Osteomyelitis in Sickle Cell Anemia

1. See Also
   1. Osteomyelitis
   2. Sickle Cell Anemia
   3. Transient Red Cell Aplasia
   4. Acute Chest Syndrome
   5. Acute Vaso-Occlusive Episode in Sickle Cell Anemia
   6. Aplastic Crisis in Sickle Cell Anemia
   7. Cerebrovascular Accident in Sickle Cell Anemia
   8. Dactylitis in Sickle Cell Anemia (Hand Foot Syndrome in Sickle Cell Anemia)
   9. Hematuria in Sickle Cell Anemia
   10. Priapism in Sickle Cell Anemia
   11. Pulmonary Hypertension in Sickle Cell Anemia
   12. Septic Arthritis in Sickle Cell Anemia
   13. Sickle Cell Anemia Related Pulmonary Hypertension
   14. Sickle Cell Anemia with Splenic Sequestration
2. Pathophysiology
   1. Infection of infarcted bone, especially long bones (multiple sites in same bone may be involved)
3. 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)
4. 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
5. Diagnosis
   1. Bone Culture
6. Labs
   1. Blood Cultures
      1. Test Sensitivity: 30 to 76%
7. Imaging
   1. See Osteomyelitis
   2. Interpretation may be difficult in Sickle Cell Anemia as bone infarcts may appear similar to Osteomyelitis
8. 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
9. 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