Epidemiologic and clinical aspects of osteomyelitis in the rheumatology ward at Point G’s University Hospital Center

Abstract

Background: Osteomyelitis is a bone infection that results from haematogenous spread, and that affects both genders. It is found in children and adolescents and is mainly found in Africans with sickle- cell disease. Management of osteomyelitis in Mali faces difficulties because of the possible passage to chronicity.
Objective: To specify the epidemiologic and clinical characteristics of osteomyelitis and to evaluate the disease prognosis with treatment.
Patients and methods: This was a retrospective study covering a 7 year period (1st January 2006 to 31st December 2012), which included hospitalization files of patients diagnosed with osteomyelitis, whether referred or not.
Results: Thirty seven patient files were studied. All patients admitted in the ward were later followed either as outpatient or transferred to the orthopaedic surgery ward according to the evolution. Osteomyelitis is frequent, representing 5.8% of hospitalizations, with a mean age of 23.5 years. Trauma and sickle-cell disease were the main predisposing factors, each with a frequency of 18.9%. Consultation at advanced stages led to complications: neighbouring arthritis, skin fistula, multiple localizations. Probabilistic antibiotherapy, although sometimes excessive, was used. Staphylococcus aureus was mostly incriminated (45.9%). One case of tuberculosis was retained. Of the 12 patients voluntarily tested for HIV 1 and 2, one patient was positive for HIV 1. Long bones were preferably infected but damage to the iliac bone was not rare. Medical treatment as well as local care were not sufficient to prevent pathologic fractures in 18.9% of patients.
Conclusion: Acute osteomyelitis appears at all ages but is more predominant in young teenagers. Sickle cell disease is the most frequent co-morbidity. HIV immunodepression can be associated. Tuberculosis although endemic is not really incriminated.

Key words: Osteomyelitis, Sickle cell disease, Rheumatology, Mali