vyseerx
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4 years old african-american male child was brought to the ER with complaints of pain in the right knee for 2 days. he was previously diagnosed with sickle-cell anemia.on examination the site was edematous ,erythematous and tender to touch. child was febrile and complained of chills. complete blood count has shown leukocytosis,predominantly neutrophils. father tells that child was adopted at 2 yearsof age and the immunization status is not known.which is the most likely organism to have caused the child's illness?
a.salmonella typhi
b.shigella sonnei
c.gram+ve cocci in chains
d.gram+ve rods
e.gram-ve rods
f.gram+ve cocci in clusters
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vyseerx
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| asmi
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ITS A
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| vyseerx
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sorry , try again!
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vyseerx
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| asmi
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E :?:
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| alice8
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f.gram+ve cocci in clusters
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| Idiopathic
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Osteomyelitis in sickle-cell px is salmonella paratyphi
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| Idiopathic
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Remember Salmonella Paratyphi for Sickle cell Patients.
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| asmi
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thanks idiopathic 
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| vyseerx
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staphylococcus aureus is the most common cause of osteomyelitis in any age group. there is a specific association between sicklecell patients and salmonella typhi as the cuasative agent. HOWEVER, STAPHYLOCOCCUS AUREUS IS STILL THE NUMBER ONE CAUSE OF OSTEOMYELITIS even in these patients. salmonella is number 2 cause . THE CORRECT ANSWER IS F (GRAM +VE COCCI IN CLUSTERS= STAPHYLOCOCCUS AUREUS)
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| Idiopathic
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This is from the AAFP and alos noted on several ortho sites:
"Salmonella species are the most common cause of osteomyelitis in children with sickle cell disease.5 Staphylococcus aureus is the second most common organism. Pneumococcus species are occasionally isolated in infants. Antibiotics should be selected to treat these organisms. "
Also, its what Goljan told us.
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| Idiopathic
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I will reiterate that, of the listed choices, the salmonella sp. is the most likely.
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| vyseerx
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my answer comes from kaplan material pediatrics handout and also listen to audio lectures!!
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vyseerx
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| Idiopathic
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Well, ok. Ill trust my sources, you trust yours. But just google the info and you will get the right answer.
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| cool
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plz clarify, then which is causative agent, i m vvv confused, plz any body could help
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| Idiopathic
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Staph aureas most common, salmonella stong association with sickle cell px. If you get a question about osteo in a sickle cell px, go with salmonella, regardless of what this post says.
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| cool
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thanks idiopathic, but can u give me some reference in support of your thought///////
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| Idiopathic
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Sure, here is the link I cited above:
"Salmonella species are the most common cause of osteomyelitis in children with sickle cell disease.5 Staphylococcus aureus is the second most common organism. Pneumococcus species are occasionally isolated in infants. Antibiotics should be selected to treat these organisms. "
from http://www.aafp.org/afp/20000915/1309.html
and from goljan.
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| BellKicker
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Wow, if I had a dollar for every time this discussion came up. (I'd have at least 3 bucks by now).
There's probably no definite answer. Loko at this review article:
http://pediatrics.aappublications.org/cgi/content...
I'm sure there won't be a board question about which is more common. We just have to remember to cover for both organisms in sickle cell patients.
BK
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| Idiopathic
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I dont know, that review seems to sum it up.
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| deea
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I'm SURE that Goljan said that Staph aureus is the most common cause of ostemyelitis in sickle cell px... review the audios.
I trust Goljan! :icon_salut:
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| Idiopathic
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Im SURE that he told me different, during my year of Pathology with him. Believe who or what you want to, but if you get a ?? about osteo in a sickler, you are a fool to put staph. if not a sickler, then you are a fool to put anything else.
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| bose
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After reading all the post above, I would stick to Kaplan and select STAPH.
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| lucky
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for board purposes , a pt with SCD and osteo. no. 1 cause is salmonella.
kaplan and brs pathology both favor this.
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| lucky
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staph is no. 1 cause overall but if the q clearly mentions SCD then i would go for salmonella.
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| MSMHero
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Holla. You gotta go w/ S. Paratyphi. I've listened to Goljan three times and every time he says S.Typhi (Lecture 6 of the pirated series), even though it is actually S. Paratyphi. Idiopathic you must go to OSU, is that an osteopathic school? I can't stand Goljan's laugh, he sounds evil, and haunts me in my sleep, that's b/c I listen to him when I go to bed. I will forgive all of that if it helps me get above a 260, I'll keep y'all posted.
Peace Up, A-town down.
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