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1.
Rev Chilena Infectol ; 36(5): 656-662, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-31859808

RESUMO

Cryptococcosis is an infectious disease caused by a ubiquitous encapsulated yeast called Cryptococcus neoformans, it is usually associated with immunosuppressed patients. Osteomyelitis occurs in 5-10%, the spine involvement is one of the most reported. The purpose of this work is to present a case of isolated vertebral cryptococcosis and detail the results of a literature review. The treatment protocol is not yet established but it is recommended to start with aggressive intravenous therapy and continue with a suppressive treatment orally during a variable time. Surgical indication is considered in lesions that affect the spinal stability, deformity or neurological compromise and for local infectious control.


Assuntos
Criptococose/patologia , Osteomielite/microbiologia , Osteomielite/patologia , Doenças da Coluna Vertebral/microbiologia , Doenças da Coluna Vertebral/patologia , Idoso , Biópsia , Criptococose/diagnóstico por imagem , Cryptococcus/isolamento & purificação , Humanos , Imagem por Ressonância Magnética , Masculino , Osteomielite/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
2.
Rev Soc Bras Med Trop ; 53: e20190328, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31859955

RESUMO

Rat-bite fever is a rarely diagnosed illness caused by Streptobacillus moniliformis . Although this disease is distributed worldwide, there have been few cases reported in Europe. Here, we report a case of vertebral osteomyelitis and sternoclavicular septic arthritis caused by S. moniliformis in a Portuguese patient previously bitten by a rat. Laboratory diagnosis was performed using molecular identification. This is the first case report of rat-bite fever in Portugal. The case described here serves as a reminder for physicians to consider this diagnosis in patients who have developed fever syndromes after being in contact with rodents.


Assuntos
Artrite Infecciosa/etiologia , Mordeduras e Picadas/complicações , Vértebras Lombares/diagnóstico por imagem , Osteomielite/etiologia , Febre por Mordedura de Rato/complicações , Articulação Esternoclavicular/diagnóstico por imagem , Idoso , Animais , Artrite Infecciosa/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Osteomielite/diagnóstico por imagem , Febre por Mordedura de Rato/diagnóstico , Ratos
3.
Schweiz Arch Tierheilkd ; 161(9): 559-568, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488397

RESUMO

INTRODUCTION: The clinical, ultrasonographic, radiographic, cytologic and bacteriologic findings, diagnosis and surgical treatment of two heifers with septic metacarpal physitis (type-1 osteomyelitis) and concurrent serofibrinous arthritis of the metacarpophalangeal (MCP) joint are described. Osteomyelitis likely occurred by haematogenous spread following bronchopneumonia in one heifer and developed post-traumatically in the other. In both patients, ultrasonographic examination using the 7.5 MHz linear probe showed moderate effusion of the palmar and dorsal MCP joint pouches and highly irre-gular bone contours with depression and periosteal new bone formation at the metacarpal growth plate. Radiographs showed an extensive radiolucent area with poorly defined margins at the level of the metacarpal growth plate. Surgical treatment was carried out under sedation and regional intravenous anesthesia and involved meticulous debridement of the osteomyelitic lesion of the meta-carpal growth plate combined with arthrotomy of the MCP joint and repeated lavage of the bone cavity and joint. Successful outcomes were achieved by combined use of systemic and locoregional antibiotics, NSAIDs, temporary external coaptation and adequate housing.


Assuntos
Artrite/veterinária , Doenças dos Bovinos/cirurgia , Osteomielite/veterinária , Animais , Artrite/diagnóstico por imagem , Artrite/tratamento farmacológico , Artrite/cirurgia , Bovinos , Doenças dos Bovinos/diagnóstico por imagem , Doenças dos Bovinos/tratamento farmacológico , Feminino , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Osteomielite/cirurgia , Resultado do Tratamento
4.
Tidsskr Nor Laegeforen ; 139(12)2019 09 10.
Artigo em Norueguês | MEDLINE | ID: mdl-31502778

RESUMO

BACKGROUND: This case report presents one of the first documented incidents of chronic Q-fever (C. burnetii) in Norway. A comprehensive workup resulted in an unexpected finding. CASE PRESENTATION: A Norwegian woman in her eighties presented to a district general hospital with lower back pain, decreased general condition and weight loss. Computer tomography (CT) revealed a large thoracic aortic aneurysm presumed to be of mycotic origin, and later magnetic resonance imaging (MRI) scans revealed osteomyelitis in the surrounding vertebrae. Conventional diagnostic workup did not identify the causative agent. After more than 6 months of different examinations, surgery, exhausting invasive procedures and antimicrobial treatment, we were ultimately successful in determining the microbial cause of chronic mycotic aneurism and osteomyelitis to be C. Burnetii (Q-fever) through serological and PCR analysis. INTERPRETATION: An increasing proportion of the population in all age groups travel abroad, and clinicians should be aware of the increasing incidence of imported infectious diseases. Obtaining a thorough medical history is still an important tool in the diagnostic process.


Assuntos
Aneurisma da Aorta Torácica/microbiologia , Osteomielite/microbiologia , Febre Q , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/diagnóstico por imagem , Coxiella burnetii/isolamento & purificação , Feminino , Humanos , Dor Lombar/microbiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/microbiologia , Imagem por Ressonância Magnética , Anamnese , Noruega , Osteomielite/diagnóstico por imagem , Febre Q/complicações , Febre Q/diagnóstico , Febre Q/tratamento farmacológico , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/microbiologia , Tomografia Computadorizada por Raios X , Doença Relacionada a Viagens , Perda de Peso
5.
BMC Med Imaging ; 19(1): 60, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370785

RESUMO

BACKGROUND: Central skull-base osteomyelitis (CSBO) represents a life-threatening complication of external ear canal infection. Computed tomography (CT) and magnetic resonance imaging (MRI) play key roles in assessment of CSBO progression. METHODS: Twelve patients with CSBO were included in a retrospective clinical study. In total, 62 scans (30 CTs and 32 MRIs) were performed to evaluate the extent of inflammatory changes. The scans were read independently by two radiologists specialised in imaging of the head and neck. The regions under the skull base were specified using the online Anatomy Atlas of the skull base. To clarify the timeline, the time period was divided into four parts, and inflammatory changes in the skull-base regions were tracked. Data were statistically analysed. RESULTS: In early stages of the disease, CT scan detects inflammatory changes closely related to the stylomastoid foramen and medially to the posterior belly of the digastric muscle, changes which have been proved to be crucial for the diagnosis of CSBO. Later the infection spreads to the contralateral side causing demineralisation of the bones. CONCLUSION: Imaging methods play a crucial role not only in establishing the diagnosis, but also in anticipating the direction of infection spread underneath the skull base.


Assuntos
Infecções Bacterianas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Osteomielite/diagnóstico por imagem , Base do Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Bactérias/isolamento & purificação , Progressão da Doença , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Osteomielite/microbiologia , Análise de Regressão , Estudos Retrospectivos , Sensibilidade e Especificidade , Base do Crânio/microbiologia , Osso Temporal/diagnóstico por imagem
6.
Surg Pathol Clin ; 12(3): 831-847, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31352990

RESUMO

Bone pathology can be challenging because the skeleton is a living tissue prone to developing a diverse array of inflammatory, metabolic, genetic, reactive, circulatory, and neoplastic abnormalities. Several areas of bone pathology are particularly difficult or problematic for hematopathologists given the close resemblance of some hematologic entities to primary/metastatic bone lesions; examples include plasmacytic disorders versus osteoblastic tumors and lymphoma/leukemia versus round cell tumors of bone. This article provides a conceptual and practical overview of selective bone disorders commonly encountered in the differential diagnosis of hematologic diseases.


Assuntos
Neoplasias Ósseas/patologia , Osteomielite/patologia , Condrossarcoma Mesenquimal/patologia , Condrossarcoma Mesenquimal/terapia , Diagnóstico Diferencial , Histiocitose de Células de Langerhans/patologia , Histiocitose de Células de Langerhans/cirurgia , Humanos , Mastocitose/patologia , Mastocitose/terapia , Osteomielite/diagnóstico por imagem , Osteomielite/cirurgia , Osteossarcoma/patologia , Osteossarcoma/cirurgia , Plasmocitoma/patologia , Plasmocitoma/cirurgia , Prognóstico
7.
Medicine (Baltimore) ; 98(27): e16331, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277182

RESUMO

Differential diagnosis of Langerhans Cell Histiocytosis (LCH) in the jaw is essential for early treatment including systemic therapy. Records of 17 patients (6 men and 11 women; mean age, 14 years) with histologically confirmed LCH were reviewed. All the lesions occurred in the mandible. Most of the cases (n=12) were intraosseous type LCH, only 5 patients had alveolar type LCH. Patients complained of facial swelling and pain most likely. In the 14 patients who underwent CT and/or MR imaging, all LCH lesions were osteolytic, with a mean size of 23 mm. LCH presented as expansile lesions with periosteal new bone formation, perilesional sclerosis, fluid attenuation/signal within the lesion, and inflammatory changes in adjacent soft tissues on CT/MR images. Considering the major symptoms of LCH were swelling and pain, the differential diagnosis of LCH from osteomyelitis might be more difficult. The differential diagnosis for osteolytic lesions of the jaw with surrounding inflammatory changes should include LCH, especially in young patients.


Assuntos
Histiocitose de Células de Langerhans/diagnóstico por imagem , Imagem por Ressonância Magnética , Mandíbula , Osteomielite/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
J Med Case Rep ; 13(1): 172, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31164170

RESUMO

BACKGROUND: Aspergillus terreus, a saprophytic fungus, is recognized as an emerging pathogen in various infections in humans. However, bone and joint involvement is uncommon. To the best of our knowledge, only seven cases of spondylodiscitis caused by Aspergillus terreus have been reported previously in humans. We report a case of a patient with Aspergillus terreus spondylodiscitis following an abdominal stab wound. CASE PRESENTATION: A 74-year-old Japanese man with no particular medical history fell from a ladder and sustained a left abdominal stab wound from an L-shaped metal peg. Computed tomography showed the trace of the L-shaped metal peg from the left abdomen to the left rib and left kidney. The scan also showed an anterolateral bone avulsion of the left side of the T12 vertebral body, as well as fractures of the L1 left transverse process and the left 10th-12th ribs. He was hospitalized and treated with conservative therapy for 6 weeks. He was readmitted to the hospital with complaints of sudden back pain, numbness of both legs, and inability to walk 13 weeks after the fall. Magnetic resonance imaging findings were typical of spondylodiscitis. Gadolinium-enhanced T1-weighted magnetic resonance imaging indicated increased signal intensity at T11-T12 vertebral bodies and severe cord compression and epidural abscess at T11-T12 associated with infiltration of soft paravertebral tissues. On the seventh day after admission, he underwent partial laminectomy at T11 and posterior fusion at T9 to L2. The result of his blood culture was negative, but Aspergillus terreus was isolated from the material of T11-T12 intervertebral disc and vertebral bodies. His Aspergillus antigen was positive in a blood examination. Histological examination showed chronic suppurative osteomyelitis. On the 35th day after admission, he underwent anterior fusion at T11 and T12 with a rib bone graft. For 5 months, voriconazole was administered, and he wore a rigid corset. Posterior partial laminectomy at T11 and anterior fusion at T11 and T12 resulted in a good clinical course. The patient's neurological dysfunction was completely recovered, and his back pain disappeared. Two years after the operation, computed tomography was performed and showed bone fusion at T11 and T12. Magnetic resonance imaging revealed no evidence of increased signal intensity at T11-T12 vertebral bodies and severe cord compression and epidural abscess at T11-T12. CONCLUSIONS: To our knowledge, this is the first report of spondylodiscitis caused by Aspergillus terreus after an abdominal penetrating injury. The histological finding of chronic suppurative osteomyelitis and the radiological findings strongly suggested direct inoculation of Aspergillus terreus.


Assuntos
Traumatismos Abdominais/diagnóstico por imagem , Aspergilose/diagnóstico por imagem , Discite/diagnóstico por imagem , Abscesso Epidural/diagnóstico por imagem , Osteomielite/diagnóstico por imagem , Ferimentos Perfurantes/diagnóstico por imagem , Traumatismos Abdominais/complicações , Acidentes por Quedas , Idoso , Antifúngicos/uso terapêutico , Aspergilose/etiologia , Aspergilose/terapia , Discite/etiologia , Discite/terapia , Abscesso Epidural/etiologia , Abscesso Epidural/terapia , Fratura Avulsão/complicações , Fratura Avulsão/diagnóstico por imagem , Humanos , Laminectomia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Imagem por Ressonância Magnética , Masculino , Osteomielite/etiologia , Osteomielite/terapia , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Voriconazol/uso terapêutico , Ferimentos Perfurantes/complicações
9.
Rev Esp Med Nucl Imagen Mol ; 38(4): 212-217, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31147296

RESUMO

OBJECTIVES: White blood cell scanning with 99mTc-hexamethylpropylene amine oxime (HMPAO) has proven a sensitive and specific imaging method in the diagnosis of suspected prosthesis infection. The aim of this retrospective study was to evaluate the usefulness of SPECT/CT performed simultaneously using a hybrid imaging device of prosthesis infections. MATERIALS AND METHODS: 99mTc-HMPAO scintigraphy was performed on 37 patients (11 men and 26 women; age range 38-84 years; mean age±SD, 65.7±5.6 years). Planar scans were acquired 2.4 and 24hour after injection. SPECT/CT was obtained 4 h after injection, using a dual-head hybrid gama camera coupled with a low-power x-ray tube. In all patients, scintigraphic results were matched with the results of surgery, cultures and clinical follow-up. RESULTS: Seventeen (45,9%) out of 37 patients had prosthesis infection and 20 (54,1%) out of 37 patients had non-infectious prosthesis pathologies with 99mTc-HMPAO scintigraphy and SPECT/CT. The 99mTc-HMPAO scintigraphy was true-positive for infection in 16 of 37 patients and true-negative in 20 of 37 patients. SPECT/CT provided an accurate anatomic localization of all positive foci. With regard to the final diagnosis, SPECT/CT added a significant clinical contribution in 22 of 37 patients (59,4%). Sensitivity, specificity, negative predictive value and positive predictive values were 100%,59.1%,100%,62.5% in planar images with 99mTc-HMPAO scintigraphy and 100%,90.1%,100%,88.2% in the planar+SPECT/CT imaging, respectively. DISCUSSION: Our results indicate that SPECT/CT performed using a hybrid device can improve imaging with 99mTc-HMPAO scintigraphy in patients with suspected osteomyelitis by providing accurate anatomic localization and precise definition of the extent of infection.


Assuntos
Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Leucócitos , Osteomielite/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiotaxia de Leucócito , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/instrumentação , Tecnécio Tc 99m Exametazima
10.
Rev. iberoam. micol ; 36(2): 86-89, abr.-jun. 2019. ilus
Artigo em Inglês | IBECS | ID: ibc-185482

RESUMO

Background: Aspergillus osteomyelitis of the ribs is relatively uncommon. It is a debilitating and severe form of invasive aspergillosis. Case report: A 61year-old female presented with spontaneous chest pain on the right side of the rib cage and a palpable soft-tissue mass. FDG-PET/CT scan identified activity in the infected site. The lesion was punctured, and purulent material was sent to the laboratory. Aspergillus complex Flavi was isolated. An antifungal treatment with voriconazole was started. The lesion healed, and no recurrence was observed at 8-month follow-up. Molecular identification of the isolate was based on PCR amplification and sequencing of β-tubulin gene. Aspergillus flavus was identified. Conclusions: Our case highlights the relevance of microbiological studies in patients with osteomyelitis and the involvement of soft tissue. The FDG-PET/CT scan was found to be a useful tool for revealing the extent of the disease and evaluating the response to the antifungal therapy


Antecedentes: La osteomielitis en la parrilla costal por Aspergillus es una forma debilitante, grave y poco frecuente de aspergilosis invasora. Caso clínico: Mujer de 61 años que presentaba dolor en la parrilla costal derecha y una masa palpable en partes blandas. La FDG-PET/CT identificó actividad en el sitio infectado. Se obtuvo por punción material purulento y se envió al laboratorio. El aislamiento se identificó por cultivo como Aspergillus perteneciente al complejo Flavi. Se indicó tratamiento antifúngico con voriconazol durante 8 meses y la lesión curó sin recurrencia. Mediante la amplificación del gen de la ß-tubulina por PCR y su posterior secuenciación se identificó el aislamiento como Aspergillus flavus. Conclusiones: Destacamos la importancia del estudio microbiológico en pacientes con osteomielitis y con compromiso en los tejidos blandos. El estudio con FDG PET/CT es útil para revelar la extensión de la enfermedad y evaluar la respuesta a la terapia antimicótica


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Aspergilose/complicações , Aspergillus flavus/isolamento & purificação , Osteomielite/microbiologia , Caixa Torácica/microbiologia , Antifúngicos/uso terapêutico , Aspergilose/diagnóstico por imagem , Aspergilose/tratamento farmacológico , Aspergillus flavus/genética , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Voriconazol/uso terapêutico
11.
Rev. cuba. angiol. cir. vasc ; 20(1)ene.-jun. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-991043

RESUMO

Objetivo: Determinar las características clínicas, serológicas e imagenológicas presentes en los pacientes con úlcera del pie diabético complicada con osteomielitis. Métodos: Estudio observacional prospectivo, en 280 pacientes ingresado en el servicio de Angiología del Hospital Provincial Universitario Comandante Faustino Pérez Hernández de Matanzas por presentar úlceras del pie diabético, con sospecha de infección y de osteomielitis de las úlceras. La osteomielitis se diagnosticó mediante histología del hueso. El período de estudio osciló entre enero de 2013 y diciembre de 2017, ambos incluidos. Resultados: Se encontraron los siguientes elementos clínicos en los pacientes diagnosticados con osteomielitis: proceder de una zona rural, edad mayor de 59 años, tiempo de evolución de la diabetes mayor a los 14 años, glucemia al ingreso mayor de 10 mmol/L, área de la lesión mayor de 5,4 cm2, infección severa según la Infectious disease Society of America, test de contacto óseo con sonda acanalada (positivo), velocidad de sedimentación globular mayor de 90 mm y rayos X positivo del pie. Conclusiones: Existen características clínicas, serológicas e imagenológicas predominantes en los pacientes con úlceras del pie diabético y diagnóstico histopatológico de osteomielitis(AU)


Objective: To determine clinical, serologic and imageonology characteristics that are present in osteomyelitis of these ulcers which are diagnosed by means of histopathological studies and bones histology. Methods: Prospective, observational study in a cohort of 280 patients with diabetic foot ulcer, with suspicious of infection and osteomyelitis of the ulcers that were attended in the Provincial Service of Angiology of Matanzas. Osteomyelitis was diagnosed by bone histology. The study period oscillated between January 2013 to December 2017, both included. Results: The following clinical elements were predominat: rural zone procedence, older than 59 years, time of evolution of the diabetes mellitus bigger than 14 years, fast plasmatic glucose of more than 10 mmol/l , wound area bigger than 5.4 cm2, severe infection according to criteria of the Infectious Disease Society of America (IDISA), probing to bone test (positive), VSG > 90 mms; and positive result in the foot´s X Ray. Conclusions: There are clinical, serological and imagenology characteristics that are predominant in the patients with diabetic foot ulcers and histopathological diagnosis of osteomyelitis(AU)


Assuntos
Humanos , Masculino , Feminino , Osteomielite/microbiologia , Osteomielite/diagnóstico por imagem , Pé Diabético/complicações , Estudos Prospectivos , Estudo Observacional
12.
BMC Musculoskelet Disord ; 20(1): 185, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31043170

RESUMO

BACKGROUND: Actinomycosis is a rare, chronic granulomatous disease caused by Gram-positive anaerobic bacteria that colonize the oral cavity. Cervicofacial actinomycosis is the most frequent clinical presentation of actinomycosis, but hematogenous osteomyelitis at distant sites can occur in rare instance in immunocompromised or pediatric patients, only a few cases have been reported in healthy patients. Here we described a new case of distal femur osteomyelitis caused by Actinomyces in an adult patient who was immunocompetent and had no predisposing factors. CASE PRESENTATION: A woman aged 52 years with no history of trauma presented with severe pain, swelling, and increased local heat in the proximal area of the right knee 3 weeks after she first noticed discomfort. Magnetic resonance imaging showed persistent osteomyelitis of the distal metaphysis and diaphysis of the femur with a multifocal intraosseous abscess pocket. An incision and drainage of the abscess were conducted. The tissue culture, fungus culture, acid fast bacillus (AFB) culture, AFB smear, and tuberculosis polymerase chain reaction test results were negative. A pathologic examination confirmed the presence of actinomycosis. The patient was successfully treated with intravenous penicillin G for 8 weeks followed by oral amoxicillin-clavulanate for 6 weeks with repeated surgical debridement and drainage. After a 5-year follow up, the patient had no signs of recurring infection or complications and she had full range of movement in the affected knee. CONCLUSIONS: Although rare, actinomycotic osteomyelitis can occur in healthy people. Furthermore, actinomycotic osteomyelitis is easily misdiagnosed as tuberculosis in areas with a high prevalence of tuberculosis. To detect and identify the bacteria accurately, pathologic examination should be performed as well as culture tests, because the probability for culture confirmation of actinomycosis is quite low. The initial treatment is vital to a successful outcome without ostectomy or amputation.


Assuntos
Actinomyces/isolamento & purificação , Actinomicose/complicações , Antibacterianos/administração & dosagem , Drenagem , Osteomielite/microbiologia , Actinomyces/imunologia , Actinomicose/imunologia , Actinomicose/microbiologia , Actinomicose/terapia , Biópsia , Feminino , Fêmur/diagnóstico por imagem , Fêmur/microbiologia , Fêmur/patologia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem , Osteomielite/imunologia , Osteomielite/terapia , Resultado do Tratamento
14.
Nucl Med Commun ; 40(8): 778-785, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31116147

RESUMO

BACKGROUND: This study aimed to evaluate fused images of single-photon emission computed tomography/computed tomography (SPECT/CT), stand-alone whole-body scintigraphy (WBS) and stand-alone CT in the diagnosis of post-traumatic chronic-infected nonunion osteomyelitis (OST) of the lower limb. PATIENTS AND METHODS: The imaging data from 144 patients with known/suspected chronic-infected fracture nonunion in the lower limbs following internal/external fixation between June 2015 and December 2017 were reviewed retrospectively. Technetium-99m-methylene diphosphonate SPECT/CT scans were performed on the patients. For each patient, the diagnosis on the basis of each imaging approach was classified as yes (OST), no (no OST), or equivocal by experienced nuclear medicine physicians and radiologists. An intraoperative bacterial culture experiment was conducted as our gold standard. The diagnostic sensitivity, specificity, accuracy, positive predictive value, negative predictive value, κ coefficient, significance level, and agreement level were analyzed. RESULTS: The diagnosis on the basis of SPECT/CT fused images showed a sensitivity of 91.3%, a specificity of 84.6%, and accuracy of 88.9% compared to that based on WBS, with a sensitivity of 52.2%, a specificity of 15.4%, accuracy of 38.9%, and CT, with a sensitivity of 65.2%, a specificity of 23.1%, accuracy of 50.0%. The fused images can show the precise sites of post-traumatic chronic-infected OST. Considerable agreement (κ 0.679) was found between the SPECT/CT diagnosis and an intraoperative bacterial culture test (WBS, κ 0.218; CT, κ = 0.184). CONCLUSION: Technetium-99m-methylene diphosphonate SPECT/CT imaging fusion can improve diagnostic confidence for post-traumatic patients with chronic nonunion OST. This imaging approach can achieve an accurate diagnosis by revealing the precise location and scope of OST with high sensitivity and specificity, which has important implications for surgical guidance by providing the precise location of OST.


Assuntos
Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/lesões , Osteomielite/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Medronato de Tecnécio Tc 99m , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Adulto Jovem
16.
BMJ Case Rep ; 12(4)2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975773

RESUMO

Acute osteomyelitis of the clavicle is rare in the paediatric age group. We treated a 5-year-old boy who presented initially with fever and left shoulder pain, and subsequently developed swelling in the region of the left clavicle. Group A Streptococcus (GAS) was isolated in blood culture. MRI of the clavicle showed osteomyelitis of the medial clavicle. The child had incision and drainage of his clavicular collection. The child received intravenous benzylpenicillin and oral cephalexin in the initial presentation; he was treated with 2 weeks of intravenous ceftriaxone and 4 weeks of oral penicillin thereafter with the resolution of his symptoms. There are no previous case reports of osteomyelitis of the clavicle in children caused by GAS. This case highlights the importance of identifying the microbial aetiology in these children to ensure early initiation of treatment with appropriate antibiotics.


Assuntos
Clavícula , Osteomielite/diagnóstico , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes/isolamento & purificação , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Pré-Escolar , Diagnóstico Diferencial , Drenagem , Humanos , Imagem por Ressonância Magnética , Masculino , Osteomielite/diagnóstico por imagem , Osteomielite/microbiologia , Osteomielite/terapia , Infecções Estreptocócicas/diagnóstico por imagem , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/terapia
17.
Rinsho Shinkeigaku ; 59(4): 205-210, 2019 Apr 25.
Artigo em Japonês | MEDLINE | ID: mdl-30930369

RESUMO

A 76-year-old man, who had undergone surgery for esophageal cancer in 2010, presented to our hospital in April 2017 complaining of prolonged slight fever, loss of appetite, and dysphagia. Initial evaluation revealed a paralyzed left vocal cord, slight muscle weakness of the extremities, left facial paralysis, hoarseness, left sternocleidomastoid and trapezius muscle weakness, tongue deviation to the left, and left hypacusia-suggesting a diagnosis of Garcin's syndrome. Laboratory tests revealed increased white blood cells and C-reactive protein. Cerebrospinal fluid (CSF) analysis showed mild pleocytosis (predominantly polymorphonuclear cells), elevated protein, and low CSF/plasma glucose ratio. CT showed mild clival erosion, with no evidence of carcinoma recurrence. Brain contrast-enhanced MRI showed abnormal clival marrow, enhanced soft tissue and dura matter from the clivus to the atlantoaxial joint, enhanced soft tissue around the left ear canal, multiple cerebral infarctions in the left watershed zones, and left internal carotid stenosis. There was excessive ear wax and inflammation of the left external acoustic meatus but no otorrhea or otalgia. On the basis of his overall presentation, he was diagnosed with atypical skull base osteomyelitis due to external otitis. He was treated with antibiotic treatment that included ceftazidime for the Pseudomonas aeruginosa detected on bacterial cultures. He did not respond to treatment and died approximately 4 months later. Skull base osteomyelitis is thus an important differential diagnosis candidate after finding unilateral, multiple cranial neuropathy, underscoring the importance of prompt treatment when suspected.


Assuntos
Infarto Cerebral/etiologia , Doenças dos Nervos Cranianos/etiologia , Meato Acústico Externo , Osteomielite/etiologia , Otite Externa/complicações , Base do Crânio , Idoso , Infarto Cerebral/diagnóstico por imagem , Doenças dos Nervos Cranianos/diagnóstico por imagem , Diagnóstico Diferencial , Imagem de Tensor de Difusão , Evolução Fatal , Humanos , Inflamação , Masculino , Osteomielite/diagnóstico por imagem , Otite Externa/diagnóstico por imagem , Otite Externa/microbiologia , Infecções por Pseudomonas , Pseudomonas aeruginosa , Síndrome , Tomografia Computadorizada por Raios X
18.
Eur J Radiol ; 114: 85-91, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31005182

RESUMO

AIM: To evaluate the utility of percutaneous CT guided bone biopsy (PCBB) for suspected osteomyelitis (OM) and its eventual impact on patient management and recovery. MATERIAL AND METHODS: Patients who received a PCBB for suspected osteomyelitis from years 2012-2018. Patient demographics, lesion location, ulcer grade, signs of toxemia, serology, wound and blood cultures, bone biopsy and cross-sectional imaging results were recorded. Diagnostic yield of the bone biopsy and its role in influencing the final treatment plan and patient recovery were evaluated. Chi-square test was used. P-value less than 0.05 was considered statistically significant. RESULTS: 115 patients with mean age 50.86 ± 14.49 years were included. The common locations were sacrum/ischium (49/115, 43%) and spine (35/115, 30%). Clinically, 40/115 (35%) had toxemia and 67/115 (58%) had ulcers. Per serology, 17/111 (15%), 95/106 (90%), and 86/98 (88%) had an elevated WBC, CRP, and sedimentation rate, respectively. 22/91 (24%) had a positive blood culture and all 23/23 had a positive wound culture. On imaging, definitive and possible OM were reported in 84.1% and 14.2%, respectively, with 1.8% as no OM. Only 24/115 (21%) had a positive bone biopsy culture and only 10/24 (42%) total positive bone cultures impacted the treatment plan. There was no significant effect of antibiotics on the diagnostic yield of culture (p = 0.08). No statistical significance was found when comparing treatment change based on bone culture results versus all other factors combined (p = 0.33), or when comparing clinical improvement with and without positive bone cultures (p = 0.12). CONCLUSION: Despite positive cross-sectional imaging findings of OM, bone biopsy yield of positive culture is low, and it leads to a small impact in changing the treatment plan or altering the course of patient recovery.


Assuntos
Osso e Ossos/diagnóstico por imagem , Biópsia Guiada por Imagem , Osteomielite/diagnóstico , Tomografia Computadorizada por Raios X , Adulto , Idoso , Antibacterianos/uso terapêutico , Osso e Ossos/microbiologia , Osso e Ossos/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem , Osteomielite/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
19.
J Hum Genet ; 64(7): 599-607, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30996299

RESUMO

Familial florid osseous dysplasia (FFOD) is an autosomal dominant disorder of connective tissue, characterized by lobulated cementum-like masses scattered throughout the jaws and the alveolar process. This study aimed to identify the genetic etiology of a three-generation Chinese family affected with FFOD. A novel missense mutation p.C356W in anoctamin 5 (ANO5) gene was successfully identified as the pathogenic mutation by whole-exome sequencing (WES). The p.C356W mutation is located in the first loop between the first and second transmembrane domain of ANO5 protein. Sequence alignment of ANO5 protein among many different species revealed that this position is highly conserved. The p.C356W mutation may damage the predicted protein stability of ANO5 by altering the structure of several extracellular loops of ANO5 and affecting the formation of the disulfide bond, thereby disrupting the correct folding of ANO5 protein. Thus, the amino acid at position 356 appears to play a key role in the protein structural stability and function of ANO5 protein. Our results may also provide new insights into the cause and diagnosis of FFOD and may have implications for genetic counseling and clinical management.


Assuntos
Anoctaminas/genética , Displasia Fibrosa Óssea/genética , Mutação de Sentido Incorreto , Osteomielite/genética , Anoctaminas/química , Densidade Óssea , China , Feminino , Displasia Fibrosa Óssea/diagnóstico por imagem , Displasia Fibrosa Óssea/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem , Osteomielite/patologia , Linhagem , Domínios Proteicos , Sequenciamento Completo do Exoma
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