Osteomyelitis

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Osteomyelitis with secondary Staphylococcus aureus infection following orthopedic correction of a fracture. Radiographs highlights the periosteal reaction, osteopenia, calcification of the soft tissue, presence of cerclage wire and intramedullary pin buried inside medullary canal[1]
Fungal osteomyelitis due to Blastomyces dermatitidis[2]

Osteomyelitis is any inflammatory or infectious disease of bone, bone marrow and surrounding periosteal tissue. It is one of the most important causes of post-operative orthopedic complications and permanent lameness.

In clinical practice, osteomyelitis is commonly seen associated with traumatic open bone wounds, post-operatively after orthopedic procedures such as bone fracture repair[3] or tibial plateau leveling osteotomy[4], reactions to orthopedic implants[1], following dental procedures or from chronic dental disease[5] or from nail bed injuries with secondary onychomycosis[6].

Hematogenous osteomyelitis is commonly seen following traumatic wounds[7], abscesses[8] or post-operative complications, wound dehiscence, retained sponges[9], and may involve multiple organ pathology[10].

In dogs, both acute and chronic osteomyelitis have a common underlying etiology, usually bacterial, fungal or parasitic in origin. More rare causes include panosteitis, thromboembolic infarction, neoplasia (e.g. osteosarcoma[11], pancreatic adenocarcinoma[12]), implant corrosion/reactions and foreign body migrations[13].

Secondary osteomyelitis is of principle concern during orthopedic procedures and may result in delayed union during bone healing.

Causative organisms include:

- Staphylococcus aureus[14], Staphylococcus intermedius[15]
- Streptococcus spp
- Pseudomonas aeruginosa[16]
- Escherichia coli
- Pasteurella canis[17]
- Proteus spp
- Brucella canis
- Clostridium perfringens[18]
- Erysipelothrix rhusiopathiae[19]
- Cryptococcus spp
- Coccidioides immitis[20]
- Blastomyces spp
- Histoplasma spp
- Actinomyces spp
- Lecythophora hoffmannii[21]
- Nocardia spp
- Aspergillus spp[22]
- Oxyporus corticola[23]
- Paecilomyces spp
- Scedosporium apiospermum[24]
- Schizophyllum commune[25]
- Hepatozoon canis[26]
- Leishmania donovani[27]

Osteomyelitis is commonly observed in orthopedic surgery, and vigilance is needed to avoid surgical contamination.

Infection, fistula, inflammatory reaction, and hypersensitivity are among the complications related to orthopedic implants[28]. Metallosis should be considered as a possible cause.

Fixation devices are foci for bacterial colonization, which may be introduced during the surgical procedure or the traumatic incident, hematogenously after the insertion of the implant, or by contiguous spreading[29]. Staphylococus aureus is the most common bacterium involved in osteomyelitis and it may be resistant to antibiotics due to B-lactamase production, intrinsic resistance, or tolerance[30]; it also stimulates bone resorption[31].

Regardless of cause, localized osteomyelitis usually requires local surgical curettage and drainage, particularly is cutaneous sinus tracts are present. Techniques such as flushing of superficial bone with povidine-iodine or instillation of crystallized penicillin is commonly employed. Exotic drugs such as ciprofloxacin amylose starch implants[32] and tobramycin calcium sulfate-bead implantation[33] are quickly entering mainstream use.

Bacterial osteomyelitis require aggressive intravenous or parenteral antimicrobial therapy, often with a number of drugs simultaneously such as enrofloxacin, ciprofloxacin, clindamycin and amoxycillin/clavulanate.

Treatment of fungal osteomyelitis requires amphotericin B, ketoconazole or itraconazole for 4 - 6 months.

The use of non-steroidal anti-inflammatory drugs is recommended to minimize pain associated with periosteal inflammation.

References

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  2. de Lorimier LP & Fan TM (2010) Delayed diagnosis of fungal osteomyelitis with early scintigraphic lesions in a dog. Can Vet J 51(12):1394-1396
  3. Captug O et al (2008) Unifocal internal and external bone lengthening with circular external skeletal fixator in 5 dogs. Pol J Vet Sci 11(2):159-173
  4. Bergh MS & Peirone B (2012) Complications of tibial plateau levelling osteotomy in dogs. Vet Comp Orthop Traumatol 25(5):349-358
  5. Niemiec BA (2008) Periodontal disease. Top Companion Anim Med 23(2):72-80
  6. Namitome K et al (2011) Isolation of Fusarium sp. from a claw of a dog with onychomycosis. J Vet Med Sci 73(7):965-969
  7. Rabillard M et al (2011) Haematogenous osteomyelitis: clinical presentation and outcome in three dogs. Vet Comp Orthop Traumatol 24(2):146-150
  8. Naughton JF et al (2005) Radiographic diagnosis - paraspinal abscess in a dog. Vet Radiol Ultrasound 46(1):23-26
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  10. Peterson PB et al (2003) Septic pericarditis, aortic endarteritis, and osteomyelitis in a dog. J Am Anim Hosp Assoc 39(6):528-532
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  12. Gear RN et al (2006) Panniculitis, polyarthritis and osteomyelitis associated with pancreatic neoplasia in two dogs. J Small Anim Pract 47(7):400-404
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  22. Schultz RM et al (2008) Clinicopathologic and diagnostic imaging characteristics of systemic aspergillosis in 30 dogs. J Vet Intern Med 22(4):851-859
  23. Brockus CW et al (2009) Disseminated Oxyporus corticola infection in a German shepherd dog. Med Mycol 47(8):862-868
  24. Hugnet C et al (2009) Osteomyelitis and discospondylitis due to Scedosporium apiospermum in a dog. J Vet Diagn Invest 21(1):120-123
  25. Mori T et al (2009) Mycotic osteomyelitis caused by Schizophyllum commune in a dog. Vet Rec 165(12):350-351
  26. Shimokawa Miyama T et al (2011) Neutropenia associated with osteomyelitis due to Hepatozoon canis infection in a dog. J Vet Med Sci 73(10):1389-1393
  27. de Souza AI et al (2005) Osteolytic osteomyelitis associated with visceral leishmaniasis in a dog. Vet Parasitol 129(1-2):51-54
  28. Rubin JP & Yaremchuk MJ (1997) Complications and toxicities of implantable biomaterials used in facial reconstructive and aesthetic surgery: a comprehensive review of the literature. Plast Reconstr Surg 100:1336–1353
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  32. Huneault LM et al (2004) Prevention and treatment of experimental osteomyelitis in dogs with ciprofloxacin-loaded crosslinked high amylose starch implants. J Orthop Res 22(6):1351-1357
  33. Ham K et al (2008) Clinical application of tobramycin-impregnated calcium sulfate beads in six dogs (2002-2004). J Am Anim Hosp Assoc 44(6):320-326