Persistent Bacteremia Due to Escherichia coli Vertebral Osteomyelitis.

Vertebral osteomyelitis is a disc and vertebral infection that causes nonspecific symptoms such as back pain, fever, and weakness. The most common causative pathogen is Staphylococcus aureus, and Escherichia coli (E. coli) is an uncommon cause. An 88-year-old man presented to the emergency department with a fever and lower back pain. His blood cultures were persistently positive for E. coli on days one, three, and five, and a diagnosis of vertebral osteomyelitis was made after an MRI of the lumbar spine. It has been reported that infectious dissemination to the vertebrae may occur through Batson's venous plexus, which is a network of paravertebral veins, and the pelvic venous plexus. Clinicians should remember that vertebral osteomyelitis can be a cause of persistent bacteremia.

A case of pyoderma gangrenosum around the urethral meatus aggravated by COVID-19 infection and further worsened due to the development of pyogenic osteomyelitis 8 years after urostomy.

After the infection with COVID-19, pyoderma gangrenosum worsened and further led to necrosis following pyogenic osteomyelitis. Infection is a major exacerbating factor in pyoderma gangrenosum.

Escherichia Coli Vertebral Osteomyelitis: A Case Report.

Diagnosis of spondylodiscitis is often challenging, delayed, or even missed due to the uncommonness of the disease, and it can lead to devastating consequences. Therefore, a high index of suspicion is needed for prompt diagnosis and improved long-term outcomes. Vertebral osteomyelitis, or spondylodiscitis, is a rare disease with increasing prevalence due to advanced spinal surgical procedures, nosocomial bacteremia, increased life expectancy, and intravenous drug use. Hematogenous infection is the most common cause of spondylodiscitis. We report a case of a 63-year-old man with a history of liver cirrhosis who initially presented due to abdominal distension. During his hospital stay, he complained of uncontrolled back pain due to Escherichia coli spondylodiscitis.

Differential effects of anti-RANKL monoclonal antibody and zoledronic acid on necrotic bone in a murine model of Staphylococcus aureus-induced osteomyelitis.

Osteomyelitis is characterized by progressive inflammatory bone destruction accompanied by severe pain and disability. However, with the exception of antibiotic therapies, there is no established therapy to protect the bone from infectious osteolysis. The anti-receptor activator of nuclear factor-kB ligand (RANKL) monoclonal antibody (anti-RANKL Ab) is a potential drug based on its proven effectiveness in preventing joint bone erosion in rheumatoid arthritis; however, the efficacy and adverse effects of anti-RANKL Ab in osteomyelitis remain to be investigated. In this study, we investigated the effects of anti-mouse RANKL Ab on acute osteomyelitis and compared them with those of zoledronic acid (ZA) using a murine model. Mice were inoculated with bioluminescent Staphylococcus aureus (Xen 29) on their left femur and then treated with ZA, anti-RANKL Ab, or phosphate-buffered saline as control. A 21-day longitudinal observational study using microcomputed tomography showed that both anti-RANKL Ab and ZA had an osteoprotective effect against infectious osteolysis. However, it was also demonstrated through bioluminescence imaging that ZA delayed the spontaneous reduction of bacterial load and through histology that it increased the amount of necrotic bone, while anti-RANKL Ab did not. Findings from histopathological and in vitro studies suggest that an intense inflammatory response around the necrotic bone could induce osteoclasts in a RANKL-independent manner, leading to the removal of necrotic bone, even after administration of the anti-RANKL Ab therapy. Collectively, anti-RANKL Ab may exert an osteoprotective effect without hampering the removal of the necrotic bone, which serves as a nidus for infection in osteomyelitis.

Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills.

Acute osteoarticular infections (AOI) should be treated as top emergencies. The first few days following the inception of infection are ultra-critical to long-term prognosis.A comprehensive road map for management of childhood AOI is still lacking despite recent advances in microbiology and imaging (magnetic resonance imaging). The many faces of childhood AOI warrant a multidiscipline approach to management.Laboratory and imaging findings of are still debatable and should not overshadow or delay a management plan based on the experienced physician's clinical judgment.Ample evidence-based practice supports the use of a few days of intravenous antibiotic administration followed by oral therapy until correlative clinical and basic laboratory (acute phase reactants) results improve.The growing body of evidence on 'high-risk' children/neonates of AOI warrants continual clinical extra-vigilance in identifying these patient subsets.Open drainage and debridement remain the mainstay of treatment of septic hips, whereas for other joints the use of alternative surgical techniques should be individualized or on case-by-case basis.Because the consequences of misdiagnosis of AOI are usually grave and permanent, proactive treatment/overtreatment is justified in the event of unconfirmed but suspicious diagnosis. Cite this article: EFORT Open Rev 2021;6:584-592. DOI: 10.1302/2058-5241.6.200155.

Acute Primary Epiphyseal Osteomyelitis of Proximal Tibia - A Case Report and Review of the Literature.

Introduction: Acute pyogenic epiphyseal osteomyelitis is a rare condition, mostly affecting children. This case report discusses the importance of clinical suspicion and the role of adjuncts in the diagnosis of these cases. Case Presentation: A 12-year-old female presented with pain in the right knee for 1 week and difficulty in walking for 4 days. Diagnosis was made with the help of magnetic resonance imaging MRI and guided biopsy. Pseudomonas aeruginosa was isolated from culture. She was treated with intravenous antibiotics with a good response. Discussion: Despite being a rarely reported entity, primary epiphyseal osteomyelitis should be kept as one of the differentials of the painful swollen knee in a child. Early diagnosis with the help of proper radiological investigations is the key to prevent the sequelae of this disease.

Pathological fracture and pyogenic osteomyelitis in a patient with type 2 Gaucher disease.

In Gaucher disease (GD), enzyme replacement therapy (ERT) results in the alleviation of hematological abnormalities and visceral infiltration as well as improvement in quality of life and life-span. However, several years may be required for skeletal manifestations, which are usually observed in type 1 and 3 GD, to respond to ERT. Infants with type 2 GD rarely present skeletal manifestations because most of these patients die within the first 2 years of life before they develop skeletal involvement. The use of ERT may prolong the lifespan of these patients and influence the natural history of the disease. The present study reports a new natural history of treated GD in which a 2-year and 7-month-old girl with type 2 GD who was receiving ERT developed valproate-induced Fanconi syndrome, pathological fractures, and pyogenic osteomyelitis. In conclusion, skeletal disease may occur in any type of GD, and Fanconi syndrome may lead to severe skeletal complications in patients with GD.

Diagnosis and modern surgical treatment of pyogenic osteomyelitis of the spine / 中国矫形外科杂志

[Objective]To explore the characteristics and management of pyogenic osteomyelitis of the spine.[Method]Thirty-nine patients with pyogenic osteomyelitis of the spine,who were treated by single-stage anterior debridement and interbody bone graft fusion,were included.The clinical presentations,laboratory,biological as well as radiological characteristics and surgical outcomes were investigated.[Result]The mean follow-up duration was 8.5 years,ranging from 2 to 17 years.All the patients had marked improvement in their back pain,17 of whom obtained complete recovery,the remaining 22 patients had occasional mild pain.Sensory deficit aggravated in 1 patient,the remaining 38 patients had marked improvement in the neurological function of the lower extremity.The recovery rate of clinical symptoms and signs ranged from 20% to 100%(averaged,75.6%).Bony fusion was obtained in all the patients in 4 months on average(ranged,2～6 months).ESR decreased from 73mm/h preoperatively to 29mm/h at 4 months after operation,while C reactive protein decreased to normal.There was no death and no other complication relating to opertion.Species of pathogen:culture positive in 19 cases(48.7%).Of these,S.aureus in 10 cases,et al.[Conclusion]The underlying diseases of patients were risk factors of pyogenic osteomyelitis of the spine,pathogens involved not only S.aureus but also other low virulent organisms.CRP was more sensitive than ESR or white cell counts,it may also be the parameter to evaluate outcomes of therapy.MRI has been shown to have the highest sensitivity,specificity and accuracy in the diagnosis of pyogenic osteomyelitis of the spine.Single-stage anterior debridement and interbody bone graft fusion are save and effective to treat pyogenic osteomyelitis of the spine.

A Clinical Study of Acute Pyogenic Osteomyelitis / 대한정형외과학회잡지

Acute pyogenic osteomyelitis is frequent in infants and children, usually hematogenous, and predominant in male. The etiology of acute osteomyelitis is of 3 types: hematogenous, direct innoculation, or postoperative. Acute pyogenic hematogenous osteomyelitis is the most frequent type in children. This study consisted of 119 cases of acute pyogenic osteomyelitis which were studied at the department of orthopedic surgery, Yonsei university, Severance hospital and Youngdong hospital for 10 years from Jan. 1974 to Dec. 1983. The result were as follows. 1. There were tendency to decrease the frequency of this disease graduaUy since 1973 except 1978. 2. 20 patient (16.8%) had the history of trauma and 43 patients (36.1%) had the entry site of infecting organism. 3. The most frequent involved sites were femur and tibia. 4. E.S.R. was definitely increased in 90.4% of male, in 100% of female. 5. 59.6% of patients revealed the definite bone change at admission on X-ray findings. 6. Staphylococcus coagulase positive was the most frequent organism isolated (95%). 7. The most sensitive antibiotics was cephalosporin and the most resistant was penicillin (90.2%). 8. The antibiotics treatment with immobilization of involved site was initially tried, if there was no symptomatic improvement, the various surgical process was performed with satisfactory result.

Management of Sequellae of Pyogenic Osteomyelilis / 대한정형외과학회잡지

After discovery of Penicillin by Fleming in 1939, a great improvement in the treatment of osteomyelitis has been made and the mortality rate in acute stage was markedly decreased. But due to misplacement of antibiotics, and the improper treatment of the osteomyelitis, the tendency to chronicity and various sequellae of the osteomyelitis are still persist. So, it will be of importance to reconsider the management of various sequellae of pyogenic osteomyelilis. We reviewed 3 cases of sepsis, 10 cases of pathologic fracture, 6 cases of sepsis, 6 cases of malignant turnor developed in an old draining sinus, 2 cases of bone defect, 3 cases of joint contracture and 4 cases of deformity and growth disturbance 604 cases of osteomyelitis treated at National Medical Center between 1972 to 1983. The results were as follows: 1. Established sepsis was noted in 3 cases, and one of these patient dead. We treat these patients with high dose of the antibiotics accompanied by decompression of the lesion. 2. Pathologic fracture developed in 10 cases, which was treated with either conservative or operative treatment. All cases obtained good union except one. 3. Spuamous cell carcinoma developed in 6 cases around the old draining sinus. All cases were treated with amputation. Theres no recurrence except one. 4. Bone defect developed in 2 cases. A case of bone defect in humeral shaft was treated with vascularized fibular graft and obtained firm union and good function. 5. Joint contracture was treated with soft tissue release and even joint fusion in severe case. The results were not gratifying. 6. Deformity and growth disturbance of limbs were treated with soft tissue release, osteotomy and stapling. Most of the cases obtained good results, but limb length discrepancy was not recovered satisfactorily.

Treatment of Non / 대한정형외과학회잡지

During the period of 25 years from Apr. 1959 to Jan. 1984, 58 patients of non-tuberculous infec-tion of the spine (53 pyogenic osteomyelitis and 5 iatrogenic and primary discitis) were admitted and treated at our department. Clinical analysis was carried out following results were obtained. 1. The incidence was higher in the 3rd and 4th decade and the sex ratio between male and female was 2.1:1 2. The relative frequency of the commonly involved sity were lumbar(60), thoracic(17.), cervical(9%), lumbosacral(7%), thoracolumbar(3.5%), cervicothoracic(1.5%), in that orders. 3. The morbidity period less than 1 month was only in 22% and that less than 1 year was only 4. The frequent clinical symptoms and signs were back pain(91), tenderness(88%), muscle spasm (76%), and fever and chillness(41%). 5. The causative microorganism was identified in 43 cases among which 77% was coagulase positive staphylococcus. 6. Expected spontaneous bony fusion was not found in any case of 9 follow-up cases of conservatively treated group, while excellent bony union was noticed in all 16 follow-up cases of anterior fusion group except one. 7. Anterior spinal fusion seems be to indicated in those cases such as with failure of conservative treatment, paraplegia, concomitant mechanical instability, long duration of sinus tract and even with dubious bacteriological diagnosis. 8. Anterior spinal fusion for pyogenic osteomyelitis and discitis has the advantages, that is eradication of diseased foci with easier bacteriological diagnosis, cord decpmpression, increase of bony stability, and promotion of bony union. 9. Laminectomy was indicated in those cases with epidural abscess. 10. Bone scan and computed tomography were useful in the early diagnosis and evaluation of treatment results.