Thanni Lateef O A, Ogunfowora Olusoga B, Olanrewaju Durotoye M
Department of Orthopedics and Traumatology, College of Health Sciences, Olabisi Onabanjo University, PMB 2022, Sagamu, Ogun State, Nigeria.
J Natl Med Assoc. 2004 Feb;96(2):224-8.
The bacterial pathogens associated with osteomyelitis in patients with hemoglobinopathy (HbSS) are controversial. There is insufficient data on the common musculoskeletal (MSS) infections in patients with hemoglobinopathies and the associated bacterial pathogens in Nigeria.
To identify the common MSS infections in children and the associated bacterial pathogens, especially in those with abnormal hemoglobin genotypes.
A retrospective case review was done of pediatric and adolescent patients admitted with bone and soft tissue infections over a seven-year period in a Nigerian teaching hospital.
One-hundred-nineteen patients were studied, with mean age 7.9+/-5.6 years and male-female ratio of 1.3:1. Out of 78 patients with known genotype, 62.8% had HbAA, 20.5% HbSS, 9% HbAS, and 7.7% HbAC. The most common MSS infections were osteomyelitis (64.7%), pyomyositis (17.6%), and septic arthritis (10.1%). Others were cellulitis (5.9%), tuberculous arthritis (0.8%), and necrotizing fasciitis (0.8%). Staphylococcus aureus (S. aureus) was isolated from 62% of chronic osteomyelitis (COM) and 58% of pyomyositis, while gram-negative bacilli accounted for 34% and 42%, respectively. S. aureus was isolated from 63% of patients with HbAA, 40% with HbSS, 58% with HbAS, and 58% with HbAC, while gram-negative bacilli accounted for 33%, 60%, 33%, and 33%, respectively. Osteomyelitis and pyomyositis appear to be similarly common in patients with and without HbSS (RR 1.29; 95% CI 0.47-3.50). Osteomyelitis and soft tissue infections in general also appear to be equally common in them (RR 1.16; 95% CI 0.39-4.11). However, osteomyelitis appears to be more common among patients with HbSS than those with HbAA (RR 2.29; 95% CI 0.58-8.99) and those with other hemoglobinopathies (RR 2.23; 95% CI 0.66-7.49)
Osteomyelitis, pyomyositis and septic arthritis are common MSS infections in hospitalized pediatric and adolescent patients, while tuberculous arthritis is uncommon. The most common bacterial pathogen in these infections is S. aureus-even in patients with HbSS and other hemoglobinopathies. Gram-negative bacilli are important causes of MSS infections in hospitalized children with HbSS. HbSS may be an independent risk factor for osteomyelitis in these patients.
与血红蛋白病（HbSS）患者骨髓炎相关的细菌病原体存在争议。关于尼日利亚血红蛋白病患者常见的肌肉骨骼（MSS）感染及其相关细菌病原体的数据不足。
确定儿童中常见的MSS感染及其相关细菌病原体，尤其是血红蛋白基因型异常的儿童。
对尼日利亚一家教学医院7年内收治的患有骨和软组织感染的儿科和青少年患者进行回顾性病例分析。
共研究了119例患者，平均年龄7.9±5.6岁，男女比例为1.3:1。在78例已知基因型的患者中，62.8%为HbAA，20.5%为HbSS，9%为HbAS，7.7%为HbAC。最常见的MSS感染是骨髓炎（64.7%）、脓性肌炎（17.6%）和化脓性关节炎（10.1%）。其他包括蜂窝织炎（5.9%）、结核性关节炎（0.8%）和坏死性筋膜炎（0.8%）。金黄色葡萄球菌（金葡菌）在62%的慢性骨髓炎（COM）和58%的脓性肌炎中分离得到，而革兰氏阴性杆菌分别占34%和42%。金葡菌在63%的HbAA患者、40%的HbSS患者、58%的HbAS患者和58%的HbAC患者中分离得到，而革兰氏阴性杆菌分别占33%、60%、33%和33%。骨髓炎和脓性肌炎在有和没有HbSS的患者中似乎同样常见（相对风险1.29；95%置信区间0.47 - 3.50）。总体而言，骨髓炎和软组织感染在他们当中似乎也同样常见（相对风险1.16；95%置信区间0.39 - 4.11）。然而，骨髓炎在HbSS患者中似乎比HbAA患者（相对风险2.29；95%置信区间0.58 - 8.99）和其他血红蛋白病患者（相对风险2.23；95%置信区间0.66 - 7.49）更常见。
骨髓炎、脓性肌炎和化脓性关节炎是住院儿科和青少年患者常见的MSS感染，而结核性关节炎不常见。这些感染中最常见的细菌病原体是金葡菌——即使在HbSS和其他血红蛋白病患者中也是如此。革兰氏阴性杆菌是HbSS住院儿童MSS感染的重要原因。HbSS可能是这些患者骨髓炎的独立危险因素。
