van Cappelle H G, Veenendaal D, de Vogel P L
Medical Center Leeuwarden, The Netherlands.
Clin Orthop Relat Res. 1995 Dec(321):235-8.
A 22-year-old man had Salmonella panama osteomyelitis of the left distal tibia. He had endured a period of untreated diarrhea without fever 6 years before. The osteomyelitis was treated successfully with surgical debridement followed by 9 weeks of oral cotrimoxazole 960 mg twice daily. Salmonella osteomyelitis is rare. Most cases occur in patients with sickle cell anemia. Other conditions of local or generalized immunosuppression are also risk factors, but none were established in this patient, nor was he a chronic carrier. In reviewing the literature, no case of Salmonella panama osteomyelitis in an otherwise healthy patient was found. Although the osteomyelitis in this patient was possibly secondary to Salmonella enteritis 6 years before, the authors believe that enteric Salmonella infections should not be treated with antibiotics unless the infection is accompanied by systemic symptoms. Otherwise, the risk of chronic carriership is substantially increased. In case of Salmonella panama osteomyelitis, surgical debridement is recommended as the main component of treatment, followed by a prolonged period of specific antibiotic therapy.
一名22岁男性患有巴拿马沙门氏菌引起的左胫骨远端骨髓炎。他在6年前曾经历一段未经治疗的腹泻期，且无发热症状。骨髓炎通过手术清创成功治疗，随后口服复方新诺明960毫克，每日两次，持续9周。沙门氏菌骨髓炎较为罕见。大多数病例发生在镰状细胞贫血患者中。局部或全身性免疫抑制的其他情况也是危险因素，但该患者未发现这些情况，他也不是慢性携带者。在查阅文献时，未发现健康患者发生巴拿马沙门氏菌骨髓炎的病例。尽管该患者的骨髓炎可能继发于6年前的沙门氏菌肠炎，但作者认为，除非感染伴有全身症状，否则肠道沙门氏菌感染不应使用抗生素治疗。否则，慢性携带的风险会大幅增加。对于巴拿马沙门氏菌骨髓炎，建议手术清创作为治疗的主要组成部分，随后进行长时间的特异性抗生素治疗。
