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Osteitis after newborn vaccination with three different Bacillus Calmette-Guérin vaccines: twenty-nine years of experience.

Newborns in Finland have been vaccinated with Bacillus Calmette-Guérin (BCG) since the 1950s. Until the end of 1970 the vaccine was made from BCG strain Gothenburg by the Swedish BCG laboratory in Gothenburg and from 1971 on from the same strain in Copenhagen, Denmark. It was replaced by the Glaxo vaccine in 1978. Complications caused by BCG vaccination have been under follow-up, and the data have been collected from nationwide registers. In this study we analyzed the incidence rates of BCG osteitis between the years 1960 and 1988. From 1960 to 1970 the incidence rate was from 2.7 to 13.0/100,000 BCG-vaccinated infants (mean, 7.3; median, 6.9). The incidence increased during the years 1971 to 1978 when it varied between 15.3 and 72.9/100,000 BCG-vaccinated infants (mean, 36.9; median, 30.4). Since 1978 the incidence has varied between 1.7 and 10.1/100,000 BCG-vaccinated infants (mean, 6.4; median, 7.2). In Britain no reports of BCG osteitis have been published despite the use of the same Glaxo vaccine. Our results indicate that the incidence of BCG osteitis in a given population depends on the BCG vaccine used. The follow-up of BCG complications is an essential part of BCG vaccination program.

Animals↗

Osteitis and other complications caused by generalized BCG-itis. Experiences in Sweden.

In 1973 an increase in the number of osteitis caused by BCG vaccination in the neonatal period was observed in Sweden. A high incidence of this complication, i.e. 1 case per 3000 vaccinated newborn children continued until this vaccination was interrupted in 1975. In the years 1972 to 1980 a total of 90 cases were reported to the Adverse Drug Reaction Committee. Earlier retrospective studies had disclosed 36 cases born between 1949-1968 and an active search for unreported cases in the 1970s revealed an additional 26 cases. Of the total of 152 known cases in Sweden, 82 were boys and 70 girls. The mean incubation period was 14 months for boys and 23 for girls. Extremely long incubation periods were seen, i.e. 6 years in two children and 12 years in one. Eleven children had multiple osteitis lesions. The epiphyses of the long bones of the extremities were the most frequent sites of the affection (109 lesions). Only in 6 patients the spine, which is the common site of osteitis caused by tuberculosis, was affected. Relapses occurred in two patients.

BCG Vaccine↗

Incidence of arthro-osteitis in patients with pustulosis palmaris et plantaris.

Arthro-osteitis at the anterior chest wall was found in 12 (9.4%) out of 128 consecutive patients with pustulosis palmaris et plantaris. This finding indicates that the concomitance of arthro-osteitis with PPP is not incidental but is based on some common aetiological factor. We propose a term ;pustulotic arthro-osteitis' for this condition.

Adult↗

Condensing osteitis of the clavicle: magnetic resonance imaging as an adjunct method for differential diagnosis.

Condensing osteitis of the clavicle is a benign disorder leading to osteosclerosis of the medial end of the clavicle. The differential diagnosis between condensing osteitis of the clavicle and ischaemic necrosis of the medial clavicular epiphysis (Friedrich's disease), osteoid osteoma, and low grade osteomyelitis can be difficult. In the case history reported here, magnetic resonance imaging was a useful non-invasive procedure for the diagnosis of condensing osteitis of the clavicle.

Adult↗

Proliferative osteitis of the femoral greater trochanter and humeral medial epicondyle as a cause of lameness in sows.

Thirteen chronically lame female breeding pigs were examined clinically and post mortem. Of the eight sows with hindleg lameness, one showed detachment of the ischial tuberosity and a second showed detachment of the ischial tuberosity on the left and a mid-shaft femoral fracture on the right. Two showed no lesions apart from a change in the positional relationship between the femoral head and the greater trochanter, resulting in a lowering of the femoral head. In the remaining four sows an apparently unreported condition was seen, which produced a proliferative osteitis of the greater trochanter. All five animals lame in the forelimb showed varying degrees of proliferative osteitis of the medial epicondyle of the humerus. Advanced cases could be palpated in the live animal. It is proposed that proliferative osteitis may be a response, at the point of attachment of the muscle masses of the major limbs, to the trauma of over exertion.

Animals↗

Osteitis pubis and instability of the pubic symphysis. When nonoperative measures fail.

Seven rugby players with osteitis pubis and vertical instability at the pubic symphysis were treated operatively after nonoperative treatment had failed to improve their symptoms. The vertical instability was diagnosed based on flamingo view radiographs showing greater than 2 mm of vertical displacement. The players had undergone at least 13 months of nonoperative therapy before surgery was considered. Operative treatment consisted of arthrodesis of the pubic symphysis by bone grafting supplemented by a compression plate. At a mean follow-up of 52.4 months, all patients were free of symptoms and flamingo views confirmed successful arthrodesis with no residual instability of the pubic symphysis. Based on our results with this procedure, we believe that arthrodesis of the pubic symphysis has a role in the treatment of osteitis pubis that is recalcitrant to nonoperative treatment. The combination of osteitis pubis and vertical pubis symphyseal instability may be the cause of failure of nonoperative treatment.

Adult↗

Condensing osteitis of the clavicle: does it exist?

Condensing osteitis of the clavicle was first described as a disease entity in 1974. There is painful localised swelling of the clavicle of undetermined origin, with increased radio-density, but an infective aetiology has not been excluded by previous authors. We report three children with the clinical and radiological findings of 'condensing osteitis'. Two of them had raised levels of antistaphylolysin titres and all responded to antibiotic therapy. We conclude that condensing osteitis is due to low-grade staphylococcal osteomyelitis; biopsy and treatment by antibiotics is recommended.

Anti-Bacterial Agents↗

Dialysate calcium levels, dialysis hours and the healing of osteitis fibrosa.

Unselected patients receiving intermittent haemodialysis at home were examined by hand radiographs to study the progression of osteitis fibrosa. Patients were using Kiil dialysers and Drake-Willock proportioning systems. The calcium phosphorus product was controlled by an adequate dialysis schedule supplemented by aluminum hydroxide gel. Dialysate calcium ranged between 5.7 and 7.3 mg/100 ml depending on the calcium content of local tap water. In 73 percent of patients the osteitis fibrosa improved radiologically and in most patients complete healing occurred. The rate of change was slow. Patients whose bones healed had significantly higher serum and tap water calcium levels than those whose bones deteriorated. There was no significant difference in the serum phosphorus levels in the two groups. Improvement of osteitis fibrosa requires both control of calcium phosphorus product and suppression of the parathyroid gland. Long dialysis hours with a positive calcium balance during dialysis were necessary to achieve the best results.

Calcium↗

[Pseudomonas aeruginosa osteitis of the spinal process after peridural anesthesia].

BACKGROUND: Osteitis of the posterior wall of the spinal canal is an exceptional complication after peridural anesthesia. Prognosis depends on early diagnosis based on clinical signs and imaging data. CASE REPORT: A 73-year-old man was hospitalized for lower back pain and fever of 3 weeks duration after a total hip arthroplasty performed under general anesthesia. Computed tomography and magnetic resonance imaging of the lumbar spine disclosed osteitis of the spinal processes. Local bacteriology sample evidenced Pseudomonas aeruginosa. Outcome was favorable after a 6-month treatment. DISCUSSION: Data in the French and English literature (since 1948) on bone infections following epidural anesthesia have included 5 cases of spondylodiscitis and 1 case of posterior wall osteitis. The diagnosis is suggested by the clinical presentation. Standard x-rays contribute little. Early diagnosis in the infraradiological phase can be obtained with bone scintigraphy. Computed tomography or magnetic resonance imaging are currently highly contributive to diagnosis and follow-up after treatment. Contamination may be direct or via the blood stream or result from an extension of a neighboring infectious focus. Antibiotic therapy and immobilization are indicated. Rigorous application of strict aseptic procedures during lumbar puncture and use of the epidural catheter are crucial for prevention.

Aged↗

[Are the principles of treatment of chronic osteitis applicable to the diabetic foot?].

OBJECTIVE: The interest of the management of bone infections in the diabetic foot, inspired by the recommendations for the treatment of chronic osteitis, was assessed in this study. METHODS: Twenty bone infections in 17 diabetic patients with moderate to mild infections of the feet were confirmed by the results of X-ray and/or scintigraphic studies and bone surgery biopsy cultures revealing one or more bacteria sensitive to standard osteitis treatment (rifampicine + fluoroquinolone). The patients had received this treatment per os for a median duration of 6 months (3 to 10 months). Clinical follow-up was carried out during a consultation at 1, 3 and 6 months during treatment and then by telephone every six months after the end of treatment. Clinical success was defined as the disappearance of any local sign of infection and by the absence of relapse during the post-treatment follow-up period. The evolution of the bone infection was also assessed by the results of a control conducted 3 to 6 months after initiation of the antibiotic treatment. RESULTS: At the end of the treatment, all signs of infection had disappeared in 15/17 patients (88.2%) and no relapse had occurred in 14 (82.3%) patients at the end of a median post-treatment period of 22 months (12 to 41 months). Resection of necrotic bone was performed at the same time as the bone biopsy in 2 patients. The median duration of hospitalisation was of 14 days (3 to 53 days). During the study, a multi-resistant germ was isolated in 4 patients (1 Pseudomonas aeruginosa, 3 Staphylococcus aureus). During the post-treatment follow-up, 3 patients dies from causes unrelated to the infection treated. No serious adverse event was reported during the study. DISCUSSION: The results of this pilot study support the rationale of applying the treatment regimens of chronic osteitis to diabetic lesions of the feet, but are only applicable to comparable patients presenting with non-severe lesions of the feet. Moreover, the use of antibiotics with potent selection of resistance such as rifampicine and fluoroquinolone, requires that bone biopsies be taken, which is not easy in all the diabetic foot care centres. We are presently conducting a study to identify the sub-populations of diabetic patients who could benefit from such treatment.

Aged↗

Osteitis or osteomyelitis of the pubis? A diagnostic and therapeutic challenge: report of 9 cases and review of the literature.

Osteitis pubis is a noninfective inflammation of the symphysis pubis, without distinct aetiology. It has often been reported after urological or gynaecological procedures, and is also associated with trauma, rheumatic disorders, pregnancy and parturition. Symptoms mostly resolve spontaneously. On the other hand, osteomyelitis of the pubis is a classical infective inflammation of bone. The differential diagnosis between both entities may be difficult. The most common complaint in both inflammatory diseases is pain under load, either local or pseudoradicular in nature. The biochemistry is normal or slightly inflammatory in osteitis pubis, but frankly inflammatory in osteomyelitis. A 3-phase bone scan may be positive in the mineralisation or delayed phase in case of osteitis, and in all three phases in case of osteomyelitis. Aspiration is the ultimate diagnostic test: in case of osteomyelitis pubis, culture of the aspirate will usually lead to the diagnosis, sometimes even after antibiotic therapy.

Adult↗

[Osteitis pubis as a similarity with prostatitis].

Twenty-eight male patients with osteitis pubis are reported. The clinical symptoms of this disease are very similar to those of chronic prostatitis. The authors think that if the patients with symptoms of prostatitis (prostatodynia) and the clinical data don't support the diagnosis of chronic prostatitis, the osteitis pubis should be considered. The patients with osteitis pubis often has tenderness over the pubic symphysis, and a plain film of the pubis should make the correct diagnosis.

Adult↗

[Immunostimulation with ibuprofen in chronic osteitis. An experimental study].

The present investigation shows that chronic posttraumatic osteitis is associated with markedly elevated prostaglandin E2 (PGE2) serum levels. Synthesis of PGE2 is inhibited by nonsteroidal antiinflammatory drugs, such as ibuprofen, which block cyclooxygenase. Osteitis patients showed significantly decreased PGE2 serum levels during treatment with ibuprofen (1200 mg/day). In addition, a significant increase in soluble interleucin-2 receptor serum levels was observed. PGE2 has significant immunosuppressive effects on cell-mediated immunity. On the other hand, soluble interleucin-2 receptor is a reliable indicator of immune system activation. Ibuprofen seems to be a potent immunostimulating agent for the treatment of chronic posttraumatic osteitis, which is characterized by depression of cell-mediated immunity.

Dinoprostone↗

Marked direct suppression of primary hyperparathyroidism with osteitis fibrosa cystica by intravenous administration of 1,25-dihydroxycholecalciferol.

A marked direct suppression of primary hyperparathyroidism with osteitis fibrosa cystica has been achieved by the intravenous administration of 1,25-dihydroxycholecalciferol [1,25(OH)2D]. In a recent survey of 306 patients with primary hyperparathyroidism (PHPT), we hypothesized that the far higher degree of parathyroid hormone (PTH) hypersecretion in PHPT with osteitis fibrosa cystica than in PHPT without overt bone disease might be due to the absence of suppression of hormonal hypersecretion by the low-to-normal circulating 1,25(OH)2D reflecting a relative vitamin D deficiency. To test this hypothesis, a patient having hypercalcemic PHPT with florid osteitis fibrosa cystica and normal serum 1,25(OH)2D was given increasing daily doses of intravenous calcitriol (0.5-2 micrograms) for several days. Doubling the level of circulating 1,25(OH)2D from 48 to 100-114 pg/ml was accompanied by a marked decline (46%) in serum iPTH(1-84), without a change in the serum calcium concentration. A lowered set point of parathyroid cells for calcium, and a diminished maximum secretory rate of PTH, may contribute to the marked suppression of PHPT.

Calcitriol↗

Surgical treatment of septic pedal osteitis in horses: nine cases (1980-1987).

Over an 8-year period, 9 horses with septic pedal osteitis were admitted to the New York State College of Veterinary Medicine. Septic pedal osteitis was defined by the presence of purulent exudate combined with radiographic evidence of lysis of the distal phalanx. The condition described involved only the distal phalanx, the laminae and hoofwall, and the soft tissues of the sole. Treatment included curettage and removal of the affected portion of the distal phalanx through a ventral approach to the foot, combined with systemic administration of antibodies. Of the 9 horses, 7 returned to soundness and original function within 12 weeks after surgery. During the early postoperative period, 2 horses died from causes unrelated to the surgery or to septic pedal osteitis.

Animals↗

The relationship of smoking to localized osteitis.

The relationship between smoking and localized osteitis was studied in 200 patients who had 400 mandibular third molars removed. Information on how much patients smoked each day and whether cigaretts, cigars, or a pipe was smoked, as well as the postoperative smoking habits of each patient, was recorded. Results indicated that there is a signficant difference in the incidence of postoperative localized osteitis at extraction sites of mandibular third molars between smokers and nonsmokers; smoking after extraction caused a definite increase in the incidence of localized osteitis.

Adolescent↗

Benign osteitis of the external auditory meatus.

Benign osteitis of the external auditory canal is a distinct clinical entity characterized by localized ulceration in the skin of the floor of the bony external auditory meatus with underlying osteitis and sequestration of the underlying tympanic bone. Consideration of clinical and pathological data suggests that continued self-inflicted minor trauma is an etiological factor in at least some cases. The purpose of this paper is to review benign osteitis of the external auditory canal, presenting further clinical documentation and to offer etiological suggestions based upon clinical, pathological and experimental observations. The benign nature of this condition is emphasized.

Aged↗

Effectiveness of imipenem in the treatment of chronic post-traumatic osteitis.

In 61 patients the effectiveness of imipenem in the treatment of chronic post-traumatic osteitis was examined. The diagnosis of post-traumatic osteitis was based on clinical and radiological signs of infection, as well as a positive bone culture from a surgical specimen. The average duration of treatment was 10 days with a dosage 3 X 500 mg imipenem daily. The most commonly identified pathogen was Staphylococcus aureus. In 75% of the cases an infection with Gram-positive pathogens was found. The majority of Gram-negative infections was caused by Pseudomonas aeruginosa. The rate of elimination was greater than 90% for both Gram-positive and Gram-negative bacteria. A definite cure was achieved in 80% of the reported cases, only four patients (7%) showed a recurrence of the infection. Allergic reactions or other adverse effects were not observed except for diarrhoea in four patients. The high rate of therapeutic effectiveness as well as the excellent toleration justify the use of imipenem in the treatment of chronic post-traumatic osteitis.

Adolescent↗