Spinal osteomyelitis caused by Proteus mirabilis in a child

Weerd, Willemien de; Kimpen, Jan L. L.; Miedema, Carien J.

doi:10.1007/s004310050547

Cited by 4 publications

(4 citation statements)

References 10 publications

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Section: Discussionmentioning

confidence: 99%

“…Proteus vertebral osteomyelitis is rare and has been reported in the English medical literature in 21 other patients over the last 75 years 1–10 . However, since 1988, only four cases have been reported 1,9,10 . In only six of the reported cases were the responsible Proteus species cultured from the pus aspirated from the affected vertebra; in all other cases the diagnosis was made on blood or urine culture combined with radiological evidence of acute osteomyelitis.…”

Section: Discussionmentioning

confidence: 99%

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Proteus vertebral osteomyelitis

Yong

2009

Int J of Rheum Dis

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Proteus organisms are rare causes of osteomyelitis. Vertebral osteomyelitis caused by this organism has only been reported in 21 cases over the last 75 years. Although Staphylococcus aureus is the most common cause of vertebral osteomyelitis, rare causes such as P. mirabilis may need to be considered in the context of recent urinary tract infection or urological surgery. Therefore biopsy should be undertaken to establish the causative organism and determine appropriate antibiotic susceptibility.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Proteus vertebral osteomyelitis

Yong

2009

Int J of Rheum Dis

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“…Osteomyelitis caused by infection with Proteus mirabilis is rare, especially in adults. [1][2][3][4] The most common pathogen causing osteomyelitis in HIV carriers, as in the general population, is Staphylococcus aureus. 5,6 The only report referring to osteomyelitis caused by Proteus mirabilis in an HIVpositive patient is by Bahebeck et al 7 In their large series of 31 musculoskeletal infections in HIV-positive patients, Proteus mirabilis was the responsible organism in six.…”

Section: Discussionmentioning

confidence: 99%

“…Osteomyelitis caused by infection with Proteus mirabilis is rare. [1][2][3][4] Its clinical course is unpredictable. To the best of our knowledge this is the first report of multifocal Proteus mirabilis osteomyelitis in an HIV carrier, as verified by repetitive cultures.…”

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confidence: 99%

MultifocalProteus mirabilisosteomyelitis requiring bilateral amputation in an HIV-positive patient

Petsatodis

Symeonidis

Karataglis

et al. 2007

The Journal of Bone and Joint Surgery. British volume

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We present a rare case of multifocal Proteus mirabilis osteomyelitis in an HIV-positive patient. Despite the patient's good immune status as assessed by her CD4 cell count and the aggressive treatment, she eventually underwent bilateral above-knee amputations to eradicate the infection. Multifocal Proteus mirabilis osteomyelitis can have an unpredictable clinical course with a severe outcome in HIV-positive patients.

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Proteus mirabilis osteomyelitis of the ribs in a girl with sickle cell anaemia

Kanfaoui¹,

Graide²,

Pétein³

et al. 1999

European Journal of Pediatrics

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Sir: In patients with sickle cell anaemia (SCA), bacterial infections are frequent, particularly osteomyelitis of the long bones [1,2].Salmonella spp. are the most common organisms causing osteomyelitis [5] whereas Proteus mirabilis is a very rare cause [4,6].A 13-year-old Zairian girl with SCA living in Belgium since 6 months was admitted to our hospital for chest pain and swelling of the left anterior thoracic region, the ®rst symptoms of which had started 4 weeks earlier. On admission, physical examination showed a good general condition, a tender subcutaneous swelling (3´3 cm) of the left anterior chest wall at the level of the 6th to 8th ribs. Thoracic auscultation revealed diminished left basal respiratory sounds. Temperature was 38.8°C. There were no enlarged regional lymph nodes.Initial laboratory evaluation revealed haemolytic anaemia and an in¯ammatory syndrome. Haemoglobin concentration was 9.2 mg/dl, reticulocytes 14%, and white blood cell count 22,000/ll with 83% polymorphonuclear cells. The ESR was 132 mm/h. Haemoglobin electrophoresis showed >90% haemoglobin S and 3.2% haemoglobin A 2 . Blood and urine cultures remained sterile. Renal ultrasonography and a DMSA scan were normal. A Mantoux test and HIV serology were negative.Chest X-ray and CT scan showed a left pleural eusion with left basal condensation and an osteolytic lesion of the 6th to 8th left ribs.A 99m Tc scan showed increased tracer uptake at the same level. Surgical exploration revealed a subcutaneous abscess and a biopsy of the ribs was performed.Histopathological examination revealed a non-speci®c in¯am-matory granuloma without caseous necrosis, compatible with an acute bacterial infection. PAS and Ziehl-Neelsen stains were negative. P. mirabilis, sensitive to ceftriaxone, was cultured from the pus and from the rib curettage material. The patient was treated with ceftriaxone (100 mg/kg per day) for 6 weeks, followed by oral cefuroxime for 1 month.Evaluation after 10 weeks of antibiotic therapy showed complete absence of symptoms and a normal chest X-ray.P. mirabilis osteomyelitis is very rare in SCA patients. It is most often associated with urinary tract infections caused by this organism and most often seen in neonates and the elderly [1, 4, 6].Recently, de Weerd et al. (6) reported the ®rst paediatric case of P. mirabilis vertebral osteomyelitis in a child aged 14 year. To our knowledge, P. mirabilis osteomyelitis of the ribs has never been reported in children.Our patient had no recent urinary tract infection and we did not ®nd an underlying urological abnormality that might have led to a urinary P. mirabilis infection with subsequent bacteraemia and osseous involvement.Acute and chronic osteomyelitis are common in SCA but generally the site of the infection is in the tubular bones. Osteomyelitis of the ribs is found in only 0.5% of cases [3]. Patients with SCA are most susceptible to encapsulated organisms such as Streptococcus pneumoniae and Haemophilus in¯uenzae and also to Salmonella spp. for reasons that include relative hypo...

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Spinal osteomyelitis caused by Proteus mirabilis in a child

Abstract: Osteomyelitis due to Proteus mirabilis is rare. Spinal osteomyelitis caused by this organism has only been described in adults. This is the first paediatric case of P. mirabilis vertebral osteomyelitis.

Cited by 4 publications

References 10 publications

Proteus vertebral osteomyelitis

Proteus vertebral osteomyelitis

MultifocalProteus mirabilisosteomyelitis requiring bilateral amputation in an HIV-positive patient

Proteus mirabilis osteomyelitis of the ribs in a girl with sickle cell anaemia

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