jean robert
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A 12 y.o. boy with sickle cell anemia develop sudden onset of fever and chills accompanied by intense pain and tenderness over the distal tibia. X ray films and CT scan of the distal leg reveal swelling of the subcutaneous tissue and bone demineralization. Blood cultures and bone biopsy are arranged to isolate the offending agent. Which of the following infectious agents will most likely be identified?
a.- Group B streptococci
b.-Hemophilus influenzae
c.-Mycobacterium tuberculosis
d.-Pseudomonas aeruginosa
e.-Staphylococus Aereus.
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| angel23
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E.staph aureus.....normally it is salmonella in sickle cell pts
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| GoodGirl
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Staph. Aureus.
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| jean robert
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| nerve09
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B.hemophilus influenzae
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| angel23
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ok...its hemophilus...splenectomy predisposes to inf with encapsulated organisms
was earlier confused abt hemophilus
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| jean robert
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Correct answer: D ( Pseudomonas Aeruginosa)
Pyogenic osteomyelitis may result from hematogenous dissemination or local spread from contiguous infectious focus. Patients with sickle cell disease are prone to osteomyelitis, and Pseudomonas Aeruginosa is the most common etiologic agent in this condition. Bone pain, fever,and x-ray evidence of early bone demineralization and soft tissue swelling are the presenting clinical picture.
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| jean robert
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Haemophilus influenzae and group B streptococci are the most causes of osteomyelitis occuring in Infants.
Staphylococcus aureus accounts for approximately 90% of all cases arising in patients without specific predisposing conditions.
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| Ig F
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well i have always read that Salmonella causes osteomyelitis in the patients of Sickle cell anemia.......i m confused now......
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| ShweHope99.9998
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 history will miss something ?? or we miss something 
GL  
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| Tiff
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?????????????????????????????????????
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| angel23
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check this out it says staph aureus
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| angel23
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http://www.emedicine.com/emerg/topic349.htm
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| Ig F
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:well now we all should think this way......well i m not imposing just suggesting.....
S. aureus is the MCC of osteomyelitis in the pt. of Sickle cell anemia and Salmonella frequently causes Osteomyelitis in the patients of sickle cell anemia......
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| keepgoing
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i doubt here,in sickle cell pat(functional asplenism)--prone to encapsulated bugs like nesseria,h.influenza,salmonella,strep.pneumonia etc.
number one cause of osteiomylitis in sickle cell pat.(MCC)--salmonella
2nd--e.coli
3rd--s.aureus.
psuedomonas how come,where its most common seen in immunocompromised pat.
plz clarify!
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| Ig F
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even i thought so that salmonella is the number one cause of osteomyelitis in the patients of SC anemia but i am confused after reading the article angel 23 posted........such a ghumaofying info.....
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| keepgoing
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oh i ddint see article but read now and here is something from it(link)(favors s.aureus as well):-
Bacterial causes of acute and direct osteomyelitis include the following:
- Acute hematogenous osteomyelitis
- Newborns (younger than 4 mo): S aureus, Enterobacter species, and group A and B Streptococcus species
- Children (aged 4 mo to 4 y): S aureus, group A Streptococcus species, Haemophilus influenzae, and Enterobacter species
- Children, adolescents (aged 4 y to adult): S aureus (80%), group A Streptococcus species, H influenzae, and Enterobacter species
- Adult: S aureus and occasionally Enterobacter or Streptococcus species
Direct osteomyelitis - Generally: S aureus, Enterobacter species, and Pseudomonas species
- Puncture wound through an athletic shoe: S aureus and Pseudomonas species
- Sickle cell disease - S aureus and Salmonellae species
Edited by keepgoing on 02/20/08 - 08:15 AM
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| jean robert
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keepgoing wrote:oh i ddint see article but read now and here is something from it(link)(favors s.aureus as well):- Bacterial causes of acute and direct osteomyelitis include the following: - Acute hematogenous osteomyelitis
- Newborns (younger than 4 mo): S aureus, Enterobacter species, and group A and B Streptococcus species
- Children (aged 4 mo to 4 y): S aureus, group A Streptococcus species, Haemophilus influenzae, and Enterobacter species
- Children, adolescents (aged 4 y to adult): S aureus (80%), group A Streptococcus species, H influenzae, and Enterobacter species
- Adult: S aureus and occasionally Enterobacter or Streptococcus species
Direct osteomyelitis - Generally: S aureus, Enterobacter species, and Pseudomonas species
- Puncture wound through an athletic shoe: S aureus and Pseudomonas species
- Sickle cell disease - S aureus and Salmonellae species
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| jean robert
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Sorry guys. Maybe the mistake is from my old Qbook (2001).
So,in the real thing, make sure that your answer is Salmonella or Staph. Aureus if the stem of question is about osteomyelitis in a patient with sickle cell disease.
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| mytime
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Hey guys,
It is usually meant to be salmonella in SCd kinda case but if they don't give that it's a trick q. they want u to pick Staph. since it's anyways the most common. Now about Pseudomonas, i remember reading that it does cause osteomyelitis but remember for that to happen the skin needs to be broken. They haven't told us how the case senario took place so it's difficult to say. Yet again, if u have to justify the answer. i would say it's Pseudomonas, according to them coz' A chronic sickler has been in an out of hospital and been put on IVs or injections. That's the punture rt. there. Coz if I remember correctly Pseudomonas is mostly Hospital acquired. Also, commonly seen in iv drug users.
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| mytime
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Happy KG? Btw, I referred the CMDT infectious disease before typing, to be surer. HUUUUUUUUUGS.
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| yoga
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nice q
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| keepgoing
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mytime wrote:
Happy KG? Btw, I referred the CMDT infectious disease before typing, to be surer. HUUUUUUUUUGS.
Thanku sunshine!  ,yes i hope we get more clue on exam if some other bug than just usual MC one.
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| new_n_lost
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Ig F wrote:even i thought so that salmonella is the number one cause of osteomyelitis in the patients of SC anemia but i am confused after reading the article angel 23 posted........such a ghumaofying info.....
Loved the word 
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| new_n_lost
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This is one of the controversial questions from Kaplan people as the scenario depicted in no way indicates a P.Arginosa unless you want to talk into hypotheticals and assumptions. But till now USMLE RULE #1 stands firm Dont think outside the Question. If there is a co-relation to be made then it will be made and a turning will be there for you to pick on. However they intend to presume that while question Pathophysio of any disease the question can jump but still NO ASSUMPTIONS. STICK TO THE QUESTION AND THATS IT.
Quoting Verbatim from Harrison's
"P. aeruginosa is the most common cause of osteochondritis of the foot following plantar puncture wounds. This infection is seen primarily in children and is usually acquired via the direct inoculation of P. aeruginosa that inhabits the moist environment found in the soles of shoes. The organism infects the small joints and bones, including the proximal phalanges, metatarsals, metatarsophalangeal joints, tarsal bones, and calcaneus. On average, local pain and swelling last for several weeks, and systemic symptoms are usually lacking. There may be plantar cellulitis over the involved area or tenderness upon deep palpation. Results of roentgenograms and bone scans are generally positive. Aspiration of the affected joint frequently yields purulent material in which P. aeruginosa can be demonstrated by Gram’s staining and by culture. "
So in my opinion there is no indication that they want to hint something other than the MCC in this case unless they are talking about something which falls along the lines of some weird stuff.
Moi 2 cents.
Edited by new_n_lost on 02/27/08 - 06:13 AM
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