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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Osteomyelitis/Infection in the Sickle Cell Patient



- 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


Reference

Osteomyelitis in Patients Who Have Sickle-Cell Disease. Diagnosis and Management.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, August 22, 2012 12:46 pm