Chronic osteomyelitis in patients with sickle cell disease.

OBJECTIVE

To determine the baseline pattern and audit management modalities of chronic osteomyelitis in patients with sickle cell disease.

DESIGN

A retrospective study.

SETTING

Jos University Teaching Hospital, Jos, Nigeria from August 1993 to July 1997.

PATIENTS

Twenty four patients with concomitant chronic sickle cell disease.

INTERVENTIONS

Fifteen patients had operations; eleven had sequestrectomy and curettage while four had incision and drainage. Eight patients were treated with antibiotics alone and one patient refused surgery.

MAIN OUTCOME MEASURES

The demographic data of patients, aetiological agents, culture and sensitivity patterns, aetiopathogenesis, treatment modalities and outcome were analysed.

RESULTS

Twenty four (36.9%) out of 65 patients who had chronic osteomyelitis also had sickle cell disease. Male:female ratio was 1.2:1. The peak age incidence (37.5%) was in the first decade of life. Seventy five per cent of infections were haematogenous. The most frequently isolated organism was Staphylococcus aureus (58.8%) while the rest were Gram negative organisms. There was no case of Salmonella osteomyelitis. The most sensitive antibiotics were gentamicin and the third generation cephalosporins. Twelve patients (50%) had good results while eight (33.3%) were still undergoing treatment. Complications recorded were persistent discharging sinuses in two cases, recurrence of symptoms in one and pathological fracture with non-union in one patient.

CONCLUSION

Though the incidence of Gram negative organisms in causation of chronic osteomyelitis in patients who have sickle cell disease is high (41.2%), Salmonella osteomyelitis may be related to endemicity of the organism in a given locality.