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The standard treatment of chromic skull-base osteomyelitis is antibiotics and surgical removal of sequestrums. Hyperbaric oxygen therapy has been found to be a useful method for managing refractory cases of chronic osteomyelitis. Since a minimal blood supply is needed for hyperbaric oxygen therapy, chronic osteomyelitis can produce necrotic infected areas that are not nutrified and therefore not assessable for hyperbaric oxygen therapy. Ozone is known to be an oxidizing medium with a strong bactericidal effect. We investigated the influence of locally applied ozonated oxygen on the development of chronic osteomyelitis in an experimental animal model using the femur of the rabbit. The proximal sides of the femurs of 40 rabbits were prepared and a needle inserted into the intramedullary cavity. Osteomyelitis was induced with an infusion of Staphylococcus aureus and sodium morrhuate into the bone. The needle was left in a intramedular location. After a 4-week delay animals were randomly separated into treatment and control groups. The infected femur of treated animals was flushed three times a day with 20 ml of ozonated oxygen at an ozone concentration of 107 micrograms/ml O2 over periods of 2 or 4 weeks. Clinical, radiographic and microbiological findings were documented. Chronic osteomyelitis occurred in all animals. Ten rabbits were excluded from further study during the investigation because of excessive weight loss (> 15% of the original weight). Bacterial cultures showed no significant reduction of S. aureus concentrations in the ozone-treated group, although comparison of radiographic results revealed less serious osteomyelitis-related bone damage in these animals (P < 0.01). These findings indicate that refractory osteomyelitis in the head and neck may benefit from locally applied "flush" therapy with ozonated oxygen in addition to treatment with antibiotics, surgery and hyperbaric oxygen.
INTRODUCTION: Many animal models of acute and chronic osteomyelitis have been developed. In these models, osteomyelitic lesions are induced using sclerosing agents and foreign bodies with bacterial strains. In the present rat model, these sclerosing agents were not used. We assessed the relationship between inoculation dose and histological, radiological, and microbiological changes in the acute phase (1 week after inoculation) using this rat osteomyelitis model. MATERIALS AND METHODS: An experimental rat model of acute osteomyelitis was developed by direct inoculation of the virulent strain BB of Staphylococcus aureus into tibial bone without sclerosants. To examine the relationship between the inoculation dose of the bacteria and the progression of the osteomyelitis, the inoculated lesions were assessed for changes in histological, radiological, and bacteriological parameters at 1 week after infection. Serial dilutions of the bacteria [6 x 10(1) to 6 x 10(5) colony-forming units (CFU)/5 microl] suspended in saline or saline alone were inoculated into the proximal metaphysis of the tibia. RESULTS: Development of significant histological and radiological signs of osteomyelitis required an inoculum of at least 6 x 10(3) CFU/5 microl. The number of viable bacteria at the lesion reached a maximum of 6 x 10(3) CFU/5 microl. CONCLUSION: These results suggest that strain BB induces the development of acute staphylococcal osteomyelitis with clear infective destruction in the tibia, and that our model may be applied to the identification of virulence factors in studies of posttraumatic osteomyelitis.
On the basis of the findings of nine of our patients and our review of previously reported cases of diffuse sclerosing osteomyelitis and chronic recurrent multifocal osteomyelitis, we discuss the similarity of these two entities. Our nine patients had initially been given diagnoses of diffuse sclerosing osteomyelitis on the basis of their clinicopathologic findings. However, technetium 99m-MDP bone scans performed on four of them revealed multiple bone lesions leading to the diagnosis of chronic recurrent multifocal osteomyelitis. Furthermore, no clear difference between clinical features in the patients with multiple bone lesions and those in the patients with diffuse sclerosing osteomyelitis was found. We conclude that diffuse sclerosing osteomyelitis is an expression of chronic recurrent multifocal osteomyelitis.
SUMMARY: A review of osteomyelitis in 54 patients treated at the Dr. Charles A. Janeway Child Health Centre over a 4-year period revealed equal frequencies of secondary and hematogenous osteomyelitis. Although the clinical picture in patients with hematogenous osteomyelitis was classic, patients with secondary osteomyelitis presented with an altered clinical response. Patients with secondary osteomyelitis have a history of an antecedent puncture wound or an inadequately treated contiguous focus of infection; antistaphylococcal antimicrobial therapy was ineffective for most because gram-negative bacilli were isolated in this group of patients. In contrast to patients with hematogenous osteomyelitis, who frequently respond to intensive antimicrobial therapy, those with secondary osteomyelitis will frequently require surgical intervention to eradicate the infection.
OBJECTIVES: To find diagnostic points and to identify the origin of osteomyelitis in synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome. METHODS: Fifty-two patients with mandibular suppurative osteomyelitis and 25 patients with mandibular osteomyelitis in SAPHO syndrome were included in the study. Radiographic patterns of the lesion, types of periosteal reaction and the presence of external bone resorption and bone enlargement were investigated in each case and compared between the two entities. RESULTS: Suppurative osteomyelitis demonstrated an osteolytic pattern and a lamellated type of periosteal reaction, whereas SAPHO syndrome revealed a mixed-pattern, solid-type periosteal reaction, external bone resorption and bone enlargement. CONCLUSIONS: Radiographic examination is suggested to be convenient and a useful diagnostic method of differentiating osteomyelitis in SAPHO syndrome from suppurative osteomyelitis. The periosteum is suspected to be the original site of osteomyelitic lesions in SAPHO syndrome.
Clinical trials of systemic antibiotic treatment of osteomyelitis are difficult to perform for many reasons, such as low incidence rate of osteomyelitis, variety of anatomic locations, stage and etiologic agents. In this article, we reviewed the experimental studies on osteomyelitis available in the English medical literature since 1968, to ascertain their actual and potential impact on the treatment of human osteomyelitis. Major results are summarized and topics of major interest, such as reproducibility of animal models, predictive value of animal models, correlation of pharmacokinetics between different animals and humans, and the correlation of outcome between animal and clinical studies are discussed. Most of the reviewed animal models are reproducible and dependable. However, establishing the right dose regimen in animals appeared a critical factor, which might undermine the predictive value of the experimental study. Due to difficulties in comparing results of animal and human studies, the predictive value of animal studies about osteomyelitis is still unclear. However, animal models gave valuable information to the clinician for choosing the minimal duration of antibiotic treatment. Even though the use of antibiotic combinations was associated with better outcome in the majority of animal studies, such a finding seems to have limited impact on clinical practice.
I) The author has successfully produced a model of experimental osteomyelitis caused by pseudomonas aeruginosa using the following procedure though such a demonstration has been said to be very difficult. After impregnation in a solution containing about 10(5) pseudomonas aeruginosa, 3 mm silk thread of No. 5 was dried under low-pressure atmosphere and then inserted into the metaphysis of right tibia of a mouse. This method can be produced experimental osteomyelitis in 100% of the animals. In the experimental osteomyelitis generated pathologically by this method, inoculated organisms do not transmigrate into blood, the kidney and the contralateral tibia. This may therefore be regarded as a local infection causing no death, making a long period of observation possible. In view of the X-ray and patho-histological findings, it is similar to human osteomyelitis. Furthermore, its host is a pure-bred mouse with constant elements making a league-scale experiment possible. II) This is an experimental model of osteomyelitis proved quite useful for the quantitative analysis of the effects of antibiotics, and would be a good method for evaluation of antibiotics to be developed in the future.
We report what we believe is the first case of vertebral osteomyelitis caused by Roseomonas species. The diagnosis of vertebral osteomyelitis can be difficult. The case illustrates the importance of the establishment of an etiologic diagnosis in vertebral osteomyelitis. The features of Roseomonas species and the evaluation of cases of vertebral osteomyelitis are reviewed.
We described a rare case of Salmonella enteritidis osteomyelitis of the tibia combined with arthritis of the ankle joint. A 4-year-old, otherwise healthy girl was hospitalized with 9-day history of fever, left leg pain, and diarrhea. On admission, her left lower leg and ankle were markedly reddened and swollen. Laboratory examinations disclosed a WBC of 16,300/microliter and a C-reactive protein of 15.6 mg/dl. A T2-weighed magnetic resonance image of the leg depicted a high intensity area around the left distal tibia and an extremely high intensity fluid in her left ankle joint, leading to our diagnosis of purulent osteomyelitis of the tibia and arthritis of the ankle joint. Salmonella enteritidis was isolated from ankle joint fluid and later aspirated bone marrow of the tibia, but not from blood or stool. Because of poor response to intravenous treatment with panipenem/betamipron for 2 days, she underwent drainage and washing of the joint fluid, and intramedullary administration of cefotaxime and ampicillin. She completely recovered without sequelae following treatment with sensitive antibiotics for 4 weeks in total. There has not been any relapse for more than 1.5 years. The authors also bibliographically surveyed the literature published from 1966 to 2002 and found 35 Japanese patients with Salmonella osteomyelitis. The present patient was the second case caused by Salmonella enteritidis in Japan. Septic arthritis is a rare complication, accounting for only 8% of the patients. Since Salmonella enteritidis has been a leading serotype among human isolates of Salmonella species during the past decade, it would be warranted to determine whether osteomyelitis due to this organism is likely to increase.
Presented is a young girl with Gaucher's disease who developed acute bone pain accompanied by signs of inflammation and who was felt to have possible pyogenic osteomyelitis. The lack of significant pathogenic bacterial growth on culture and the findings at orthopedic surgery led the authors to conclude that this child probably represented a case of pseudo-osteomyelitis, but the isolation of an anaerobe from the operative culture of the involved bone leaves the exact diagnosis unclear. Since this child underwent an open surgical procedure, she was treated with antibiotics to prevent the possible development of chronic osteomyelitis. This anaerobic growth on culture, although strongly felt to be a contaminant, also played a role in this decision. She had an uneventful hospital course and subsequently has done well. It is suggested that great caution be taken before subjecting a patient with Gaucher's disease to orthopedic surgical procedures. If pyogenic osteomyelitis is strongly suspected, obtaining multiple blood cultures and culture by needle aspirate may be preferred over an open surgical procedure. The use of empiric antibiotic therapy without an attempt at further diagnosis is not recommended. If an orthopedic surgical procedure is necessary in a patient with Gaucher's disease, antibiotic coverage is indicated and long-term observation of the operative sight for drainage and/or other signs of chronic inflammatory changes in mandatory.
This is an overview of the most important aspects of pathogenesis, etiology, diagnostics, therapy and differential diagnostics of the subacute and primary chronic osteomyelitis in children. This group of disease includes Brodie's abscess, plasma cellular osteomyelitis, sclerosing osteomyelitis (Garré) and the chronic recurrent multifocal osteomyelitis. The treatment of children with these not completely understood diseases requires a close cooperation between pediatricians, pediatric surgeons and radiologists.
The cases of five children/adolescents and two young adults with unilateral chronic osteomyelitis of the clavicle are reported. The clinical course was prolonged and characterized by intermittent periods of exacerbation followed by improvement. Extensive investigations revealed no causative organisms and the disease seemed resistant to antibiotic therapy. The only laboratory abnormality was elevated ESR, present in five cases. Osteomyelitis of other bones was detected in four cases and pustulosis palmoplantaris in two, suggesting that the disease is a manifestation of chronic recurrent multifocal osteomyelitis.
We present a rare case of chronic infectious multifocal osteomyelitis with affectation symmetric in the both femures in a patient with spondyarthropathic secondary Inflammatory Bowel Disease. The diagnosis was confirmed with culture of the bone biopsy. The aim of this work is the revision of the Chronic Infectious Multifocal Osteomyelitis and the Chronic Recurrent Multifocal Osteomyelitis into SAPHO syndrome that both were the possibilities diagnoses.
Morphological changes of blood vessel walls including various kinds of capillaries have been induced by administration of soluble immune complexes. After repeated administrations, those experimental animals who survived the phase of initial anaphylactic shock developed osteomyelitis. In this paper, the formative processes of osteomyelitis will be discussed in relation to Aschoff's definition of inflammation. We will emphasize the importance of the capillarization of the sinusoidal endothelia for the formation of osteomyelitis.
We have reviewed 60 patients with primary bone infections; 21 of these (35%) had subacute osteomyelitis, a figure which supports other recent observations that this variant of bone infection is becoming more widespread. In this group open culture and biopsy were necessary in order to exclude bony malignancy, and a raised erythrocyte sedimentation rate proved a useful diagnostic aid. All the patients with acute osteomyelitis or with vertebral infection responded to primary treatment, but five of those with subacute osteomyelitis had recurrences.