Osteomyelitis in Sickle Cell Anemia

Aka: Osteomyelitis in Sickle Cell Anemia, Osteomyelitis in Thalassemia, Osteomyelitis in Hemoglobinopathy

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II. Pathophysiology

  1. Infection of infarcted bone, especially long bones (multiple sites in same bone may be involved)

III. Causes

  1. Salmonella
    1. Most common organism in Sickle Cell AnemiaOsteomyelitis
    2. Other Gram Negative Bacteria may also occur
  2. Staphylococcal Aureus (<25% of cases)

IV. Signs

  1. Fever
    1. Fever duration directly correlates with likelihood of Osteomyelitis (risk increases 80% each day of fever)
  2. Extremity swelling
    1. Osteomyelitis likelihood increases 8.4 fold
  3. Bone pain
    1. Osteomyelitis likelihood increases 20% each day of pain

V. Diagnosis

  1. Bone Culture

VI. Labs

  1. Blood Cultures
    1. Test Sensitivity: 30 to 76%

VII. Imaging

  1. See Osteomyelitis
  2. Interpretation may be difficult in Sickle Cell Anemia as bone infarcts may appear similar to Osteomyelitis

VIII. Management

  1. See Osteomyelitis
  2. Antibiotics are similar to those used in other Osteomyelitis with added Salmonella and Gram Negative coverage
    1. Total Antibiotic course: 6 to 8 weeks
    2. Initial IV: Vancomycin AND (Ciprofloxacin or Ceftriaxone)
    3. Later: May transition to Oral fluoroquinonoles (Ciprofloxacin, Levofloxacin) for susceptible Gram Negative causes

IX. References

  1. Lowe and Wang (2018) Crit Dec Emerg Med 32(11): 17-25
  2. Welsh and Welsh (2016) Crit Dec Emerg Med 30(11): 15-23

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