Pseudoglutamicibacter cumminsii in polymicrobial osteomyelitis of the tibia in a female patient - a case report.

Introduction: Pseudoglutamicibacter cumminsii (formerly Arthrobacter cumminsii) is a microorganism rarely reported as a cause of infection. It is a Gram-positive, non-motile, and non-spore-forming bacterium belonging to the Micrococcaceae family. It is known for its environmental ubiquity, being frequently found in soil, water, and other ecological niches. Case report: A 39-year-old woman with a history of glucose-6-phosphate dehydrogenase deficiency and multiple surgeries at the left lower extremity for osteomyelitis at the left tibia presented with a relapse of chronic osteomyelitis of the left tibia. She underwent surgical debridement, and cultures grew Enterococcus faecalis, Pseudomonas aeruginosa, Klebsiella oxytoca, Proteus mirabilis, and Pseudoglutamicibacter cumminsii, according to identification with matrix-assisted laser desorption/ionization-time of flight mass spectrometry. Targeted antimicrobial treatment with ciprofloxacin and amoxicillin-clavulanate for six weeks led to patient recovery. Conclusions: Accurate identification by advanced diagnostic techniques is essential for effectively managing rare pathogens. Further research and reporting of cases are needed to understand better the epidemiology, pathogenesis, optimal treatment, and improved clinical outcomes associated with P. cumminsii infections.

Ilizarov External Fixator Versus Orthofix LRS in Management of Femoral Osteomyelitis: A Propensity Score Matched Analysis.

Purpose: Treatment of osteomyelitis (OM) is challenging. Ilizarov bone transport is a commonly used technique for management of OM. The recently introduced limb reconstruction system (LRS) has been effectively used for management of OM. It was suggested to be easier in use and less invasive. The present retrospective study aimed to compare LRS and Ilizarov bone transport in management of femoral OM using a propensity score matched analysis. Methods: The present retrospective study included 80 consecutive patients with femoral OM. The studied patients were managed either using Ilizarov external fixator (n = 40) or Orthofix LRS (n = 40). The clinical outcome measurements included union time, limb length discrepancy, additional operative procedures, refracture and infection. Results: Patients in the LRS group were exposed to significantly higher frequency of bone transport (30.0 versus 15.0%) and lower frequency of acute compression and lengthening (10.0 versus 32.5%). Patients in Ilizarov group had significantly higher frequency of tobramycin pellets as compared to their counterparts. The studied groups were comparable regarding the operative complications including pin-tract infection, non-union at docking site and refracture. Patients in the Ilizarov had significantly shorter time to union (8.2 ± 3.2 versus 11.0 ± 5.6 months, p = 0.012). No statistically significant differences were found between the studied groups regarding the quality-of-life domains. Conclusions: Use of Ilizarov external fixator and Orthofix LRS devices proved to be effective and reliable. Their influences on patients' quality appear to be comparable.

Clival Osteomyelitis in an Adult Patient: A Case Report.

Clival osteomyelitis is an uncommon skull base infection that mostly affects elderly diabetics and is frequently caused by malignant otitis externa or paranasal sinus infections. It manifests as severe otalgia, fever, auditory fullness, and purulent otorrhea. Clinical history, physical examination, test data, radiographic findings, and pathogen identification all contribute to a diagnosis. Treatment consists of extended intravenous broad-spectrum antibiotics, with severe cases necessitating surgical debridement. We present a case of a 20-year-old girl with bilateral ear discharge, nasal blockage, and purulent rhinorrhea, as well as a dull neck ache increased by extension. An MRI revealed osteomyelitis in the clivus and right atlanto-occipital joint. The clival abscess was drained transnasally using endoscopic techniques. Microbiological tests revealed Streptococcus intermedius. The post-operative recovery was uneventful, with extended antibiotic therapy. Early identification and treatment are critical for preventing serious consequences, as illustrated in this case, where surgical and antibiotic care improves patient outcomes.

A rare case of candida osteomyelitis of the mandible associated with osteoradionecrosis and biofilm formation.

Candida osteomyelitis, in general, is a relatively rare manifestation compared to its bacterial counterparts. The mandible's involvement is rarer, lacking established management and fewer guidelines. Herein, we aim to illustrate the significant challenge in treatment, namely due to the persistent and resistant nature of Candida albicans-associated biofilm. A multidisciplinary approach involving adjunctive use of antifungals with surgical interventions is typically necessary and feasible in this case. However, surgical interventions may not always be possible in challenging instances in which the patient may be structurally (including osteoradionecrosis) and vascularly compromised, raising questions about the feasibility of standard-of-care as well as the success of alternative therapies aimed at disrupting biofilm formation. Clinicians should maintain a high index of suspicion for complicating, deep-seated Candidiasis in at-risk populations and endeavor to treat as aggressively as possible to limit recurrent disease owing to persistence.

A Rare Case of Emphysematous Osteomyelitis With Concurrent Septic Arthritis.

A rare and possibly fatal infection of the bone called emphysematous osteomyelitis (EO) is caused by the presence of intraosseous gas due to gas-forming organisms. Common gas-producing organisms are in the Enterobacteriaceae family or are anaerobes. This gas within bones is most frequently detected using computed tomography (CT) imaging, and prompt diagnosis is important due to the high mortality rate. We present a 76-year-old male who complained of altered mental status, right upper and lower extremity weakness, and lower back pain. The MRI of the lumbar spine showed moderate edema in L3 and L4, with fluid in L3-L4 and L4-L5 concerning discitis/osteomyelitis. A CT-guided biopsy of L3/L4 was then performed by interventional radiology, revealing air present in the L3 and L4 vertebral bodies. Bone cultures from the L3 and L4 vertebra were later positive for E. coli that was susceptible to all tested antibiotics, and this was consistent with a diagnosis of vertebral EO. The infectious disease team recommended a six-week course of intravenous ceftriaxone. During the patient's hospital stay, he also developed a septic right knee joint positive for E. coli, alongwith the concurrent vertebral EO.

Septic Arthritis of the Knee Due to Chronic Osteomyelitis of the Femur in an Adult: A Case Report.

Introduction: Adult cases of septic arthritis due to concomitant persistent osteomyelitis are incredibly uncommon. This study describes a rare example of septic arthritis in an adult's knee joint caused by long-term femur osteomyelitis. A cement rod laced with antibiotics proved to be an effective treatment for the illness. Case Report: A case of septic knee arthritis caused by reactivated chronic osteomyelitis is described in this study. Initial radiographs revealed an osteolytic lesion, prompting further imaging, including a magnetic resonance imaging, which verified the diagnosis. To treat the infected intra-articular knee joint and ream the femoral intramedullary canal, we chose open debridement over arthroscopic surgery based on the patient's history, physical examination, and imaging data. To close the dead space and remove the infection, a cement rod impregnated with antibiotics was placed into the medullary cavity, in addition to administering long-term antibiotic treatment. This approach was successful in eradicating the infection. Following a period of rehabilitation, the patient regained the ability to walk independently. Conclusion: Cement rods infused with antibiotics are effective for delivering high doses of antibiotics locally while providing structural support to the bone. Over the last three decades, they have demonstrated encouraging outcomes in treating infections, and due to their affordability, simplicity, and effectiveness, they remain an excellent treatment option. Here, we highlight the use of colistin in making antibiotic-coated cement rods for the eradication of chronic, long-standing infection.

Granulocyte colony-stimulating factor mediates bone loss via the activation of IL-1ß/JNK signaling pathway in murine Staphylococcus aureus-induced osteomyelitis.

Staphylococcus aureus (S. aureus)-induced bone loss is a significant challenge in the treatment of osteomyelitis. Our previous study was the first to confirm that granulocyte colony-stimulating factor (G-CSF) mediates S. aureus-induced bone loss. However, the underlying mechanism remains unknown. The objective of this study was to elucidate this. We found G-CSF mediated BMSC senescence and increased IL-1ß concentration of serum and bone marrow in mice after S. aureus infection. Furthermore, we demonstrated that G-CSF promoted the expression of IL1b in murine bone marrow-derived neutrophils. Notably, we identified that IL-1ß mediated BMSC (bone marrow mesenchymal stromal cell) senescence in mice after S. aureus infection. Importantly, IL-1ß neutralizing antibody effectively alleviated BMSC senescence and bone loss caused by S. aureus infection in mice. In terms of molecular mechanism, we found IL-1ß induced BMSC senescence by JNK/P53 and JNK/BCL2 pathways. Collectively, G-CSF promotes IL-1ß production which induces BMSC senescence via JNK/P53 and JNK/BCL2 pathways, leading to S. aureus-induced bone loss. This study identified novel targets for preventing and treating S. aureus-induced bone loss in osteomyelitis.

Pubic symphysis osteomyelitis associated with costal osteitis caused by Staphylococcus aureus after trauma: A case report.

Osteomyelitis of the pubic symphysis is a rare infectious disease commonly caused by the opportunistic bacteria Staphylococcus aureus and Pseudomonas aeruginosa. The clinical context includes fever, and pubic, or abdominal pain, thus should prompt a biological, microbiological, and radiological assessment. We report the case of a 16-year-old patient who developed inflammatory pygalgia in a febrile context laboratory examination showed an elevation of C-reactive protein and sedimentation rate. Pelvic X-rays and magnetic resonance showed bilateral bone lysis and destruction of the edges of the pubic symphysis, in addition to a pubic pelvic collection. Bacteriological examination revealed by methicillin-sensible S. aureus. The patient was put on antibiotic therapy for 2 months with good clinical and radiological evolution without surgical debridement. In conclusion, osteomyelitis of pubic symphysis can be misdiagnosed because of its atypical manifestations. Recovery is often achieved if adequate treatment is started early.

Anterior and posterior surgical approach for vertebral lumbar Mycobacterium abscessus osteomyelitis.

Mycobacterium abscessus (M. abscessus) infections primarily affect immunocompromised patients who commonly present with non-orthopedic infections. We present a case of a 63-year-old female presented with persistent back pain and radicular pain. Computed tomography and magnetic resonance imaging showed a large multiloculated anterior epidural abscess. We show here the unique occurrence of lumbar M. abscessus vertebral osteomyelitis, which was treated with L2 and L3 corpectomies, anterior lumbar interbody fusion, and posterior instrumentation via an anterolateral thoracoabdominal (TA) incision. Vascular surgery provided L1-L4 spine exposure via a left anterolateral TA incision, whereas orthopedic surgery performed L2 and L3 corpectomies with lumbar cage placement and posterior instrumentation in two separate procedures. The patient was discharged to a skilled nursing facility, retaining all neurological function, and is progressing well on follow-up.

Genetic background affects neutrophil activity and determines the severity of autoinflammatory osteomyelitis in mice.

The knowledge about the contribution of the innate immune system to health and disease is expanding. However, to obtain reliable results, it is critical to select appropriate mouse models for in vivo studies. Data on genetic and phenotypic changes associated with different mouse strains can assist in this task. Such data can also facilitate our understanding of how specific polymorphisms and genetic alterations affect gene function, phenotypes, and disease outcomes. Extensive information is available on genetic changes in all major mouse strains. However, comparatively little is known about their impact on immune response and in particular on innate immunity. Here, we analyzed a mouse model of chronic multifocal osteomyelitis (CMO), an autoinflammatory disease driven exclusively by the innate immune system, which is caused by an inactivating mutation in the Pstpip2 gene. We investigated how the genetic background of BALB/c, C57BL/6J, and C57BL/6NCrl strains alters the molecular mechanisms controlling disease progression. While all mice developed the disease, symptoms were significantly milder in BALB/c and partially also in C57BL/6J when compared to C57BL/6NCrl. Disease severity correlated with the number of infiltrating neutrophils and monocytes and with the production of chemokines attracting these cells to the site of inflammation. It also correlated with increased expression of genes associated with autoinflammation, rheumatoid arthritis, neutrophil activation, and degranulation, resulting in altered neutrophil activation in vivo. Together, our data demonstrate striking effects of genetic background on multiple parameters of neutrophil function and activity influencing the onset and course of the CMO disease.

Analysis of PANoptosis-related ceRNA network reveals lncRNA MIR17HG involved in osteogenic differentiation inhibition impaired by tumor necrosis factor-α.

BACKGROUND: Inflammatory cytokines such as Interleukin 1ß(IL1ß), IL6,Tumor Necrosis Factor-α (TNF-α) can inhibit osteoblast differentiation and induce osteoblast apoptosis. PANoptosis, a newly identified type of programmed cell death (PCD), may be influenced by long noncoding RNA (lncRNAs) which play important roles in regulating inflammation. However, the potential role of lncRNAs in inflammation and PANoptosis during osteogenic differentiation remains unclear. This study aimed to investigate the regulatory functions of lncRNAs in inflammation and apoptosis during osteogenic differentiation. METHODS AND RESULTS: High-throughput sequencing was used to identify differentially expressed genes involved in osteoblast differentiation under inflammatory conditions. Two lncRNAs associated with inflammation and PANoptosis during osteogenic differentiation were identified from sequencing data and Gene Expression Omnibus (GEO) databases. Their functionalities were analyzed using diverse bioinformatics methodologies, resulting in the construction of the lncRNA-miRNA-mRNA network. Among these, lncRNA (MIR17HG) showed a high correlation with PANoptosis. Bibliometric methods were employed to collect literature data on PANoptosis, and its components were inferred. PCR and Western Blotting experiments confirmed that lncRNA MIR17HG is related to PANoptosis in osteoblasts during inflammation. CONCLUSIONS: Our data suggest that TNF-α-induced inhibition of osteogenic differentiation and PANoptosis in MC3T3-E1 osteoblasts is associated with MIR17HG. These findings highlight the critical role of MIR17HG in the interplay between inflammation, PANoptosis, and osteogenic differentiation, suggesting potential therapeutic targets for conditions involving impaired bone formation and inflammatory responses.

A Case of Winkia neuii (Actinomyces neuii) Vertebral Osteomyelitis and Review of the Literature.

This case report presents an unusual occurrence of Winkia (Actinomyces) neuii vertebral osteomyelitis in a 55-year-old male patient with diabetes mellitus. W. neuii is a distinct species formerly placed within the Actinomyces genus, exhibiting unique morphological and clinical characteristics. Vertebral osteomyelitis caused by Actinomyces species is rare, with only one prior case reported in the literature. The patient was successfully managed with a combination of intravenous ceftriaxone during hospitalization and an oral antibiotic regimen for an extended period. This case report contributes to the limited body of knowledge surrounding W. neuii, as well as actinomycotic vertebral osteomyelitis.

Case Report: Extensive Osteomyelitis of the Craniofacial Skeleton Following Operative Fracture Treatment.

Osteomyelitis is a bone inflammation caused by an infectious microorganism, which may lead to complete structure decay. Over time, along with the discovery and usage of powerful antibiotics, it became a rare occurrence in modern practice. In this paper, we will present a case of a patient with craniofacial osteomyelitis, which occurred as a complication of previous trauma and incomplete surgical treatment, due to lack of compliance. Chronic diseases in the non-cooperative patient led to the development of a severe clinical state. We believe that the existence of communication between defects on the anterior wall of the frontal sinus and corresponding subcutaneous and cutaneous tissue may have prevented further complications, in particular endocranial. Despite of a severe local finding, there was no dramatic increase in inflammatory parameters in laboratory analysis, as expected in such cases. A careful diagnostic procedure, identification of causative agent, adequately applied antibiotic therapy followed by surgical treatment debridement, improved the general condition of the patient as well as local finding. A severe form of osteomyelitis of the facial bones can be a complication after facial bone osteosynthesis. The absence of endocranial complications can be explained by drainage of purulent content through defects in the skin of the face. Quick and precise diagnostics, followed by treatment that includes a combination of surgery and conservative treatment, give the best results in such complex conditions.

Gelatin-based nanoparticles and antibiotics: a new therapeutic approach for osteomyelitis?

The result of infection of bone with microorganisms is osteomyelitis and septic arthritis. Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for most of its cases (more than 50%). Since MRSA is resistant to many treatments, it is accompanied by high costs and numerous complications, necessitating more effective new treatments. Recently, development of gelatin nanoparticles have attracted the attention of scientists of biomedicine to itself, and have been utilized as a delivery vehicle for antibiotics because of their biocompatibility, biodegradability, and cost-effectiveness. Promising results have been reported with gelatin modification and combinations with chemical agents. Although these findings have been suggested that gelatin has the potential to be a suitable option for continuous release of antibiotics in osteomyelitis and septic arthritis treatment, they still have not become routine in clinical practices. The most deliver antibiotic using gelatin-derived composites is vancomycin which is showed the good efficacy. To date, a number of pre-clinical studies evaluated the utility of gelatin-based composites in the management of osteomyelitis. Gelatin-based composites were found to have satisfactory performance in the control of infection, as well as the promotion of bone defect repair in chronic osteomyelitis models. This review summarized the available evidence which provides a new insight into gelatin-derived composites with controlled release of antibiotics.

Comparison of CT-Guided needle biopsy versus percutaneous endoscopic debridement and drainage in pathogen identification and pain outcomes for spondylodiscitis patients: A systematic review and literature review.

Introduction: Spondylodiscitis (SD) is an infection of the intervertebral disc with involvement of the adjacent vertebral bodies. Diagnostic tests with CT-guided biopsy only provide a positive yield in 14%-48% of cases. Percutaneous endoscopic debridement and drainage (PEDD) has recently shown promise in the treatment of spondylodiscitis. Research question: The purpose of this study is to determine differences in pathogen identification and clinical outcomes for PEDD versus CT-guided needle biopsy in SD patients. Materials and methods: We conducted a systematic review of the literature using PRISMA guidelines to determine differences in positive microbiology results, perioperative complications, pain control, and long-term clinical outcomes for PEDD vs. CT-guided needle biopsy in SD patients. Results: 1078 studies were evaluated, 87 of which underwent full review. 15 studies met the inclusion and exclusion criteria, including 7 PEDD, 7 CT-guided biopsy, and 1 CT-guided biopsy vs. PEDD article, for a total of 192 PEDD patients and 604 CT-guided biopsy patients. We found 36.59% of CT-guided biopsy patients had positive microbiology results, compared to 84.38% of PEDD patients. No major perioperative complications occurred as a result of the PEDD procedure. Of the five PEDD studies that reported pain outcomes, greater than 80% of patients experienced relief after intervention. Discussion and conclusion: These results suggest that PEDD may improve pathogen identification while simultaneously reducing pain compared to CT-guided needle biopsy in SD. Although current treatment guidelines recommend CT-guided biopsy, in patients with severe back pain and suspected SD, PEDD can be considered an alternative intervention.

Continuous local antibiotic perfusion for deep infection of the foot and ankle.

BACKGROUND: This study aimed to report the outcome of deep infections of the foot and ankle, which are among the most challenging orthopedic conditions to treat, after continuous local antibiotic perfusion. METHODS: Eleven patients with deep foot and ankle infections were treated with continuous local antibiotic perfusion between January 2019 and March 2024. After surgical debridement, we performed continuous perfusion of high concentrations of gentamicin (60 mg/50 ml) directly into the infected bone and soft tissue for two weeks using bone marrow needles and double-lumen tubes. Patient characteristics, infection relapse, and adverse events were investigated. RESULTS: The mean age of the patients was 53 years (range 12-79 years), with six males and five females. The infections were controlled without additional surgeries in ten patients with a mean follow-up of 40 months (12-62 months). Two patients developed a fungal infection, of which one required an additional debridement surgery, and the other was treated with oral antifungal medication. No adverse events occurred due to high-concentration gentamicin. CONCLUSIONS: Short-term infection control was achieved using continuous local antibiotic perfusion; thus, it can be a treatment option for deep infections of the foot and ankle.

Impact of COVID-19 Disease on the Development of Osteomyelitis of Jaws: A Systematic Review.

Background/Objectives: Osteomyelitis is characterized by an inflammatory process affecting both bone and bone marrow, leading to cell death and the formation of bone sequestrum. Recent literature from the past five years has documented instances of osteomyelitis following infections of SARS-CoV-2. This systematic review explores the link between osteomyelitis of the jaw (OMJ) and COVID-19 infections. Methods: This review adhered to the PRISMA guidelines, systematically analyzing literature from 2020 to 2024 sourced from databases including Medline, Embase, Scopus, and Web of Science. PROSPERO ID: CRD42024526257. Results: The review selected 42 articles, detailing 201 cases of osteomyelitis of the jaw related to COVID-19 (COMJ). The demographic breakdown included 195 male (74.4%) and 67 female patients (25.6%), with a median age of 52.7 years, ranging from 24 to 71 years. A significant portion of COMJ patients (41.5%) were hospitalized due to COVID-19, and 58.5% received corticosteroid therapy. Diabetes mellitus was a common comorbidity among COMJ patients (65.1%). Most cases involved maxilla (182 cases; 90.5%), with nearly half showing sinus involvement (49.4%). The mandible was affected in 19 cases (9.5%). Mucormycosis and aspergillosis emerged as the predominant fungal infections, identified in 103 (51.2%) and 50 (24.9%) cases, respectively. Conclusions: Individuals with pre-existing health conditions such as diabetes mellitus who have been treated for COVID-19 are at an increased risk of developing OMJ, particularly maxillary fungal osteomyelitis. COMJ poses a significant diagnostic and therapeutic challenge for dental and maxillofacial professionals, who are often the first to encounter these cases.

sCD14-ST and Related Osteoimmunological Biomarkers: A New Diagnostic Approach to Osteomyelitis.

Osteomyelitis (OM) is a major challenge in orthopedic surgery. The diagnosis of OM is based on imaging and laboratory tests, but it still presents some limitations. Therefore, a deeper comprehension of the pathogenetic mechanisms could enhance diagnostic and treatment approaches. OM pathogenesis is based on an inflammatory response to pathogen infection, leading to bone loss. The present study aims to investigate the potential diagnostic role of a panel of osteoimmunological serum biomarkers in the clinical approach to OM. The focus is on the emerging infection biomarker sCD14-ST, along with osteoimmunological and inflammatory serum biomarkers, to define a comprehensive biomarker panel for a multifaced approach to OM. The results, to our knowledge, demonstrate for the first time the diagnostic and early prognostic role of sCD14-ST in OM patients, suggesting that this biomarker could address the limitations of current laboratory tests, such as traditional inflammatory markers, in diagnosing OM. In addition, the study highlights a relevant diagnostic role of SuPAR, the chemokine CCL2, the anti-inflammatory cytokine IL-10, the Wnt inhibitors DKK-1 and Sclerostin, and the RANKL/OPG ratio. Moreover, CCL2 and SuPAR also exhibited early prognostic value.

Maxillary Diffuse Large B-Cell Lymphoma Enshrouded as Osteomyelitis: A Case Report.

Extranodal non-Hodgkin's lymphoma (NHL) afflicting the head and neck region is rare, accounting for only about 5%. Diffuse large B-cell lymphoma (DLBCL) is the most common type of NHL affecting the oral cavity. Due to its variable clinical presentation and non-pathognomic course, it can be easily misdiagnosed with overlapping characteristics to common oral pathologies. In the present case, the authors report an unusual presentation of DLBCL and highlight the significant diagnostic challenge encountered by the clinician. In our case, osteonecrosis of the maxilla with soft tissue swelling misleads the diagnosis of chronic osteomyelitis. However, further, work-up was pursued, and the patient was managed successfully with chemotherapy and is currently disease-free for the past 1 year. An accurate clinico-radiological diagnosis with histopathological confirmation is emphasized to deliver a potentially curative treatment in a timely manner.