Cutaneous Manifestations of HIV: Overview, Manifestations by HIV Disease Stage, Manifestations in HIV-Infected ...
Osteomyelitis Pubis Versus Osteitis Pubis: A Case Presentation And Review Of The Literature
An athletic 23 year old man presented with suprapubic tenderness, fever, and raised inflammatory blood variables. A diagnostic laparoscopy was performed, with a presumed diagnosis of retrocaecal appendicitis, but no abnormalities were found, apart from free fluid in the pouch of Douglas. Imaging of the pubic area suggested bony infection and inflammation. Biopsy and culture confirmed the presence of Staphylococcus aureus, a very common pathogen. The final diagnosis was osteomyelitis pubis, an infectious disease, and osteitis pubis, an inflammatory disease.
Treatment Of Osteitis Pubis And Osteomyelitis Of The Pubic Symphysis In Athletes: A Systematic Review
Objectives The authors examined the most current evidence for treatment options in athletes with osteitis pubis and osteomyelitis pubis, attempting to determine which options provide optimal pain relief with rapid return to sport and prevention of symptom reoccurrence.
Methods Three databases—MEDLINE, Cochrane Database of Systematic Reviews and CINAHL—were searched using the OVID interface for all years between 1985 and May 2008. References were analysed from included studies, and additional relevant articles were obtained for inclusion. Inclusion criteria included (1) humans only, (2) subjects had no apparent risk factors for development of osteitis pubis or osteomyelitis of the pubic symphysis other than athletic involvement, (3) both physical exam findings and diagnostic imaging were used to confirm either diagnosis, and (4) a definitive treatment strategy was identifiable for management of osteitis pubis or osteomyelitis of the pubic symphysis. In total, 25 articles were included in the review.
Results There were no randomised controlled trials identified with this study's search strategy. A total of 195 athletes were diagnosed as having osteitis pubis (186 males, nine females) and treated with either conservative measures/physical therapy, local injection with corticosteroids and/or local anaesthetic, dextrose prolotherapy, surgery or antibiotic therapy. Six case reports/series described conservative treatment measures (physical therapy, rest, non-steroid anti-inflammatory drugs). Four case series explored the use of corticosteroid injections in treatment. One case series described the use of dextrose prolotherapy as a treatment modality. Six case series described various surgical techniques (pubic symphysis curettage, polypropylene mesh placement and pubic bone stabilisation) in treatment. Ten case reports/series (10 subjects) outlined antibiotic treatment of osteomyelitis of the pubic symphysis.
Conclusions The current medical literature shows only level 4 evidence of the treatment for osteitis pubis in 24 case reports/series in athletes. Without any direct comparison of treatment modalities, it is difficult to determine which individual treatment option is the most efficacious. Further study comparing the different treatment options is necessary to determine which modality provides the fastest return to sport.
Girl Catches Rare Bone Infection From Kitten
A teen girl's kitten turned out to cause much more trouble than usual. In a new case report this month, doctors in Portugal describe how the cat likely transmitted an usually mild germ that caused the girl to develop a serious and rare bone infection. Thankfully, once the infection was identified and treated, the girl recovered fully.
The feline fiasco was detailed earlier this month in BMJ Case Reports by doctors in Portugal. According to the report, the girl visited doctors with severe pain in her right abdomen and a fever. She reported no recent travel or contact with animals, at least initially. A physical examination failed to find any clear culprit behind her symptoms, but a medical scan revealed an abscess—pockets of pus, usually caused by a bacterial infection—along the tissues that surround the spinal cord as well as bone erosion.
The doctors ruled out some potential causes of the infection and a second CT scan allowed them to collect a sample of the abscess, which tested positive for Bartonella bacteria. At that point, the family recalled to the doctors that they had "a young cat some time before." With that final clue in place, the doctors diagnosed the girl as having caught an unusual case of cat scratch disease.
Cat scratch disease is caused by Bartonella henselae, rod-shaped bacteria that survive by hiding and replicating inside other cells, much like viruses. Though cats are a common vector for these infections, with the germ lurking in their saliva, B. Henselae and related species can also be spread through dogs or parasites like ticks, fleas, and lice.
Bartonella infections usually don't cause severe illness in otherwise healthy people, though they can be dangerous in those with weakened immune systems (some evidence has also suggested that they can very rarely trigger psychiatric illness). The most common symptoms of cat scratch fever specifically are enlarged lymph nodes, rashes, and fever. So the girl's bone infection, also known as osteomyelitis, is an especially rare complication, with reported rates hovering between 0.17% to 0.27% of diagnosed cases.
Because Bartonella bacteria live inside our cells, it can be difficult to diagnose these infections and treat them successfully with antibiotics. But in this case, the girl made a complete recovery following treatment with doxycycline and rifampicin.
"Cat scratch disease is a challenging diagnosis in the absence of typical features," the doctors wrote. "However, B. Henselae must be investigated if common pathogens are ruled out and response to therapy is poor."
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