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Revue Medicale Suisse Oct 2019Back pain is a frequent reason for consultation. Although commonplace most of the time, back pain can sometimes be the only symptom of vertebral osteomyelitis, an... (Review)
Review
Back pain is a frequent reason for consultation. Although commonplace most of the time, back pain can sometimes be the only symptom of vertebral osteomyelitis, an infection that usually affects an intervertebral disc and the two adjacent vertebrae. Microbiology varies with the host's risk factors and local epidemiology. MRI is the preferred radiologic modality. Nevertheless, the definitive diagnosis is based on microbiological and histopathological elements. Antibiotic therapy alone may in some cases lead to cure, while in other cases the use of surgery is necessary. If it isn't diagnosed in time, vertebral osteomyelitis can have serious consequences. Thus, the physician must be familiar with the anamnestic, clinical and paraclinical elements that will bring him to actively look for this disease.
Topics: Adult; Anti-Bacterial Agents; Back Pain; Humans; Intervertebral Disc; Lumbar Vertebrae; Magnetic Resonance Imaging; Osteomyelitis
PubMed: 31599523
DOI: No ID Found -
Current Opinion in Otolaryngology &... Oct 2021Skull base osteomyelitis (SBO) is a life-threatening condition. Due to an aging and increasingly multimorbid population, clinicians are more often challenged with this... (Review)
Review
PURPOSE OF REVIEW
Skull base osteomyelitis (SBO) is a life-threatening condition. Due to an aging and increasingly multimorbid population, clinicians are more often challenged with this disease. Yet, there is no consensus on the optimal diagnostic and follow-up management. This review should aid clinicians in decision-making for their patients.
RECENT FINDINGS
Treatment-resistant otalgia or headache is suspicious of SBO. Pseudomonas aeruginosa remains the most common pathogen but clinicians are challenged with increasing rates of sterile or fungal cultures due to previously applied antibiotics/steroids. No single imaging modality is able to detect the full extent of the disease. Whereas functional nuclear imaging with gallium-67 or methylene diphosphonate-technetium-99m was once advocated, its actual benefit is questionable. Newer modalities such as fluoro-D-glucose-positron emission tomography (PET)/computed tomography, PET/magnetic resonance imaging (MRI), or diffusion-weighted MRI seem to be promising in diagnosis and follow-up. Finding the causative pathogen is of utmost importance followed by long-term intravenous antibiotics until the disease has completely resolved. Surgery plays a minor role in treatment but can be helpful in selected cases.
SUMMARY
The numerous challenges in SBO render management difficult, but with a clear work-up including regular clinical, laboratory and imaging examinations, outcome can be improved.
Topics: Anti-Bacterial Agents; Humans; Osteomyelitis; Positron Emission Tomography Computed Tomography; Skull Base
PubMed: 34412065
DOI: 10.1097/MOO.0000000000000745 -
Foot & Ankle Specialist Oct 2021The sensitivity and specificity for magnetic resonance imaging (MRI) diagnosis of osteomyelitis is 90% and 80%, respectively; findings include bone marrow edema,...
The sensitivity and specificity for magnetic resonance imaging (MRI) diagnosis of osteomyelitis is 90% and 80%, respectively; findings include bone marrow edema, T2-weighted image hyperintensity (HI-T2WI), T1-weighted image confluent signal(CS-T1WI), and cortical erosion (CE). The goal is to determine which risk factors and MRI findings are most predictive of osteomyelitis. After institutional review board approval, records of patients who underwent bone biopsy of the foot/ankle between 2015 and 2017 were reviewed. Diagnosis was determined histologically. Blinded MRI review identified indicators of osteomyelitis: HI-T2WI, CS-T1WI, ulcer depth, and CE. Bivariate and multivariate regression determined an association between osteomyelitis and radiographic indicators. Of 59 subjects, 41 (69.5%) and 18 (30.5%) had pathologic evidence of osteomyelitis or were indeterminate. The sensitivity and specificity by radiologist diagnosis was 51.4% and 91.7%, respectively. Diabetes (relative risk [RR]=2.9, 95% CI = 1.0.8-7.77, P = .034), CS-T1WI (RR = 1.6, 95% CI = 1.23-2.20, P < .001), and CE (RR = 1.8, 95% CI = 1.34-2.28, P < .001) were risk factors on bivariate analysis. Ulcer depth demonstrated a trend toward statistical significance. Diabetes (RR = 2.4, 95% CI = 1.00-5.69, P = .049) and CE (RR = 1.7, 95% CI = 1.27-2.37, P < .001) were independent risk factors on multivariate analysis. Diabetes and CS-T1WI are independent risk factors for pedal osteomyelitis. Patients with diabetes, CS-T1WI, and CE should be evaluated for osteomyelitis with recommendation for bone biopsy in appropriate clinical settings. Level III Retrospective Comparative Study.
Topics: Bone Marrow Diseases; Humans; Magnetic Resonance Imaging; Osteomyelitis; Retrospective Studies; Risk Factors
PubMed: 32418456
DOI: 10.1177/1938640020921572 -
The Journal of Orthopaedic and Sports... Oct 2020A 9-year-old active girl presented to physical therapy via direct access with intermittent severe pain deep in the distal third of her left thigh that had a 2-year...
A 9-year-old active girl presented to physical therapy via direct access with intermittent severe pain deep in the distal third of her left thigh that had a 2-year history. Twenty months prior, her pediatrician ordered radiographs that were noncontributory and diagnosed her with "growing pains." During examination, an osseous nontender enlargement of the femur was found proximal to the patella, and the patient was referred to her pediatrician for imaging. Radiographs demonstrated an expansile bone lesion with a mixed matrix and an open surgical biopsy determined the mass to be consistent with nonbacterial osteomyelitis. .
Topics: Anti-Inflammatory Agents, Non-Steroidal; Biopsy; Child; Chronic Disease; Female; Humans; Naproxen; Osteomyelitis; Radiography
PubMed: 32998612
DOI: 10.2519/jospt.2020.9221 -
Handchirurgie, Mikrochirurgie,... Jun 2021Osteomyelitis of the hand and wrist is uncommon compared to the infections of the long bones but not rare. There is poor evidence on many answers to questions concerning...
Osteomyelitis of the hand and wrist is uncommon compared to the infections of the long bones but not rare. There is poor evidence on many answers to questions concerning this disease. This includes careful consideration of the prevalence, pathogenesis, microbiology, diagnostic methods and the conservative, medical and surgical treatment. The emergence of the disease can subdivided in post-traumatic, postoperative, spread from contiguous infections and hematogenous. The individual patient-specific risk must be considered. Early diagnosis and correct management are essential to preserve bony structures and the articular function of the hand. A two-step surgical procedure is usually necessary, but uncertainties about the optimal treatment are still existing. Satisfactory control rates of the infection and successful bone reconstructions can be achieved. But complications, a limited range of motion and amputations of finger parts can still not be avoided in all cases.
Topics: Hand; Humans; Osteitis; Osteomyelitis; Wrist; Wrist Joint
PubMed: 34134160
DOI: 10.1055/a-1394-6332 -
Expert Review of Molecular Diagnostics May 2022Procalcitonin (PCT) is a biomarker with established performance in the differentiation between bacterial and viral infections, predominantly in pulmonary infections, as... (Review)
Review
INTRODUCTION
Procalcitonin (PCT) is a biomarker with established performance in the differentiation between bacterial and viral infections, predominantly in pulmonary infections, as well as the diagnosis and prognosis of bacterial sepsis. However, the role of PCT in extra-pulmonary infections is not well described.
AREAS COVERED
We reviewed the role of PCT in commonly experienced extra-pulmonary infections including meningitis, diabetic foot infection, prosthetic joint infection, osteomyelitis, and skin and soft tissue infection. PubMed and Medline online libraries were searched, from 2013 till 2022, for relevant articles.
EXPERT OPINION
For meningitis, PCT could distinguish bacterial from viral meningitis. PCT distinguished septic arthritis from different inflammatory states but had variable performance in discriminating septic arthritis from crystal arthropathy. For periprosthetic joint infections, results were inconclusive. PCT had a potential role in diagnosis of more complex infections such as osteomyelitis and diabetic foot infections, but further studies are needed for a definitive cutoff. In skin and soft tissue infections, PCT performance was variable requiring further investigation to define cutoff for the discrimination of cellulitis from necrotizing fasciitis. We find that PCT performed best for meningitis and helps in the reduction of unnecessary antibiotic treatment, but has variable outcomes with other extra-pulmonary infections.
Topics: Arthritis, Infectious; Biomarkers; Diabetic Foot; Humans; Osteomyelitis; Procalcitonin; Sepsis
PubMed: 35757858
DOI: 10.1080/14737159.2022.2094705 -
The Thoracic and Cardiovascular Surgeon Jan 2021It is widely believed that the first and the second pericardium surgeries were done in the nineteenth century by Francisco Romero and Dominique Jean Larrey,...
It is widely believed that the first and the second pericardium surgeries were done in the nineteenth century by Francisco Romero and Dominique Jean Larrey, respectively; however, Galen was the first surgeon who proceeded with pericardiectomy. This ancient case report of sternum osteomyelitis and pericardiectomy illuminates some dark part of the history of medicine and the ability of physicians in that era.
Topics: Heart Diseases; History, Ancient; Humans; Osteomyelitis; Pericardiectomy; Sternum; Surgeons
PubMed: 33126275
DOI: 10.1055/s-0040-1716568 -
Wounds : a Compendium of Clinical... Jun 2023Patients with diabetes and peripheral neuropathy have a 25% risk of developing a foot ulcer, and these can lead to soft tissue infections that worsen and result in...
INTRODUCTION
Patients with diabetes and peripheral neuropathy have a 25% risk of developing a foot ulcer, and these can lead to soft tissue infections that worsen and result in osteomyelitis. While Charcot neuroarthropathy is not as common as osteomyelitis, it is often misdiagnosed as osteomyelitis.
CASE REPORTS
Three patients presented with diabetes, neuropathy, and foot ulcers. They underwent prophylactic surgery but later developed swelling at the surgical sites. Radiographs showed fragmentations that caused concern about osteomyelitis. The authors maintained diagnoses of Charcot neuroarthropathy and treated the patients with immobilization and offloading. All patients resolved the fragmentations without antibiotics or surgery.
CONCLUSION
While Charcot neuroarthropathy and osteomyelitis have similar signs and symptoms, understanding the similarities and differences between the conditions can aid providers in appropriate wound management.
Topics: Humans; Osteomyelitis; Foot Ulcer; Peripheral Nervous System Diseases; Radiography; Arthropathy, Neurogenic; Diabetic Foot
PubMed: 37347597
DOI: 10.25270/wnds/22063 -
Stomatologiia 2023The pandemic of coronavirus infection existed from 2019 to 2023. The World Health Organization (WHO) has announced on May 5, 2023 that the pandemic had ended. However,... (Review)
Review
The pandemic of coronavirus infection existed from 2019 to 2023. The World Health Organization (WHO) has announced on May 5, 2023 that the pandemic had ended. However, it does not cease to have an adverse effect on the health of the world population. Necrotic lesions of the bones of the facial skeleton are now a characteristic sign of a severe coronavirus infection. We conducted a review of scientific publications that reflected the relationship between coronavirus and necrotic processes of the skull bones, methods of treatment, prevention and the latest developments in this direction. The purpose of this article is to review existing studies on Post-Covid osteomyelitis of facial bones, its impact, features of the clinical picture of this disease, analysis of methods and means of treatment of this group of patients. Analysis of literature data has shown that the search for an ideal dressing material continues, especially the developments of native developers stand emphasized. The advantages of modern materials over traditional ones have become unquestionable, but further research in this direction is required.
Topics: Humans; COVID-19; Facial Bones; Osteomyelitis; Necrosis
PubMed: 38096398
DOI: 10.17116/stomat202310206268 -
Otology & Neurotology : Official... Dec 2022Temporal bone osteomyelitis is an invasive infection most often caused by bacteria and associated with high mortality. Fungal etiologies are rare and little is known of... (Review)
Review
INTRODUCTION
Temporal bone osteomyelitis is an invasive infection most often caused by bacteria and associated with high mortality. Fungal etiologies are rare and little is known of the predictors of disease severity and outcomes in fungal temporal bone osteomyelitis.
MATERIALS AND METHODS
A scoping review was performed to determine what is known from the literature on how clinical, diagnostic, and treatment characteristics relate to patient outcomes in fungal temporal bone osteomyelitis. Using PRISMA guidelines, three databases were searched to identify all published cases of fungal temporal bone osteomyelitis. Data were extracted from each study, including clinical, diagnostic, and treatment characteristics, and outcomes.
RESULTS
Sixty-eight studies comprising 74 individual cases of fungal temporal bone osteomyelitis were included. All studies were case reports. There were high rates of diabetes, facial nerve palsy, infectious complications, and need for surgical intervention, as well as a significant delay in the evaluation and diagnosis of fungal temporal bone osteomyelitis. Disease recovery was greater in patients presenting with otorrhea, comorbid diabetes, and in those without facial nerve palsy.
DISCUSSION
Many of the defining characteristics of fungal temporal bone osteomyelitis remain unknown, and future reports should focus on determining factors that improve timely diagnosis and treatment of fungal TBO in addition to identifying prognostic indicators for outcomes and survival.
Topics: Humans; Comorbidity; Osteomyelitis; Paralysis; Prognosis; Temporal Bone
PubMed: 36351221
DOI: 10.1097/MAO.0000000000003714