- See:
Osteomyelitis:
- Osteomyelitis:
- look for OM in multiple areas and in the diaphisis of long bones as
compared to the metaphysis in unaffected children;
- diagnosis of osteomyelitis: in patients with sickle cell anemia is complicated by the difficulty
in distinguishing the syptoms from those of acute bone crisis (bone infarction);
- fever, localized or generalized bone pain, & localized erythema,
tenderness, & swelling are characteristic of both conditions;
- elevated sed rate & high leukocyte count are typical both w/ bone infarction & w/ osteomyelitis;
- sickling crisises are thought to be more than 50 times more common than bacterial osteomyelitis;
- aspiration of pus from bone confirms dx of osteomyelitis;
-
bacteriology:
-
staph aureus is the most common infecting organism in sickle cell patients;
-
salmonella (&
enterobacter) are also common in these patients, perhaps due to
bowel microinfarcts which allows egress of these organisms;
- Radiographs:
- changes common to both bone infarction and osteomyelitis;
- in early stages, affected bone has normal findings or soft-tissue swelling;
- after 10-14 days, destruction of bone and periosteal reaction are evident;
- Bone Scan:
- some evidence that
gallium scanning may assist distinguishing bone infarct from osteomyelitis;
- Treatment of Osteomyelitis in Sickle Cell Patient: (see:
osteomyelitis)
- medical therapy is based on culture results;
- initial therapy should cover staph aureus;
-
antibiotic choices:
-
penase resistant penicillin;
-
third generation cephalosporin (covers staph and salmonella);
-
vancomycin
-
ciprofloxacin +
rifampin;
Osteomyelitis in Patients Who Have Sickle-Cell Disease.
Diagnosis and Management.
