Osteomyelitis in patients who have sickle-cell disease. Diagnosis and management

Fifteen patients who had sickle-cell disease and osteomyelitis (affecting thirty bones) were treated with operative decompression and parenteral administration of antibiotics between 1973 and 1988. Organisms were isolated on culture of specimens of bone from all fifteen patients. Parenteral antibiotic therapy was continued for a minimum of six weeks after operative decompression. The osteomyelitis resolved in twenty-nine (97 per cent) of the thirty affected bones after follow-up ranging from two to fifteen years. With their compromised immune status and poor circulation of blood in bone, patients who have sickle-cell disease and osteomyelitis are prone to have complications. In our series, the complications included an adhesive pericapsulitis of the shoulder in two patients, avascular necrosis of the humeral head in one, and a pathological fracture of the femur in one. In four of the fifteen patients, chronic osteomyelitis persisted, but in three of the four, the infections of bone healed six to fourteen months after the initial operative decompression. Staphylococcus aureus was isolated on culture of specimens of bone from eight to the fifteen patients; Salmonella, from six; and Proteus mirabilis, from one. Although Salmonella has been cited as the principal causative organism of osteomyelitis in patients who have sickle-cell disease, in our experience Staphylococcus aureus was the most common infecting organism. Therefore, Salmonella may not be the most common cause of osteomyelitis associated with sickle-cell disease in all countries or in all areas of a particular country.