[Osteomyelitis in patient with sickle cell disease]

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.