HEMOGLOBINOPATHY AND PATTERN OF MUSCULOSKELETAL INFECTION IN CHILDREN: Results

Posted by James

A total of 119 patients were studied. Their mean age was 7.9±5.6 years. Sixty-eight (57.1%) of them were males and 51 (42.9%) were females, giving a male-female ratio of 1.3:1 As shown in Table 1, among 78 patients whose genotype were determined, 49 (62.8%) had hemoglobin genotype AA (HbAA) and 16 (20.5%) had HbSS, while seven (9%) and six (7.7%) had HbAS and HbAC, respectively. My Canadian Order net

Table 1. Clinical and Demographic Features of the 119 Patients

Number (%)	Age
<13 years	57
13-18 years	62
Sex
Male	68 (57.1)
Female	51 (42.9)
Genotype
HbAA	49 (62.8)
HbSS	16 (20.5)
HbAS	7(9)
HbAC	6 (7.7)
Signs and Symptoms
Pain	83 (69.7)
Swelling	79 (66.4)
Tenderness	69 (58)
Sinus	31 (26.1)
Ulcer	13 (10.9)
Limp	4 (3.4)
Temperature
Mean	38.6°C±0.7°C
Range	37.4°C-40.5°C

The most common MSS infection was COM— 53.8%. The least common were tuberculous arthri­tis and necrotizing fasciitis—one patient each— Table 2. Others include pyomyositis (17.6%), septic arthritis (10.1%), and cellulitis (5.9%). Septic arthritis affected the knee in 55.6% of patients, while the hip, elbow, and shoulder joints were affected in 22.2%, 11.1 %, and 11.1 %, respectively.
cialis soft tablets

Table 2. Prevalence of Musculoskeletal Infections and Bacterial Pathogens

	Number		%
Diagnosis
Chronic osteomyelitis		64	53.8
Acute osteomyelitis		13	10.9
Pyomyositis		21	17.6
Cellulitis		7	5.9
Septic arthritis		12	10.1
Tuberculous arthritis		1	0.8
Necrotizing fasciitis		1	0.8
Bacterial Isolate
Staphylococcus aureus		38	47.5
Klebsiella sp		11	13.8
Pseudomonas sp		9	11.3
Proteus sp		5	6.3
Non hemolytic streptococcus		2	2.5
E. coli		1	1.3
No growth		14	17.5
Total		80	100

Sixty-six bacterial pathogens were isolated from 59 patients. Fifty-two were isolated in single cultures and 14 in mixed cultures. Staphylococcus aureus (S. aureus) was the most common pathogen—57.6% (38/66). Others were Klebsiella sp—16.7% (11/66), Pseudomonas sp—13.6% (9/66) and Escherichia coli (E. coli)—1.5% (1/66). S. aureus accounted for 62% (29/47) of the pathogens isolated in COM and 58% (7/12) in pyomyositis. On the other hand, Gram-negative bacilli accounted for 34% (16/47) and 42% (5/12) of these infections respectively. S. aureus was the most common single pathogen isolated from patients with HbAA—63% (17/27), HbSS—40% (4/10), and from those with HbAC and HbAS— 58% (7/12). The prevalence of Gram-negative bacilli in these groups of patients was 33%, 60%, and 33%, respectively (Table 3).
trusted canadian pharmacy

Table 3. Distribution of Bacterial Pathogens by Genotype

		Bacterial Pathogens
Genotype	S. aureus	Pseudomonas	Klebsiella	E. coli	Proteus	Nonhem. Str.	No growth
HbAA	17	4	5	0	0	1	9
HbSS	4	3	1	1	1	0	2
HbAS	4	2	0	0	0	0	0
HbAC	3	0	1	0	1	1	1
Total	28	9	7	1	2	2	12
S. aureus: Staphylococcus aureus
E. coli: Escherichia coli
Nonhem str: Nonhemolytic streptococcus

Pain and swelling were the most frequent presenting complaint, occurring in 83 (69.7%) and 79 (66.4%) patients, respectively. Fever was present on admission in 42 patients. The mean temperature on admission was 38.6°C±0.7°C (range 37.4°C-40.5°C). Thirty-one (26%) patients presented with a discharging sinus, while 13 (10.9%) had an ulcer (Table 1). Radiographic evidence of COM was documented in 33 (51.6%) of the 64 patients with this condition. Total leucocyte count ranged between 2,700 and 26,390 per cumm (mean 8,796±5,056 per cumm). Erythrocyte sedimentation rate (ESR) on admission ranged from 2- to 80 mm/hour (mean 53±14 mm/hour).
eriacta 100 mg

Table 4. Distribution of MSS Infections by Genotype

		Genotype (%)
Diagnosis	HbAA	HbSS	HbAS	HbAC	Total
Chronic osteomyelitis	31 (63.3)	8 (50)	4(57)	4(67)	47
Acute osteomyelitis	4 (8.2)	6 (38)	0	0	10
Pyomyositis	7(14.3)	1 (6)	2 (29)	0	10
Cellulitis	3(6.1)	1 (6)	0	0	4
Septic arthritis	3(6.1)	0	1 (14)	2 (33)	6
Necrotizing fasciitis	1(2.0)	0	0	0	1
Total	49	16	7	6	78

Table 4 shows that COM was the most common MSS infection in all patients irrespective of genotype. It accounted for 63% (31/49) of the infections in those with HbAA, 50% (8/16) in those with HbSS, 57% (4/7) in those with HbAS, and 67% (4/6) in those with HbAC. Patients with hemoglobinopathies in general seem to be equally as likely as those with normal genotype to have osteomyelitis rather than pyomyositis—22/25 versus 35/42 (RR=1.29; 95% CI 0.47-3.50), P=0.4. Also they appear to be equally likely to have osteomyelitis compared with soft tissue infections generally, 22/29 versus 35/49 (RR=1.16; 95% CI 0.39-4.11), P=0.9. The likelihood of having osteomyelitis among hospitalized patients with HbSS is twice that of those with HbAA, 14/16 versus 35/49 (RR2.29; 95% CI 0.58-8.99) p=0.3. Also patients with HbSS are twice as likely, as those with the other hemoglobinopathies, to have osteomyelitis 14/16 versus 8/13 (RR=2.23; 95% CI 0.66-7.49) p=0.2. These differences are not statistically significant.
buy antibiotics canada