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One case of malignant external otitis in a non-diabetic patient is presented. Malignant external otitis is a rare but severe bacterial infection, caused by Pseudomonas aeruginosa, predominantly in elderly diabetic patients. The process starts in the external auditory canal and after crossing the cartilaginous-osseus junction invades the connective tissue, cartilage, bone, and nerves of the temporal bone and the surrounding parts of the base of the skull. The clinical syndrome is a severe, painful inflammation of the external auditory canal with edematous obstruction of the external canal and typical granulation tissue in the canal wall. Diagnostic criteria are pain, edema, exudate, granulations, microabscess, diabetes, old age, identification of Pseudomonas aeruginosa, and even cranial nerve involvement. Further important criteria are failure of local treatment and a positive Tc-99 scan demonstrating osteomyelitis of the temporal bone as a sign of connective tissue, cartilage, and bone invasion. In most cases there is also a positive radiograph or HR-CT of the base of the skull. Except for sequestrations, surgical treatment in malignant external otitis is impractical because of the deep penetration into the base of the skull and the lack of demarcation lines in this diffuse pathological process. Nowadays long term i.v. antibiotic therapy is preferred. In our case we applied Ceftazidim (Fortum) 2 g for 12 weeks twice a day. After this period the patient was completely cured. Our case demonstrates that malignant external otitis should be considered even in non-diabetic patients.
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PMID:[A rare case of malignant otitis external in a non-diabetic patient]. 766 39

Foot disease in patients with diabetes mellitus is multifactorial and results from a combination of peripheral neuropathy, vascular compromise and superimposed infection. Foot complications in diabetic patients are common and account for more hospital days than any other aspects of their disease. Therefore, familiarity with the spectrum of findings in the different imaging modalities appears essential. Radiographically, significant changes include Charcot joints of the tarsus (destructive type) and bone absorption of the forefoot (mutilating type). In diabetic foot problems, magnetic resonance imaging and leukocyte scintigraphy appear to be the most effective tools for detection of osteomyelitis, and a negative study makes osteomyelitis unlikely. However, the findings of both techniques in active, noninfected neuropathic osteoarthropathy may be indistinguishable from those of osteomyelitis.
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PMID:[The diabetic foot]. 767 22

Diabetic muscle infarction (DMI) is a painful and potentially serious complication in patients with poorly controlled diabetes mellitus. The incidence of DMI is likely much greater than reports in the literature suggest, perhaps secondary to the difficulty in making the diagnosis and excluding other more serious etiologies. This paper describes the role of MRI in the evaluation of a diabetic patient with a painful, swollen limb. Early application of MRI can more accurately classify the disease process and focus the differential diagnosis, thus avoiding the hazards of medical therapy associated with other etiologies such as deep venous thrombosis, cellulitis, or osteomyelitis. This paper describes the evaluation and diagnostic pitfalls encountered in two patients. MRI techniques and applications are presented with a discussion of clinical and radiological differential diagnoses.
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PMID:MRI evaluation of diabetic muscle infarction. 773 75

A rare case of a patient with non-insulin-dependent diabetes mellitus (NIDDM) with small cell lung cancer, initially diagnosed as pyogenic vertebral osteomyelitis, was reported. A 40-year-old male patient was diagnosed with NIDDM about 3 years earlier, but he did not receive any treatment. Then, a two-month history of high fever, persistent cough and back pain developed. Chest X-ray film showed a lung infiltrate with a small cavity in the upper portion of the left lung. Computed tomography and magnetic resonance imaging of the chest revealed a tumor mass shadow with osteoclasia along the bodies of the 6th and 7th thoracic vertebral bone. Staphylococcus aureus infection was confirmed by arterial blood culture. Administration of antibiotics resulted in the disappearance of the left lung infiltrate and a slight reduction of the tumor mass in the thoracic vertebral bone, suggesting pyogenic vertebral osteomyelitis as an unusual complication of NIDDM. However, as the tumor mass still remained, needle biopsy for the mass lesion was performed, resulting in the diagnosis of metastasis of small cell carcinoma from the left lung. Gene aberration in this lung disease has been reported recently, and its correlation with NIDDM which may also be induced by genetic abnormality is an interesting question that remains to be resolved.
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PMID:[A rare case of a diabetic patient with small cell lung cancer, initially diagnosed as pyogenic vertebral osteomyelitis]. 775 Jun 28

The objective of this report is to describe the bacterial pathogens in diabetic patients with osteomyelitis due to neuropathic foot ulcerations. The authors reviewed the records of 36 diabetic patients with osteomyelitis of the foot due to neuropathic ulceration. Intraoperative deep soft tissue and bone specimens were obtained from each patient. The mean age of patients was 56.7 years, and the mean duration of diabetes was 14.9 years. Streptococcus species (61%) and Staphylococcus aureus (47%) were the most common organisms identified. Gram-negative aerobes were found in 18 cultures (50%). Only five patients' cultures (14%) were identified with anaerobic pathogens. The average number of pathogens per patient was 2.25. The most common bacterial pathogens in bone infections in diabetics were Streptococcus species and Staphylococcus aureus. Anaerobes were uncommon.
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PMID:Microbiology of osteomyelitis in diabetic foot infections. 778 Mar 95

Bacterial spondylodiskitis--i.e., adjacent vertebral osteomyelitis and diskitis--was studied in 80 adult patients. The infection was due to Mycobacterium tuberculosis in 31 cases (39%) and to pyogenic bacteria in 49 cases (61%). The latter pathogens included gram-negative bacilli in 16 cases (20%), Staphylococcus species in 15 (19%), Streptococcus species in 9 (11%), and Corynebacterium species in 1 (1%); the pathogens in the 8 remaining cases (10%) were not identified. Of the patients with tuberculous spondylodiskitis, 55% came from countries where tuberculosis is endemic (P < .001). Cases due to staphylococci and those due to M. tuberculosis were associated with a high frequency of previous active infection with those respective organisms at any site (47% and 42%, respectively; P < .001) and with a high rate of neurological complications (33% and 32%, respectively; P < .001). Nine patients with pyogenic spondylodiskitis (18%) but only one patient with tuberculous spondylodiskitis (3%) had diabetes mellitus (P < .05). Blood cultures were positive in 23 (56%) of the 41 cases of pyogenic spondylodiskitis due to an identified bacterium. Discovertebral needle biopsy contributed to the bacteriologic diagnosis in 29 (74%) of 39 cases.
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PMID:Pyogenic and tuberculous spondylodiskitis (vertebral osteomyelitis) in 80 adult patients. 780 42

This study assessed the impact of an inpatient diabetes education program on: 1) staff nurses' and patients' knowledge about diabetes, 2) hospital length of stay, and 3) patients' glycemic control. Over the course of 1 year, a certified diabetes educator updated nursing staff about diabetes care and education and coordinated a diabetes education program on two experimental medical units. Length of stay of insulin-requiring patients with diabetes and their diabetes knowledge and glycemic control were compared with two control medical units that received no structured diabetes education program. Results showed a significant difference in length of stay and patient knowledge between experimental and control units. Three conditions commonly associated with diabetes (diabetic ketoacidosis, osteomyelitis, foot ulcer) did not account for this difference in length of stay. There was no significant difference between the groups in glycemic control following discharge. While all groups showed improvement in their glycosylated hemoglobin values, only the change in the values of the total population and the control groups was significant. The findings suggest that a Certified Diabetes Educator can decrease length of stay in the hospital setting.
Diabetes Educ
PMID:An inpatient diabetes educator's impact on length of hospital stay. 785 Dec 25

We describe a previously healthy 69-year-old man presenting with osteomyelitis of the humerus due to the zygomycete Apophysomyces elegans. The infection was acquired in Aruba, The Netherlands Antilles. The skin provided the most likely portal of entry, although there was no history of a traumatic inoculation. The patient had no history of diabetes, and no underlying immune defects were found. Despite treatment with 7.9 g of amphotericin B, an interthoracoscapular amputation proved necessary to curtail the rapid spread of the fungus in this immunocompetent host.
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PMID:Severe osteomyelitis due to the zygomycete Apophysomyces elegans. 788 8

The purpose of this study was to investigate factors that contribute to the development of osteomyelitis of the foot after a puncture wound in patients with diabetes. Forty-five male and 21 female adults with diabetes that were admitted to the hospital for a foot infection precipitated by a puncture were included in the study. Twenty-two (33%) patients had osteomyelitis (O) based on either a positive bone culture or pathology report. Forty-four patients had soft tissue infections (ST). Age and duration of diabetes were similar in both groups. Patients with osteomyelitis received medical treatment later than patients with soft tissue infections. A significant difference was identified when comparing the time interval from the time of the injury until patients were hospitalized and until they had the puncture wound surgically debrided, and when comparing the interval from when patients first received initial professional medical evaluation until they were hospitalized and until they had the puncture wound surgically debrided. Patients with punctures involving the forefoot (FF) and patients that wore shoes (S) at the time of the injury were more likely to develop osteomyelitis than patients that had rearfoot (RF) injuries O: FF = 20, 90%, RF = 2, 10%, ST: FF = 30, 70%, RF = 13, 30%, p < 0.05) and patients that were barefoot (B) at the time of injury (O: S = 15, 88%, B = 2, 12%, ST: S = 21, 57%, B = 16, 43%, p < 0.05). Osteomyelitis is a common complication in patients with diabetes with a foot infection following a puncture wound.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Infected puncture wounds in adults with diabetes: risk factors for osteomyelitis. 789 2

Pyomyositis is an uncommon infection in temperate climates, usually resulting from Staphylococcus aureus infection of skeletal muscle. In this report, the authors describe a patient with untreated Type 2 diabetes mellitus who suffered nonpenetrating blunt trauma to his left anterior thigh, and S. aureus pyomyositis and secondary osteomyelitis of his proximal tibia and patella subsequently developed as a result of delayed diagnosis and treatment. Patients with diabetes mellitus are at increased risk for the development of pyomyositis because of more frequent S. aureus colonization of skin, nasal mucosa, and oropharynx; a delay in definitive treatment can lead to significant morbidity in these patients. Computed tomography or magnetic resonance imaging may be helpful in the diagnosis of pyomyositis. An anemia of chronic disease may result from this disorder, which resolves with treatment.
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PMID:Case report: diabetes mellitus as a predisposing factor in the development of pyomyositis. 794 86


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