mani
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can u plz share with us ur experience or knowledge about the most common cause of osteomyelitis in a pt with sickle cell disease?
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| humbty
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i am not bactitech, but as i know Salmonella osteomyelitis is very common in sickle cell patients. I think that is often in sickle cell anemia because some sinuses in the bone marrow are blocked and salmonelle can settle there. :o
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| mani
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lemme tell what i m thinking by an example, remember the figures i give r just example and not real, jus to make things clear the way i think about it:
say we make 2 groups of pts having osteomylitis with 1000 pts in each group. one group is otherwise normal and other group is having sickle cell disease. among normal group 5 pts had salmonella n all rest S aureus. but in sicke cell dis group, 50 had salmonella n all rest staph. i hope i conveyed it the way i wanted
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| bactitech
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I'm a medical technologist, not a doc :-). Thanks for asking though.
I've been a tech for 30 years, and in micro for about 25 of those. I have worked at hospitals with a lot of sickle cell patients. I have not PERSONALLY seen Salmonella osteomyelitis (that's not to say that someone else didn't work up a culture) in 30 years. What we DID see last year was a positive shoulder fluid with Salmonella (I don't think the patient had sickle cell). Seems the patient (from the story we heard) had some sort of shoulder deal going on. Doc put the patient on NSAID's and sent him home. I believe he had some sort of shoulder strain injury from either work or home but don't quote me here. Anyway, the patient didn't get better, became febrile, and went back to the hospital. They drained the fluid surgically and it grew a gram negative rod. I pulled the sensi off of our machine and couldn't believe it. I pulled the plates, got out the Salmonella typing serum and typed it (and no, I don't remember which one it was - probably group B but I don't remember). Anyway, we called the floor with the results. I can't remember if he also had a positive blood culture with the organism also. I have no idea how this gentleman got Salmonella in a joint fluid. I don't believe stool studies were ever done.
Salmonella can be a systemic organism, whereas Shigella isn't. Back in the 70's we had a patient with a pure culture of Salmonella Group B in her sputum (that was a surprise also). They treated her, she ended up with a pure culture of Candida albicans in her sputum, and then she died. I don't remember what her original diagnosis was.
I would say that one of the more common organisms we see is Staph. aureus in osteomyelitis. We also see a lot of coagulase negative Staph, but I'm not sure if that's a function of an infection or lousy culture technique. Pseudomonas aeruginosa also shows up.
Humbty, I'd sure like a source for your "very common in sickle cell anemia" comment...:-). I'd say over 98% of the Salmonella I've seen over the years have been from feces.
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| humbty
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Kaplan says Salmonella is the most common cause for osteomyelitis in sickle cell disease (>80%). :? :idea:
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| bluedusk
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yeah, that's interesting. goljan says s. aureus is most common in sickle, but that when you do find salmonella, it is most common in sickle. humbty, does kaplan word it in a way that contradicts this?
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| Alina T
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bluedusk, "my Goljan" :lol: says that Salmonella osteomyelitis is most common in sickle cell! , although Staph is most common OM overall.
see guys, this is y I hate these MCC qs so much.....sooooo many opinions in diff books and i dont know if it's really that important.....
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| bactitech
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Hmmm, interesting. Please do realize I'm speaking from my experience in NW Ohio. Do not forget that the population of patients determines the isolates. I have worked at four different laboratories throughout my career. Each laboratory served a slightly different patient population. My current position serves four hospitals in NW Ohio - not your typical hotbed of sickle cell cases. If you were practicing in, say, NY City, or somewhere in Africa, or in Washington, DC, then your patient populations would be totally different.
You guys, as future physicians, MUST realize that what you will see in the infectious disease area is totally population dependent. Antibiotic sensitivity patterns will change depending on where you will do your residency and ultimately practice. Different patient populations will determine a lot of your clinical decisions. I realize that you are studying for an examination, but please realize that there is a bigger picture here.
http://www.spine-surgery.com/Articles/salmonella.... I googled and came up with this - only EIGHT cases worldwide of Salmonella vertebral ostelmyelitis. Could be why I haven't seen it :-).
Do they teach you guys to look for horses instead of zebras any more :-) :-)????
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| bactitech
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http://www.merck.com/mrkshared/mmanual/section5/c...
http://www.spine-health.com/topics/cd/infection/o...
http://www.nlm.nih.gov/medlineplus/ency/article/0...
These articles will give you a more realistic picture of what you will see out there. The last reference shows a population incidence of osteomyelitis of 2 in 10,000 people. Obviously Salmonella osteomyelitis is NOT common. These articles go along with what I'm seeing on cultures. We deal with a lot of orthopedic surgery cultures. A lot are from post-op infections. Our lab is obviously dealing with many more of these cultures than a typical clinical laboratory would (remember - patient population...). Two of the hospitals that send us cultures are Level 1 trauma centers (not your typical hospital).
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| bluedusk
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alina, i submit to your correctness : )
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| Alina T
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:icon_bounce:
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| bactitech
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Interestingly enough, we had an inservice at our weekly lab meeting, and our Ph.D. microbiologist talked about Salmonella - in osteomyelitis in SICKLE CELL PATIENTS :-). Wow - I was blown away. I'll try to get ahold of the notes...he had a handout.
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| mani
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bactitech, i have no doubt about salmonella osteomyelitis being commoner in sickle cell pts than general population. problem to be solved is it the MOST COMMON CAUSE of osteomyelitis in sickle cell pts or doest S aureus retains this postion in these pts as well as it does in general population?
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| bactitech
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Sorry, I really don't know. We have no way of knowing when we get cultures from osteomyelitis whether they are sickle cell patients or not. That would be a good question for your local infectious disease doc.
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