Doppelt E, de La Rocque F, Morriet Y, Reinert P
l'Etude Epidémiologique clinique et biologique de la Drépanocytose, Région de Paris.
Arch Fr Pediatr. 1990 Dec;47(10):715-20.
From 1977 to 1989, 23 children with sickle cell disease were identified as having 21 episodes of acute and 3 episodes of chronic osteomyelitis, respectively. The responsible organisms were found in 17 cases: Salmonella (12 cases), coagulase-negative Staphylococcus (3 cases). Haemophilus influenzae (1 case), Escherichia coli (1 case). The mean age was 7 7/12 years. In 15 patients, osteomyelitis occurred in 1 bone; osteomyelitis of more than one bone was recorded in 9 cases. The most commonly affected bone was the femur (7 episodes); 5 episodes of hand-foot syndrome with osteomyelitis occurred in children in the first 2 years of life (mean age 16 months). Two patients had a Salmonella vertebral osteomyelitis. Incision and drainage were performed in 5 cases and bone aspiration in 9 cases. Etiologic agents were obtained with these two procedures in respectively 5 and 3 cases. Radionuclide scans were used in 7 episodes: uptake on bone scan was increased in 5 cases and normal in 2. In all cases, the outcome was satisfactory. Differentiation from acute bone infarcts in difficult. An extensive workup is required to confirm the diagnosis of infection: early scintigraphy, bone aspiration or surgical biopsy in patients with negative blood cultures should be performed. Until the results of cultures, the antimicrobial regimen chosen for initial therapy should be broad enough to treat the likely etiologic agents including Salmonella.
1977年至1989年期间，23例镰状细胞病患儿分别被确诊发生21次急性骨髓炎和3次慢性骨髓炎。在17例病例中发现了致病微生物：沙门氏菌（12例）、凝固酶阴性葡萄球菌（3例）、流感嗜血杆菌（1例）、大肠杆菌（1例）。平均年龄为7又7/12岁。15例患者的骨髓炎发生在1块骨；9例记录有1块以上骨的骨髓炎。最常受累的骨是股骨（7次发作）；5例1至2岁儿童（平均年龄16个月）发生手足综合征合并骨髓炎。2例患者发生沙门氏菌性脊椎骨髓炎。5例行切开引流，9例行骨穿刺。通过这两种操作分别在5例和3例中获得了病原体。7次发作中使用了放射性核素扫描：5例骨扫描摄取增加，2例正常。所有病例预后均良好。与急性骨梗死鉴别困难。需要进行全面检查以确诊感染：对于血培养阴性的患者，应进行早期闪烁扫描、骨穿刺或手术活检。在培养结果出来之前，初始治疗选择的抗菌方案应足够广泛，以治疗包括沙门氏菌在内的可能病原体。
