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Knee MRI: osteomyelitis of the proximal tibia (red arrows) at six months follow up A: coronal T1-weighted sequence; B: coronal T2-weighted sequence
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Salmonella osteomyelitis is an uncommon pathological condition. Usually, it is associated with hemoglobinopathies or other underlying disorders. Osteomyelitis due to Salmonella is extremely rare in a previously healthy patient. We present a case of a 12-year-old previously healthy male who suffered Salmonella osteomyelitis of the proximal tibia as...
Context in source publication
Context 1
... patient was followed up by clinical, imaging and laboratory (WBC, ESR and CRP) examinations every week the first month, monthly the next five months and every six months until the two years follow up. At six month post-surgery follow up a knee MRI was performed ( Figure 5). MRI revealed that the bone marrow had improved and the lytic lesion (Salmonella osteomyelitis) was reduced. ...
Citations
... 3 Diabetes, autoimmune disorders, granulomatous diseases, immunodeficiencies, and HIV infection are other predisposing factors. 4 At present, most of the studies of Salmonella OM are focused on children with hemoglobinopathies. In this light, we present an uncommon case of Salmonella OM in a young adult with no common predisposing factors. ...
... Radius, ulna, tibia, and lumbar vertebrae are other commonly involved bones. 4,[8][9][10][11] Vertebral OM is usually caused by non-typhoidal Salmonella or S. paratyphi. 1 Third generation cephalosporins, fluoroquinolones, and chloramphenicol are the most commonly used antibiotics. ...
... 12 Since a preceding history of gastrointestinal infections is usually absent, Salmonella OM is often overlooked causing a delay in diagnosis or misdiagnosis. 3,4,11 In our case the diagnosis was delayed for over 3 months. This could be due to long incubation period or non-intestinal route of pathogen entry. ...
Salmonella osteomyelitis (OM) is more common in individuals with hemoglobinopathies like sickle cell anemia or thalassemia. The cardinal symptoms of OM such as fever, pain, and soft tissue swelling do not point towards a specific etiological agent. Since a preceding history of gastrointestinal infections is usually absent it causes a diagnostic challenge for Salmonella OM which is often overlooked causing a delay in diagnosis. In cases of fluoroquinolone resistance, third generation cephalosporins become the drug of choice. Due to absence of standardized guidelines, management is usually on a case-to-case basis. Previous studies have been focused mostly on children. Here, we present a rare case of Salmonella typhi OM in a 25-year male without any common predisposing factors.
... Additional presentations of invasive salmonella infection include bacteremia, meningitis, septic arthritis, and pneumonia. Osteomyelitis makes up only 0.8% of salmonella infections [5]. ...
... Other reports have described central nervous system salmonella abscess in a 12-month-old and 26-month-old following neurosurgical procedures [8,9]. There are various reports of salmonella osteomyelitis in teenagers and older children, who tend to have far more of the typical exposure and individual risk factors than our patient [5,[10][11][12][13][14][15][16][17]. ...
... Multifocal osteomyelitis was uncommon, with 5/42 (12%) of cases [18]. Others report that 0.45%-2% of osteomyelitis in pediatric patients is caused by Salmonella species [5,10]. ...
Salmonella infections are common, though rarely cause disseminated or severe disease in immunocompetent children. We present a case of severe salmonella osteomyelitis and epidural abscess in a patient without significant risk factors. This patient presented over the course of multiple visits with nonspecific symptoms of fever, malaise, and eventual joint pain. As symptoms progressed, the workup was broadened to find the eventual source of infection.
... Salmonella osteomyelitis is common in the metaphysis and diaphysis. Rarely, it can cause osteomyelitis in the vertebrae and pelvis [5,6]. ...
Abstract
Salmonella infections of the bone and joints are very rare. They are common in hemoglobinopathies and immunocompromised children. The diaphysis and metaphysis of the long bones are common sites. The spine pelvis, ribs, and cranium are rare sites. The clinical course is indolent compared to acute osteomyelitis. Serological tests and culture can be used for the diagnosis. Radiographs are frequently negative early in the disease. CT scans and MRI scans can be used in certain cases. The majority of cases can be managed with antibiotics. In this review, we describe the etiology, clinical features, investigations, and management of Salmonella bone and joint infections. We have described the features of Salmonella bone and joint infections in normal and sickle disease patients. We also present an illustrative case of Salmonella septic arthritis of the shoulder in an immunocompetent infant one month after COVID-19 infection.
... Salmonella osteomyelitis is common in the metaphysis and diaphysis. Rarely, it can cause osteomyelitis in the vertebrae and pelvis [5,6]. ...
Salmonella infections of the bone and joints are very rare. They are common in hemoglobinopathies and immunocompromised children. The diaphysis and metaphysis of the long bones are common sites. The spine pelvis, ribs, and cranium are rare sites. The clinical course is indolent compared to acute osteomyelitis. Serological tests and culture can be used for the diagnosis. Radiographs are frequently negative early in the disease. CT scans and MRI scans can be used in certain cases. The majority of cases can be managed with antibiotics. In this review, we describe the etiology, clinical features, investigations, and management of Salmonella bone and joint infections. We have described the features of Salmonella bone and joint infections in normal and sickle disease patients. We also present an illustrative case of Salmonella septic arthritis of the shoulder in an immunocompetent infant one month after COVID-19 infection.
... Regardless of the primary illness, Salmonella species as a causative agent of osteomyelitis is mostly seen in individuals with hemoglobinopathies and immunosuppressive disorders. It is very rarely seen in immunocompetent adults [2][3][4][5]. The clinical and radiological presentation is also indistinguishable from osteomyelitis caused by other common microorganisms. ...
Salmonella osteomyelitis is usually seen in patients with hemoglobinopathies and immunodeficient individuals. However, it is a rare clinical entity in an immunocompetent person with very few cases reported in clinical literature usually caused by non-typhoid Salmonella. Here, we report a case of S. typhi osteomyelitis of the right tibia in a 40-year-old immunocompetent lady. She developed a pathological fracture of the right tibia during the course of her treatment. It was then managed successfully by debridement and external fixation using a rail fixator. Salmonella osteomyelitis does not present with unique clinical or radiological signs. High index of suspicion with appropriate testing will help in determining the causative agent correctly and thus aid in its successful management.
... Salmonella species are rare causative organisms of osteomyelitis, responsible for only 0.45% of all cases, and are both clinically and radiologically indistinguishable from osteomyelitis caused by other organisms. 10,11 Patients with hemoglobinopathies are believed to be predisposed to infection with Salmonella species due to repetitive vaso-occlusive crises causing devitalization of gut and bone, red cell breakdown products of chronic hemolysis saturating the macrophage system, and underlying splenic and hepatic dysfunction. 9,12 Risk factors for Salmonella infections include food-borne exposures and handling of reptiles or live poultry. ...
... 14 There have been case reports of invasive disease with osteomyelitis due to other nontyphoid Salmonella species. 6,11 However, to our knowledge, this is the first report of serovar S. Poona as an etiology of osteomyelitis. This case report of osteomyelitis in a healthy young woman, along with reports of S. Poona bacteremia in otherwise healthy individuals, may suggest enhanced virulence of S. Poona, even in patients without traditional risk factors like sickle cell disease. ...
We present a case of vertebral osteomyelitis in a previously healthy, adolescent Caucasian female athlete. After months of lower back pain, spinal imaging demonstrated phlegmon and suspected osteomyelitis of the L4 vertebral body. A bone biopsy was obtained, and microbiologic cultures yielded pure growth of Salmonella enterica subsp. enterica serovar Poona ( S. Poona), a member of the nontyphoid Salmonella group associated with food-borne gastroenteritis in the United States. This case represents the first reported association of S. Poona with osteomyelitis and is interesting in that the infection developed in a patient without traditional risk factors for invasive Salmonella disease (i.e. sickle cell disease). This case highlights the importance of keeping a broad differential diagnosis for lower back pain and emphasizes the value of obtaining specimens for microbiologic culture to aid in diagnosing non-traditional and potentially emerging bacterial pathogens.
Salmonella Typhi osteomyelitis is a rare occurrence as compared to enteric fever and diarrhoea which are common manifestations caused by this microorganism. In reported cases of Salmonella osteomyelitis, commonly involved sites are long bones like the femur and humerus. Uncommon reports of Salmonella osteomyelitis from sites such as radius, ulna, tibia and vertebrae have also emerged. Extremely rare incidences of the same have been reported from the clavicle, skull and small bones of hands. Osteomyelitis could be bacterial or non-bacterial, and among bacterial osteomyelitis, Salmonella Typhi is a very rare entity. We present a case of Salmonella osteomyelitis and discuss the importance of microbiological diagnosis of osteomyelitis in diagnosing unusual pathogens from unusual sites. This case report is unique due to its site and difference in clinical presentation. The difference in presentation in an elderly immunocompetent male with no major comorbidities was different from other reported cases. Our patient was successfully managed with surgical debridement followed by a series of vacuum dressings and intravenous antibiotics for 6 weeks.
Case:
A 26-year-old healthcare professional presented with knee pain and was found to have Salmonella osteomyelitis of the distal femur. Two operations, including antibiotic bead placement followed by a 6-week course of oral ciprofloxacin, were successful in eradicating the infection.
Conclusion:
Salmonella osteomyelitis is a well-known complication of hemoglobinopathies but is unusual in healthy individuals. This case required molecular testing and multiple cultures to obtain a diagnosis. Treatment may require debridement and antibiotics.
