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[Osteomyelitis in patient with sickle cell disease]
E Doppelt1, F de La Rocque, Y Morriet
1l'Etude Epidémiologique clinique et biologique de la Drépanocytose, Région de Paris.
Insights
Children with sickle cell disease frequently develop osteomyelitis, often caused by Salmonella. Prompt diagnosis and broad-spectrum antibiotics are crucial for successful treatment of bone infections in these patients.
Area of Science:
- Pediatric infectious diseases
- Hematology
- Orthopedics
Context:
- Sickle cell disease (SCD) predisposes children to infections, including osteomyelitis.
- Osteomyelitis in SCD patients presents diagnostic challenges, often mimicking bone infarcts.
- Salmonella species are a common cause of osteomyelitis in children with SCD.
Purpose:
- To analyze the epidemiology and causative agents of osteomyelitis in children with sickle cell disease.
- To evaluate diagnostic methods and treatment outcomes for osteomyelitis in this population.
- To provide recommendations for the initial management of suspected osteomyelitis in children with SCD.
Summary:
- A retrospective study identified 23 children with sickle cell disease experiencing 24 episodes of osteomyelitis between 1977 and 1989.
- Salmonella was the most frequent pathogen (12 cases), followed by coagulase-negative Staphylococcus (3 cases).
- The femur was the most commonly affected bone; hand-foot syndrome with osteomyelitis occurred in younger children.
- Diagnostic procedures included bone aspiration and radionuclide scans, with satisfactory outcomes reported in all cases.
- Early scintigraphy, bone aspiration, or biopsy are recommended for diagnosis, with broad-spectrum antibiotics including coverage for Salmonella for initial therapy.
Impact:
- Highlights the significant risk of osteomyelitis in children with sickle cell disease.
- Emphasizes the importance of considering Salmonella in the differential diagnosis.
- Informs clinical practice regarding diagnostic workup and empirical antimicrobial therapy for osteomyelitis in SCD patients.
Abstract:
From 1977 to 1989, 23 children with sickle cell disease were identified as having 21 episodes of acute and 3 episodes of chronic osteomyelitis, respectively. The responsible organisms were found in 17 cases: Salmonella (12 cases), coagulase-negative Staphylococcus (3 cases). Haemophilus influenzae (1 case), Escherichia coli (1 case). The mean age was 7 7/12 years. In 15 patients, osteomyelitis occurred in 1 bone; osteomyelitis of more than one bone was recorded in 9 cases. The most commonly affected bone was the femur (7 episodes); 5 episodes of hand-foot syndrome with osteomyelitis occurred in children in the first 2 years of life (mean age 16 months). Two patients had a Salmonella vertebral osteomyelitis. Incision and drainage were performed in 5 cases and bone aspiration in 9 cases. Etiologic agents were obtained with these two procedures in respectively 5 and 3 cases. Radionuclide scans were used in 7 episodes: uptake on bone scan was increased in 5 cases and normal in 2. In all cases, the outcome was satisfactory. Differentiation from acute bone infarcts in difficult. An extensive workup is required to confirm the diagnosis of infection: early scintigraphy, bone aspiration or surgical biopsy in patients with negative blood cultures should be performed. Until the results of cultures, the antimicrobial regimen chosen for initial therapy should be broad enough to treat the likely etiologic agents including Salmonella.