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. 1980 Mar;55(3):175–184. doi: 10.1136/adc.55.3.175

Salmonella osteomyelitis in childhood. A report of 63 cases seen in Nigerian children of whom 57 had sickle cell anaemia.

A A Adeyokunnu, R G Hendrickse
PMCID: PMC1626764  PMID: 7387161

Abstract

A review of 63 Nigerian children with salmonella osteomyelitis showed that in all but 2 of them the disease occurred in association with HbS either in the homozygous state (57 patients) or in heterozygous combination with other haemoglobins (4 patients). Osteomyelitis was most prevalent during the first 2 years of life, and boys were more often affected than girls. In the majority, multiple sites were involved and lesions were usually bilateral and often symmetrical. Salmonella sp. was isolated from blood or pus, or both, in all patients. In some patients additional pathogens were also isolated from blood or pus. Clinical presentation was variable. In many patients the illness was slight and they were treated entirely as outpatients, but serious toxaemia, severe bone lesions with pathological fractures, and chronic suppuration occurred in others. Most patients responded well to chloramphenicol and conservative management. There were 4 deaths. 17 patients recovered with sequelae. It is suggested that the peculiar susceptibility of patients with sickle cell anaemia to salmonella osteomyelitis is due to spread of salmonella from the intestine facilitated by devitalisation of gut caused by intravascular sickling, and that infarcts in bone became infected either by transient bacteraemia or by activation of dormant foci of salmonella in bone marrow when tissues are devitalised. It is further suggested that immunological defects in sicklers may impair host response to infection, while haemolysis and hepatic dysfunction, both of which occur in sickle cell anaemia, favour propagation of salmonellae.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ANDERSON T. R., ZIMMERMAN L. E. Relapsing fever in Korea; a clinicopathologic study of eleven fatal cases with special attention to association with Salmonella infections. Am J Pathol. 1955 Nov-Dec;31(6):1083–1109. [PMC free article] [PubMed] [Google Scholar]
  2. BLACK P. H., KUNZ L. J., SWARTZ M. N. Salmonellosis--a review of some unusual aspects. N Engl J Med. 1960 Apr 21;262:811–contd. doi: 10.1056/NEJM196004212621606. [DOI] [PubMed] [Google Scholar]
  3. Barrett-Connor E. Bacterial infection and sickle cell anemia. An analysis of 250 infections in 166 patients and a review of the literature. Medicine (Baltimore) 1971 Mar;50(2):97–112. [PubMed] [Google Scholar]
  4. CARROLL D. S., HUGHES J. G. Salmonella osteomyelitis complicating sickle cell disease. Pediatrics. 1957 Feb;19(2):184–191. [PubMed] [Google Scholar]
  5. COLLARD P., SEN R. Salmonella types isolated in Ibadan, Nigeria. Trans R Soc Trop Med Hyg. 1958 May;52(3):283–287. doi: 10.1016/0035-9203(58)90089-0. [DOI] [PubMed] [Google Scholar]
  6. COLLARD P., SEN R. Salmonellosis at Ibadan, Nigeria. (5. Strains isolated during 1956-1960). West Afr Med J. 1962 Jun;11:106–112. [PubMed] [Google Scholar]
  7. DE TORREGROSA M. V., DAPENA R. B., HERNANDEZ H., ORTIZ A. Association of Salmonella-caused osteomyelitis and sickle-cell disease. Report of three cases. JAMA. 1960 Sep 24;174:354–356. doi: 10.1001/jama.1960.03030040008002. [DOI] [PubMed] [Google Scholar]
  8. Diggs L. W. Bone and joint lesions in sickle-cell disease. Clin Orthop Relat Res. 1967 May-Jun;52:119–143. doi: 10.1097/00003086-196700520-00011. [DOI] [PubMed] [Google Scholar]
  9. GIACCAI L., IDRISS H. Osteomyelitis due to Salmonella infection. J Pediatr. 1952 Jul;41(1):73–78. doi: 10.1016/s0022-3476(52)80029-0. [DOI] [PubMed] [Google Scholar]
  10. GOLDING J. S., MACIVER J. E., WENT L. N. The bone changes in sickle cell anaemia and its genetic variants. J Bone Joint Surg Br. 1959 Nov;41-B:711–718. doi: 10.1302/0301-620X.41B4.711. [DOI] [PubMed] [Google Scholar]
  11. GREEN T. W., CONLEY C. L., BERTHRONG M. [The liver in sickle cell anemia]. Bull Johns Hopkins Hosp. 1953 Feb;92(2):99–127. [PubMed] [Google Scholar]
  12. HENDRICKSE R. G., COLLARD P. Salmonella osteitis in Nigerian children. Lancet. 1960 Jan 9;1(7115):80–82. doi: 10.1016/s0140-6736(60)92900-7. [DOI] [PubMed] [Google Scholar]
  13. HENDRICKSE R. G. Sickle cell anaemia in Nigerian children. Cent Afr J Med. 1960 Feb;6:45–57. [PubMed] [Google Scholar]
  14. Johnston R. B., Jr, Newman S. L., Struth A. G. An abnormality of the alternate pathway of complement activation in sickle-cell disease. N Engl J Med. 1973 Apr 19;288(16):803–808. doi: 10.1056/NEJM197304192881601. [DOI] [PubMed] [Google Scholar]
  15. Kaye D., Gill F. A., Hook E. W. Factors influencing host resistance to Salmonella infections: the effects of hemolysis and erythrophagocytosis. Am J Med Sci. 1967 Aug;254(2):205–215. doi: 10.1097/00000441-196708000-00011. [DOI] [PubMed] [Google Scholar]
  16. Pearson H. A., Cornelius E. A., Schwartz A. D., Zelson J. H., Wolfson S. L., Spencer R. P. Transfusion-reversible functional asplenia in young children with sickle-cell anemia. N Engl J Med. 1970 Aug 13;283(7):334–337. doi: 10.1056/NEJM197008132830703. [DOI] [PubMed] [Google Scholar]
  17. Pearson H. A., Spencer R. P., Cornelius E. A. Functional asplenia in sickle-cell anemia. N Engl J Med. 1969 Oct 23;281(17):923–926. doi: 10.1056/NEJM196910232811703. [DOI] [PubMed] [Google Scholar]
  18. ROBBINS J. B., PEARSON H. A. NORMAL RESPONSE OF SICKLE CELL ANEMIA PATIENTS TO IMMUNIZATION WITH SALMONELLA VACCINES. J Pediatr. 1965 May;66:877–882. doi: 10.1016/s0022-3476(65)80062-2. [DOI] [PubMed] [Google Scholar]
  19. ROBERTS A. R., HILBURG L. E. Sickle cell disease with Salmonella osteomyelitis. J Pediatr. 1958 Feb;52(2):170–175. doi: 10.1016/s0022-3476(58)80089-x. [DOI] [PubMed] [Google Scholar]
  20. SAPHRA I., WINTER J. W. Clinical manifestations of salmonellosis in man; an evaluation of 7779 human infections identified at the New York Salmonella Center. N Engl J Med. 1957 Jun 13;256(24):1128–1134. doi: 10.1056/NEJM195706132562402. [DOI] [PubMed] [Google Scholar]
  21. SCHATTEN W. E., DESPREZ J. D., HOLDEN W. D. A bacteriologic study of portal-vein blood in man. AMA Arch Surg. 1955 Sep;71(3):404–409. doi: 10.1001/archsurg.1955.01270150098011. [DOI] [PubMed] [Google Scholar]
  22. SONG Y. S. Hepatic lesions in sickle cell anemia. Am J Pathol. 1957 Mar-Apr;33(2):331–351. [PMC free article] [PubMed] [Google Scholar]
  23. VANDEPITTE J., COLAERT J., LAMBOTTE-LEGRAND C., PERIN F. Les ostéites à Salmonella chez les sicklanémiques; à propos de 5 observations. Ann Soc Belg Med Trop (1920) 1953 Oct 31;33(5):511–522. [PubMed] [Google Scholar]
  24. WIGH R., THOMPSON H. J., Jr Cortical fissuring in osteomyelitis complicating sickle-cell anemia. Radiology. 1950 Oct;55(4):553–556. doi: 10.1148/55.4.553. [DOI] [PubMed] [Google Scholar]
  25. Weinberg A. G., Currarino G. Sickle cell dactylitis: histopathologic observations. Am J Clin Pathol. 1972 Nov;58(5):518–523. doi: 10.1093/ajcp/58.5.518. [DOI] [PubMed] [Google Scholar]
  26. Winkelstein J. A., Drachman R. H. Deficiency of pneumococcal serum opsonizing activity in sickle-cell disease. N Engl J Med. 1968 Aug 29;279(9):459–466. doi: 10.1056/NEJM196808292790904. [DOI] [PubMed] [Google Scholar]

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