disturbances. We argue in favor of the early recognition of mycobacterial disease by specific molecular assays in children with infantile PESAO living in high-burden areas.