Fournier's gangrene complicated by lower limb necrotising fasciitis and pelvic bone osteomyelitis: A case report with literature review.

INTRODUCTION AND IMPORTANCE: Fournier's gangrene is a urological emergency associated with high mortality and morbidity. Severe gangrene resulting in pelvic bone and lower limb involvement are extremely rare. CASE PRESENTATION: We report a rare case of Fournier's gangrene that is complicated by necrotising fasciitis of the lower limb and osteomyelitis of the pelvic bone, in a patient with previous prostatic adenocarcinoma. The patient was promptly resuscitated, started on broad spectrum antibiotics and then underwent an emergent surgical debridement, followed by multiple relook debridement and definitive reconstruction. Throughout the patient's hospitalisation, he was managed in a multidisciplinary team involving surgeons from different specialities, physicians and allied health staff. CLINICAL DISCUSSION: Extension of Fournier's gangrene into distant structures is rare but serious complications. To date, there is only one other case reported in literature. The relationship between prior prostatic malignancy and Fournier's gangrene can be explored in subsequent studies. CONCLUSION: We present a rare case of Fournier's gangrene with pelvic and distal limb involvement. We highlight the possible yet devastating complications of this disease and discuss treatment options available for the holistic management of patients with Fournier's gangrene.

Infectious Aspects of Chronic Wounds.

The treatment, maintenance, and suppression of infection in chronic wounds remain a challenge to all practitioners. From an infectious disease standpoint, knowing when a chronic wound has progressed from colonized to infected, when to use systemic antimicrobial therapy and when and how to culture such wounds can be daunting. With few standardized clinical guidelines for infections in chronic wounds, caring for them is an art form. However, there have been notable advances in the diagnosis, treatment, and management of infected wounds. This article will discuss the pathophysiology of infection in older adults, including specific infections such as cutaneous candidiasis, necrotizing soft tissue infection, osteomyelitis, and infections involving hardware.

A Tale of Two Diagnoses; Gout Vs Chronic Osteomyelitis. A Case Report.

Gout can potentially be diagnosed clinically and treated, if classical symptoms are present. In some cases, gout and osteomyelitis can have similar presenting signs and symptoms and it may be difficult to differentiate just on clinical presentation, routine laboratory workup and imaging like radiography or ultrasound. Arthrocentesis can be crucial in such scenarios to differentiate the two entities as missed opportunity to treat infectious etiology can have detrimental outcomes. We present a case of patient with ankle pain and swelling treated as recurrent gout, as there were no risk factors for osteomyelitis. Arthrocentesis confirmed the diagnosis of osteomyelitis and patient was treated with intravenous antibiotics, resulting in resolution of symptoms.

Patient-reported outcome survey of user-experiences in the spinal cord injured-community with MPPT for treating wounds and pressure injuries and for controlling soft tissue infection caused by osteomyelitis.

Background: People with spinal cord injury (SCI) are at high risk of developing pressure injuries. Reports in the SCI-community had indicated that a new class of wound treatment, MPPT (micropore-particle-technology), was effective in treating pressure injuries. The British Spinal Injuries Association therefore conducted a survey among MPPT-users to learn from their experiences. Methods: Online survey restricted to individuals with spinal cord injury. Participants were requested to identify themselves to permit validation of statement. Results: The survey had 41 respondents reporting on a total of 49 wounds of which the two main categories were wounds (n = 33), primarily pelvic pressure ulcers; and draining fistulas (n = 9) caused by osteomyelitis. All wounds reported had reached full closure. Median duration of MPPT use and time to closure were 3 and 4 weeks for acute wounds (<6 weeks old) and 8 and 10 weeks for chronic wounds, respectively. On draining fistulas, MPPT had been used to reduce wound size, remove soft tissue infection, avoid sepsis, reduce autonomic dysreflexia, improve overall health, and avoid bed rest, whilst waiting for surgery. Comments on MPPT were 84% highly positive, 11% positive, and 0% negative. No adverse events were reported. Conclusions: MPPT achieved a 100% closure rate of acute and chronic wounds, and, in draining fistulas, effectively controlled soft tissue infection resulting from osteomyelitis. MPPT does not require bed rest and is suitable for self-care and telemedicine, promoting independence and higher quality-of-life. The findings strongly agree with a recent clinical study of MPPT.

Metastatic Disease Mimicking Osteomyelitis in the Foot.

Cervical cancer most commonly spreads hematogenously to the lungs, liver, and bone. However, it rarely metastasizes to the foot. There is only one other case of cervical cancer with metastasis to the foot. In addition, the initial imaging of metastatic disease has difficulty in differentiating from infectious or other inflammatory processes, particularly in a clinical setting highly suspicious of infectious sources. Here, we present a rare case of cervical cancer metastasizing to the calcaneus masquerading as osteomyelitis, highlighting the importance of diagnostic imaging in conjunction with histological confirmation.

Initial therapeutic evidence of a borosilicate bioactive glass (BSG) and Fe3O4 magnetic nanoparticle scaffold on implant-associated Staphylococcal aureus bone infection.

Implant-associated Staphylococcus aureus (S. aureus) osteomyelitis is a severe challenge in orthopedics. While antibiotic-loaded bone cement is a standardized therapeutic approach for S. aureus osteomyelitis, it falls short in eradicating Staphylococcus abscess communities (SACs) and bacteria within osteocyte-lacuna canalicular network (OLCN) and repairing bone defects. To address limitations, we developed a borosilicate bioactive glass (BSG) combined with ferroferric oxide (Fe3O4) magnetic scaffold to enhance antibacterial efficacy and bone repair capabilities. We conducted comprehensive assessments of the osteoinductive, immunomodulatory, antibacterial properties, and thermal response of this scaffold, with or without an alternating magnetic field (AMF). Utilizing a well-established implant-related S. aureus tibial infection rabbit model, we evaluated its antibacterial performance in vivo. RNA transcriptome sequencing demonstrated that BSG + 5%Fe3O4 enhanced the immune response to bacteria and promoted osteogenic differentiation and mineralization of MSCs. Notably, BSG + 5%Fe3O4 upregulated gene expression of NOD-like receptor and TNF pathway in MSCs, alongside increased the expression of osteogenic factors (RUNX2, ALP and OCN) in vitro. Flow cytometry on macrophage exhibited a polarization effect towards M2, accompanied by upregulation of anti-inflammatory genes (TGF-ß1 and IL-1Ra) and downregulation of pro-inflammatory genes (IL-6 and IL-1ß) among macrophages. In vivo CT imaging revealed the absence of osteolysis and periosteal response in rabbits treated with BSG + 5%Fe3O4 + AMF at 42 days. Histological analysis indicated complete controls of SACs and bacteria within OLCN by day 42, along with new bone formation, signifying effective control of S. aureus osteomyelitis. Further investigations will focus on the in vivo biosafety and biological mechanism of this scaffold within infectious microenvironment.

Secondary mandibular osteomyelitis complicated with a pathological fracture.

INTRODUCTION AND IMPORTANCE: Pathological mandibular fractures, defined as fractures that occur in regions where bone has been weakened by an underlying pathological process, are rare, accounting for fewer than 2 % of all fractures of the mandible. Mandibular pathological fractures can have several aetiologies including osteomyelitis, osteoradionecrosis (ORN), surgical interventions, bisphosphonate-related osteochemonecrosis of the jaw and tumoral lesions. CASE PRESENTATION: We present a case of a 13-year-old male patient following a tooth infection with a right facial swelling and limited mouth opening, multiple purulent cutaneous fistulas and mandibular hypoplasia. Intraoral examination revealed the presence of generalized calculus, dental mobility in quadrants 3 and 4. We carried out an orthopantomography which revealed a mandibular angle fracture and the diagnosis of secondary mandibular osteomyelitis with pathological fracture was retained. Sequestrectomy was carried out followed by an open reduction with mini reconstruction plates. CLINICAL DISCUSSION: At 13 years old, this patient with a secondary mandibular osteomyelitis, to the best of our knowledge is the youngest case reported having a secondary mandibular osteomyelitis as etiology of his pathological fracture. Due to the early onset, the patient presented with a bird's profile clinically. His pathological fracture was due to a vicious cycle limiting bone turnover created by the secondary osteomyelitis. CONCLUSION: Pathological mandibular fractures are complex and challenging to treat because of their different aetiologies and also clinicians often have to deal with individuals with grossly infected bone with the fracture management dependent on the resulting bony defect.

Surgical management of scapular osteomyelitis with secondary septic arthritis of the gleno-humeral joint in a 12 year old boy: A case report.

INTRODUCTION AND IMPORTANCE: Acute scapular osteomyelitis is an exceptional entity with a misleading clinical presentation. If not urgently diagnosed and treated correctly, it may lead to articular surfaces damage, deformation of the humeral head, and humerus shortening. CASE PRESENTATION: A 12-year-old boy without any medical history with osteomyelitis of the scapular neck complicated with secondary septic arthritis of the gleno-humeral joint was evaluated. Through a posterior surgical approach, a large washout and articular drainage were performed. In the last follow-up visit 18 months later, the functional result was satisfactory: complete loss of pain, good shoulder mobility, and no anatomical anomalies were noted. CLINICAL DISCUSSION: The most frequent site of hematogenous acute osteomyelitis is the long bones' metaphysis. Flat and short bones are rarely involved. The delayed diagnosis can be explained by unusual clinical presentation, so clinicians should point their reflections towards this particular entity because an early diagnosis as well as early treatment is crucial in order to achieve a satisfactory anatomical and functional result. Late diagnosis can be the cause of articular surface damage, and the involvement of the proximal humerus may lead to deformation of the humeral head. Early diagnosis and urgent treatment are the key combination for a satisfying outcome. CONCLUSION: Acute osteomyelitis of the scapula requires specific surgical management to avoid any further complications, especially in children. We call attention to the importance of both urgent medical and surgical treatment for a better functional and anatomical outcome.

Infective endocarditis and spondylodiscitis-impact of sequence of surgical therapy on survival and recurrence rate.

OBJECTIVES: To date, there are no standardized treatment algorithms or recommendations for patients with infective endocarditis (IE) and concomitant spondylodiscitis (SD). Therefore, our aim was to analyse whether the sequence of surgical treatment of IE and SD has an impact on postoperative outcome and to identify risk factors for survival and postoperative recurrence. METHODS: Patients with IE underwent surgery in 4 German university hospitals between 1994 and 2022. Univariable and multivariable analyses were performed to identify possible predictors of 30-day/1-year mortality and recurrence of IE and/or SD. RESULTS: From the total IE cohort (n = 3991), 150 patients (4.4%) had concomitant SD. Primary surgery for IE was performed in 76.6%, and primary surgery for SD in 23.3%. The median age was 70.0 (64.0-75.6) years and patients were mostly male (79.5%). The most common pathogens detected were enterococci and Staphylococcus aureus followed by streptococci, and coagulase-negative Staphylococci. If SD was operated on first, 30-day mortality was significantly higher than if IE was operated on 1st (25.7% vs 11.4%; P = 0.037) and we observed a tendency for a higher 1-year mortality. If IE was treated 1st, we observed a higher recurrence rate within 1 year (12.2% vs 0%; P = 0.023). Multivariable analysis showed that primary surgery for SD was an independent predictor of 30-day mortality. CONCLUSIONS: Primary surgical treatment for SD was an independent risk factor for 30-day mortality. When IE was treated surgically 1st, the recurrence rate of IE and/or SD was higher.

Latent Chronic Osteomyelitis Presenting Decades After Initial Trauma: A Case Report and Literature Review.

Osteomyelitis is an inflammatory bone process secondary to infection, and often presents as a chronic, recurrent illness, posing diagnostic and treatment challenges. It is frequently the result of previous inadequate treatment or undiagnosed acute infection. Clinical suspicion, thorough evaluation, laboratory studies, and advanced imaging modalities such as magnetic resonance imaging (MRI) and computed tomography (CT) play crucial roles in diagnosis. Treatment typically entails a combination of antibiotics and surgical debridement to eliminate infection and facilitate bone healing. In this report, we present a rare case involving a 64-year-old male who presented with new-onset pain in the right femur decades after experiencing a complicated femur fracture and forearm crush injury. Imaging studies revealed evidence of chronic osteomyelitis, leading to a diagnosis of latent infection. The patient underwent a comprehensive evaluation, including clinical examination, imaging studies, laboratory tests, and bone biopsy, confirming the diagnosis. This case of latent osteomyelitis highlights the clinical presentation, diagnostic modalities, and treatment strategies employed in managing this challenging condition.

RANKL-mediated osteoclast formation is required for bone loss in a murine model of Staphylococcus aureus osteomyelitis.

Staphylococcus aureus osteomyelitis leads to extensive bone destruction. Osteoclasts are bone resorbing cells that are often increased in bone infected with S. aureus. The cytokine RANKL is essential for osteoclast formation under physiological conditions but in vitro evidence suggests that inflammatory cytokines may by-pass the requirement for RANKL. The goal of this study was to determine whether RANKL-dependent osteoclast formation is essential for the bone loss that occurs in a murine model of S. aureus osteomyelitis. To this end, humanized-RANKL mice were infected by direct inoculation of S. aureus into a unicortical defect in the femur. Mice were treated with vehicle or denosumab, a human monoclonal antibody that inhibits RANKL, both before and during a 14-day infection period. The severe cortical bone destruction caused by infection was completely prevented by denosumab administration even though the bacterial burden in the femur was not affected. Osteoclasts were abundant near the inoculation site in vehicle-treated mice but absent in denosumab-treated mice. In situ hybridization demonstrated that S. aureus infection potently stimulated RANKL expression in bone marrow stromal cells. The extensive reactive bone formation that occurs in this osteomyelitis model was also reduced by denosumab administration. Lastly, there was a notable lack of osteoblasts near the infection site suggesting that the normal coupling of bone formation to bone resorption was disrupted by S. aureus infection. These results demonstrate that RANKL-mediated osteoclast formation is required for the bone loss that occurs in S. aureus infection and suggest that disruption of the coupling of bone formation to bone resorption may also contribute to bone loss in this condition.

Key risk factors and adverse outcomes in metachronous vertebral osteomyelitis following periprosthetic joint infection: A 5-year retrospective study.

Purpose: Periprosthetic joint infection (PJI) is a leading cause of joint arthroplasty failure, potentially leading to critical complications like vertebral osteomyelitis (VO). The factors contributing to VO after PJI and the outcomes for these patients are not well understood. Our study aims to (1) identify risk factors for VO following PJI and (2) assess the clinical outcomes in these cases. Methods: We included PJI patients treated surgically at our centre from January 2006 to December 2020, excluding those with simultaneous VO post-PJI. Our focus was on patients with VO occurring after PJI, monitored for at least 5 years. Analysis included patient comorbidities, PJI treatment approaches, pathogen identification and clinical outcomes. Results: Of 1701 PJI cases, 21 (1.23%) developed VO. Key risk factors for VO post-PJI were identified: systemic inflammatory response syndrome, substance misuse, polymicrobial infection and undergoing at least three stages of resection arthroplasty (odds ratios: 1.86, 54.28, 52.33 and 31.88, respectively). Adverse outcomes were noted in VO patients, with recurrent VO in 6/21 and repeated PJIs in 18/21 cases. Conclusions: Patients with PJI, especially those with certain risk factors, have an increased likelihood of developing VO and encountering negative outcomes. The potential role of bacteremia in the development of VO after PJI needs further exploration. Level of Evidence: Level III.

Clinical prediction for surgical versus nonsurgical interventions in patients with vertebral osteomyelitis and discitis.

Background: Vertebral osteomyelitis and discitis (VOD), an infection of intervertebral discs, often requires spine surgical intervention and timely management to prevent adverse outcomes. Our study aims to develop a machine learning (ML) model to predict the indication for surgical intervention (during the same hospital stay) versus nonsurgical management in patients with VOD. Methods: This retrospective study included adult patients (≥18 years) with VOD (ICD-10 diagnosis codes M46.2,3,4,5) treated at a single institution between 01/01/2015 and 12/31/2019. The primary outcome studied was surgery. Candidate predictors were age, sex, race, Elixhauser comorbidity index, first-recorded lab values, first-recorded vital signs, and admit diagnosis. After splitting the dataset, XGBoost, logistic regression, and K-neighbor classifier algorithms were trained and tested for model development. Results: A total of 1,111 patients were included in this study, among which 30% (n=339) of patients underwent surgical intervention. Age and sex did not significantly differ between the two groups; however, race did significantly differ (P<0.0001), with the surgical group having a higher percentage of white patients. The top ten model features for the best-performing model (XGBoost) were as follows (in descending order of importance): admit diagnosis of fever, negative culture, Staphylococcus aureus culture, partial pressure of arterial oxygen to fractional inspired oxygen ratio (PaO2:FiO2), admit diagnosis of intraspinal abscess and granuloma, admit diagnosis of sepsis, race, troponin I, acid-fast bacillus culture, and alveolar-arterial gradient (A-a gradient). XGBoost model metrics were as follows: accuracy =0.7534, sensitivity =0.7436, specificity =0.7586, and area under the curve (AUC) =0.8210. Conclusions: The XGBoost model reliably predicts the indication for surgical intervention based on several readily available patient demographic information and clinical features. The interpretability of a supervised ML model provides robust insight into patient outcomes. Furthermore, it paves the way for the development of an efficient hospital resource allocation instrument, designed to guide clinical suggestions.

A case of recurrent osteomyelitis due to retained micro-catheter after cerebral angiography.

Infections associated with healthcare manipulations, particularly bloodstream infections stemming from catheters and medical devices, significantly heighten the probability of vertebral osteomyelitis. The diagnosis of infective endocarditis (IE) frequently overlaps with vertebral osteomyelitis (VO). In cases where individuals are suspected of having hematogenous vertebral osteomyelitis and have an intravascular catheter or device, it is recommended to undertake blood culture collection. We present a case of a 39-year-old male with a history of interventional AVM embolization and cerebral angiography, experiencing recurrent vertebral osteomyelitis. No definitive source of infection had been found, and transthoracic echocardiography (TTE) yielded negative results for IE. In Trans Esophageal Echocardiography (TEE), a retained micro-catheter extending from the aortic arch to the inguinal artery was discovered. Although we cannot definitively attribute the source of the osteomyelitis to the retained micro-catheter, no episodes of infection have been reported ever since. This case underscores the need to enhance our approaches and guidelines related to operating protocols in the surgical setting. Improving these guidelines can prevent similar occurrences in the future, emphasizing the importance of continuous improvement in healthcare practices.

Malassezia restricta as an unexpected cause of infectious osteomyelitis diagnosed by metagenomic sequencing: a case report and literature review.

BACKGROUND: Malassezia restricta, a lipophilic and lipodependent yeast belonging to the basidiomycetes group, is an opportunistic fungal pathogen associated with various skin diseases, including seborrheic dermatitis and dandruff. Typically, Malassezia infection in neonates manifests as fungemia or hematogenous dissemination to the bone or lungs. However, vertebral osteomyelitis caused by these fungi is rarely reported owing to non-specific clinical presentations and laboratory/imaging findings. The Pathogen Metagenomics Sequencing (PMseq) technique enables direct high-throughput sequencing of infected specimens, facilitating the rapid and accurate detection of all microorganisms in clinical samples through comprehensive reports. CASE PRESENTATION: A 52-year-old male was admitted to our hospital on July 20, 2022 with a 3-month history of ambulatory difficulties and localized low back pain. Magnetic Resonance Imaging (MRI) examination of the spinal column revealed irregular bone destruction affecting the L2, L3, and L5 vertebral bodies. Additionally, low T1 and high T2 intensity lesions were observed at the intervertebral discs between L3 and L5. The presumptive diagnosis of tuberculous spondylitis was made based on the imaging findings, despite negative results in all mycobacterium tests. However, the patient exhibited no improvement after receiving regular anti-tuberculosis treatment for 3 months. Subsequent MRI revealed an expansive abnormal signal within the vertebral body, leading to progressive bone destruction. The absence of spinal tuberculosis or other infective microorganisms was confirmed through culture from blood and pathological tissue from the L4 vertebral body. Subsequently, PMseq was performed on the specimens, revealing M. restricta as the predominant pathogen with the highest relative abundance value. The pathological examination revealed the presence of fungal mycelium in the L4 vertebral body, with positive findings on periodic Schiff-methenamine and periodic acid-Schiff staining. The anti-tuberculosis treatment was discontinued, and an antifungal combination of fluconazole and voriconazole was administered. All symptoms were resolved after 7 consecutive months of treatment, and the patient was able to ambulate autonomously. Vertebral lesions were reduced on MRI during the 13-month follow-up. CONCLUSIONS: M. restricta is not a commonly recognized pathogen associated with infectious vertebral osteomyelitis. However, PMseq can aid in diagnosis, timely treatment, and decision making for some non-specific infectious diseases.

Robinsoniella peoriensis Infections in Humans-A Narrative Review.

Robinsoniella peoriensis is a Gram-positive, strictly anaerobic, spore-forming, rod-shaped bacterium belonging to the phylum Firmicutes and the family Lachnospiraceae. Until now, R. peoriensis is the only species of its genus. It was first isolated in 2003 during a study into the flora of lagoons and manure pits. Given the rarity of this microorganism and the sparse information in the literature about its way of transmission, the way to diagnose its infections and identify it in the microbiology laboratory, and its public health relevance, the present study aimed to identify all the published cases of Robinsoniella, describe the epidemiological, clinical, and microbiological characteristics, and provide information about its antimicrobial resistance, treatment, and outcomes. A narrative review was performed based on a Pubmed/Medline and Scopus databases search. In total, 14 studies provided data on 17 patients with infections by Robinsoniella. The median age of patients was 63 years and 47% were male. The most common types of infection were bone and joint infections, bacteremia, infective endocarditis, and peritonitis. The only isolated species was R. peoriensis, and antimicrobial resistance to clindamycin was 50%, but was 0% to the combination of piperacillin with tazobactam, aminopenicillin with a beta-lactamase inhibitor, and metronidazole which were the most commonly used antimicrobials for the treatment of these infections. The overall mortality depends on the type of infection and is notable only for bacteremia, while all other infections had an optimal outcome. Future studies should better assess these infections' clinical and epidemiological characteristics and the mechanisms of the antimicrobial resistance of this microorganism from a mechanistic and genetic perspective.

A Case Report of Brodie's Abscess of the Cuboid Treated by Anatomic Antibiotic-Cement Spacer.

Background: A case of chronic osteomyelitis with Brodie's abscess of the cuboid caused by a wooden foreign body penetrating the plantar foot. Total cuboidectomy was carried out with implantation of an anatomically molded antibiotic-impregnated cement spacer with culture-specific postoperative intravenous antibiotics. At six months of follow-up, the patient was completely asymptomatic without evidence of a recurrence of infection. Final radiographs also didn't show spacer migration or surrounding bone erosions. The spacer obviated the need for any foot fusion which preserved foot biomechanics. The patient didn't need to use any braces or insoles. Conclusion: Osteomyelitis should always be on the differential list of lytic lesions of the tarsal bones, especially if there is a history of prior foot trauma. In this case, cuboid excision and placement of an antibiotic-impregnated cement spacer provided sustained relief of symptoms without evidence of recurrence or complications for six months.Level of Evidence: V.

Ambiguity of Primary Patellar Tuberculous Osteomyelitis as a Pre-Patellar Bursitis: A Case Report.

CASE: A 47-year-old male with swelling over the patella and associated pain, subsiding with medicines but recurring after a few days. Diagnosed as prepatellar bursitis by the family physician, it eventually turns out to be osteomyelitis of the patella. Treated with curettage, biopsy, and placement of bio-composite mixed with antibiotics. Intra-operative findings and histopathology confirmed tuberculosis of the patella. On follow-up after 6 years and the completion of anti-tuberculosis treatment, the patient showed full functional and radiological recovery without recurrence. CONCLUSION: Early treatment with antibiotics and surgery gives excellent results. Identifying it as a tuberculous osteomyelitis is challenging when the condition is closely resembles pre-patellar bursitis.

An injectable magnesium-coordinated phosphate chitosan-based hydrogel loaded with vancomycin for antibacterial and osteogenesis in the treatment of osteomyelitis.

Microbial infections of bones, particularly after joint replacement surgery, are a common occurrence in clinical settings and often lead to osteomyelitis (OM). Unfortunately, current treatment approaches for OM are not satisfactory. To address this issue, this study focuses on the development and evaluation of an injectable magnesium oxide (MgO) nanoparticle (NP)-coordinated phosphocreatine-grafted chitosan hydrogel (CMPMg-VCM) loaded with varying amounts of vancomycin (VCM) for the treatment of OM. The results demonstrate that the loading of VCM does not affect the formation of the injectable hydrogel, and the MgO-incorporated hydrogel exhibits anti-swelling properties. The release of VCM from the hydrogel effectively kills S.aureus bacteria, with CMPMg-VCM (50) showing the highest antibacterial activity even after prolonged immersion in PBS solution for 12 days. Importantly, all the hydrogels are non-toxic to MC3T3-E1 cells and promote osteogenic differentiation through the early secretion of alkaline phosphatase and calcium nodule formation. Furthermore, in vivo experiments using a rat OM model reveal that the CMPMg-VCM hydrogel effectively kills and inhibits bacterial growth, while also protecting the infected bone from osteolysis. These beneficial properties are attributed to the burst release of VCM, which disrupts bacterial biofilm, as well as the release of Mg ions and hydroxyl by the degradation of MgO NPs, which inhibits bacterial growth and prevents osteolysis. Overall, the CMPMg-VCM hydrogel exhibits promising potential for the treatment of microbial bone infections.

Orthopedic Manifestations of Disseminated Cryptococcal neoformans Infection in an Immunocompromised Patient: a Case Report.

Introduction: Cryptococccus neoformans is a fungus which typically presents in immunocompromised hosts, commonly presenting as meningoencephalitis. There have been very few documented incidents of intramuscular manifestations of this pathogen. Case Report: We report on a case of a 45-year-old caucasian male with disseminated Cryptococcus neoformans who developed cryptococcal intramuscular abscesses of all extremities and osteomyelitis of the left upper limb. Clinical treatment and surgical debridement of the forearm was performed. Persistent infection resulted in a left humeral amputation and ultimately the patient's death. This is one of the few documented intramuscular abscesses of Cryptococcus neoformans. Conclusion: Orthopedic manifestations of cryptococcal infections are rare; however, awareness and prompt diagnosis may improve outcomes.