Transcript PREVALENCE OF OSTEOMYELITIS IN HIV INFECTED PATIENTS.

PREVALENCE OF
OSTEOMYELITIS IN HIV
INFECTED PATIENTS.
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PRESENTERS:
1.
MOHAMED M. NOORANY- MBChB V (MUSOM)
2.
MUKOYA AQUINATA (Sr)- MBChB V (MUSOM)
FACILITATORS:
1.
DR. JAMES OBONDI (Chief Orthopedic Specialist)
2.
DR. STEVE OKELLO (MBChB, MMED registrar- ortho)
BACKGROUND
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Osteomyelitis is an infection of bone leading to
inflammatory destruction and necrosis of bone, and new
bone formation. It may be acute, sub acute or chronic.
M:F- 2:1. It has a bimodal distribution; acute infection
mostly in children & adolescent, while chronic form in >45
years. The tibia & femur are the most commonly affected
bones.
Immunosuppression, SCD and local trauma, among others
predispose to osteomyelitis.
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Staphylococcus aureus is the organism most
commonly implicated in this infection, followed by
Streptococcus pyogenes and Hemophilus influenza.
Definitive management mainly involves intravenous
antibiotics (e.g Flucloxacillin 50-100mg IV QID ) until
systemic symptoms decline after which oral
antibiotics are continued for 4-6 weeks.
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Apley and Solomon’s Concise System of Orthopaedics and Trauma 4th Ed, pg18-9
OBJECTIVES
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To compare prevalence of osteomyelitis in HIV
infected population to the general population.
To determine the common causative organisms of
osteomyelitis in HIV infected population
To find out the risk factors for osteomyelitis in
HIV infected patients
To compare management of osteomyelitis in HIV
infected population to the general population
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METHODOLOGY
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A review of current literature on osteomyelitis in
HIV infected patients was done.
‘Google Scholar’ and ‘Pubmed’ were the main
reference platforms
A total of 7 studies were analyzed, ranging from 1
case report to a cohort of 4023 participants
The articles were published from as early as 1995 to
2014
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RESULTS
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PREVALENCE
The annual incidence rate of osteomyelitis was
found to be 13 per 100,000 in the general
population
The prevalence of osteomyelitis in HIV infected
patients was seen as 348 per 100000.
21.6% of patients who developed osteomyelitis
also showed positive results for HIV
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COMMON CAUSATIVE ORGANISM
3 of the 7 studies analyzed vouched for
Staphylococcus aureus as the main culprit leading to
osteomyelitis in HIV infected patients
2 studies grew more of Streptococcus pneumoniae in
their bacterial cultures
1 study found that Staphylococcus aureus was
commoner in HIV non infected patients while
Streptococcus pneumoniae was found more often in
HIV infected patients
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3.
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RISK FACTORS
All of the studies that addressed this concern (3
of 7) described IV drug abuse as a significant
risk factor for osteomyelitis in HIV infected
patients
No other risk factors were mentioned
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4.
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MANAGEMENT APPROACH
There was no particular approach described for
patients with concomitant HIV and osteomyelitis
infections
Use of broad spectrum antibiotics before culture
results, changed to targeted antibiotic therapy
after culture was chorused.
No specific modifications to the ARV treatments
were mentioned
Use of anti pneumococcal vaccine in HIV infected
patients. To give or not to give is the question.
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DISCUSSION
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Despite being a rare infection in HIV infected
patients, osteomyelitis is commoner in them than in
the general population
An imunosuppressed state, caused by HIV infection
leads to increased susceptibility of the patients to
invasion by infectious microbes leading to infections
e.g osteomyelitis.
Also, the more advanced stages of HIV infection lead
to rapid progression of osteomyelitis, manifesting
more with complications than in the
immunocompetent individuals
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The unsterility adopted by IV drug users predisposes
them to infectious microbes from their infected partners
leading to a greater incidence of both HIV and
osteomyelitis in these individuals
S. aureus most commonly causes osteomyelitis. Both,
this & Streptococcus pneumoniae are also opportunistic
organisms that lead to infections more often in
immunosuppressed patients
Various organisms can lead to osteomyelitis. Culture
may take up to 2 weeks, as such, broad spectrum
antibiotics are started as empirical therapy, and later
changed to definitive treatment based on culture results
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CONCLUSION
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Osteomyelitis is commoner in HIV infected patients
as compared to the general population.
Staphylococcus aureus and Streptococcus pneumoniae
are the commonest organisms isolated in
osteomyelitis in HIV infected patients. There is mixed
evidence on which of the two is commoner
IV drug abuse is a significant risk factor for
osteomyelitis in HIV infected patients
Broad spectrum antibiotics should be initiated in such
patients.
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RECOMMENDATIONS
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Most of the researches were conducted in developed
countries which have different disease burdens as
compared to developing countries. As such, we need
local data to understand the actual burden,
pathogenesis and clinical course of osteomyelitis in
HIV patients to aid its proper diagnosis and
management.
Investigate on importance on pneumococcal vaccine
in HIV infected patients
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African Journal of Pediatric Surgery, 2014,
vol11,issue 4, pg 297-303.
BMC pediatrics 2008, pg 8-45, © Risse et al.2008.
Journal of Paediatric Orthopaedics, 2012 March, 32
(2), pg 215-219.
New England Journal of Medicine, 2001.
Heart Lung. 1999 Jan-Feb; 28 (1): 74-76
Presse Med. 1995 Nov 4;24 (33):1566-8
Acta Orthop Scand. 1997 Dec; 68 (6): 554-8
Medicine (Baltimore). 1997 Jul; 76 (4):284-94
Apleys and Solomon’s concise system of orthopedics
and trauma, 4th Ed- pg 18-19
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