Putrid infectious pubic osteitis: case report and review of the literature on the differential diagnosis and treatment of infectious pubic osteitis and inflammatory pubic osteitis

Tiemann, A.; Röhm, C; Hofmann, Gunther O.

doi:10.1007/s00068-010-0012-2

Cited by 6 publications

(12 citation statements)

References 18 publications

(30 reference statements)

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“…The symptoms, diagnosis and treatment of PPSS were in accordance with those in published case studies [1,10,11,20,21]. However, our result differ from those of Cosma et al's [1] review, which reported that the outcome was excellent in most cases when prompt treatment was established.…”

Section: Discussionsupporting

confidence: 86%

“…After the abscess is aspirated and/or blood culture samples are collected, treatment with broad-spectrum antibiotics covering group G streptococci, staphylococci and diptheroids should be started. Analgesics including paracetamol and NSAIDs as well as bed rest should be prescribed [1,11,20,21].…”

Section: Treatmentmentioning

confidence: 99%

“…This diagnosis requires a bone scan or radiological signs of engagement of the pubic bone, i.e., oedema or irregular indentations of the adjacent joint surfaces, which are not observed in the very acute phase [15]. Septic symphysitis has been reported to be related to female incontinence surgery, pelvic surgery, pelvic malignancies, intravenous drug use, trauma, cardiac catheterization, and impaired venous circulation in the pubic vein [11,[16][17][18][19][20][21]. The most common pathogens responsible for septic symphysitis are Staphylococcus aureus, Pseudomonas aeruginosa, and Streptococcus mitis.…”

Section: Differential Diagnosismentioning

confidence: 99%

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Postpartum Septic Symphysitis, a Rare Condition With Possible Long-Term Consequences: A Cohort Study With Long-Term Follow-Up

Elden

Olsén

Hussein

et al. 2021

Preprint

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BackgroundPostpartum septic symphysitis (PPSS) is defined as acute onset of severe pain around the symphysis, restricted movement, fever and elevated inflammatory parameters. It is a rare but serious condition requiring urgent diagnosis and treatment. The aim of this study was to describe the incidence, symptoms, diagnosis, treatment and long-term follow-up of PPSS.MethodsThis was a follow-up study including 19 women diagnosed with PPSS from 1989 to 2017 at one tertiary care hospital in Sweden. Clinical data were retrieved from hospital records and compared to those retrieved from a regional registry. Women completed a postal questionnaire, and those who reported lumbo-pelvic pain (LPP) were offered a clinical examination.Results1) PPSS was diagnosed after a normal postpartum period of 24 to 50 hours by blood tests (n=19); MRI, (n=13/19); ultrasonography (n=8 /19) or CT (n=3/19). Treatment included aspiration of symphyseal abscesses, i.v. antibiotics and physiotherapy. Women with PPSS more frequently were primiparous (n=14/19, p=0.001), had an instrumental delivery (n=14/19, p=0.003), had a longer time of active labour (p=0.01) and second stage of labour (p=0.001) than women in the regional registry. 2) Ten out of nineteen (52%) women reported LPP at follow-up. These women more often suffered impaired function related to LPP (Pelvic Girdle Questionnaire, 27 versus 0, p<0.0001), a poorer health-related quality of life (EuroQol-5 dimensions p=0.001 and EuroQol-visual analogue scale, 65 mm versus 84 mm, p=0.022) and higher levels of anxiety and depression (Hospital Anxiety Depression Scale (HADS)-A, 7 versus 2, p=0.010; and HADS-D, 1 versus 0, p=0.028) than women with no pain. 3). Of the eight women who received a clinical assessment, one had lumbar pain and seven had PGP.ConclusionsIn the largest cohort of patients with PPSS to date, primiparas and women with instrumental vaginal delivery were overrepresented, indicating that first and complicated deliveries might be risk factors. Approximately half of the women reported PGP, with considerable consequences affecting health-related quality of life and function decades after delivery. Prospective multicentre studies are needed to establish risk factors for, long-term consequences of and adequate treatment for this rare pregnancy complication.

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Section: Discussionsupporting

confidence: 86%

Section: Treatmentmentioning

confidence: 99%

Section: Differential Diagnosismentioning

confidence: 99%

See 1 more Smart Citation

Postpartum Septic Symphysitis, a Rare Condition With Possible Long-Term Consequences: A Cohort Study With Long-Term Follow-Up

Elden

Olsén

Hussein

et al. 2021

Preprint

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“…Accurate diagnosis can be a challenge and requires a methodical approach and the use of a variety of diagnostic measures [12,13]. The antibiotic treatment is adjusted depending on the microbiological diagnosis, adding NSAIDs, and bed rest [1,7].…”

Section: Discussionmentioning

confidence: 99%

Septic arthritis of the pubis symphysis: clinical and therapeutic features

et al. 2017

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Septic arthritis of the pubis symphysis is rare and difficult to diagnose. The objective of our study was to describe the biological, clinical, radiological and therapeutic aspects of this disease. This is a retrospective study of 4 cases of septic arthritis of the pubic symphysis collected in the Department of Rheumatology and Orthopaedics in Sousse in Tunisia over a period of 16 years (2000-2016). Our population consists of 3 women and one men. The mean age was 47 years (18-83). Clinical signs of appeal were inflammatory groin pain, pubic pain and fever. Symptoms appeared after forceps delivery in 2 cases, after surgery on the pelvis in one case and in a context of sepsis in one case. Radiographs showed pubic disjunction with irregular shoreline in all cases. CT performed in all patients and MRI in 2 patients showed erosions of the banks of the pubic symphysis with infiltration of the soft parts in all cases. The causative organisms were isolated in 3 cases by biopsy of soft tissue abscess under CT in 2 cases and vaginal swab in one case. Identified germs were staphylococcus aureus Méti-S (n=1), proteus mirabilis (n=1) and varied flora (n=1). The treatment consisted of appropriate antibiotics in all cases and surgical drainage of soft tissue abscess resistant to medical treatment in 2 cases. The outcome was favorable in all cases. Diagnosis of septic arthritis of the pubic symphysis is based on clinic supported by microbiologic culture results, image methods, and proteins augment during acute phase.

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“…Septic symphysitis has been reported to be related to female incontinence surgery, pelvic surgery, pelvic malignancies, intravenous drug use, trauma, cardiac catheterization, and impaired venous circulation in the pubic vein [ 11 , 16 – 21 ]. The most common pathogens responsible for septic symphysitis are S. aureus , P. aeruginosa , and S. mitis .…”

Section: Introductionmentioning

confidence: 99%

Postpartum septic symphysitis, a rare condition with possible long-term consequences: a cohort study with long-term follow-up

Elden

Olsén

Hussein

et al. 2021

BMC Pregnancy Childbirth

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Background Postpartum septic symphysitis (PPSS) is defined as acute onset of severe pain around the symphysis, restricted movement, fever, and elevated inflammatory parameters. It is a rare but serious condition requiring urgent diagnosis and treatment. The aim of this study was to describe the incidence, symptoms, diagnosis, treatment, and long-term follow-up of PPSS. Methods This follow-up study included 19 out of 21 women diagnosed with PPSS from 1989 to 2017 at one tertiary care hospital in Sweden. Clinical data were retrieved from hospital records and compared to those retrieved from a regional registry. Women completed a postal questionnaire, and those who reported lumbopelvic pain (LPP) were offered a clinical examination. Results 1) PPSS was diagnosed after a normal postpartum period of 24 to 50 h by blood tests (n = 19/19), ultrasonography (n = 9 /19), computer tomography (n = 8/19) or magnetic resonance imaging (n = 16/19) Treatment included aspiration of symphyseal abscesses, i.v. antibiotics and different physiotherapeutic interventions. Women with PPSS more frequently were primiparous (n = 14/19, p = 0.001), had an instrumental delivery (n = 14/19, p = 0.003), longer time of active labour (p = 0.01) and second stage of labour (p = 0.001) than women in the regional registry. 2) Ten out of 19 (52%) women reported LPP at follow-up. These women more often suffered impaired function related to LPP (Pelvic Girdle Questionnaire, 27 versus 0, p < 0.0001), a poorer health-related quality of life (EuroQol-5 dimensions p = 0.001 and EuroQol-visual analogue scale, 65 mm versus 84 mm, p = 0.022) and higher levels of anxiety and depression (Hospital Anxiety Depression Scale (HADS) HADS-Anxiety, 7 versus 2, p = 0.010; and HADS-Depression, 1 versus 0, p = 0.028) than women with no pain. 3). Of the eight women who were clinically assessed, one had lumbar pain and seven had pelvic girdle pain (PGP). Conclusions In the largest cohort of patients with PPSS to date, primiparas and women with instrumental vaginal delivery were overrepresented, indicating that first and complicated deliveries might be risk factors. Approximately half of the women reported PGP at follow-up, with considerable consequences affecting health-related quality of life and function decades after delivery. Prospective multicentre studies are needed to establish risk factors, long-term consequences, and adequate treatment for this rare pregnancy complication.

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Putrid infectious pubic osteitis: case report and review of the literature on the differential diagnosis and treatment of infectious pubic osteitis and inflammatory pubic osteitis

Cited by 6 publications

References 18 publications

Postpartum Septic Symphysitis, a Rare Condition With Possible Long-Term Consequences: A Cohort Study With Long-Term Follow-Up

Postpartum Septic Symphysitis, a Rare Condition With Possible Long-Term Consequences: A Cohort Study With Long-Term Follow-Up

Septic arthritis of the pubis symphysis: clinical and therapeutic features

Postpartum septic symphysitis, a rare condition with possible long-term consequences: a cohort study with long-term follow-up

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