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  #1  
Old 05-04-2010
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Microbiology Osteomyleitis in sickle cell patients:

I came across this and it kind of confused me. Both in Kaplan and FA salmonella is listed as the number one cause of osteomyleitis in sickle cell patients, while the second is S.Aureus. However, I came across a part in the PASS program where he specifically pointed out that when you encounter a question about osteomyleitis in sickle cell always go for S. Aureus first then if it's not there pick salmonella. He even went as far as saying that FA and other resources are wrong in this point.

My question is which is correct?
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Old 05-04-2010
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First of all, I'm pretty sure that they will not be available at the same time.

In any case, please refer to the following article (the pdf is free online)

PEDIATRICS Vol. 101 No. 2 February 1998, pp. 296-297
REVIEW ARTICLE:
Etiology of Osteomyelitis Complicating Sickle Cell Disease.



On the other hand, e-Medicine states: "Patients with sickle cell disease are prone to infection of the bone and bone marrow, or osteomyelitis, in areas of infarction and necrosis. Although Staphylococcus aureus is the most common cause of osteomyelitis in the general population, studies have shown that in patients with sickle cell disease, the relative incidence of Salmonella osteomyelitis is twice that of staphylococcal infection." (Updated: May 6, 2009).

The race goes on, and the only ones to give responsible answers are SCD specialists or fellows that have worked in such a clinic.
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Old 05-05-2010
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yeah i agree. pls stick to salmonella. there's a reason y. im sure if we dig deep into research articles we can find the biochemistry reason to this. just like they specifically mention that SS carrier patients are protected from malaria.
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Old 05-08-2010
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i came across a same question in wikitestprep and the answer they gave is salmonella , but in the option staph was also there

but yaa in pass sprogram he mentions even though u see both optioons go for staph, its really confusing
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Old 05-09-2010
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Ok guys here's the trick to the question and how they try to play with you in exam.

Whenever you hear a word "MOST COMMON" than means it has nothing to do with the disease. for example, what is the most common cause of osteomyelitis in a pt. with sickle cell disease. careful guys the question is trying to fool you by saying sickle cell disease. it does not matter what disease they put because the most common is the most common no matter what disease it is.

But on the other hand if they say which one has the " higher incidence " then it is salmonella. eg. which disease has the higher incidence of osteomyelitis in a pt with sickle cell disease. look at Goljan rapid review 3rd edition page- 216 (C-3). The book does not say most common cause but rather increased incidence.

I Hope this will help to clear out the dust guys

cheers..... Good luck to ya all
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Old 05-09-2010
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thanks that helps a little bit
one more question if they give the pt is a black american then describe the case about osteomyleitis then what to choose??? salmonella??
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Old 05-09-2010
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Default hi

this is the exact question from wikitestprep

A 5-year-old African-American boy with a history of sickle cell anemia presents with several days of left lower leg pain. The patient’s temperature is 102.3°F. Physical examination reveals a swollen, red area overlying the left tibia that is warm and tender to palpation. Which of the following organisms is most likely responsible for these signs and symptoms?

A. Escherichia coli
B. Neisseria gonorrhoeae
C. Salmonella
D. Staphylococcus aureus
E. Streptococcus pneumoniae
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Old 05-09-2010
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Quote:
Originally Posted by ecgram View Post
this is the exact question from wikitestprep

A 5-year-old African-American boy with a history of sickle cell anemia presents with several days of left lower leg pain. The patient’s temperature is 102.3°F. Physical examination reveals a swollen, red area overlying the left tibia that is warm and tender to palpation. Which of the following organisms is most likely responsible for these signs and symptoms?

A. Escherichia coli
B. Neisseria gonorrhoeae
C. Salmonella
D. Staphylococcus aureus
E. Streptococcus pneumoniae
Here the ans is C. The question is not interested in MCC of osteomyelitis but rather most likely and that means incidence hence C is the best ans.

cheers m8
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Old 05-09-2010
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yup got it thanks
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Old 05-15-2016
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Sickle cell + osteomyelitis is always salmonella on the test. In real life, not so much
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