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Query: UMLS:C0011849 (diabetes)
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Sixty patients with bone and joint infections secondary to gram negative infection were evaluated in relation to treatment with amikacin. Forty-seven of these patients had osteomyelitis, and 13 had joint infections, including 3 prosthetic replacements. The patients' average was 35 years and there was no predilection for any particular skeletal location. Only 6 patients had no associated predisposing medical problems. Of these problems fracture, diabetes and narcotic abuse were most common. Thirty patients had Psuedomonas infection, and 15 others had multiple pathogens including Pseudomonas. Aminoglycoside antibiotics had been previously used in 25. Amikacin was given for an average of 22 days with a mean dose of 13.4 mg/kg. Bone and synovial fluid levels of amikacin were in therapeutic range. At least 48 patients had concurrent local wound treatment in addition to parenteral administration of amikacin. In 47 patients enough information was available to determine the efficacy of treatment. Twenty-seven (57%) of these patients were considered cured, both clinically and for bacteriologic response; and additional 9 (19%) were considered partially cured. Amikacin is effective against susceptible pathogens in bone and joint infections and is a reasonable choice when aminoglycoside antibiotic is indicated.
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PMID:Gram negative bone and joint infection: sixty patients treated with amikacin. 36 14

Because of alarming delays in the diagnosis and treatment of vertebral osteomyelitis we have reviewed our experience over the past 15 years. Of the 36 cases, 25 were pyogenic and 11 tuberculous. Because of late referral there was a delay from onset of symptoms to diagnosis of at least three months in 13 patients. The reason for this was the failure of the initial physician to consider osteomyelitis in the differential diagnosis of a febrile illness associated with back pain. The majority of our patients from the onset did not have intense localized pain, tenderness and a high fever which is the classical clinical picture in this condition. Seven patients with a long history required surgical exploration and debridement of the lesion in order to eradicate the infection. The remainder did well on 6 to 12 weeks of antibiotic therapy. None required spinal fusion. Ten of 11 patients with spinal tuberculosis had curettage of the lesion and spinal fusion. Patients with diabetes, malignancy, alcoholism, corticosteroid therapy and recent lower urinary tract surgery were found to be at particular risk of developing spinal osteomyelitis. Very often it was difficult to identify differences in the presentation of pyogenic and tuberculous infections.
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PMID:Atypical manifestations of spinal infections. 40 8

Twenty-one diabetic patients with anesthetic peripheral neuropathy who never suffered a foot infection or local ulceration had roentgenograms of both feet to seek whether osseous changes characteristic of diabetic osteopathy were present. We found nine patients with vascular calcification (all 21 patients had palpable pedal pulses); four patients with ancient fractures; one patient with two phalangeal erosions; and two patients with equivocal osseous cystic lesions. No patient had findings typical of diabetic osteopathy. From this study, plus experience with other diabetic patients who had infected, ulcerated feet, we conclude that diabetic osteopathy represents healing or healed lesions of local osteomyelitis.
Diabetes Care
PMID:On diabetic osteopathy: a radiographic study of 21 patients. 72 Jan 84

Diabetes mellitus and arteriosclerotic vascular disease have been found to be the predisposing factors of osteomyelitis associated with peripheral vascular disease (10). A diabetic person is more susceptible to osteomyelitis because of the microangiopathy, peripheral neuropathy and decreased resistance to infection. In diabetes mellitus there can be microangiopathy which results from the proliferation of the endothelium of the intima and thickening of the basement membrane. This further contributes to a sluggish blood flow. In the patient with arteriosclerotic vascular disease, the lumens of the arterioles and arterioles are compromised by the atheromatous plaques. The anatomic structure of the blood supply to bone along with the pathologic membrane thickening, allows for slowing of blood. This slowing of blood flow causes micro-thrombi and enhances bacterial growth. In diabetes mellitus it has been shown that there is a decreased immunologic response which, along with the above, contributes to the sheltering and proliferation of bacteria in the small bones of the foot.
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PMID:Osteomyelitis associated with peripheral vascular disease secondary to diabetes mellitus. 103 Jul 28

The evolution of destructive and restorative alterations was morphologically followed up in 82 tuberculotics that died of non-tiberculous diseases. In the majority of the deceased, the restorative alterations were observed with manifested mesenchymal and immunologic reactions with morphological peculiarities as in the treated with anti tuberculous remedies. The destructive alteration are clearly manifested and the restorative manifestations are depressed in tuberculotics with non-treated diabetes and osteomyelitis treated with cortison. In a negligible part of the patients died of non-tuberculous diseases, a reactivation of the foci developed around the fibrocaseous lung foci, tracheobronchial lymph nodes, kidneys and suprarenals, manifested with filamented neutrophyils in the calcified and caseous matter, fresh necrosis, tubercula, specific granular tissue, friable capsule with appearance of lymphoid cells and specific granular tissue.
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PMID:[Morphological characteristics of the destructive and reparative changes in tuberculosis in those dying of nontubercular diseases]. 122 81

Radiation osteomyelitis of the sternum is rare and usually difficult to cure. A 75-year-old man, who had undergone an exploratory sternotomy for a mediastinal tumor, not resected after all, 9 years earlier and received radiation therapy successively for the histological diagnosis of malignant thymoma, was admitted to our hospital with the chief complaint of fever and pus discharge of the anterior chest wall. He also suffered from diabetes mellitus. The skin around the fistula was dark-red and atrophic due to irradiation dermatitis and the manubrium was fissured in the midline. Open drainage and two-stage operation of direct closure was tried in vain. This case was treated successfully by resection of necrosed portion of sternum and pectoral muscle flap closure.
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PMID:[A case report of radiation osteomyelitis 9 years after irradiation for thymoma]. 140 66

A case of Torulopsis glabrata osteomyelitis of the thoracic spine producing spinal cord compression and myelopathy is reported. The patient displayed several of the predisposing factors to T. glabrata infection, including diabetes mellitus, a history of abdominal surgery, and intravenous catheterization with hyperalimentation. The patient was successfully managed with surgical decompression, debridement, and curettage of the affected bone, postoperative immobilization, and systemic amphotericin B therapy. Her pain was relieved, spinal cord function recovered, and the vertebrae healed uneventfully. T. glabrata osteomyelitis is a rare and unpredictably progressive infection. This case demonstrates that it requires prompt therapy and close observation.
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PMID:Torulopsis glabrata vertebral osteomyelitis. 152 Sep 98

A 56-year-old woman presented with a chronic infection of her right first toe. The woman had a 15-year history of diabetes mellitus and had been insulin dependent for the past five years. Her toe had been injured one month earlier when hit by a frozen chicken that fell out of the freezer. The accident caused a bruise and a small cut. Serous to purulent drainage then developed. When she presented, the toe was reddened and draining. Physical examination showed a nonobese woman with no fever or other evidence of systemic infection. The wound showed no evidence of necrotizing fasciitis. Peripheral pulses were 2+ and capillary refill was slow. Sensation in both feet was decreased. The transcutaneous oxygen tension in the feet was reduced at 20 mm Hg. Relevant laboratory findings included a serum glucose of 250 and creatinine of 1.5. X-rays of the foot were compatible with diffuse osteomyelitis of the distal phalanx of the great toe. Technetium and indium scans were positive, with increased uptake localized to the area of x-ray changes (Figure 1). The patient was admitted to the hospital.
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PMID:Infection in the diabetic foot. 154 29

Osteomyelitis of the foot is a well-known complication of diabetes mellitus. In this study, the validity of 111In-labeled human nonspecific immunoglobulin G (IgG) scintigraphy was studied in 16 diabetic patients with foot ulcers, gangrene or painful Charcot joints. In all patients, plain radiographs, conventional bone scan images and 111In-IgG images were recorded. The results were verified by histologic examination of surgical specimens in patients who did not respond to antibiotic treatment within 2-3 wk (10 lesions) or long-term clinical follow-up of at least 6-mo (16 lesions). On the bone scans, all seven osteomyelitic foci were detected. However, 19 additional foci not due to osteomyelitis were seen. The absence of true-negative bone scans in this study resulted in a specificity of 0%. On the plain radiographs, four of seven osteomyelitis foci were detected; for 111In-IgG scintigraphy, six of seven (sensitivity 57% and 86%, respectively). Plain radiographs correctly ruled out osteomyelitis in 15 of 19 lesions, 111In-IgG scintigraphy in 16 of 19 (specificity 79% and 84%, respectively). All imaging procedures gave false-positive results in penetrating ulcers over the calcaneus in two patients and in one patient with a Charcot joint, most likely due to recent fractures. A false-negative 111In-IgG study was observed in a patient with severe arterial angiopathy. Accurate estimation of probable osteomyelitis was not possible from the results of soft-tissue cultures, since in only 6 of 12 positive cultures, osteomyelitic foci could be proven. Indium-111-IgG scintigraphy can contribute to adequate evaluation of osteomyelitis in diabetic foot complications because it improves specificity when compared to bone scan and radiographic findings and improves sensitivity in comparison to plain radiographs.
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PMID:Evaluation of infectious diabetic foot complications with indium-111-labeled human nonspecific immunoglobulin G. 161 74

Three phase radionuclide bone imaging procedures are used to differentiate cellulitis and osteomyelitis. Acute cellulitis is shown only as increased radioactivity in the blood flow and blood pool images; a persistent area of high activity in a delayed image is usually diagnosed as acute osteomyelitis. We present a patient with Charcot's joint secondary to diabetes mellitus whose three-phase bone imaging as well as radiographic studies revealed a consistent picture of acute osteomyelitis. In the appropriate clinical setting, Charcot's joint, along with several other etiologies (including bone tumors, leukemia, trauma, recent surgery, Paget's disease, and malunion of fracture), should be included in the differential diagnosis.
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PMID:Diabetic Charcot joint mimicking acute osteomyelitis in radiography and three-phase radionuclide bone imaging study. 185 3


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