Salmonella Osteomyelitis

Bone infarcts or sickling in the periosteum usually is indicated by pain and swelling over an extremity. Osteomyelitis also should be considered. Salmonella species are the most common cause of osteomyelitis in SCD children, followed by Staphylococcus aureus. 27 Select an appropriate antibiotic to cover the suspected organisms empirically. 

Chloramphenicol remains a major treatment of typhoid and paratyphoid fever in developing countries. However, with increasing resistance to ampicillin, trimethoprim-sulfamethoxazole and, to some extent, chloramphenicol, fluoroquinolones and some third-generation cephalosporins (e.g., ceftriaxone) have become the drugs of choice. Salmonella infections, such as osteomyelitis, meningitis and septicemia, have also been indications for chloramphenicol use. Nevertheless, antibiotic resistance patterns can be a problem. As noted previously, nonty-phoidal salmonella enteritis is not benefited by treatment with chloramphenicol or other antibiotics. 

Osteomyelitis may be acute or chronic and the causative bacteria arrive in the bloodstream or are implanted directly (through a compound fracture, chronic local infection of local tissue, or surgical operation). Staphylococcus aureus is the commonest isolate in all patient groups but Haemophilus influenzae is frequently seen in children (much reduced now by the Hib vaccine), and Salmonella species in the tropics. Chronic osteomyelitis of the lower limbs (especially when underlying chronic skin infection in the elderly) frequently involves obligate anaerobes (such as Bacteroides species) and coliforms. 

Osteomyelitis in apatient with a hemoglobinopathy, such as sickle cell anemia, is commonly caused by either Salmonella or S. aureus. Thus empirical antibiotics of first choice are ceftriaxone or cefotaxime. Alternatives are chloramphenicol and ciprofloxacin (in adults). 

Respiratory symptoms, cough and hemoptysis may occur due to pulmonary infiltrates of Salmonella typhi and secondary pneumococcal infection. Bacteremia leads to focal disease, which presents with osteomyelitis, endocarditis, particularly in valvular disease, meningitis, soft-tissue abscesses, glomerulonephritis and skin lesions. CNS complications, such as meningitis, mental disturbances, delirium or depressed level of consciousness may occur in severe cases. 

Most cases of food-bome gastrointestinal illness resolve spontaneously. Shigella and Salmonella infections have also been associated with Reiter s syndrome or reactive arthritis. Salmonella may also lead to osteomyelitis and endocarditis. They are also associated with haemolytic uraemic syndrome (HUS) in children. 

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