Abstract: Fever, infection, or both occurred at some time during hospitalization in 67% of patients on a referral spinal cord injury service. A single cause of fever was generally found, with urinary tract and soft-tissue infections predominating; these responded well to appropriate management. In contrast, spinal cord injury patients on other services seen in consultation by the infectious disease service had far more complicated and advanced disease. Multiple infections were diagnosed in the majority of these patients, with urinary tract and decubitus ulcers predominating. Complicating osteomyelitis was present in more than half of those who had infected decubitus ulcers. In both groups of patients, diagnosis required careful attention to physical and laboratory examination because multiple potentially infected areas could be identified and because usual symptoms were sometimes masked by altered sensation. (JAMA1982;248:66-70)

Abstract: Researchers have reviewed the three-phase bone scans, radiographs, and histologic findings of 39 diabetic patients with serious foot problems. The sensitivity and specificity of bone scans were 83% and 75%, respectively, for osteomyelitis of the small bones of the foot. The positive and negative predictive values were 87% and 69%, respectively. The radiographs were less sensitive (62%) and less specific (69%), with predictive values of 80% (positive) and 47% (negative).

Abstract: The usefulness of radionuclear scanning in the treatment of 18 patients with necrotizing progressive "malignant" external otitis is discussed. A Tc 99-m bone scan, a valuable test since results are positive in early cases of osteomyelitis of the temporal bone and base of skull, showed increased uptake in all 18 patients. In 6 patients, Ga-67 citrate scans were obtained at the start of therapy and at 5-6 week intervals thereafter. The serial gallium scans were useful in evaluating the effectiveness of therapy since the uptake decrease with control of infection.

Abstract: Pasteurella multocida is a common cause of infection following bites or scratches caused by dogs and (especially) cats. It is rarely reported, however, and apparently often overlooked as a pathogen. The typical clinical manifestation is a rapidly developing cellulitis at the site of injury. The infection is potentially dangerous and can cause a chronic local infection of deep tissues and osteomyelitis. It responds well to several antimicrobials, with penicillin being the drug of choice. Fifty-five patients are reported—72% with cat bites andlor scratches and 28% with dog bites. Ninety-two percent of the wounds went deeply through the skin. All patients presented for treatment 12 to 72 hours after receiving the animal wounds to their hands. Drainage from all wounds was serosanguineous or purulent, and cultures taken were positive for P. multocida . All of the wounds responded to surgical drainage and penicillin. One patient developed osteomyelitis. The acute onset of cellulitis, lymphangitis, and serosanguineous or purulent drainage from hand wounds 12 to 24 hours after cat or dog bites should suggest P. multocida as the predominant etiologic agent. Immediate surgical drainage and penicillin therapy is the treatment of choice.

Abstract: Based on experience with 22 cases of neonatal osteomyelitis in 10 years, the authors suggest these patients can be divided into two groups depending on severity of disease. Premature infants requiring umbilical catheterization and severely ill full-term infants constitute a high-risk group; signs are more overt, multifocal infection and joint involvement more frequent, and severe skeletal deformities more common. The patients in the low-risk group had much milder disease but also presented more difficulty in diagnosis because of the vagueness of the presenting signs. Radiographic examination is essential for diagnosis and follow-up of osteomyelitis, particularly limb deformities. Bone scans should be reserved for situations in which the clinical and radiographic findings are equivocal.

Abstract: Seven cases of osteomyelitis of the pubis are reported. Predisposing factors leading to osteomyelitis included parenteral drug abuse in six patients and pelvic surgery in one patient. The average duration of symptoms before diagnosis was three weeks. Needle aspiration of the symphysis pubis was performed in five patients, and culture results were positive in three of them. Two patients with negative cultures of needle aspirates had positive cultures from open biopsy specimens of the symphysis pubis. Blood cultures were done in all patients, and results were positive in two of them. Pseudomonas aeruginosa was the responsible pathogen in five patients, Escherichia coli in one, and Staphylococcus aureus in one. Most patients required several weeks of antibiotic therapy. None required surgical debridement.

Abstract: We reviewed the case of three of our own patients who had osteomyelitis of the symphysis pubis, as well as those of twenty-five patients described in the literature. The early symptoms of osteomyelitis of the symphysis mimic those of osteitis pubis. Osteomyelitis almost invariably is preceded by urological or gynecological surgery (often when a technical complication has occurred), and does not respond to shortterm antibiotic treatment. Characteristic radiographic findings develop. Osteomyelitis of the symphysis pubis should be treated by debridement and curettage, together with long-term treatment with an appropriately high dose of antibiotics.

Abstract: The importance and role of computed tomography (CT) are discussed on the basis of 36 cases of vertebral osteomyelitis. The bone images themselves, the detection of lumbar disk hypodensity, and the exploration of soft paraspinal regions in the search for an abscess are factors that contribute to the superiority of this method in difficult cases. In cases where the diagnosis is already known, CT offers an excellent method to assess the extent of the lesions. Its accuracy, coupled with its rapidity and noninvasive nature, affects the role of conventional tomography, a method that is incomplete and involves higher radiation doses. CT offers an excellent method for follow-up after treatment of vertebral osteomyelitis.

Abstract: Five percent of patients with acute osteomyelitis and 30%-60% of patients with chronic osteomyelitis have polymicrobial infections. Three illustrative cases and a review of the literature involving 104 patients are presented in this report. There were 2.4 isolates per child among the 31 pediatric cases ad 3.9 isolates per adult among the 71 adult cases reviewed. Staphylococcus aureus was the single most common isolate involved in polymicrobial disease in both adults and children. In adults, one-third of the aerobic isolates were gram-negative bacterial species; some enterococci were also involved. Of the isolates from adults, 46% were anaerobic. The number of isolates per case was similar for the acute (3.2) and chronic (3.1) forms of infection. Polymicrobial osteomyelitis resulted most frequently from spread of infection from a contiguous focus (59% of cases) or occurred in the patient with peripheral vascular insufficiency or neuropathy (17% of cases); however, the hematogenous route can produce polymicrobial disease (13% of cases). Bones mot often involved are those of the skull, face, and feet. Standard antibiotic therapy for monomicrobial osteomyelitis with semisynthetic penicillins or cephalosporins may lead to failures of treatment in polymicrobial disease.

Abstract: Acute osteomyelitis was induced in 18 rabbits after direct injection of a solution of Staphylococcus aureus culture into a proximal tibial metaphysis. Serial plain radiographs and radionuclide studies with indium-111 oxide labeled while blood cells and technetium-99m methylene diphosphonate were performed over the next 4 weeks. Visual and quantitative analysis by measuring the isotope activity of 111In and 99mTc over the infected tibias as compared with the opposite bones revealed that the white blood cell scans were positive in 15 (83%) of the 18 rabbits during the first week after injection of the microorganism. During the same period, the 99mTc bone scans were positive in only 22% of the animals (p less than 0.005). In the animals that survived, both white blood cell and bone scans were positive during the second week, and thereafter, the bone scans revealed consistently higher activity than was observed with white blood cell scans. Computed tomography performed in six rabbits revealed an increased att...

Abstract: Three cases of spinal osteomyelitis due to brucellosis are reported, all in women. Radiological confirmation was delayed for at least three months after the first clinical manifestation, while in one patient a bone scan was positive at an early stage. In two of the three cases the diagnosis was delayed because of insufficient awareness of the disease. Spinal osteomyelitis caused by Brucella is indistinguishable radiologically from that caused by other micro-organisms and needle aspiration or exploration is frequently performed to establish the correct diagnosis. Increased awareness of brucellosis and the carrying out of appropriate blood cultures and serological tests may make these procedures unnecessary.

Abstract: Osteomyelitis was induced in the tibiae of rabbits by injecting a suspension of Staphylococcus aureus and sodium tetradecylsulphate, a sclerosing agent. These rabbits were then divided into two groups: one group remained untreated and the other was fed a diet containing sodium salicylate. Two and four weeks after induction of osteomyelitis the tibiae taken from untreated rabbits with osteomyelitis and incubated in vitro released significantly more prostaglandin E and F than the control uninjected or uninfected tibiae. Tibiae taken from rabbits treated with sodium salicylate showed minimal radiographic changes and a significantly decreased release of prostaglandin E and F compared to the untreated rabbits. Prostaglandins are known to be potent bone resorbing agents and the results of this study suggest that they may also be involved in the destruction of bone which is characteristic of osteomyelitis. The treatment of rabbits with osteomyelitis using anti-inflammatory drugs, which block synthesis of prostaglandins, in addition to antibiotics, may prevent the destruction of bone and possible sequestration thereby decreasing the risk of chronic disease.

Abstract: In a clinical study we compared three different types of therapy in chronic maxillary sinusitis. 45 patients, 3-40 years old, were treated, 19 with antibiotics, 18 with acupuncture and 8 with Laser-acupuncture. There was no statistical difference of results between Laser-therapy and antibiotics (Chi-Square-Test). Compared to previous treatments with antibiotics, results and duration of improvement was significantly better after acupuncture. Conclusion: Acute sinusitis, especially of frontal sinus and in younger children, will better be treated by antibiotics because of the danger of osteomyelitis and meningitis. Acupuncture should be tried in chronic and recurrent stages after exclusion of large adenoids in children or bone inhibition of sinus clearance, especially before an invasive operation like removal of sinus mucosa is carried out.

Abstract: Ten cases of septic bursitis in children during a 25 year period were reviewed. Infection occurred in five girls and five boys with a mean age of 9 1/6 years. None had prior bursal disease. Direct trauma or local infection preceded the bursitis in seven children. The involved bursae were prepatellar (eight), olecranon (one), and subacromial (one). Presenting signs included fever with localized swelling, tenderness, and erythema; superficial fluctuance and painless joint motion were helpful diagnostic findings. Bursal fluid cultures yielded Staphylococcus aureus (nine) and Streptococcus pyogenes (one). Surgical therapy included needle aspiration (three), incision and drainage (three), and both procedures (four). Antimicrobial therapy was given to nine children; four received only oral antimicrobials. Nine children including all who received oral antimicrobials recovered rapidly without apparent sequelae. One child's course was complicate by patellar osteomyelitis and septic arthritis. Septic bursitis is an uncommon infection in children and should be differentiated from cellulitis and septic arthritis. Rapid recovery is usually seen with appropriate therapy.

Abstract: Moraxella osloensis osteomyelitis of the femur developed in a paraplegic man. He responded to treatment with oral ampicillin. Disease in humans caused by this unusual clinical isolate is reviewed.

Abstract: A quantitative analysis of the results obtained by sequential 99mTc methylene diphosphonate (MDP) and 67Ga-citrate (Ga) imaging to disclose and distinguish infections in bone, synovium and adjacent soft tissue is reported. There were 129 patients with proved or probable osteomyelitis, septic arthritis and cellulitis, and 94 patients who were eventually shown to be free of sepsis, but not necessarily free of some other nonseptic affliction. Of the 159 patients referred with a presumptive clinical diagnosis of osteomyelitis 94 were eventually shown to be free of infection. The results of this group by sequential imaging were true positive 0.72, true negative 0.86 and accuracy 0.80 when low-grade Ga uptakes, which were similar in distribution to MDP, were excluded. In 26 patients with septic arthritis, the true-positive fraction for combined MDP and Ga was 0.84. The true-positive fraction for Ga in 38 patients with cellulitis was 0.79.

Abstract: A 9-year-old boy developed osteomyelitis of the calcaneus following a puncture wound by a toothpick Culture of the bone yielded a pure culture of Eikenella corrodens, an organism that is normally found in oral secretions Recovery was complete following incision and drainage and antibiotic treatment with penicillins

Abstract: Immobilization of fractures associated with instability and comminution by an external skeletal device facilitates wound care, skin coverage, and ultimate reconstructive surgery. External skeletal fixation was applied in 20 patients who sustained complex open injuries of the upper extremity. All injuries were associated with extensive soft tissue and skin defects. Associated neurovascular injuries included 14 nerve injuries and five major vascular injuries. The Hoffman fixation device was used in the majority of cases. Skin coverage was obtained in all patients by an appropriate method of skin grafts, pedicle flaps, and a free myocutaneous flap. Primary bone union was achieved in five of 16 patients. Ten of 16 patients required secondary procedure to obtain union in cases of delayed union or nonunion, and one case remained with a nonunion. Pin tract infection in three patients and osteomyelitis in two patients were effectively treated with antibiotics and appropriate surgery. The initial treatment goals of limb salvage, skin coverage, and bone stabilization without drainage or persistent osteomyelitis can be accomplished by the use of external skeletal fixation devices.

Abstract: • Two infants, younger than 2 months of age, had brachial plexus involvement and true paralysis secondary to osteomyelitis of the proximal humerus. To date, no previous cases of this association have been reported. Electromyography (EMG) demonstrated significant denervation in muscles innervated by the upper trunk, with scattered involvement of other muscles. Nerve conduction velocities were normal in both patients. Both patients had significant residual weakness after appropriate antibiotic therapy. One patient, 12 months after therapy for osteomyelitis, continued to demonstrate both clinical and EMG evidence of a lower motor neuron neuropathy. The pathophysiologic cause was thought to be ischemic nerve damage secondary to occlusion of vasa nervorum. (Am J Dis Child1982;136:1054-1056)

Abstract: A black male adolescent with intact cellular and humoral immunity developed Aspergillus flavus-caused osteomyelitis involving the right tibial epiphysis following penetrating injury to that area. There was an apparent cure following amphotericin B therapy for six weeks. The clinical, pathologic, and therapeutic features of this case are described and compared with those in previously published cases. This case report represents the first well documented case of Aspergillus osteomyelitis in an immunocompetent host. The increasing incidence of invasive disease due to Aspergillus species and the increased awareness of the incidence of mycotic bone infections, particularly in pediatric patients, may allow further definition of pathogenesis and appropriate therapy.

Abstract: An animal model was used to evaluate and compare silver methacrylate with gentamicin methacrylate in experimental Staphylococcus osteomyelitis. One tibia from each of 54 rabbits was innoculated with 4 X 10(6) CFU of S. aureus and inserted with prepolymerized PMM rods containing either 1% Ag2SO4, 2.5% gentamicin, or no additives. By six weeks, the mortality rate was 61% in controls, 22% in Ag-PMM animals and 6% in gentamicin-PMM animals. Bacterial counts from the bone of dying and surviving animals were significantly lower than controls, 23.6% of controls for the Ag-PMM treated and 6.0% for the gentamicin-PMM treated groups. All surviving animals were culture positive, except for three sterile bones obtained from the gentamicin-PMM group. In light of these results and the favorable characteristics as an antimicrobial agent, further investigation of silver in bone cement (or other vehicles) for the prevention or treatment of bone infection appears warranted.

Abstract: A child with almost total loss of the radius from h judicious diaphysial sequesfrectomy after acute haematogenous osteomyelitis developed a severe radial club hand and loss of function. She was admitted to the University Teaching Hospital, Lusaka, where the ulna was “radialised” producing a one-bone forearm and a stable and functional limb. This unusual case is reported to discourage premature diaphysial sequestrectomy and to describe a method of salvage which gave gratifying results.

Abstract: Increased patellar uptake on bone scans is seen quite commonly but the possible or probable etiologies of this finding have not been previously well described. A review of 100 consecutive bone scans showed that the incidence of bilateral "hot" patellae is 15%. Identified etiologies include osteoarthritic degenerative disease (35%), fracture, possible metastatic disease, bursitis, Paget's disease, and osteomyelitis. The value of careful history, physical examination, and radiographs is stressed.

Abstract: Candida vertebral osteomyelitis was diagnosed in a patient with systemic lupus erythematodes following X-ray evidence of osteomyelitis and the repeated culturing of Candida albicans from material obtained by needle biopsies from the third lumbar vertebra. The patient had been on glucocorticosteroids and parenteral nutrition six months previously. At that time, a yeast was cultured from the blood and the tip of the subclavian catheter which had been removed. After candida vertebral osteomyelitis was diagnosed, she was treated with ketoconazole for seven months. Recovery was impressive, as judged by the clinical and radiographic findings. At the time of writing this paper--12 months after the withdrawal of ketoconazole--the patient showed no signs of recurrence.