7th aug 2012'
I am Swati Patel, intern People's College of Medical Sciences, currently posted to medicine.
Today i met a 25 year old patient suffering from sickle cell anaemia from when she was just 5 yrs of age. After talking to her i felt it was important to actually experience a patient with a condition that i had just read from a book as a part of our curriculum. I felt i could relate much more when the patient tells me her problems and my mind starts thinking why did this happen...
I am convinced that spending time in the ward attending to patients can really help a lot in learning..
This patient had presented with extreme pain and localized tenderness and swelling in her right upper tibia which was being managed as osteomyelitis. Yesterday the bony swelling in her upper tibia had been aspirated and the material sent for culture.
I read papers about occurence of osteomyelitis in sickle cell anemia as i was asked to find out if the fact that 'salmonella was the commonest organism as per our MCQ answers was actually a fact or perhaps just a myth.
One of them was from J Bone Joint Surg Am. 1991 Oct;73(9):1281-94. They had studied "Fifteen patients who had sickle-cell disease and osteomyelitis (affecting thirty bones) and were treated with operative decompression and parenteral administration of antibiotics between 1973 and 1988. Staphylococcus aureus was isolated on culture of specimens of bone from eight to the fifteen patients; Salmonella, from six; and Proteus mirabilis, from one. Although Salmonella has been cited as the principal causative organism of osteomyelitis in patients who have sickle-cell disease, in these authors' experience Staphylococcus aureus was the most common infecting organism. Therefore, Salmonella may not be the most common cause of osteomyelitis associated with sickle-cell disease in all countries or in all areas of a particular country."
I found another review article Pediatrics Vol. 101 No. 2 February 1, 1998
pp. 296 -297 which looked promising as it seemed to address my question around
"the controversy around whether S aureus is the most common cause of infection in these children overall, or does Salmonella actually predominate. They began by stating "The authors of the chapter on osteomyelitis and septic arthritis in the current edition of a major pediatric text state that “Salmonella osteomyelitis tends to occur more often in children with hemoglobinopathies, although even in this group, S aureus remains the predominant pathogen."
On the other hand there are other authors who in their chapter on osteomyelitis and septic arthritis in the current edition of a major pediatric infectious diseases text state that “seventy percent of all lesions or blood cultures in children with hemoglobinopathies and presumed osteomyelitis yieldSalmonella microorganisms, 10% contain S aureus, and aerobic Gram-negative rods are isolated in 7%."
Wish i had the full text to figure out where this led.
I am Swati Patel, intern People's College of Medical Sciences, currently posted to medicine.
Today i met a 25 year old patient suffering from sickle cell anaemia from when she was just 5 yrs of age. After talking to her i felt it was important to actually experience a patient with a condition that i had just read from a book as a part of our curriculum. I felt i could relate much more when the patient tells me her problems and my mind starts thinking why did this happen...
I am convinced that spending time in the ward attending to patients can really help a lot in learning..
This patient had presented with extreme pain and localized tenderness and swelling in her right upper tibia which was being managed as osteomyelitis. Yesterday the bony swelling in her upper tibia had been aspirated and the material sent for culture.
I read papers about occurence of osteomyelitis in sickle cell anemia as i was asked to find out if the fact that 'salmonella was the commonest organism as per our MCQ answers was actually a fact or perhaps just a myth.
One of them was from J Bone Joint Surg Am. 1991 Oct;73(9):1281-94. They had studied "Fifteen patients who had sickle-cell disease and osteomyelitis (affecting thirty bones) and were treated with operative decompression and parenteral administration of antibiotics between 1973 and 1988. Staphylococcus aureus was isolated on culture of specimens of bone from eight to the fifteen patients; Salmonella, from six; and Proteus mirabilis, from one. Although Salmonella has been cited as the principal causative organism of osteomyelitis in patients who have sickle-cell disease, in these authors' experience Staphylococcus aureus was the most common infecting organism. Therefore, Salmonella may not be the most common cause of osteomyelitis associated with sickle-cell disease in all countries or in all areas of a particular country."
I found another review article Pediatrics Vol. 101 No. 2 February 1, 1998
pp. 296 -297 which looked promising as it seemed to address my question around
"the controversy around whether S aureus is the most common cause of infection in these children overall, or does Salmonella actually predominate. They began by stating "The authors of the chapter on osteomyelitis and septic arthritis in the current edition of a major pediatric text state that “Salmonella osteomyelitis tends to occur more often in children with hemoglobinopathies, although even in this group, S aureus remains the predominant pathogen."
On the other hand there are other authors who in their chapter on osteomyelitis and septic arthritis in the current edition of a major pediatric infectious diseases text state that “seventy percent of all lesions or blood cultures in children with hemoglobinopathies and presumed osteomyelitis yieldSalmonella microorganisms, 10% contain S aureus, and aerobic Gram-negative rods are isolated in 7%."
Wish i had the full text to figure out where this led.
