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The Indian Journal of Medical Research Jan 2022
Topics: Humans; Osteomyelitis; Osteopetrosis
PubMed: 35859433
DOI: 10.4103/ijmr.IJMR_2340_20 -
Frontiers in Cellular and Infection... 2022Fungal osteoarticular infection (FOI) is not commonly seen in clinical practice but proposes a great challenge to orthopedic surgeons. In this study, we aimed to...
BACKGROUND
Fungal osteoarticular infection (FOI) is not commonly seen in clinical practice but proposes a great challenge to orthopedic surgeons. In this study, we aimed to investigate the risk factors, the clinical features, and surgical outcomes of FOI in our institution. Specifically, we aimed to explore the role of metagenomic next-generation sequencing (mNGS) in the diagnosis and treatment of FOI.
METHODS
All the patients who were diagnosed and managed with FOI in our institution from January 2007 to December 2020 were retrospectively reviewed, including primary fungal implant-related infection, primary fungal osteomyelitis or arthritis, and fungal infections secondary to bacterial osteomyelitis or implant-related bacterial infections. The potential risk factors and the clinical and surgical features were analyzed. The pathogen data were compared between culture and the mNGS test.
RESULTS
A total of 25 patients were included, namely, 12 primary implant-related infections, 7 primary fungal osteomyelitis or arthritis, and 6 fungal infections secondary to bacterial osteomyelitis or implant-related bacterial infections. Most cases had undergone multiple surgeries or long-term antibiotic treatment. Diagnosis was mainly based on microbial culture and the mNGS test. Optimization of culture methods and the use of mNGS assisted the diagnosis. Specifically, mNGS was performed in 12 patients, 5 of whom were culture-negative. In the remaining seven cases, mNGS demonstrated the same results as culture. Management of FOI was complicated as most patients required multiple surgeries followed by long-term antifungal treatment. In selected cases, antifungal-impregnated cement spacer retention can be an optional choice. The overall success rate was 100% (25/25) for our cohort.
CONCLUSION
We concluded that patients with comorbidities and a history of multiple surgeries or long-term antibiotics are under higher risk for FOI. Use of mNGS assists the diagnosis and treatment of FOI. Surgery combined with long-term antifungal treatment achieved satisfactory outcomes. In selected cases, antifungal-impregnated cement spacer retention can be an optional treatment choice.
Topics: Humans; Retrospective Studies; Metagenomics; Metagenome; Mycoses; Antifungal Agents; Osteomyelitis; Arthritis; Postoperative Complications; Anti-Bacterial Agents
PubMed: 36506031
DOI: 10.3389/fcimb.2022.1072539 -
Japanese Journal of Radiology Jul 2020Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome and chronic recurrent multifocal osteomyelitis (CRMO) have been described as disorders of... (Review)
Review
Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome and chronic recurrent multifocal osteomyelitis (CRMO) have been described as disorders of chronic osteoarthritic inflammation frequently associated with skin manifestations, and SAPHO and CRMO (SAPHO/CRMO) are rare autoinflammatory disorders of unknown etiology. SAPHO tends to occur in adults and CRMO predominantly occurs in children and adolescents. SAPHO/CRMO can affect any skeletal region (e.g., anterior chest wall, spine, or long bones). As SAPHO/CRMO are diagnoses of exclusion, the diagnoses might be difficult if skin manifestations are not clearly evident. However, knowledge of the imaging findings of skeletal disorders is helpful for correcting the diagnosis and avoiding unnecessary invasive procedures, as well as in facilitating early diagnosis and adequate treatment. This pictorial review describes the appearance of increased skeletal uptake for SAPHO/CRMO on bone scintigraphy along with findings from radiography, computed tomography, and magnetic resonance imaging.
Topics: Acquired Hyperostosis Syndrome; Bone and Bones; Diagnostic Imaging; Female; Humans; Male; Osteomyelitis
PubMed: 32356235
DOI: 10.1007/s11604-020-00953-1 -
Jornal de Pediatria 2024Signs and symptoms of osteomyelitis or septic arthritis in neonates and infants are often nonspecific and early-stage bone infections in infants may often go unnoticed....
OBJECTIVE
Signs and symptoms of osteomyelitis or septic arthritis in neonates and infants are often nonspecific and early-stage bone infections in infants may often go unnoticed. The objective of this study was to analyze the clinical characteristics of newborns and infants with osteomyelitis and septic arthritis to improve understanding of the disorder and to assist clinicians with diagnosis.
METHODS
A retrospective multicenter study was conducted on neonates (0-28 days old, n = 94) and infants (1-12 months old, n = 415) with osteoarticular infections. Data consisting of clinical characteristics, complications, laboratory outcomes, and the pathogenic microorganisms causing osteomyelitis were tabulated. The statistics were further broken down into two regions and the significant differences between neonates and infants were evaluated and compared to the literature.
RESULTS
Compared to infants, neonates had significantly lower incidences of fever (p < 0.0001), higher incidences of localized swelling (p = 0.0021), higher rate of infection at the humerus (p = 0.0016), higher percentage of Escherichia coli (p < 0.0001) and Klebsiella pneumoniae (p = 0.0039) infections, lower percentage of Staphylococcus aureus infections (p < 0.0001) and were more likely to develop septic arthritis (p < 0.0001).
CONCLUSION
Distinct differences were found between neonatal and infants with osteoarticular infections. Future studies should focus on improving diagnosis and subsequent treatment regimens for younger age groups.
Topics: Humans; Osteomyelitis; Arthritis, Infectious; Retrospective Studies; Infant, Newborn; Infant; Male; Female; Staphylococcal Infections
PubMed: 38642591
DOI: 10.1016/j.jped.2024.03.003 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Nov 2021Post-traumatic osteomyelitis is one of the most common disorders of bone infection, which is secondary to open fracture caused by machinery injury, traffic accident, and...
Post-traumatic osteomyelitis is one of the most common disorders of bone infection, which is secondary to open fracture caused by machinery injury, traffic accident, and it is also the main manifestation in the postoperative infection of open fracture. After trauma, bacteria invade bone tissue and reproduce rapidly in large quantities, which easily leads to osteomyelitis. Patients are often complaint of pain at the affected limb, loss of function, or even amputation due to deteriorated infection, resulting in loss of labor capability and poor quality of life. Because the diagnosis and treatment are not timely and standard, the treatment for post-traumatic osteomyelitis is often delayed, resulting in the difficulty of clinical cure. It also makes patients and their families bear a serious financial burden. However, the diagnosis and treatment for this disease is difficult for orthopedic physicians. In recent years, imaging methods (such as CT and MRI) combined with immune techniques have significantly improved the diagnostic accuracy and early diagnosis ability. The application of new diagnostic technologies (such as gene chip and second-generation sequencing) also makes the diagnosis more convenient and sensitive. The novel reconstruction and repair surgery (such as Ilizarov technology and Orthofix LRS technology) provides new treatment direction for orthopedic surgeons and patients.
Topics: Humans; Ilizarov Technique; Osteomyelitis; Quality of Life; Treatment Outcome
PubMed: 34911865
DOI: 10.11817/j.issn.1672-7347.2021.200621 -
The Surgeon : Journal of the Royal... Oct 2020The diagnosis of diabetic food infection is usually clinical, and its severity is related to location and depth of the lesion, and the presence of necrosis or gangrene.... (Review)
Review
OBJECTIVE
The diagnosis of diabetic food infection is usually clinical, and its severity is related to location and depth of the lesion, and the presence of necrosis or gangrene. Osteomyelitis of the foot and ankle can be extremely debilitating, and, in the preantibiotic era acute staphylococcal osteomyelitis carried a mortality rate of 50%. The microbiology of diabetic foot osteomyelitis (DFO) is usually polymicrobial. Indeed, gram-negative and gram-positive bacilli can be identified using molecular techniques applied to bone biopsies compared to conventional techniques. The aim of the present study is to report a complete overview regarding medical and surgical management of diabetic foot osteomyelitis (DFO) in combination or alone.
MATERIALS AND METHODS
We performed a search in PubMed and Scopus electronic databases (up to January 2019) of articles assessing the epidemiology, diagnostic strategy and pharmacological treatment of diabetic foot infection. In the search strategy, we used various combinations of the following key terms: infection, orthopaedic, diabetic foot, management, DFO.
RESULTS
This article discusses the definition, epidemiology, microbiological assessment, clinical evaluation, pharmacological and surgical management and a comparison between them, of DFO. After the initial literature search and removal of duplicate records, a total of 756 potentially relevant citations were identified. After a further screening and according to the inclusion criteria, a total of 65 articles were included in the present review.
CONCLUSION
The association of antibiotic and surgical therapy seems to be more effective compared to each one alone. The lack of comparison studies and randomized controlled trials makes it difficult to give information about the efficacy of the different management therapies.
Topics: Diabetic Foot; Humans; Osteomyelitis
PubMed: 32081665
DOI: 10.1016/j.surge.2020.01.007 -
European Archives of... Aug 2021Skull base osteomyelitis (SBO) is an uncommon and a potentially life-threatening condition if not promptly recognized and properly treated. The aim of our study was to...
PURPOSE
Skull base osteomyelitis (SBO) is an uncommon and a potentially life-threatening condition if not promptly recognized and properly treated. The aim of our study was to present a 32-case series of patients diagnosed with SBO at a single center.
METHODS
In this retrospective study, we reviewed the data of patients diagnosed with otogenic SBO between January 2011 and January 2020. 32 patients were enrolled in the study. SBO diagnosis was based on a combination of symptoms and physical examination, bone scan, brain magnetic resonance imaging, and pathologic examination findings. The following clinical data were collected during the follow-up period: types of antibiotics used, duration of antibiotic treatment, C-reactive protein level, presence of disease control, duration from the onset of symptoms to diagnosis, and patient survival.
RESULTS
The mean follow-up period was 11 (1-110) months. The mean duration of antibiotic treatment was 115 (19-223) days. The mean C-reactive protein levels at the time of diagnosis and at the endpoint of follow-up were 3.05 (0.56-18.31) and 0.21 (0.03-33.61) mg/dL, respectively (P < 0.001). Disease control rate was 34.9% at 1-year and 83.7% at 5-year follow-up. Patient survival rate was 90.6% at 1- and 3-year follow-ups. At the endpoint of follow-up, three patients died. The mean durations from the onset of symptoms to diagnosis were 50 (5-360) and 90 (30-480) days in patients with the controlled disease and in those with the uncontrolled disease, respectively, at the endpoint of follow-up (P = 0.043).
CONCLUSION
Comprehensive assessment and aggressive treatment of patients exhibiting symptoms suggestive of SBO would help in the rapid diagnosis of otogenic SBO, resulting in an improvement in prognosis.
Topics: Anti-Bacterial Agents; Humans; Magnetic Resonance Imaging; Osteomyelitis; Retrospective Studies; Skull Base
PubMed: 32960351
DOI: 10.1007/s00405-020-06366-0 -
Nuclear Medicine Communications Jan 2021The aim of the study was to evaluate the value of single-photon emission computed tomography/computed tomography (SPECT/CT) for therapy response assessment of jaw...
OBJECTIVE
The aim of the study was to evaluate the value of single-photon emission computed tomography/computed tomography (SPECT/CT) for therapy response assessment of jaw osteomyelitis.
MATERIALS AND METHODS
Thirty-four baseline and 74 follow-up SPECT/CT examinations for therapy response assessment were performed in 34 patients with jaw osteomyelitis. SPECT/CT and planar late-phase bone scintigraphy images were assessed at baseline and follow-up, according to the following criteria: tracer uptake grade (0 = no uptake, 1 = low uptake, 2 = moderate uptake and 3 = high uptake); and morphologic signs (osteolysis, sequestration, sclerosis, periosteal reaction and pathologic fracture).
RESULTS
At baseline, SPECT/CT showed marked (grade 2 or 3) uptake in 91% (31/34) of the patients, osteolysis in 85% (29/34), sclerosis in 71% (24/34), periosteal reaction in 44% (15/34) and a sequestrum in 24% (8/34). In 24 patients with clinically complete remission during or after at least 12 months' therapy, bone scintigraphy showed grade 0 or 1 uptake in 100% (24/24) and SPECT/CT in 91% (22/24) of the patients. Sclerosis with the disappearance of osteolysis, sequestration and periosteal reactions was the predominant morphologic finding in complete responders (68%; 16/24). In 10 patients with symptoms of exacerbation of the osteomyelitis, 80% (8/10) showed increasing uptake, 90% (9/10) sclerosis, 80% osteolysis (8/10) and 40% (4/10) osteolysis and periosteal reactions.
CONCLUSION
SPECT/CT is a valuable tool to accurately assess therapy response, disease exacerbation and complications of jaw osteomyelitis. Low-grade (grade 1) residual tracer uptake is common in patients with clinically complete remission and is suggestive of ongoing bone remodeling and healing.
Topics: Adult; Female; Follow-Up Studies; Humans; Jaw; Male; Middle Aged; Osteomyelitis; Single Photon Emission Computed Tomography Computed Tomography; Treatment Outcome
PubMed: 32991397
DOI: 10.1097/MNM.0000000000001297 -
American Family Physician Oct 2021
Topics: Adult; Anti-Bacterial Agents; Child; Humans; Osteomyelitis
PubMed: 34652124
DOI: No ID Found -
British Journal of Neurosurgery Jun 2023
Topics: Humans; Spine; Osteomyelitis
PubMed: 31625398
DOI: 10.1080/02688697.2019.1678739