Salmonella osteomyelitis and arthritis in sickle cell disease

Anand, Ajay; Glatt, Aaron E.

doi:10.1016/0049-0172(94)90076-0

Cited by 95 publications

(64 citation statements)

References 87 publications

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“…Many of the strains of salmonella, including the typhoidal and non-typhoidal, cause bone infection and patients often have no clinical symptoms of generalised salmonella infection [5,7]. Salmonella typhimurium has been reported in 6-30% of sickle-cell related infections, and chronic bacteraemia has been noted to precede vertebral infection [2].…”

Section: Discussionmentioning

confidence: 99%

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Possible salmonella osteomyelitis of spine following laser disc decompression

Farrar

Walker

Cowling

1998

European Spine Journal

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A 52-year-old Asian man was diagnosed clinically and with CT scan as having right sciatica due to an L4/5 disc protrusion causing pressure on the right L5 nerve root. Conservative management was unsuccessful and he underwent laser disc decompression with a KTP Laser delivering 1250 J energy (Laserscope, Gwent, UK).The patient had a past history of pulmonary tuberculosis, but bronchoscopy performed 2 months before the surgery was negative. His leg pain did not improve, and 1 month after the disc decompression he was admitted for bed rest. His straight leg raise was restricted at 40°, but there was no other neurological deficit. An MRI scan was performed (Fig. 1), which showed end plate oedema and disc changes, which were interpreted as being consistent with the operative procedure. His symptoms improved and he was discharged.The back and leg pain returned, and 6 months following the disc decompression further investigations were performed. The patient was afebrile; white cell count and differential, plasma viscosity, plasma protein electrophoresis, C-reactive protein and antistaphylococcal antibodies were normal. Three sets of samples of early morning urine, sputum and blood cultures taken for tuberculosis were negative.A second MRI scan was performed (Fig. 2), which showed signs of an acute or chronic discitis at L4/5 with destruction of the disc space and adjacent end plates anteriorly. There was minimal abscess formation and an enhancing soft tissue mass extending posteriorly to the theca. Blood cultures grew Salmonella typhimurium (phage type 104). Aspiration of the L4/5 disc space was attempted under local anaesthesia, but was unsuccessful. Stool culture was negative.Assuming the Salmonella to be the infecting organism, treatment was initiated with 2 g intravenous ceftriaxone once daily and 750 mg oral ciprofloxacin twice daily, to which the organism showed in vitro sensitivity. Symptoms improved with bed rest and plaster jacket, combination antibiotics were given for a total of 6 weeks and oral ciprofloxacin for a further 6 weeks. Three months after stopping antibiotics, the patient's back and leg pain had improved and MRI scan (Fig. 3) showed resolution of the soft tissue mass with progression towards osseous fusion between the L4 and L5 vertebral bodies. DiscussionPercutaneous laser disc decompression is a relatively new technique, and its clinical effectiveness is yet to be established. In uncontrolled clinical studies it has been shown to be a safe procedure with no septic complications reported to date [3,6]. We believe that this is the first report of septic complications following this procedure. AbstractWe report a case of chronic discitis and vertebral osteomyelitis that we believe was caused by Salmonella typhimurium following laser decompression of the L4/5 disc for symptomatic disc protrusion in a 50-year-old Asian man. The infection was successfully treated with intravenous ceftriaxone combined with oral ciprofloxacin. We believe this to be the only report of such a complication following this ...

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Section: Discussionmentioning

confidence: 99%

“…Salmonella osteomyelitis is most commonly associated with Sickle Cell Disease [2], but the organism is recognised in non-sickle subjects [7]. Many of the strains of salmonella, including the typhoidal and non-typhoidal, cause bone infection and patients often have no clinical symptoms of generalised salmonella infection [5,7].…”

Section: Discussionmentioning

confidence: 99%

Possible salmonella osteomyelitis of spine following laser disc decompression

Farrar

Walker

Cowling

1998

European Spine Journal

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“…It has also been reported after iguana bites [91]. Salmonellosis, osteomyelitis and joint infections are also common in sickle cell disease [5]. The cause for this is probably the fact that intravascular sickling causes capillary occlusion, which devitalises and possibly infarcts the gut, permitting salmonella invasion.…”

Section: Predisposing Causesmentioning

confidence: 99%

“…Reduced function of the liver and spleen together with interference of reticuloendothelial system function due to erythrophagocytosis also suppresses clearance of Salmonella from the blood stream. Abnormal opsonisation and complement function probably also play a role [5].…”

Section: Predisposing Causesmentioning

confidence: 99%

Septic arthritis in Western and sub-Saharan African children - a review

Lavy¹

2006

International Orthopaedics (SICOT)

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“…However, approximately 5-7.6% of patients develop bacteremia [1,2]. Salmonella osteomyelitis is common in children with hemoglobinopathies, such as sickle cell disease, but it is an extremely rare consequence of Salmonella bacteremia in healthy children [3][4][5]. We encountered a case in which acute osteomyelitis of the femoral neck caused by Salmonella enterica occurred without gastro-intestinal manifestations in a healthy 9-year-old boy.…”

Section: Introductionmentioning

confidence: 99%