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Acute haematogenous osteomyelitis in Nigeria
Tropical and Geographical Medicine
|December 1, 1978
Summary
Acute osteomyelitis is uncommon, particularly in sickle cell disease patients. Infections in these patients often involve Gram-negative bacteria and show antibiotic resistance, leading to severe complications despite conservative treatment.
Area of Science:
- Orthopedics
- Hematology
- Infectious Diseases
Background:
- Osteomyelitis is a bone infection that can be acute or chronic.
- Sickle cell disease is a genetic blood disorder that affects red blood cells.
- Patients with sickle cell disease are at increased risk for certain infections.
Purpose of the Study:
- To investigate the incidence and characteristics of acute osteomyelitis in patients with different hemoglobin genotypes.
- To compare the clinical presentation, causative organisms, and treatment outcomes of acute osteomyelitis in sickle cell disease patients versus those with normal hemoglobin.
- To highlight the challenges in managing acute osteomyelitis in sickle cell disease, including antibiotic resistance and complications.
Main Methods:
- Retrospective analysis of 125 consecutive osteomyelitis cases over a minimum of six months follow-up.
- Classification of patients based on hemoglobin genotype: normal (AA), sickle cell trait (AS), homozygous sickle cell disease (SS), sickle cell hemoglobin C disease (SC), and hemoglobin AC trait.
- Detailed review of patient demographics, clinical presentation, diagnostic findings, treatment modalities, and outcomes.
Main Results:
- Acute osteomyelitis accounted for less than a quarter of all osteomyelitis cases.
- In acute osteomyelitis, 1/3 occurred in normal hemoglobin (AA), 1/3 in SS and SC disease, and 1/4 in AS and AC trait.
- Gram-negative bone infections and multiple diaphysial involvement were more common in SS and SC disease. High antibiotic resistance was observed.
- Conservative treatment was common, with no deaths but high complication rates.
Conclusions:
- Acute osteomyelitis is less frequent but presents with distinct patterns in sickle cell disease patients.
- Gram-negative infections and antibiotic resistance pose significant challenges in managing osteomyelitis in SS and SC disease.
- Early diagnosis, sensitivity testing, and prompt surgical intervention in non-sickle cell patients are crucial for better outcomes.