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Wang Q, Du J, Sun Q, Xiao S, Huang W. Evaluation of the osteoconductivity and the degradation of novel hydroxyapatite/polyurethane combined with mesoporous silica microspheres in a rabbit osteomyelitis model. J Orthop Surg (Hong Kong) 2023; 31:10225536231206921. [PMID: 37820377 DOI: 10.1177/10225536231206921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Bone defects caused by osteomyelitis can lead to severe disability. Surgeons still face significant challenges in treating bone defects. Nano-hydroxyapatite (n-HA) plays an important role in bone tissue engineering due to its excellent biocompatibility and osteoconductivity. Levofloxacin (Levo) was encapsulated in mesoporous silica nanoparticles (MSNs) via electrostatic attraction to serve as a drug delivery system. MSNs were incorporated with n-HA and polyurethane (PU). The degradation and osteoconductivity properties of these novel composite scaffolds and their effectiveness in treating chronic osteomyelitis in a rabbit model were assessed. Gross pathology, radiographic imaging, micro-computed tomography, Van Gieson staining, and hematoxylin and eosin staining were conducted at 6 and 12 weeks. The group of composite scaffolds combining n-HA/PU with MSNs containing 5 mg Levo (n-HA/PU + Nano +5 mg Levo) composite scaffolds showed superior antibacterial properties compared to the other groups. At 12 weeks, the n-HA/PU + Nano +5 mg Levo composite scaffolds group exhibited significantly greater volume of new trabecular bone formation compared to the other three groups. The surface of the novel composite scaffolds exhibited degradation after 6 weeks implantation. The internal structure of the scaffolds collapsed noticeably after 12 weeks of implantation. The rate of material degradation corresponded to the rate of new bone ingrowth. This novel composite scaffold, which is biodegradable and osteoconductive, has potential as a drug delivery system for treating chronic osteomyelitis accompanied by bone defects.
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Affiliation(s)
- Qi Wang
- Department of Orthopedics, Affiliated Hospital of Heze Medical College, Heze, China
| | - Jialei Du
- Department of Orthopedics, Affiliated Hospital of Heze Medical College, Heze, China
| | - Quanbo Sun
- Department of Orthopedics, Affiliated Hospital of Heze Medical College, Heze, China
| | - Shanwen Xiao
- Department of Orthopedics, Affiliated Hospital of Heze Medical College, Heze, China
| | - Wei Huang
- Department of Orthopaedic Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Bruzzese GL, McKenna S. Surgical Ulcer Debridement in a Patient With Spina Bifida Complicated by Osteomyelitis, Obesity, and Diabetes. Cureus 2023; 15:e43470. [PMID: 37588133 PMCID: PMC10425705 DOI: 10.7759/cureus.43470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 08/18/2023] Open
Abstract
The combination of obesity, diabetes mellitus (DM), and reduced mobility due to spina bifida can contribute to an increased risk of osteomyelitis. Spina bifida, a congenital defect of the spinal cord, causes vertebral column deformities and neurological impairment. Obesity can lead to increased pressure and stress on the bones and joints, as well as poor circulation and immune dysfunction, including neutrophil migration disorders. Similarly, DM can also contribute to poor circulation and inadequate immune function. These changes can increase the risk of neuropathic ulcerations and osteomyelitis. We report a case of a 59-year-old man who presented for surgical consultation at the inpatient care unit. He had a nonhealing sacral ulcer on the left buttock that persisted for a year. He had a history of spina bifida, type 2 DM, and anemia, and his body mass index was 57.6 kg/m2. Physical examination revealed an unstageable left buttock pressure ulcer. The patient was afebrile, and his laboratory findings and imaging results indicated osteomyelitis. Despite intravenous antibiotic treatment, healing of the sacral ulcer remained poor, and the patient experienced chronic pain. Subsequent surgical intervention in the operating room involved debridement of the skin and soft tissue using high-powered water via the VERSAJET™ Hydrosurgery System (Smith & Nephew, London, UK). Ulcerated and necrotic skin and subcutaneous tissue extending deeper than the muscles and bones were observed. Loop colostomy was performed after determining that the wound would not heal owing to its proximity to the rectum and the inevitable contamination with stool. Postoperatively, sacral bone biopsy confirmed osteomyelitis. Alternative treatment options remained limited, as several other treatment methods failed prior to surgical debridement and colostomy placement. Although repeated debridement improved tissue viability, loop colostomy was performed to divert stool and prevent contamination of the ulcer.
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Affiliation(s)
- Gabriella L Bruzzese
- Department of General Surgery, Frederick Health Hospital, Frederick, USA
- Department of Anatomy, West Virginia School of Osteopathic Medicine, Lewisburg, USA
| | - Stephen McKenna
- Department of General Surgery, Frederick Health Hospital, Frederick, USA
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Subramanyam KN, Mundargi AV, Prabhu MV, Gopakumar KU, Gowda DSA, Reddy DR. Surgical management of chronic osteomyelitis: Organisms, recurrence and treatment outcome. Chin J Traumatol 2023:S1008-1275(23)00003-2. [PMID: 36828768 PMCID: PMC10388580 DOI: 10.1016/j.cjtee.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/20/2022] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
PURPOSE The study aimed to identify the risk factors of recurrence in chronic osteomyelitis (COM) and to document the microbiological patterns pre- and intra-operatively and at recurrence, if any. METHODS We performed retrospective review on COM patients treated with surgical debridement and a six-week course of antibiotics. The patients with symptoms of osteomyelitis for at least six weeks, present or past episodes of discharging sinus, documentation of bone sequestration in operative notes or preoperative images were included in the study. Patients with symptoms of osteomyelitis < 6 weeks, lack of history of discharging sinus or lack of evidence of sequestration in preoperative images or intraoperative notes were excluded. Logistic regression models were used to assess the impact of risk factors of recurrence. Cohen-Kappa scores were derived to see the concordance between pre-operative and intra-operative isolates and at recurrence. RESULTS Totally, 147 COM patients (115 males and 32 females, mean age (33 ± 19) years) were included in this study. Recurrence was noted in 28 patients (19.0%). Polymicrobial growth and extended spectrum beta-lactamase producing Enterobacteriaceae increased the chance of recurrence. Cierny-Mader stage-1, hematogenous aetiology and negative intraoperative culture reduced the chance of recurrence. Concordance between pre-operative and intra-operative cultures was 59.85% (Kappa score 0.526, p < 0.001) and between index surgery and at recurrence was 23.81% (Kappa score 0.155, p < 0.001). Lack of knowledge of causative organism preoperatively did not affect outcome. At mean follow-up (42 ± 15) months, all patients were apparently infection free for at least one year. CONCLUSION Polymicrobial growth and multi-drug resistant organisms increase the risk of recurrence in COM. Patients' age, gender, diabetes mellitus, previous failed treatment, duration of symptoms, haemoglobin, white cell count, C-reactive protein and erythrocyte sedimentation rate at presentation did not have any impact on the recurrence of infection. Preoperative isolation of organism is of questionable value. Recurrences of infections do occur and are more of re-infections than relapses. Diligent isolation of organism must be attempted even in re-debridements. Even patients with recurrences do well with appropriate debridement and antibiotic therapy.
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Affiliation(s)
- Koushik Narayan Subramanyam
- Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences - Prasanthigram, Puttaparthi, Andhra Pradesh, 515134, India.
| | - Abhishek Vasant Mundargi
- Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences - Prasanthigram, Puttaparthi, Andhra Pradesh, 515134, India
| | - Milind Vittal Prabhu
- Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences - Prasanthigram, Puttaparthi, Andhra Pradesh, 515134, India
| | - K U Gopakumar
- School of Liberal Arts, Indian Institute of Technology, Jodhpur, Rajasthan, 342001, India
| | - D S Ankush Gowda
- Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences - Prasanthigram, Puttaparthi, Andhra Pradesh, 515134, India
| | - Devagiri Raviteja Reddy
- Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences - Prasanthigram, Puttaparthi, Andhra Pradesh, 515134, India
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Mulualem B, Belay G, Bogale EK. Magnitude of chronic osteomyelitis and its associated factors in children as diagnosed on X-ray visiting at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia: A cross-sectional study. SAGE Open Med 2023; 11:20503121231161191. [PMID: 36949827 PMCID: PMC10026118 DOI: 10.1177/20503121231161191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/15/2023] [Indexed: 03/19/2023] Open
Abstract
Objectives To assess the magnitude of chronic osteomyelitis and its associated factors in children at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia, in 2022. Methods A hospital-based cross-sectional study was done between April 15, 2022 and August 15, 2022, in children with an age of 18 years or below, who visited Felege Hiwot Comprehensive Specialized Hospital. A total sample size of 168 participants was involved in the study. The random sampling technique was applied to select the study participants. The data were collected from the patients, their charts, and X-ray requests. The data were cleaned, stored, checked for completeness, and entered into EpiData Version 3.1, which were then exported to SPSS Version 23 for analysis. Descriptive analysis was done, and bivariable and multivariable logistic regression were used for analysis. Results The prevalence of chronic osteomyelitis was found to be 86.3%. The tibia and femur were the most commonly involved bones, and metaphyseal involvement was very common. The most common radiological findings were sequestrum (56%) and involucrum (53%). Of the total patients with radiological evidence of chronic osteomyelitis, 16.6% had complications, the most common of which was a pathologic fracture (12.4%). Being male (adjusted odds ratio = 6.162, 95% confidence interval: 1.12-34.147), being over 10 years old (adjusted odds ratio = 4.048, 95% confidence interval: 1.032-15.886), living in a rural area (adjusted odds ratio = 4.046, 95% confidence interval: 1.236-13.364), having a discharging sinus (adjusted odds ratio = 5.237, 95% confidence interval: 1.393-19.693), having a clinical complaint lasting more than 1 year (adjusted odds ratio = 5.189, 95% confidence interval: 1.247-21.588), and a preceding event of trauma (adjusted odds ratio = =10.363, 95% confidence interval: 1.101-97.509) were the factors associated with chronic osteomyelitis. Conclusion The prevalence of chronic osteomyelitis is high. In this study, being male, being in the age group above 10 years, having rural residency, having a discharging sinus, having a clinical complaint duration of more than 1 year, and having a preceding event of trauma were the factors associated with chronic osteomyelitis. Therefore, healthcare providers should have a high index of suspicion of chronic osteomyelitis in older male children from rural areas with a chronic discharging sinus following trauma.
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Affiliation(s)
- Biruk Mulualem
- School of Medicine and Health Sciences,
Department of Dermatovenereology, Bahir Dar University, Bahir Dar, Amhara,
Ethiopia
| | - Genetu Belay
- School of Medicine and Health Sciences,
Department of Dermatovenereology, Bahir Dar University, Bahir Dar, Amhara,
Ethiopia
| | - Eyob Ketema Bogale
- Health Promotion and Behavioral
Sciences Department, Bahir Dar University, Bahir Dar, Amhara, Ethiopia
- Eyob Ketema Bogale, Health Promotion and
Behavioral Sciences Department, Bahir Dar University, Bahir Dar, Amhara,
Ethiopia.
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Walsh RB, Mwingwa A, Yongolo NM, Biswaro SM, Mwanswila MJ, Kelly C, Mmbaga BT, Mosha F, Gray WK, McIntosh E, Walker RW. The spectrum and burden of in-patient paediatric musculoskeletal diseases in Northern Tanzania. Paediatr Int Child Health 2022; 42:12-21. [PMID: 35452362 PMCID: PMC9397128 DOI: 10.1080/20469047.2022.2062561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND Musculoskeletal diseases (MSD) are a major contributor to the global burden of disease and disability, and disproportionally affect low- and middle-income countries; however, there is a dearth of epidemiological data. Affected children often face increased morbidity, social isolation and economic hardship. AIM To assess the spectrum and burden of paediatric MSD in children aged 5-18 years admitted to a major referral hospital in Tanzania. METHODS This was a retrospective cohort study of children aged 5-18 years admitted to Kilimanjaro Christian Medical Centre (KCMC) whose initial diagnosis was recognised as a musculoskeletal condition by the International Classification of Diseases-10 between 1 January and 31 December 2017. RESULTS During 2017, 163 cases of confirmed paediatric MSD were admitted to KCMC, representing 21.2% of all admissions of children aged 5-18 years (n = 769). Bone disease was the most common diagnosis. They comprised 106 (65.0%) traumatic fractures, 31 (19.0%) osteo-articular infections, 9 (5.5%) malunions and 3 (1.8%) pathological fractures. Congenital defects and rheumatic disease were relatively uncommon, accounting for only 6 (3.7%) and 4 (2.5%) MSD admissions, respectively. CONCLUSION The majority of cases of MSD were related to fractures, followed by osteo-articular infections, while recognised cases of rheumatic disease were rare. The study, although small, identified the sizeable burden and spectrum of paediatric MSD admitted to a hospital in Tanzania over a 12-month period and highlights the need for larger studies to inform the optimal allocation of health resources. ABBREVIATION CI: confidence interval; HIC: high-income countries; HIV: human immunodeficiency virus; ICD-10: International Classification of Diseases 10; IQR: interquartile range; JIA: juvenile idiopathic arthritis; KCMC: Kilimanjaro Christian Medical Centre; LMIC: low- and middle-income countries; MSD: musculoskeletal diseases: NAI: non-accidental injury; NIHR: National Institute for Health Research; PAFLAR: Paediatric Society of the African League Against Rheumatism; RTA: road traffic accidents; SCD: sickle cell disease; SLE: systemic lupus erythematosus; SSA: sub-Saharan Africa.
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Affiliation(s)
- Rebecca B. Walsh
- Institute of Ageing and Health, Newcastle University, Newcastle upon Tyne, UK,CONTACT Rebecca B. Walsh
| | - Anthony Mwingwa
- Department of Microbiology and Immunology, Kilimanjaro Christian Medical University College, Moshi, Tanzania,Department of Research, Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Nateiya M. Yongolo
- Department of Research, Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania,Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sanjura M. Biswaro
- Department of Research, Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania,Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Manasseh Joel Mwanswila
- Department of Health Management Systems, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Clive Kelly
- Institute of Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Blandina T. Mmbaga
- Department of Research, Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania,Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Faith Mosha
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - William K. Gray
- Institute of Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Richard W. Walker
- Institute of Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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Jerzy K, Francis H. Chronic Osteomyelitis - Bacterial Flora, Antibiotic Sensitivity and Treatment Challenges. Open Orthop J 2018; 12:153-163. [PMID: 29755606 PMCID: PMC5925860 DOI: 10.2174/1874325001812010153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/09/2018] [Accepted: 03/14/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Chronic osteomyelitis is a catastrophic sequel of delayed diagnosis of acute osteomyelitis. Objectives: The objectives of the study were to determine bacterial flora and antibiotic sensitivity, and to evaluate the outcome of an aggressive surgical approach to chronic osteomyelitis. Methods: This is a single surgeon, prospective cohort study on 30 consecutive patients with clinically and radiologically diagnosed chronic osteomyelitis presented to a hospital. We prospectively recorded demographic, clinical, radiological features, treatment protocol, microbiologic results of culture and sensitivity. The main treatment outcome measures were clinical signs of eradication of infection. Results: Microbiologic results showed that Gram-negative and mixed flora accounts for more than half of chronic osteomyelitis cases while Staphylococcus aureus was a dominating single pathogen (39%). We detected a high resistance rate to common antibiotics, e.g. 83% of S. aureus isolates were resistant to oxacillin (MRSA). The mean duration of bone infection was 4.2 years (3 months to 30 years) and the mean number of operations was 1.5 (1-5) . The mean follow-up was 15 months (12-18 months). Infection was eradicated in 95% (21 out of 22) treated by a single procedure and in all patients (n=8) by double procedure. Conclusion: Presented the high rate of MRSA strains is alarming and calls for updating of the antibiotic therapy guidelines in the country. Good results in treatment of chronic osteomyelitis can be achieved by a single-stage protocol including radical debridement combined with systemic and topical antibiotic.
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Affiliation(s)
- Kuzma Jerzy
- Faculty of Medicine and Health Sciences, Divine Word University (DWU) and Modilon General Hospital (MGH), Madang, Papua, New Guinea
| | - Hombhanje Francis
- St. Mary's School of Nursing (DWU), Rabaul Campus P.O.Box 58, Kokopo East New Britain Province, PNG, Papua, New Guinea
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7
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Hotchen AJ, McNally MA, Sendi P. The Classification of Long Bone Osteomyelitis: A Systemic Review of the Literature. J Bone Jt Infect 2017; 2:167-174. [PMID: 29119075 PMCID: PMC5671929 DOI: 10.7150/jbji.21050] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 08/11/2017] [Indexed: 11/24/2022] Open
Abstract
Background: Osteomyelitis is a complex disease. Treatment involves a combination of bone resection, antimicrobials and soft-tissue coverage. There is a difficulty in unifying a classification system for long bone osteomyelitis that is generally accepted. Objectives: In this systematic review, we aim to investigate the classification systems for long bone osteomyelitis that have been presented within the literature. By doing this, we hope to elucidate the important variables that are required when classifying osteomyelitis. Methods: A complete search of the Medline, EMBASE, Cochrane and Ovid databases was undertaken. Following exclusion criteria, 13 classification systems for long-bone osteomyelitis were included for review. Results: The 13 classification systems that were included for review presented seven different variables that were used for classification. Ten of them used only one main variable, two used two variables and one used seven variables. The variables included bone involvement (used in 7 classification systems), acute versus chronic infection (used in 6), aetiopathogenesis (used in 3), host status (used in 3), soft tissue (used in 2), microbiology (used in 1) and location of infected bone (used in 1). The purpose of each classification system could be grouped as either descriptive (3 classification systems), prognostic (4) or for management (4). Two of the 13 classification systems were for both prognostic and management purposes. Conclusions: This systematic review has demonstrated a variety of variables used for classification of long bone osteomyelitis. While some variables are used to guide management and rehabilitation after surgery (e.g., bone defect, soft tissue coverage), others were postulated to provide prognostic information (e.g., host status). Finally, some variables were used for descriptive purposes only (aetiopathogenesis). In our view and from today's perspective, bone involvement, antimicrobial resistance patterns of causative micro-organisms, the need for soft-tissue coverage and host status are important variables to include in a classification system.
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Affiliation(s)
- Andrew J Hotchen
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK.,Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Martin A McNally
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - Parham Sendi
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK.,Institute for Infectious Diseases, University of Bern, Bern, Switzerland.,Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland.,Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Basel, Switzerland
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8
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Geurts J, Hohnen A, Vranken T, Moh P. Treatment strategies for chronic osteomyelitis in low- and middle-income countries: systematic review. Trop Med Int Health 2017; 22:1054-1062. [PMID: 28665557 DOI: 10.1111/tmi.12921] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify a standard treatment regime or highly successful procedure for chronic osteomyelitis in low- and middle-income countries. METHODS Systematic review following PRISMA guidelines. RESULTS The initial search resulted in 102 studies of which nine met the inclusion criteria and were analysed qualitatively. The included studies involved 1173 patients from Africa and Asia. All patients were diagnosed with chronic osteomyelitis. Surgical and antibiotic treatment regimens differed substantially. No better judgement than moderate risk of selection bias could be made due to the study designs. CONCLUSIONS The evidence is not sufficiently robust to identify the most effective treatment, or to even allow a recommendation of the best suitable treatment of chronic osteomyelitis in low-income countries.
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Affiliation(s)
- J Geurts
- Department of Orthopaedic Surgery, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - A Hohnen
- Department of Orthopaedic Surgery, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - T Vranken
- Department of Orthopaedic Surgery, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - P Moh
- St.John of God Hospital, Duayaw Nkwanta, Ghana
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9
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Jaramillo D, Dormans JP, Delgado J, Laor T, St Geme JW. Hematogenous Osteomyelitis in Infants and Children: Imaging of a Changing Disease. Radiology 2017; 283:629-643. [DOI: 10.1148/radiol.2017151929] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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Pommelet V, Vincent QB, Ardant MF, Adeye A, Tanase A, Tondeur L, Rega A, Landier J, Marion E, Alcaïs A, Marsollier L, Fontanet A, Chauty A. Findings in patients from Benin with osteomyelitis and polymerase chain reaction-confirmed Mycobacterium ulcerans infection. Clin Infect Dis 2014; 59:1256-64. [PMID: 25048846 DOI: 10.1093/cid/ciu584] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mycobacterium ulcerans is known to cause Buruli ulcer (BU), a necrotizing skin disease leading to extensive cutaneous and subcutaneous destruction and functional limitations. However, M. ulcerans infections are not limited to skin, and osteomyelitis, still poorly described in the literature, occurs in numerous young patients in Africa. METHODS In a retrospective matched case-control study conducted in a highly endemic area in Benin, we analyzed demographic, clinical, biological, and radiological features in all patients with M. ulcerans infections with bone involvement, identified from a cohort of 1257 patients with polymerase chain reaction-proved M. ulcerans infections. RESULTS The 81 patients studied had a median age of 11 years (interquartile range, 7-16 years) and were predominantly male (male-female ratio, 2:1). Osteomyelitis was observed beneath active BU lesions (60.5%) or at a distance from active or apparently healed BU lesions (14.8%) but also in patients without a history of BU skin lesions (24.7%). These lesions had an insidious course, with nonspecific clinical findings leading to delayed diagnosis. A comparison with findings in 243 age- and sex-matched patients with BU without osteomyelitis showed that case patients were less likely to have received BCG immunization than controls (33.3% vs 52.7%; P = .01). They were also at higher risk of longer hospital stay (118 vs 69 days; P = .001), surgery (92.6% vs 63.0%; P = .001), and long-term crippling sequelae (55.6% vs 15.2%; P < .001). CONCLUSIONS This study highlighted the difficulties associated with diagnosis of M. ulcerans osteomyelitis, with one-fourth of patients having no apparent history of BU skin lesions, including during the current course of illness. Delays in treatment contributed to the high proportion (55.6%) of patients with crippling sequelae.
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Affiliation(s)
| | - Quentin B Vincent
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Recherche Médicale U980 (INSERM) Université Paris Descartes, Sorbonne Paris Cité, Imagine Institute
| | - Marie-Françoise Ardant
- Centre de Diagnostic et de Traitement de la Lèpre et de l'Ulcère de Buruli, Fondation Raoul Follereau, Pobè, Bénin
| | - Ambroise Adeye
- Centre de Diagnostic et de Traitement de la Lèpre et de l'Ulcère de Buruli, Fondation Raoul Follereau, Pobè, Bénin
| | - Anca Tanase
- Department of Pediatric Radiology, Robert Debré Children University Hospital, Assistance Publique-Hôpitaux de Paris
| | - Laura Tondeur
- Emerging Diseases Epidemiology Unit, Institut Pasteur
| | - Adelaide Rega
- Department of Pediatric Radiology, Robert Debré Children University Hospital, Assistance Publique-Hôpitaux de Paris
| | - Jordi Landier
- Emerging Diseases Epidemiology Unit, Institut Pasteur
| | - Estelle Marion
- Centre de Diagnostic et de Traitement de la Lèpre et de l'Ulcère de Buruli, Fondation Raoul Follereau, Pobè, Bénin ATOMycA, Inserm Avenir Team, CRCNA, Inserm U892, 6299 CNRS, Université et CHU LUNAM, Université d'Angers, France
| | - Alexandre Alcaïs
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Recherche Médicale U980 (INSERM) Université Paris Descartes, Sorbonne Paris Cité, Imagine Institute CIC-0109 Cochin-Necker Inserm, Unité de Recherche Clinique, Paris Centre Descartes Necker Cochin, Assistance Publique-Hôpitaux de Paris et EA 3620, Université Paris Descartes Conservatoire National des Arts et Métiers, Paris
| | - Laurent Marsollier
- ATOMycA, Inserm Avenir Team, CRCNA, Inserm U892, 6299 CNRS, Université et CHU LUNAM, Université d'Angers, France
| | - Arnaud Fontanet
- Emerging Diseases Epidemiology Unit, Institut Pasteur Conservatoire National des Arts et Métiers, Paris
| | - Annick Chauty
- Centre de Diagnostic et de Traitement de la Lèpre et de l'Ulcère de Buruli, Fondation Raoul Follereau, Pobè, Bénin
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11
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Pääkkönen M, Peltola H. Simplifying the treatment of acute bacterial bone and joint infections in children. Expert Rev Anti Infect Ther 2014; 9:1125-31. [DOI: 10.1586/eri.11.140] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Fosco M, Gualdrini G, Ben Ayad R. The role of active immunization therapy as preoperative treatment for chronic osteomyelitis. Musculoskelet Surg 2013; 98:45-52. [PMID: 23728857 DOI: 10.1007/s12306-013-0272-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 05/13/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND This retrospective study was performed to assess the effectiveness of active immunostimulation therapy with bacterial immunotherapy (BIT) in treatment for chronic osteomyelitis (COM). MATERIALS AND METHODS We analyze 154 patients affected by COM and treated with BIT from 1995 to 2009 at our Institution. Using Cierny and Mader classification, patients were divided according to their clinical status and anatomic nature of septic process. The data were analyzed considering several confounding factors, such as antibiotic therapy and hyperbaric oxygen therapy combined with the administration of BIT. According to clinical and radiographic parameters, patients were considered as unchanged, improved, or healed. RESULTS After a mean follow-up of 40.4 months (median 38 months), healing was achieved in 41.6 % of cases. Multivariate statistical analysis showed that patient's clinical status is the most important prognostic factor of responding (p < 0.0005) and healing (p = 0.008) after therapy. The best healing rate (62 % of cases) was achieved in patients with a normal clinical condition (Cierny-Mader group A); it was worse (20 % of cases) in those patients with a compromised clinical status (Cierny-Mader group B). There was no healing case in group C. CONCLUSIONS The results show the effectiveness of BIT in treatment of patients affected by COM with uncompromised clinical status. The use of this therapy must be assessed critically in patients with alterations in clinical conditions.
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Affiliation(s)
- M Fosco
- Department of Orthopaedic Surgery, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136, Bologna, Italy,
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Abstract
An acute osteoarticular infection in a child is most often hematogenous. The infection manifests as osteomyelitis or septic arthritis. The most common causative organism is Staphylococcus aureus. Medical advice is usually sought within 2 to 6 days from the onset of symptoms. A child with an osteomyelitis in a lower extremity characteristically presents with limping with or without notable local tenderness, whereas acute septic arthritis is often readily visible because the joint is red, tender, and swollen. Early diagnosis and prompt treatment remain pivotal in avoiding complications in acute bacterial bone and joint infections.
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Affiliation(s)
- Markus Pääkkönen
- Department of Orthopaedics and Traumatology, Turku University Hospital, University of Turku, Turku 20521, Finland.
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An 11-year-old male with refractory osteomyelitis. Case Rep Pediatr 2012; 2012:285980. [PMID: 23243541 PMCID: PMC3518094 DOI: 10.1155/2012/285980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 11/08/2012] [Indexed: 11/17/2022] Open
Abstract
We present a case of empirical treatment failure for chronic osteomyelitis in a previously healthy 11-year-old male involving the distal phalanx of the right first digit. After initial debridement, empiric antibiotics were started for presumed Staphylococcus aureus infection. Operative bacterial cultures yielded no growth. Despite three weeks of antistaphylococcal antibiotics the patient's symptoms worsened and the destruction of bone progressed. A repeat plain X-ray revealed a new lesion in the proximal phalanx of the right second digit. The recognition of multifocal osteomyelitis led to reexamination of bone tissue specimens using special stains which demonstrated rare broad-based budding yeast. Fungal cultures eventually grew Blastomyces dermatitidis. Treatment with amphotericin B led to rapid clinical improvement. This case illustrates that clinicians must remain vigilant for warning signs that empiric treatment may be failing for presumptive Staphylococcus aureus, provoking reconsideration of the differential diagnosis and an intensification of efforts to evaluate for alternative etiologies.
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