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At least 19 recordsLinked to original sources
PubMed1975

Osteomyelitis in children: comparison of hematogenous and secondary 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.

Abscess↗
PubMed1979

[An experimental study on Pseudomonas osteomyelitis with special reference to the production of experimental osteomyelitis in mice (author's transl)].

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.

Animals↗
PubMed1975

Experimental osteomyelitis induced by repeated administration of soluble immune complexes: consideration of the fundamental pathogenesis of osteomyelitis.

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.

Animals↗
PubMed1979

[A study on experimental pyogenic osteomyelitis. 1. The preferential site of hematogenous osteomyelitis. 2. The role of foreign body in hematogenous infection (author's transl)].

The author undertook the experiments as described below in order to determine the preferential site of hematogenous osteomyelitis and possible effects of foreign bodies in the bone marrow on development of infection. I) In the first experiment, mice were inoculated with 10(7) cells of staphylococcus aureus intravenously into the tail vein and examined for the distribution and proliferation of the organisms in the bones, all over the body. It was found that the orgaisms in the blood stream were distributed to the bones all over the body almost evenly and that after prolonged observation, remarkable proliferation was noted in both femur and tibia. This bacteriological fact was supported by roentgenographic examination of all the bones. II) In the second experiment, inoculation of staphylococcus aureus into the tail vein was made after a foreign body (No. 5 sterile silk thread of 3 mm in lenght) had been inserted into the proximal metaphysis of a tibia of mice. The tibia of both legs was divided into 3 parts: proximal metaphysis, diaphysis and distal metaphysis. Observation were made for the distribution of organisms and state of proliferation in each of these three parts. In order to elucidate how the inserted foreign body promoted the establishment of infection, the group inserted with silk thread was compared with the control group (un-inserted group). The following results were obtained: 1. Although after 2 weeks of inoculation, the foreign body exerted no influences on the distribution and proliferation of organisms, but it was experimentally demonstrated to play a very important role for retention of organisms and maintenance of infection for a long period. 2. When the inoculum size was 10(6) to 10(7), the organisms were distributed evenly throughout the tibia. However, in the diaphysis the organisms tended to disappear, while in the metaphyseal area the organisms were easy to proliferate. It was also shown that at least 10(5) of organisms were needed for the establishment of infection and that the success or failure of establishment of infection is determined usually within 24 hours after inoculation of the organisms. As described above, from this study it was demonstrated that the femur and tibia were the preferential site of hematogenous osteomyelitis and that metaphyseal areas of the long bones were commonly affected. Once hematogenous invasion of organisms occurred, administration of antibiotics should be started as soon as possible, no later than 24 hours. According to our common experience, removal of foreign body is necessary for the complete cure of the injection.

Animals↗
PubMed1976

Pyogenic cervical osteomyelitis. Chondro-osteomyelitis of the cervical spine frequently associated with parenteral drug use.

Pyogenic osteomyelitis of the cervical spine was successfully treated without bone grafting in 11 of 12 patients. Staphylococcus aureus was the most common organism. Four of the patients were heroin addicts, and six others had received parenteral injections under medical supervision. The patients were immobilized promptly, and after diagnostic procedures, cultures, and drainage when appropriate, they were treated with antibiotics, which led to spontaneous fusion in the 11 who survived. In the preantibiotic era, these infections frequently evolved into "epidural abscess", with resultant cord compression leading to permanent paralysis or death. Therefore, early differential diagnosis from tuberculosis or cancer is necessary. Today, with early diagnosis, immobilization, an anterior surgical approach when necessary, and the appropirate antibiotic, cure without neurological deficit should be the rule.

Adult↗
PubMedDate not supplied

Pediatric osteomyelitis: II. Arizona hinshawii osteomyelitis.

Two children with sickle cell disease and kwashiorkor developed osteomyelitis caused by an Arizona hinshawii infection. Biologically, this organism is related to the Salmonella species. The infections were successfully treated by surgical drainage and chloramphenicol.

Anemia, Sickle Cell↗
PubMed2024

Shotgun metagenomic analysis of saliva microbiome suggests Mogibacterium as a factor associated with chronic bacterial osteomyelitis.

Osteomyelitis of the jaw is a severe inflammatory disorder that affects bones, and it is categorized into two main types: chronic bacterial and nonbacterial osteomyelitis. Although previous studies have investigated the association between these diseases and the oral microbiome, the specific taxa associated with each disease remain unknown. In this study, we conducted shotgun metagenome sequencing (≥10 Gb from ≥66,395,670 reads per sample) of bulk DNA extracted from saliva obtained from patients with chronic bacterial osteomyelitis (N = 5) and chronic nonbacterial osteomyelitis (N = 10). We then compared the taxonomic composition of the metagenome in terms of both taxonomic and sequence abundances with that of healthy controls (N = 5). Taxonomic profiling revealed a statistically significant increase in both the taxonomic and sequence abundance of Mogibacterium in cases of chronic bacterial osteomyelitis; however, such enrichment was not observed in chronic nonbacterial osteomyelitis. We also compared a previously reported core saliva microbiome (59 genera) with our data and found that out of the 74 genera detected in this study, 47 (including Mogibacterium) were not included in the previous meta-analysis. Additionally, we analyzed a core-genome tree of Mogibacterium from chronic bacterial osteomyelitis and healthy control samples along with a reference complete genome and found that Mogibacterium from both groups was indistinguishable at the core-genome and pan-genome levels. Although limited by the small sample size, our study provides novel evidence of a significant increase in Mogibacterium abundance in the chronic bacterial osteomyelitis group. Moreover, our study presents a comparative analysis of the taxonomic and sequence abundances of all genera detected using deep salivary shotgun metagenome data. The distinct enrichment of Mogibacterium suggests its potential as a marker to distinguish between patients with chronic nonbacterial osteomyelitis and chronic bacterial osteomyelitis, particularly at the early stages when differences are unclear.

Humans↗
PubMed1975

[Course and treatment of osteomyelitis in childhood (author's transl)].

In the years 1955-1972 132 children with osteomyelitis were treated in the Pediatric, Surgical and Orthopedic Department of the university of Kiel. There was no increase in the incidence of osteomyelitis during this period. Acute hematogenous osteomyelitis was diagnosed in 111 children, chronic hematogenous osteomyelitis in 11 children, traumatic and postoperative osteomyelitis in 10 children. Secondary chronic osteomyelitis occurred in 1 patient. Mainly staphylococci (in 90%) were the pathogenic bacteria, whereas haemophilus, pseudomonas, streptococci group A, E. coli and mixed infections occurred less frequently. In 17 of 111 patients with acute hematogenous osteomyelitis there were no roentgenological changes. Bacteriological investigations of blood and pus, and the antistaphylolysin reaction (repeated in the course of the disease) were helpful to establish the diagnosis in many cases. 107 of 111 patients with acute hematogenous osteomyelitis were cured (8 patients with defects). 4 children died in septic shock or because of complications (meningitis, pleural empyema, pneumonia). Bactericidal antibiotics in high dosage (penicillins, gentamicin) were superior to bacteriostatic antibiotics. Additional surgical treatment was necessary in 49 of 111 patients with acute hematogenous osteomyelitis. Recommendations for antibiotic therapy of osteomyelitis are given.

Acute Disease↗
PubMed1992

Reversible renal failure due to IgA nephropathy associated with osteomyelitis.

Clinical features of acute glomerulonephritis, with microscopic hematuria, red blood cell (RBC) casts, proteinuria, and acute renal insufficiency developed in a patient with chronic osteomyelitis. Before the development of osteomyelitis, renal function and findings on urinalysis were normal. Complete eradication of osteomyelitis by surgical amputation led to resolution of the abnormal urinary findings, and renal function returned to near pre-osteomyelitis levels. Although acute glomerular disease has been reported to occur as a rare complication of osteomyelitis, the unique feature of the present case was the histological finding of IgA nephropathy. There was no arthritis, purpura, skin rash, or gastrointestinal involvement to suggest a diagnosis of Henoch-Schönlein purpura and there was no evidence of chronic liver disease. The temporal relationship between the onset of the renal disease, which followed the development of chronic osteomyelitis, and its resolution following removal of the focus of infection, suggests that the IgA nephropathy may have been related directly to the osteomyelitis (secondary IgA nephropathy). Glomerular diseases associated with chronic bacterial infections, including osteomyelitis, are discussed, with emphasis on infections that have been associated with the development or exacerbation of IgA nephropathy.

Acute Kidney Injury↗
PubMed1992

Multifocal osteomyelitis in childhood. Review by radionuclide bone scan.

Multifocal osteomyelitis is considered an uncommon complication of acute osteomyelitis. Over a 3-year period, 136 infants and children who had a final diagnosis of acute osteomyelitis were reviewed, and multifocal osteomyelitis was detected in 27 (19%) patients. The major age peak of acute osteomyelitis was between 6 weeks and 3 years (46%). Two age peaks were found for multifocal disease-less than 6 weeks (38%), and 9 to 12 years (44%). Three patients with multifocal disease had septicemia and photon-deficient areas on bone scans. Another adolescent group had nonspecific bone and joint pain that in some cases persisted for more than 3 months and were finally diagnosed as multifocal osteomyelitis. Organisms were isolated in 15/27 (56%). Multifocal osteomyelitis is well recognized in the neonatel age group. However, it occurs more commonly than previously described in older patients. This higher incidence can most likely be attributed to the higher use of the radionuclide bone scan early in the disease and the high sensitivity of the scan for the detection of osteomyelitis.

Acute Disease↗
PubMed1976

Osteomyelitis: early scintigraphic detection in children.

The value of scintigraphy in the early detection of osteomyelitis is demonstrated in children who had signs and symptoms suggestive of bone infection. Nine patients between 2 and 13 years of age were evaluated with technetium Tc 99m diphosphonate bone scintigrams and roentgenograms. Blood cultures were performed in all patients, and bone biopsy or drainage was obtained in six patients. The diagnosis of osteomyelitis was made in seven patients; one patient had a subperiosteal abscess surrounded by osteomyelitis, and one patient had cellulitis. The seven children with osteomyelitis had focal increase of radiopharmaceutical uptake in the bone. The child with the subperiosteal abscess had an area of decreased uptake in the center of the abscess surrounded by a zone of increased uptake of the radioactive bone-seeker. The patient with cellulitis had soft tissue changes by X-ray and a normal bone scintigram. In the seven patients with osteomyelitis, the bone scintigram was performed during the early phase of the disease and no bony changes were present on the roentgenogram. In one patient with subacute osteomyelitis, soft tissue changes were seen radiologically. Only three of the seven children with osteomyelitis developed radiological bony changes. Since bone scintigraphy can detect early local bone derangement, it is recommended in the initial evaluation of children in whom osteomyelitis is suspected.

Abscess↗
PubMed1979

[Rare forms of chronic osteomyelitis in children (author's transl)].

4 cases of chronic osteomyelitis in children and adolescents are described. The first one concerns a girl with severe plasmacellular osteomyelitis of the right upperarm. As the treatment with antibiotics failed a partial resection of the right humerus, followed by plastic covering of the resulting defect was successful. Two further cases of chronic metatarsal osteomyelitis of both feet could be classified as a kind of "sclerosing osteomyelitis Garré", mostly corresponding to the clinical feature of the "chronic recurrent multifocal osteomyelitis" (Björkstén et al., 1978). Furthermore, a case of chronic ostitis localized in the symphyseal area is described, the clinical symptoms of which were resembling to the cortical osteoid, a special kind of sclerosing osteomyelitis. It is suggested that these different forms of chronic osteomyelitis in children are caused by bacterial infections. Nevertheless, this hypothesis remains to be proved. The problems of the differential diagnosis are discussed. Generally, the only therapy with antibotics is not successful, whereas the combination of removing of the inflammatory process with plastic covering of the bone-defect usually results in recovery.

Adolescent↗
PubMed1977

Radionuclide imaging. Use in diagnosis of osteomyelitis in children.

Forty-four children were studied for the presence of osteomyelitis by scintigraphy using Tc 99m etidronate tin complex. Evidence of osteomyelitis on radionuclide images was found in 16 of 19 patients considered to have osteomyelitis by their attending physicians. Bone scintigraphic changes were noted prior to or in the absence of roentgenographic abnormalities in 10 of 19 patients. Cases of acute hematogenous osteomyelitis, chronic osteomyelitis, and osteomyelitis caused by penetrating trauma and contiguous infection were identified. Three bone infarctions were correctly diagnosed.

Bone Diseases↗
PubMed1992

Photopenic defects in marrow-containing skeleton on indium-111 leucocyte scintigraphy: prevalence at sites suspected of osteomyelitis and as an incidental finding.

The skeletal distribution of red marrow-containing sites with a decreased uptake of indium-111-labelled leucocytes was examined as part of a retrospective review of 128 consecutive scans in 113 patients. The prevalence of photopenic defects was determined for sites of suspected osteomyelitis and for other skeletal locations included as part of limited or total-body surveys. Of 52 sites suspected of osteomyelitis based upon radiological and clinical data, 21 (40%) demonstrated a decreased leucocyte uptake. The prevalence of photopenia ranged from 79% (11/14) in the spine and 63% (5/8) in the pelvis to 25% (4/16) in the proximal femur and 0% elsewhere in the extremities (0/9) and in the skull (0/3). Fourteen of these 21 defects (67%) were due to active (n = 9) or healed (n = 5) osteomyelitis/discitis. All sites of active osteomyelitis showed destructive changes on correlative radiographs and were associated with infectious processes of more than 1 months duration. Thirty-seven photopenic defects were observed as incidental findings. The prevalence of photopenia as an incidental finding ranged from 0% in the skull, neck and chest to 3%-4% in the thoracolumbar spine and pelvis and 14% in the femoral heads, the latter reflecting primarily bilateral loss of femoral head marrow. No incidentally found photopenic defect reflected active osteomyelitis. At sites in the spine and pelvis with radiologic evidence of bone destruction suggestive of osteomyelitis, an absence of normal red marrow uptake of labelled leucocytes often reflects a variant presentation for active chronic infection. In contrast, incidental photopenia is uncommon at all skeletal sites except the femoral heads, and should not raise concern over unsuspected active osteomyelitis.

Bone Marrow↗
PubMed1992

What's new in exogenous osteomyelitis?

By the increase in road and occupational accidents during the past few decades posttraumatic osteomyelitis has become not only the most important type of exogenous but of all inflammatory bone processes. The major morphologic, bacteriologic and immunologic studies about posttraumatic bone inflammation will be outlined in this survey. The histologic classification of chronic osteomyelitis has proved useful for the observation of the course and for the selection of the treatment in 1,500 patients. Detailed morphological studies have shown that posttraumatic osteomyelitis often begins with a necrosis of the outer tangential lamella of the tubular bone partly promoted by partial periosteal retrogression, possibly followed by a necrosis of the fracture ends caused by a disturbance of the medullary blood circulation. Type and extent of osteomyelitis are determined by several traumatic, therapeutic and endogenous factors. Bacteriologically an infection with staphylococcus aureus is still prevailing. Comparative studies about the causative agents shortly after the trauma and during the following osteomyelitis have basically shown an identical range of causative agents. Immunologic studies with monoclonal antibodies in the actual site of inflammation have on the one hand found a decrease in the number of T-lymphocytes and the T-helper cells and on the other hand an increase in the T-suppressor cells, natural killer cells, macrophages in the osteomyelitic site. The impact of these findings on the therapy of osteomyelitis can presently not be estimated. However, they will become important after immunohistochemical studies of the bone and soft tissue Lager in osteosynthetic material after aseptic bone surgery have been carried out.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents↗