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Muacevic A, Adler JR, Cuellar ST, Mushtaq MA, Qureshi S. Probing Beyond the Pain Scale: A Rare Case of Cutibacterium Acnes Septic Arthritis. Cureus 2022; 14:e31864. [PMID: 36579211 PMCID: PMC9792366 DOI: 10.7759/cureus.31864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 11/25/2022] Open
Abstract
Patients with sickle cell disease frequently present to the hospital for pain control secondary to vaso-occlusive crises (VOCs). Diagnostic challenges exist for healthcare providers in distinguishing joint pain secondary to a VOC from an intraarticular infection at initial presentation due to the lack of established clinical markers exclusive to one or the other. We present a 35-year-old female with sickle cell disease and avascular necrosis of bilateral hips and the right shoulder with several previous admissions for VOC pain control complaining of a "different" kind of pain in her shoulder. Treated initially for pain control, our patient was found to be suffering from culture-positive septic arthritis of the shoulder with Cutibacterium acnes, a rare source of de novo intraarticular infection. This case highlights the importance of incorporating patients' subjective descriptions of illness into differential diagnosis considerations, notably for those caring for patients with sickle cell disease. This case also establishes C. acnes as a rare organism responsible for de novo septic arthritis in the setting of sickle cell disease.
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Willen J, Mayer J, Habeck C, Weiner S. Chronic Salmonella Osteomyelitis in a Healthy, Immunocompetent Man: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00079. [PMID: 34937045 DOI: 10.2106/jbjs.cc.21.00356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 26-year-old healthcare professional presented with knee pain and was found to have Salmonella osteomyelitis of the distal femur. Two operations, including antibiotic bead placement followed by a 6-week course of oral ciprofloxacin, were successful in eradicating the infection. CONCLUSION Salmonella osteomyelitis is a well-known complication of hemoglobinopathies but is unusual in healthy individuals. This case required molecular testing and multiple cultures to obtain a diagnosis. Treatment may require debridement and antibiotics.
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Affiliation(s)
- Jacob Willen
- Department of Orthopaedic Surgery, Summa Health System - Akron City Hospital, Akron, Ohio
| | - Joseph Mayer
- Department of Orthopedic Surgery, Northeast Ohio Medical University, Rootstown, Ohio
| | - Caleb Habeck
- Department of Pediatrics, Akron Children's Hospital, Akron, Ohio
| | - Scott Weiner
- Department of Orthopaedic Surgery, Summa Health System - Akron City Hospital, Akron, Ohio
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Staccioni M, Guadagno C, Minguzzi MT, Marchetti F. Child With Leg Pain. Ann Emerg Med 2021; 77:316-356. [PMID: 33618810 DOI: 10.1016/j.annemergmed.2020.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Mario Staccioni
- Department of Pediatrics, University of Ferrara, Arcispedale Sant'Anna University Hospital, Ferrara, Italy
| | - Chiara Guadagno
- Department of Pediatrics, University of Ferrara, Arcispedale Sant'Anna University Hospital, Ferrara, Italy
| | - Maria T Minguzzi
- Department of Radiodiagnostics, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Federico Marchetti
- Department of Pediatrics, Santa Maria delle Croci Hospital, Ravenna, Italy
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Alsaif MA, Abdulbaqi M, Al Noaim K, Aghbari M, Alabdulqader M, Robinson JL. Prevalence of Serious Bacterial Infections in Children with Sickle Cell Disease at King Abdulaziz Hospital, Al Ahsa. Mediterr J Hematol Infect Dis 2021; 13:e2021002. [PMID: 33489041 DOI: 10.4084/MJHID.2021.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/07/2020] [Indexed: 02/02/2023] Open
Abstract
Objective The main aim was to report the prevalence and severity of serious bacterial infections (SBI) in children with sickle cell disease at King Abdulaziz Hospital (KAH), Al Ahsa, Saudi Arabia, to aid in determining whether outpatient management of such cases is appropriate. Methods We conducted a retrospective chart review of febrile children less than 14 years of age admitted with sickle cell disease 2005 through 2015. Results During 320 admissions, 25 children had SBIs (8%) including pneumonia (n=11), osteomyelitis (n=8), bacteremia (n=3, all with Salmonella species) and UTI (n=3). All recovered uneventfully. Conclusion It appears that in the current era, less than 10% of febrile children with sickle cell disease in our center are diagnosed with an SBI. Over 11 years, there were no sequelae or deaths from SBI. Given these excellent outcomes, outpatient ceftriaxone should be considered for febrile well-appearing children with sickle cell disease if they have no apparent source and parents are judged to be reliable.
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Kao CM, Yee ME, Maillis A, Lai K, Bakshi N, Rostad BS, Jerris RC, Lane PA, Yildirim I. Microbiology and radiographic features of osteomyelitis in children and adolescents with sickle cell disease. Pediatr Blood Cancer 2020; 67:e28517. [PMID: 32710705 PMCID: PMC8369475 DOI: 10.1002/pbc.28517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at increased risk for bacterial infections including osteomyelitis (OM). Fever and bone pain, key presenting symptoms of OM, are common in SCD, thus complicating diagnosis. We reviewed presentation, imaging features, and microbiologic etiologies of children with SCD treated for OM. METHODS The comprehensive SCD clinical database of children and adolescents with SCD followed at a single, large tertiary pediatric center were searched to identify all diagnostic coding for potential cases of osteomyelitis in children ages 6 months to 21 years from 2010 to 2019. Medical charts were reviewed to determine OM diagnostic probability based on radiographic and microbiologic findings and the duration of prescribed antibiotic treatment for OM. RESULTS Review of 3553 patients (18 039 person-years) identified 20 episodes of probable OM in 19 children. Magnetic resonance imaging (MRI) findings to support OM were definitive in 4/19 (21%), probable in 10/19 (53%), suspected in 5/19 (26%), based on blinded radiologist review. Blood and/or operative cultures from bone and tissue debridement isolated Salmonella species in seven (35%) cases and methicillin-susceptible Staphylococcus aureus (MSSA) in two (10%). Six patients received antibiotic treatment prior to obtainment of cultures. Of culture-positive cases, MRI findings for OM were definitive or probable in six of nine (67%), suspected in three of nine (33%). CONCLUSIONS Distinction between OM and sickle-related bone infarct or vasoocclusion is difficult based on imaging findings alone. Early attainment of blood and operative cultures increases the likelihood of identifying and adequately treating OM.
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Affiliation(s)
- Carol M. Kao
- Department of Pediatrics, Division of Infectious Diseases, Emory University, Atlanta, GA
| | - Marianne E. Yee
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA.,Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, GA
| | - Alexander Maillis
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Kristina Lai
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Nitya Bakshi
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA.,Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, GA
| | - Bradley S. Rostad
- Department of Radiology and Imaging Services, Emory University, Atlanta, GA
| | - Robert C. Jerris
- Department of Pathology and Laboratory Medicine, Children’s Healthcare of Atlanta, Atlanta, GA.,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Peter A. Lane
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA.,Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, GA
| | - Inci Yildirim
- Department of Pediatrics, Division of Infectious Diseases, Emory University, Atlanta, GA.,Department of Epidemiology, Rollins School of Public Health, Atlanta, GA
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Hsu LL, Fan-Hsu J. Evidence-based dental management in the new era of sickle cell disease: A scoping review. J Am Dent Assoc 2020; 151:668-677.e9. [PMID: 32854869 DOI: 10.1016/j.adaj.2020.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/24/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is an emerging global health issue with rapid progress in therapy especially since 2017. However, systematic reviews found no clinical trials on dental treatment of SCD. TYPES OF STUDIES REVIEWED Using a scoping review approach, the authors examined citations from 13 national SCD guidelines and 10 books spanning 4 decades. The authors also searched the following databases: PubMed, Cumulative Index to Nursing and Allied Health Literature, ScienceDirect, Scientific Electronic Library Online, and GoogleScholar. Eligibility criteria included SCD, oral health care and dental treatment, related to oral and systemic health, original data, or observations. RESULTS Systemic treatment of SCD might have opposing effects on caries, perhaps explaining the conflicting results published. Malocclusion correlates with marrow expansion. Other unusual orofacial findings reflect ischemia. Of 86 full-text articles examined, only 1, a Brazilian esthetic dentistry study, was a randomized clinical trial. No disease-specific data were found on risk of developing bacterial endocarditis, safety of inhaled nitrous oxide, safety of epinephrine with local anesthetic, or the benefit of comprehensive oral health care. PRACTICAL IMPLICATIONS In SCD, oral health and systemic health could be strongly linked. Penicillin, vaccines, and hydroxyurea might impact caries and bone. The interaction of SCD treatments and oral health merit study.
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Autore G, Bernardi L, Esposito S. Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Antinfective Therapy. Antibiotics (Basel) 2020; 9:antibiotics9080486. [PMID: 32781552 PMCID: PMC7459809 DOI: 10.3390/antibiotics9080486] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/28/2020] [Accepted: 08/04/2020] [Indexed: 01/01/2023] Open
Abstract
Acute bone and joint infections (BJIs) in children may clinically occur as osteomyelitis (OM) or septic arthritis (SA). In clinical practice, one-third of cases present a combination of both conditions. BJIs are usually caused by the haematogenous dissemination of septic emboli carried to the terminal blood vessels of bone and joints from distant infectious processes during transient bacteraemia. Early diagnosis is the cornerstone for the successful management of BJI, but it is still a challenge for paediatricians, particularly due to its nonspecific clinical presentation and to the poor specificity of the laboratory and imaging first-line tests that are available in emergency departments. Moreover, microbiological diagnosis is often difficult to achieve with common blood cultures, and further investigations require invasive procedures. The aim of this narrative review is to provide the most recent evidence-based recommendations on appropriate antinfective therapy in BJI in children. We conducted a review of recent literature by examining the MEDLINE (Medical Literature Analysis and Retrieval System Online) database using the search engines PubMed and Google Scholar. The keywords used were “osteomyelitis”, OR “bone infection”, OR “septic arthritis”, AND “p(a)ediatric” OR “children”. When BJI diagnosis is clinically suspected or radiologically confirmed, empiric antibiotic therapy should be started as soon as possible. The choice of empiric antimicrobial therapy is based on the most likely causative pathogens according to patient age, immunisation status, underlying disease, and other clinical and epidemiological considerations, including the local prevalence of virulent pathogens, antibiotic bioavailability and bone penetration. Empiric antibiotic treatment consists of a short intravenous cycle based on anti-staphylococcal penicillin or a cephalosporin in children aged over 3 months with the addition of gentamicin in infants aged under 3 months. An oral regimen may be an option depending on the bioavailability of antibiotic chosen and clinical and laboratory data. Strict clinical and laboratory follow-up should be scheduled for the following 3–5 weeks. Further studies on the optimal therapeutic approach are needed in order to understand the best first-line regimen, the utility of biomarkers for the definition of therapy duration and treatment of complications.
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Rasche T, Emmert D, Seidel H, Sellin J, Conrad R, Mücke M. [Pain management in sickle cell disease]. Schmerz 2020; 34:285-296. [PMID: 32367470 DOI: 10.1007/s00482-020-00465-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sickle cell disease is associated with numerous symptoms and complications. Acute painful crisis is the most characteristic manifestation of the disease. In addition, many patients report chronic pain. As both acute and chronic pain severely diminish quality of life, adequate pain management is crucial. Recommendations for the treatment of acute painful crises are based on the World Health Organization analgesic ladder, which has been developed for cancer-related pain. Chronic pain can be treated with basic long-acting opioids and on-demand short-acting opioids. If patients show signs of neuropathic pain, administration of anticonvulsants, antidepressants or possibly ketamine should be considered.
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Affiliation(s)
- T Rasche
- Zentrum für seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - D Emmert
- Zentrum für seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - H Seidel
- Centrum für Blutgerinnungsstörungen und Transfusionsmedizin (CBT), Bonn, Deutschland
| | - J Sellin
- Zentrum für seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - R Conrad
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - M Mücke
- Zentrum für seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland.
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