Osteomyelitis in Sickle Cell Anemia


Osteomyelitis in Sickle Cell Anemia, Osteomyelitis in Thalassemia, Osteomyelitis in Hemoglobinopathy

  • Pathophysiology
  1. Infection of infarcted bone, especially long bones (multiple sites in same bone may be involved)
  • Causes
  1. Salmonella
    1. Most common organism in Sickle Cell AnemiaOsteomyelitis
    2. Other Gram Negative Bacteria may also occur
  2. Staphylococcal Aureus (<25% of cases)
  • Signs
  1. Fever
    1. Fever duration directly correlates with likelihood of Osteomyelitis (risk increases 80% each day of fever)
  2. Extremity swelling
    1. Osteomyelitis likelihood increases 8.4 fold
  3. Bone pain
    1. Osteomyelitis likelihood increases 20% each day of pain
  • Diagnosis
  1. Bone Culture
  • Imaging
  1. See Osteomyelitis
  2. Interpretation may be difficult in Sickle Cell Anemia as bone infarcts may appear similar to Osteomyelitis
  • Management
  1. See Osteomyelitis
  2. Antibiotics are similar to those used in other Osteomyelitis with added Salmonella and Gram Negative coverage
    1. Total antibiotic course: 6 to 8 weeks
    2. Initial IV: Vancomycin AND (Ciprofloxacin or Ceftriaxone)
    3. Later: May transition to Oral fluoroquinonoles (Ciprofloxacin, Levofloxacin) for susceptible Gram Negative causes
  • References
  1. Lowe and Wang (2018) Crit Dec Emerg Med 32(11): 17-25
  2. Welsh and Welsh (2016) Crit Dec Emerg Med 30(11): 15-23