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1.
Medicine (Baltimore) ; 99(22): e20375, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481422

RESUMO

INTRODUCTION: The prevalence of diabetes continues to rise around the world. Diabetic foot is a serious complication of diabetes, and diabetic patients with diabetic foot osteomyelitis (DFO) have a fourfold increased risk of amputation, usually indicating death. Therefore, it is particularly important to seek a more effective treatment for DFO. The treatment of DFO varies from person to person, and antimicrobial therapies vary widely. A large number of clinical studies have shown that rifampicin adjuvant therapy can reduce the rate of amputation and mortality in DFO patients. However, there is no systematic summary of clinical evidence, which limits the clinical application of rifampicin. Therefore, we attempted to provide high-quality evidence for the clinical efficacy and safety of rifampin in the adjuvant treatment of DFO through this meta-analysis. METHODS: English literature is mainly searched in Cochrane Library, PubMed, EMBASE and Web of Science, while Chinese literature is from CNKI, CBM, VIP and Wangfang databases. At the same time, we will search clinical registration tests and gray literature. Two methodologically trained researchers will read the title, abstract, and full text, and independently select qualified literature based on inclusion and exclusion criteria. Binary data is expressed as relative risk, continuous data is expressed as mean difference or standard mean difference. The final data are synthesized using a fixed effect model or a random effect model, depending on the presence of heterogeneity. In the end, the patient's amputation rate and mortality were the main research indicators. Survival rate, HbA1c, serum creatinine, changes in ulcer area, and SF-36 quality of life assessment were used as secondary indicators. We will perform a sensitivity analysis to assess the stability of the results. Then the publication bias was evaluated by funnel plot analysis and Egger test. Finally, we will use a "recommendation grading, evaluation, formulation and evaluation" system to assess the quality of the evidence. All data analysis will be meta-analyzed by the statistical software RevMan software version 5.3. RESULTS: This study will provide a high-quality comprehensive report on the effectiveness and safety of rifampicin in the treatment of DFO, and our findings will be published in peer-reviewed journals. CONCLUSION: This systematic review and meta-analysis will provide a comprehensive summary and careful evaluation of rifampicin as an adjuvant treatment of DFO with a view to providing multiple options for clinical treatment of the disease. REGISTRATION NUMBER:: is INPLASY202040084.


Assuntos
Antibacterianos/uso terapêutico , Pé Diabético/tratamento farmacológico , Osteomielite/tratamento farmacológico , Rifampina/uso terapêutico , Adjuvantes Farmacêuticos/uso terapêutico , Pé Diabético/complicações , Humanos , Osteomielite/etiologia
2.
Pediatr Blood Cancer ; 67(5): e28225, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32065511

RESUMO

BACKGROUND: Patients with sickle cell disease (SCD) are at increased risk for osteomyelitis (OM). Diagnosis of OM in SCD is challenging as the clinical presentation is similar to a vasoocclusive crisis (VOC) with no diagnostic gold standard. We report characteristics and outcomes of OM in SCD patients treated at our center over 10-year period. DESIGN/METHOD: We conducted a retrospective analysis of patients with SCD who were treated for OM at our center over a 10-year period (2006-2016). Cases were identified utilizing radiology data mining software. Radiology reports and medical charts of potential OM cases were reviewed. RESULTS: Twenty-eight children with SCD were treated for OM at our institution. Patients treated for OM were largely similar to patients treated for a VOC. However, patients treated for OM had significantly higher C-reactive protein (10 mg/dL vs 5.58 mg/dL, P = 0.03) and erythrocyte sedimentation rate (60 mm/h vs 47 mm/h, P = 0.02). Magnetic resonance imaging (MRI) findings were consistent with OM in 18 (64%) patients and indeterminate in the remaining. Based on clinical, laboratory, and radiological findings, the diagnosis of OM was considered confirmed in 3 patients, probable in 6 patients, and presumed in 19 patients. Nontyphoidal Salmonella was isolated from cultures in 9 (32%) patients, while no organism was identified in 19 (67%) patients. All patients were treated with antibiotics. Six patients (21%) required surgical interventions. CONCLUSIONS: OM continues to pose diagnostic challenges. Most patients are treated for OM without definitive confirmation. Nontyphoidal Salmonella was the only organism identified in our cohort.


Assuntos
Anemia Falciforme , Imagem por Ressonância Magnética , Osteomielite , Infecções por Salmonella , Salmonella/isolamento & purificação , Adolescente , Anemia Falciforme/complicações , Anemia Falciforme/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Osteomielite/tratamento farmacológico , Osteomielite/etiologia , Osteomielite/microbiologia , Estudos Retrospectivos , Salmonella/classificação , Infecções por Salmonella/tratamento farmacológico , Infecções por Salmonella/etiologia , Infecções por Salmonella/microbiologia
3.
BMC Infect Dis ; 20(1): 133, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32050917

RESUMO

BACKGROUND: Vertebral osteomyelitis can be attributed to many factors including immunosuppression, diabetes, malignancy, collagen disease, periodontal disease, open fractures, and endoscopic procedures. Anaerobic bacteria, such as Veillonella species, are found in the oral cavity and are rarely implicated in the infection. This report describes vertebral osteomyelitis secondary to a dental abscess with positive Veillonella cultures. CASE DESCRIPTION: A 76-year-old man presented to the hospital due to back pain with a four-day history of fever and chills. CT scans revealed several abscesses in the lumbar region as well as indications of vertebral osteomyelitis. After a psoas drain, the patient began antibiotics with a combination of ampicillin-sulbactam, metronidazole, and levofloxacin, but due to the patient's penicillin allergy, he was initially desensitized to this antibiotic for a significant period of time. Laminectomies, foraminotomies, and facetectomies were performed, but the infection spread to vertebral levels. The patient was then switched to a combination of vancomycin, metronidazole, and levofloxacin which eliminated the infection. Final laminectomy was performed with posterior segmental instrumentation and arthrodesis. Post-operatively, there were no signs of infection. The patient recovered well and regained mobility. Deeper examination of the patient's medical history revealed a severe tooth abscess immediately before the onset of bacteremia. CONCLUSION: We believe that a delay in the onset of antibiotic treatment is what led to the initial bacteremia that ultimately took root in the lower lumbar vertebrae. To the best of our ability, we could identify only one other case that linked vertebral osteomyelitis to the oral cavity.


Assuntos
Abscesso/tratamento farmacológico , Bacteriemia/microbiologia , Osteomielite/etiologia , Osteomielite/terapia , Abscesso Periodontal/complicações , Abscesso/diagnóstico por imagem , Idoso , Antibacterianos/uso terapêutico , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/tratamento farmacológico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Foraminotomia , Humanos , Laminectomia , Vértebras Lombares/microbiologia , Vértebras Lombares/cirurgia , Masculino , Osteomielite/diagnóstico por imagem , Osteomielite/microbiologia , Abscesso Periodontal/microbiologia , Tomografia Computadorizada por Raios X , Veillonella/patogenicidade
4.
BMC Dermatol ; 20(1): 2, 2020 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-32008574

RESUMO

BACKGROUND: Atopic eczema is a relapsing, itchy chronic cutaneous inflammatory disease that commonly affects children. The disease is often complicated by cutaneous infections such as eczema herpeticum, eczema vaccinatum and a varied number of bacterial infections - impetigo, cellulitis and erysipelas. However, rare case reports of infective endocarditis, otitis media and osteo-articular infections have been associated with atopic eczema. These associations possibly represent the extracutaneous infectious complications of atopic eczema. CASE PRESENTATION: Here we present two cases of osteomyelitis in HIV negative children with habitual scratching of poorly managed and/or uncontrolled atopic eczema respectively. Both cases presented to the orthopaedic surgeons and were admitted as acute phalangeal osteomyelitis and acute - on - chronic tibial osteomyelitis respectively. The first case was an 8 year old girl who had moderate-severe poorly-controlled atopic eczema and contiguously spread phalangeal osteomyelitis. The second case was an 11 year old pre-pubertal boy who had untreated atopic eczema and tibial osteomyelitis possibly from haematogenously spread Staphylococcus aureus infection. Both were successfully discharged from hospital and currently have well controlled eczema. The 11 year old patient is also being reviewed monthly by the orthopaedic surgeons and is chronic suppressive antibiotics. He may require sequestrectomy, should it be needed. CONCLUSIONS: Invasive staphylococcal and streptococcal osteo-articular (OA) infection can arise as an extra-cutaneous infectious complication of poorly controlled atopic eczema. It is more common in the 3 to 15 year age group and especially in boys with a septic arthritis to osteomyelitis ratio of around 29:5. Clinicians should maintain a high index of suspicion in patients with moderate-severe atopic eczema and they ought to promptly manage these OA infections with intravenous antibiotics to avoid further complications.


Assuntos
Dermatite Atópica/complicações , Osteomielite/etiologia , Infecções Estafilocócicas/complicações , Staphylococcus aureus , Criança , Dermatite Atópica/microbiologia , Feminino , Dedos , Humanos , Masculino , Prurido/etiologia
5.
Ann R Coll Surg Engl ; 102(4): 256-262, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32081026

RESUMO

INTRODUCTION: Collocated burn and fracture injuries, defined as a burn overlying the site of a fracture, represent a serious subset of major burns and trauma. The literature pertaining to these rare injuries is inconclusive. Recent studies cast doubt on the safety of operative fixation in this population. No study to date has examined outcomes of collocated burn and fracture injuries compared with control. The aim of this study was to compare characteristics, injury patterns and complication rates in major burns and fracture patients with a collocated injury to those without. METHODS: A retrospective chart review of all consecutive patients with dermal burns and major fractures were undertaken between January 2005 and December 2015 at a tertiary referral trauma hospital. Outcomes assessed included demographics, injury characteristics and complications, including infection. Orthopaedic infection was defined as orthopaedic surgical site infection or osteomyelitis. RESULTS: Of the 40 patients identified, 21 subjects sustained collocated injuries. Patients with collocated injuries demonstrated a trend towards higher injury severity, higher percentage of total body surface area affected, longer length of stay and greater overall and orthopaedic complication rate. Significant predictors of orthopaedic infection were related to injury severity rather than collocation or operative management. CONCLUSION: There are differences in the characteristics and complication rates between collocated and non-collocated burn and fracture injuries. Collocated injuries tend to result from greater energy mechanisms, undergo longer inpatient stays and demonstrate increased morbidity. Injury severity appears to be the most important factor in determining postoperative orthopaedic infection. These characteristics must be considered when managing these rare but significant injuries.


Assuntos
Queimaduras/complicações , Fraturas Ósseas/complicações , Osteomielite/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Queimaduras/diagnóstico , Queimaduras/cirurgia , Feminino , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/cirurgia , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia , Centros de Traumatologia/estatística & dados numéricos , Adulto Jovem
6.
Radiol Med ; 125(2): 177-187, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31650327

RESUMO

Bone and soft tissue infection involving the foot is a serious complication of diabetes mellitus and represents a major public health and socioeconomic burden to National Health Services worldwide. Research in the past decade has improved diagnosis and treatment of these frequent and potentially devastating complications of diabetic foot which often remain difficult to be diagnosed and treated despite the availability of various clinical, serological, and imaging modalities. Furthermore, neuropathic osteoarthropathy can share many clinical and imaging features of osteomyelitis, and infection is often superimposed in patients with neuropathic disease. Thus, distinguishing between the two abnormalities is further complicated. Although the reference standard for diagnosis remains microbiologic analysis of bone specimens, in most clinical practice, soft tissue and bone infection involving the diabetic foot is diagnosed solely on the basis of a combination of clinical evaluation, serum inflammatory markers, and imaging modalities. Correlation between imaging findings and clinical features is very important as well as a common knowledge base for treatment team members rather than a compartmentalized view. Thus, the primary purpose of this review article was to provide radiologist and clinician with important clinical knowledge and relevant radiological semiotics, respectively, in order to facilitate a prompt diagnosis and personalised treatment of diabetic foot infections.


Assuntos
Pé Diabético/complicações , Osteomielite/diagnóstico por imagem , Osteomielite/etiologia , Infecções dos Tecidos Moles/diagnóstico por imagem , Infecções dos Tecidos Moles/etiologia , Diagnóstico Diferencial , Humanos
7.
Int J Infect Dis ; 91: 79-86, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31759168

RESUMO

OBJECTIVES: Conventional imaging techniques are routinely used in the diagnostic work-up of patients with suspected osteomyelitis or orthopaedic implant-associated infections. Hybrid nuclear medicine imaging techniques are a suitable alternative to routine imaging modalities as they provide anatomical and functional information within one procedure. Our study investigated the performance of anti-granulocyte SPECT/CT using 99mTc-labelled monoclonal antibodies in the diagnosis of osteomyelitis and orthopaedic implant-associated infections. METHODS: In this retrospective analysis, we included patients with 99mTc-antigranulocyte SPECT/CT acquired in the context of a suspected bone and joint infection. All patients underwent routine diagnostics and/or had a clinical follow-up of at least 12months. RESULTS: 26 episodes were included. Fifteen exams were performed for suspected osteomyelitis, and 11 for suspected orthopaedic implant-associated infection. SPECT/CT was ordered most often if standard diagnostic tests or conventional imaging modalities remained inconclusive. The overall sensitivity and specificity for the diagnosis of an infection were 77.8% and 94.1%, respectively. The positive predictive value was 87.5% and the negative predictive value 88.9%. Diagnostic accuracy was 88.5%. CONCLUSIONS: 99mTc-antigranulocyte SPECT/CT imaging has a high accuracy in the diagnosis of osteomyelitis and orthopaedic implant-associated infections and is a suitable non-invasive diagnostic tool if standard diagnostic examinations are inconclusive or not applicable.


Assuntos
Equipamentos Ortopédicos/efeitos adversos , Osteomielite/diagnóstico , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
J Foot Ankle Surg ; 59(1): 27-30, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882144

RESUMO

Ray resection is frequently performed in cases of infection or ischemia, but the literature is scarce concerning its outcome as a definitive treatment. In this retrospective cohort study, we reviewed our cohort with transmetatarsal ray resection with a mean follow-up of 36.3 months. Reulcerations, transfer ulcers, and reamputations were determined. Risk factor analysis for revision surgery was conducted. Among 185 patients, 71 (38.4%) had revision surgery within a mean of 1.4 ± 2.6 years (range 2 days to 12.9 years), 22 (11.9%) had major amputations, 49 (26.5%) had minor amputations, 11 (5.9%) had same-ray reulceration, 40 (21.6%) had transfer ulceration, and 2 (1.1%) had both reulceration and transfer ulceration. Occurrence of a postoperative ulcer was statistically significantly associated with revision surgery (p < .01). In conclusion, metatarsal ray resection is a reasonable treatment option in cases of forefoot ischemia or infection to prevent major amputation but fails in 11.9%, and reulceration is associated with further revisions, making ulcer prevention paramount.


Assuntos
Amputação , Úlcera do Pé/cirurgia , Ossos do Metatarso/cirurgia , Osteomielite/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Úlcera do Pé/etiologia , Úlcera do Pé/patologia , Gangrena/etiologia , Gangrena/cirurgia , Humanos , Isquemia/etiologia , Isquemia/cirurgia , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Osteomielite/patologia , Reoperação , Resultado do Tratamento
9.
Isr Med Assoc J ; 12(21): 806-811, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31814344

RESUMO

BACKGROUND: Untreated dental caries or even dental manipulations, such as a tooth extraction, might cause direct spread of an odontogenic infection and consequently the development of life-threatening conditions such as deep neck infections (DNI). The most common source of DNI is of odontogenic origin (38.8-49%). Abscess formation or cellulitis can lead to life-threatening complications, despite new diagnostic imaging technology and widespread availability of antibiotics. OBJECTIVES: To demonstrate the dangers of DNI, which can create life-threatening situations. METHODS: Five cases of DNI of odontogenic origin, which were referred to the oral and maxillofacial surgery unit, are presented. RESULTS: Clinical manifestations included trismus, dysphagia, dysphonia, dyspnea, and infection symptoms. In all cases, computed tomography confirmed diagnosis and extent of abscess. Complications included mediastinitis, respiratory distress, osteomyelitis of the jaws, and in rare cases the mandibular condyle. Treatment included securing the airway, immediate surgical drainage, removal of the infection source, and antibiotic therapy. All patients were discharged in stable and improved condition. CONCLUSIONS: DNI treatment on an emergency basis requires proper diagnosis and effective management. To confirm diagnosis and prevent serious complications, it is essential for physicians to recognize the spaces of the head and neck that are likely to be affected by DNI.


Assuntos
Abscesso , Antibacterianos/administração & dosagem , Celulite (Flegmão) , Cárie Dentária/complicações , Drenagem/métodos , Pescoço , Procedimentos Cirúrgicos Bucais/métodos , Extração Dentária/efeitos adversos , Abscesso/diagnóstico , Abscesso/etiologia , Abscesso/fisiopatologia , Abscesso/cirurgia , Adulto , Idoso , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/etiologia , Celulite (Flegmão)/fisiopatologia , Celulite (Flegmão)/cirurgia , Feminino , Humanos , Masculino , Mediastinite/diagnóstico , Mediastinite/etiologia , Mediastinite/terapia , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Pescoço/patologia , Osteomielite/diagnóstico , Osteomielite/etiologia , Osteomielite/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
10.
PLoS One ; 14(12): e0225969, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800625

RESUMO

BACKGROUND: The trajectory pattern of erythrocyte sedimentation rate (ESR) in patients with pyogenic vertebral osteomyelitis (PVO) and its clinical significance is unclear. We further evaluated whether the first-4-week ESR variability can predict the trajectory pattern, treatment duration and recurrence of PVO. METHODS: The longitudinal ESR patterns of adults with PVO within the first 6 months were characterized through group-based trajectory modeling (GBTM). The ESR variability within the first 4 weeks was defined using the absolute difference (AD), coefficient of variation, percent change, and slope change. The first-4-week ESR variabilities were analyzed using ordinal logistic regression to predict the 6-month ESR trajectory and using logistic regression to predict treatment duration and recurrence likelihood. The discrimination and calibration of the prediction models were evaluated. RESULTS: Three ESR trajectory patterns were identified though GBTM among patients with PVO: Group 1, initial moderate high ESR with fast response; Group 2, initial high ESR with fast response; Group 3, initial high ESR with slow response. Group 3 patients (initial high ESR with slow response) were older, received longer antibiotic treatment, and had more comorbidities and higher recurrence rates than patients in the other two groups. The initial ESR value and ESR - AD could predict the 6-month ESR trajectory. By incorporating the first-4-week ESR variabilities and the clinical features of patients, our models exhibited moderate discrimination performance to predict prolonged treatment (≥12 weeks; C statistic, 0.75; 95% confidence interval [CI], 0.70 to 0.81) and recurrence (C statistic, 0.69; 95% CI, 0.61 to 0.78). CONCLUSIONS: The initial ESR value and first-4-week ESR variability are useful markers to predict the treatment duration and recurrence of PVO. Future studies should validate our findings in other populations.


Assuntos
Sedimentação Sanguínea , Osteomielite/sangue , Osteomielite/diagnóstico , Doenças da Coluna Vertebral/sangue , Doenças da Coluna Vertebral/diagnóstico , Idoso , Antibacterianos/uso terapêutico , Biomarcadores , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológico , Osteomielite/etiologia , Prognóstico , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Doenças da Coluna Vertebral/tratamento farmacológico , Doenças da Coluna Vertebral/etiologia , Fatores de Tempo , Resultado do Tratamento
11.
JBJS Case Connect ; 9(4): e0181, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31850955

RESUMO

CASE: A severe acquired constriction band in the proximal calf in an infant treated with a below-knee cast, which was protected with a waterproof sheet secured with a rubber band, is described. The radiological and computed tomography features of an elastic band causing the acquired constriction are presented for their novelty and uniqueness in the complication of cast treatment. CONCLUSIONS: The waterproof covering of plaster casts in children secured with a rubber band to prevent soiling can cause an acquired constriction band, which mimics osteomyelitis. The imaging modalities showed the elastic band shadow cutting through the bone and soft tissues as demonstrated in this case. We recommend that the complication can be prevented by avoiding the use of elastic bands to hold the waterproofing covers for the cast.


Assuntos
Moldes Cirúrgicos/efeitos adversos , Bandagens Compressivas/efeitos adversos , Perna (Membro)/patologia , Doenças Musculoesqueléticas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Diagnóstico Diferencial , Humanos , Lactente , Perna (Membro)/diagnóstico por imagem , Masculino , Doenças Musculoesqueléticas/patologia , Osteomielite/diagnóstico por imagem , Osteomielite/etiologia , Síndrome
12.
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
13.
JBJS Case Connect ; 9(4): e0028, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31850954

RESUMO

CASE: A 62-year-old man with no comorbidities presented with back and bilateral leg pain and progressive paraplegia that developed over a 1-week period. He had received 2 lumbar epidural steroid injections (LESIs) for lumbar stenosis 39 and 25 days before presentation. Workup revealed osteomyelitis of L4 and L5 with epidural abscesses. He ultimately underwent all-posterior L4 and L5 corpectomy with reconstruction and L1-pelvis arthrodesis, followed by 8 weeks of intravenous antibiotics. His weakness improved, but neurological deficits persisted. CONCLUSIONS: This case illustrates a catastrophic complication after LESI, resulting in permanent neurological injury in a patient with no apparent risk factors.


Assuntos
Injeções Epidurais/efeitos adversos , Vértebras Lombares , Osteomielite , Doenças da Coluna Vertebral , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Dor nas Costas/tratamento farmacológico , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem , Osteomielite/etiologia , Osteomielite/cirurgia , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/etiologia , Doenças da Coluna Vertebral/cirurgia , Esteroides/administração & dosagem , Esteroides/uso terapêutico
14.
J Med Case Rep ; 13(1): 351, 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31775881

RESUMO

BACKGROUND: Actinomycosis is a chronic, slowly progressive infection caused by the Actinomyces species. Lumbar vertebral involvement of Actinomyces israelii is extremely rare; this is the first case report of lumbar vertebral osteomyelitis and psoas abscess caused by Actinomyces israelii after an operation under general anesthesia. CASE PRESENTATION: A 66-year-old Japanese man with end-stage renal disease was admitted to our hospital for an operation for cervical canal stenosis. After the operation under general anesthesia, during which tracheal intubation and nasogastric tube insertion were performed, he developed low back pain. During a second hospitalization, computed tomography revealed osteolysis of the lumbar endplates of L2 and L3, swelling of the intervertebral disk of L2/L3, and swelling of the left psoas major muscle. Percutaneous drainage of the intervertebral disc was performed, and the culture of the aspirate grew Actinomyces israelii. Based on the susceptibility, ampicillin was administered but his condition did not improve. We changed the antibiotics to ampicillin-sulbactam for coverage of unidentified oral commensals, and his symptoms and signs finally improved. CONCLUSION: Our patient's long-term end-stage renal disease had made the oral and gastrointestinal mucosal barriers very fragile. Under these conditions, even mildly invasive procedures such as tracheal intubation and nasogastric tube insertion could be the cause of infectious complication by oral commensals, including Actinomyces.


Assuntos
Actinomyces , Actinomicose/diagnóstico , Anestesia Geral/efeitos adversos , Falência Renal Crônica/complicações , Osteomielite/diagnóstico , Abscesso do Psoas/diagnóstico , Actinomicose/diagnóstico por imagem , Actinomicose/etiologia , Actinomicose/microbiologia , Idoso , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/microbiologia , Masculino , Osteomielite/diagnóstico por imagem , Osteomielite/etiologia , Osteomielite/microbiologia , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/etiologia , Abscesso do Psoas/microbiologia , Tomografia Computadorizada por Raios X
15.
Lakartidningen ; 1162019 Nov 19.
Artigo em Sueco | MEDLINE | ID: mdl-31742654

RESUMO

Seventeen cases of infections in spinal structures were reported 2010-2017 to the Swedish Health and Social Care Inspectorate (IVO), a government agency responsible for supervising health care, for missed or delayed diagnosis. All patient records were scrutinized in order to find underlying causes and common factors. The delayed diagnoses were equally found among men and women and most frequent in in the age-group 65 to 79 years of age. The diagnostic delay most probably in many cases led to patient harm and avoidable sequelae, many with severe impairment for daily life. Several of the patients had a locus minoris resistentiae in the spine and in several cases the entry port of infections were cutaneous wounds, for example leg ulcers. The most important finding was that in the majority of cases the clinical investigation was inadequate and the clinical follow-up - while in hospital! - was inferior, without documentation of muscular weakness and sensory loss. In several cases a too passive management was found, when the losses eventually had become apparent, delaying surgical interventions.


Assuntos
Doenças da Coluna Vertebral , Idoso , Síndrome da Cauda Equina/complicações , Síndrome da Cauda Equina/diagnóstico , Síndrome da Cauda Equina/etiologia , Síndrome da Cauda Equina/terapia , Diagnóstico Tardio , Erros de Diagnóstico , Discite/complicações , Discite/diagnóstico , Discite/etiologia , Discite/terapia , Tratamento de Emergência , Feminino , Humanos , Masculino , Osteomielite/complicações , Osteomielite/diagnóstico , Osteomielite/etiologia , Osteomielite/terapia , Qualidade da Assistência à Saúde/normas , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/etiologia , Doenças da Coluna Vertebral/terapia , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Estenose Espinal/etiologia , Estenose Espinal/terapia , Espondilite/complicações , Espondilite/diagnóstico , Espondilite/etiologia , Espondilite/terapia , Vértebras Torácicas , Tempo para o Tratamento
16.
J Am Podiatr Med Assoc ; 109(6): 437-444, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31755766

RESUMO

BACKGROUND: On a national level, heroin-related hospital admissions have reached an all-time high. With the foot being the fourth most common injection site, heroin-related lower-extremity infections have become more prevalent owing to many factors, including drug preparation, injection practices, and unknown additives. METHODS: We present a 16-month case series in which eight patients with lower-extremity infections secondary to heroin abuse presented to The Jewish Hospital in Cincinnati, Ohio. RESULTS: Three cases of osteomyelitis were seen. All of the infections were cultured and yielded a wide array of microbes, including Staphyloccoccus, Streptococcus, Bacillus, Serratia, Prevotella, and Eikenella. All of the patients were treated with intravenous antibiotic agents, with nearly all receiving combination therapy. Seven of the eight patients underwent surgery during their hospital stay, with two undergoing amputation. Only half of the patients followed up after discharge. CONCLUSIONS: This case series brings to light many considerations in the diagnosis and management of the heroin user, including multivariable attenuation of immunity, existing predisposition to infection backed by unsterile drug preparation and injection practices, innocuous presentation of deep infections, microbial spectrum, and recommendations on antimicrobial intervention, noncompliance, and poor follow-up. By having greater knowledge in unique considerations of diagnosis and treatment, more efficient care can be provided to this unique patient population.


Assuntos
Dependência de Heroína/complicações , Osteomielite/diagnóstico , Infecções dos Tecidos Moles/diagnóstico , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Antibacterianos/uso terapêutico , Feminino , Heroína/efeitos adversos , Dependência de Heroína/imunologia , Humanos , Hiperalgesia/induzido quimicamente , Extremidade Inferior , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológico , Osteomielite/etiologia , Manejo da Dor , Cooperação do Paciente , Radiografia , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/cirurgia
17.
Khirurgiia (Mosk) ; (11): 13-19, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714524

RESUMO

OBJECTIVE: To analyze the results of chest wall reconstruction with titanium mesh implant in patients with total sternal instability following postoperative sternomediastinitis. MATERIAL AND METHODS: There were 100 patients with total sternal instability for the period from January 2016 to December 2018. Median of age was 62 (58; 68) years. Male/female ratio was 82/18. All patients were treated in accordance with standardized protocol. Postoperative complications were assessed using Clavien-Dindo scale. Staged surgical treatment including one or more debridement procedures before the final thoracoplasty was performed in 62 (62%) out of 100 patients. Aseptic sternal instability was observed in 38 patients. RESULTS: Follow-up period ranged from 3 weeks to 35 months after the final thoracoplasty. Complicated postoperative period occurred in 15 (15%) out of 100 patients (95% CI 9.3-23.3). One patient died in 9 days after surgery from acute heart failure. Complications without need for redo surgery, postoperative wound suppuration and seroma were noted in 3 patients. Redo surgery was required in 11 patients due to postoperative wound suppuration, eventration after thoracoomentoplasty, intermuscular hematoma and delayed divergence of major pectoral muscles. Removal of mesh implant was performed in 1 out of 100 patient (95% CI 0.2-5.5) in 7 days after surgery due to suppuration. There was no recurrent sternal instability within 30 days. CONCLUSION: Anterior chest wall reconstruction using titanium mesh implant is an effective and safe procedure in patients with postoperative sternal instability following postoperative sternomediastinitis.


Assuntos
Mediastinite/cirurgia , Osteomielite/cirurgia , Complicações Pós-Operatórias/cirurgia , Esterno/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Toracoplastia/métodos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Mediastinite/etiologia , Pessoa de Meia-Idade , Osteomielite/etiologia , Implantação de Prótese , Recidiva , Estudos Retrospectivos , Telas Cirúrgicas , Titânio
18.
Infez Med ; 27(3): 225-238, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31545766

RESUMO

Diabetic foot infection (DFI), a multi-facetted disease requiring a multidisciplinary approach for successful treatment, mostly affects the forefoot. Calcaneal osteomyelitis (CO) is an uncommon presentation of DFI with a somewhat different epidemiology, clinical features, and approach to management. These patients, compared to those with non-calcaneal DFI, more often require special surgical techniques and off-loading approaches. In this narrative review targeted to non-surgical clinicians, we explore how CO differs from other types of DFI affecting other anatomical locations. Based on our review of the literature and personal experience, we also highlight important issues regarding the management of CO osteomyelitis, including the need for specialized surgical approaches.


Assuntos
Calcâneo , Pé Diabético/complicações , Osteomielite/etiologia , Idoso , Antibacterianos/uso terapêutico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/microbiologia , Pé Diabético/diagnóstico , Pé Diabético/epidemiologia , Pé Diabético/terapia , Diagnóstico por Imagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Osteomielite/diagnóstico , Osteomielite/epidemiologia , Osteomielite/terapia , Análise de Regressão , Resultado do Tratamento
19.
Med. infant ; 26(3): 272-275, sept. 2019. Tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1026763

RESUMO

Introducción: En pacientes pediátricos quemados la osteomielitis fúngica es una complicación infrecuente que conduce a una significativa morbilidad. La información en la literatura está limitada a unos escasos reportes de casos. Objetivo: Describir las características clínicas, epidemiológicas y de evolución de niños quemados con osteomielitis fúngica. Métodos: Se llevo a cabo un estudio retrospectivo y descriptivo de pacientes mayores de 1 mes y menores de 18 años quemados con osteomielitis fúngica internados en el hospital Juan P. Garrahan, un hospital terciario en Buenos Aires, Argentina. Resultados: entre enero del 2007 y enero del 2017, de 600 niños quemados, 9 pacientes presentaron diagnóstico confirmado de osteomielitis fúngica. La mediana de edad fue de 42.5 meses (RIC, 27-118 meses) y la mediana de superficie quemada fue de 33.5% (RIC, 18.5-58%). La osteomielitis fue diagnosticada con una mediana de 30 días luego de la quemadura. Las localizaciones más frecuentes de osteomielitis fueron los miembros superiores y a nivel de calota. Los microorganismos aislados a partir del cultivo de hueso fueron: Fusarium spp. en tres pacientes, Mucor spp. en un paciente; Trichosporon asahii en un paciente; Cándida albicans en dos pacientes y Candida parapsilosis en dos pacientes. En dos casos la infección fúngica fue asociada con aislamientos bacteriano concomitante. Todos los pacientes presentaron hallazgos histopatológicos compatibles con osteomielitis. La mediana de tiempo de tratamiento fue de 44.5 días (RIC, 34.5- 65.5 días). Seis pacientes (67%) presentaron secuela motora. Conclusión: La osteomielitis fúngica fue infrecuente Candida spp. y Fusarium spp. fueron los hongos más comúnmente identificados. La secuela funcional fue frecuente (AU)


Introduction: In pediatric burn patients fungal osteomyelitis is a rare complication that leads to significant morbidity. Data in the literature are limited to sporadic case reports. Objective: To describe the clinical and epidemiological features and outcome in burned children with fungal osteomyelitis. Methods: A retrospective descriptive study was conducted in burn patients older than 1 month and younger than 18 years admitted to Hospital Juan P. Garrahan, a tertiary hospital in Buenos Aires, Argentina. Results: Between January 2007 and January 2017, of 600 burned children, nine had a confirmed diagnosis of fungal osteomyelitis. Median age was 42.5 months (IQR, 27-118 months) and median burn surface was 33.5% (IQR, 18.5-58%). Osteomyelitis was diagnosed at a median of 30 days after the burn. The most common location of osteomyelitis were the upper limbs and skull. The microorganisms isolated form bone cultures were Fusarium spp. in three patients, Mucor spp. in one patient; Trichosporon asahii in one patient; Candida albicans in two patients; and Candida parapsilosis in two patients. In two cases the funal infection was associated with concomitant bacterial isolation. In all patients, the histopathological findings were compatible with osteomyelitis. Median duration of treatment was 44.5 days (IQR, 34.5-65.5 days). Six patients (67%) had motor sequelae. Conclusion: Fungal osteomyelitis is a rare disease. Candida spp. and Fusarium spp. were most frequently identified fungi. Functional sequelae were common (AU)


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Osteomielite/diagnóstico , Osteomielite/etiologia , Osteomielite/epidemiologia , Queimaduras/complicações , Micoses/microbiologia , Candida/isolamento & purificação , Miose/tratamento farmacológico , Estudos Retrospectivos , Fusarium/isolamento & purificação , Antifúngicos/uso terapêutico
20.
Am J Pathol ; 189(10): 2077-2089, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31381888

RESUMO

Osteomyelitis remains a serious inflammatory bone disease that affects millions of individuals worldwide and for which there is no effective treatment. Despite scientific evidence that Staphylococcus bacteria are the most common causative species for human bacterial chondronecrosis with osteomyelitis (BCO), much remains to be understood about the underlying virulence mechanisms. Herein, we show increased levels of double-stranded RNA (dsRNA) in infected bone in a Staphylococcus-induced chicken BCO model and in human osteomyelitis samples. Administration of synthetic [poly(I:C)] or genetic (Alu) dsRNA induces human osteoblast cell death. Similarly, infection with Staphylococcus isolated from chicken BCO induces dsRNA accumulation and cell death in human osteoblast cell cultures. Both dsRNA administration and Staphylococcus infection activate NACHT, LRR and PYD domains-containing protein (NLRP)3 inflammasome and increase IL18 and IL1B gene expression in human osteoblasts. Pharmacologic inhibition with Ac-YVAD-cmk of caspase 1, a critical component of the NLRP3 inflammasome, prevents DICER1 dysregulation- and dsRNA-induced osteoblast cell death. NLRP3 inflammasome and its components are also activated in bone from BCO chickens and humans with osteomyelitis, compared with their healthy counterparts. These findings provide a rationale for the use of chicken BCO as a human-relevant spontaneous animal model for osteomyelitis and identify dsRNA as a new treatment target for this debilitating bone pathogenesis.


Assuntos
Reabsorção Óssea/etiologia , Osteoblastos/patologia , Osteocondrose/veterinária , Osteomielite/etiologia , Doenças das Aves Domésticas/etiologia , RNA de Cadeia Dupla/genética , Infecções Estafilocócicas/complicações , Animais , Reabsorção Óssea/epidemiologia , Reabsorção Óssea/patologia , Galinhas , Modelos Animais de Doenças , Humanos , Inflamassomos , Necrose , Osteoblastos/metabolismo , Osteoblastos/microbiologia , Osteocondrose/epidemiologia , Osteocondrose/etiologia , Osteomielite/epidemiologia , Osteomielite/patologia , Doenças das Aves Domésticas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus/genética , Staphylococcus/isolamento & purificação
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