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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.