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Osteomyelitis variolosa: Forgotten complication of an eradicated disease
Ankit Khurana1, Anand Vardhan1, Deepak Negi2
1Department of Orthopaedics, AIIMS, New Delhi, India.
Background:
Orthopedic manifestations and sequelae of small pox disease are largely forgotten. Presening features in the modern era are not only the classical deformities but also includes precocious arthritis, pathological fractures and joint instability.
Objectives:
To conduct a thorough and systematic review of the literature for all articles reporting osteomyelitis variolosa and its sequelae post eradication and to present an additional case as an illustration.
Study Design:
Systematic review and case report.
Method:
ology: PubMed, EMBASE and Google Scholar databases were searched for relevant articles using different combinations of the keywords till 20th June 2017. All articles reporting cases of osteomyelitis variolosa following small pox eradication were included. Pearling of the bibliographies of selected articles was conducted to locate articles missed by the primary database search. Data from these reports were collected on pre-defined forms and the results were analysed.
Results:
A total of 8 cases have been reported in the literature so far post-eradication of small pox and all cases are from India. These cases have predominant involvement of elbow followed by hands, feet and ankle. Characteristic clinical signs in the present era are secondary arthritis, pathological fractures, joint instability and some cases even have incidental presentation.The diagnosis is further confirmed by plain radiographs which show pathognomonic features of this condition. Rate of missed/misdiagnosis is very high due to rarity of this condition. All cases in the published literature were managed conservatively except those presenting with pathological fracture.
Conclusions:
The purpose of this study is to remind clinicians of an easily recognised sequelae of an eradicated disease and make them aware of its complications.
Insights
Osteomyelitis variolosa, a complication of smallpox, presents with arthritis and fractures even after disease eradication. This review highlights its modern manifestations and diagnostic challenges.
Area of Science:
- Orthopedics
- Infectious Diseases
- Public Health
Background:
- Orthopedic complications of smallpox are often overlooked.
- Modern presentations include arthritis, fractures, and joint instability.
Purpose of the Study:
- To systematically review literature on osteomyelitis variolosa post-smallpox eradication.
- To present a case illustrating the condition.
Main Methods:
- Systematic literature review of PubMed, EMBASE, and Google Scholar.
- Inclusion of all reported cases of osteomyelitis variolosa after smallpox eradication.
- Data collection and analysis of reported cases.
Main Results:
- Eight cases reported post-eradication, all from India.
- Elbow involvement is most common, followed by hands, feet, and ankle.
- Diagnosis confirmed by radiographs; high rate of misdiagnosis due to rarity.
Conclusions:
- Clinicians should be aware of osteomyelitis variolosa as a sequela of smallpox.
- Recognizing this condition and its complications is crucial.
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