[Humoral and cell-mediated immune reactions in chronic posttraumatic osteomyelitis (author's transl)]

What's new in exogenous osteomyelitis?

By the increase in road and occupational accidents during the past few decades posttraumatic osteomyelitis has become not only the most important type of exogenous but of all inflammatory bone processes. The major morphologic, bacteriologic and immunologic studies about posttraumatic bone inflammation will be outlined in this survey. The histologic classification of chronic osteomyelitis has proved useful for the observation of the course and for the selection of the treatment in 1,500 patients. Detailed morphological studies have shown that posttraumatic osteomyelitis often begins with a necrosis of the outer tangential lamella of the tubular bone partly promoted by partial periosteal retrogression, possibly followed by a necrosis of the fracture ends caused by a disturbance of the medullary blood circulation. Type and extent of osteomyelitis are determined by several traumatic, therapeutic and endogenous factors. Bacteriologically an infection with staphylococcus aureus is still prevailing. Comparative studies about the causative agents shortly after the trauma and during the following osteomyelitis have basically shown an identical range of causative agents. Immunologic studies with monoclonal antibodies in the actual site of inflammation have on the one hand found a decrease in the number of T-lymphocytes and the T-helper cells and on the other hand an increase in the T-suppressor cells, natural killer cells, macrophages in the osteomyelitic site. The impact of these findings on the therapy of osteomyelitis can presently not be estimated. However, they will become important after immunohistochemical studies of the bone and soft tissue Lager in osteosynthetic material after aseptic bone surgery have been carried out.(ABSTRACT TRUNCATED AT 250 WORDS)

Aspects of the microbe: host relationship in staphylococcal hematogenous osteomyelitis

Nasal carriage of staphylococci, and some in vitro tests of host antimicrobial defense were studied in a group of children who had recovered from staphylococcal hematogenous osteomyelitis at least one year previously. The same studies were carried out in a group of first degree relatives, and in age- and sex-matched controls. Nasal carriage was significantly more common (P = .039) in these children than in age- and sex-matched controls, and commoner (P = .19) in the first degree relatives than in controls. Total immunoglobulin G (IgG) levels were significantly lower in the children studied than in controls (P = .022), and in relatives than in controls (P = .032), but the levels remained within an accepted normal range. IgG levels were also significantly lower in carriers of Staphylococcus aureus than in non carriers (P = .033). Other immunoglobulin levels, complement levels, leukocyte phagocytic and killing power, leukocyte chemotaxis, and leukocyte migration inhibition, were indistinguishable between the children, their relatives, and controls. No statistically significant association between histocompatibility antigen profile and previous history of osteomyelitis, or nasal carriage of staphylococci, was found. More detailed studies are required to confirm and clarify the associations.

[Antibodies against staphylococci in patients of a department for orthopedic surgery (author's transl)]

Sera from different groups of patients in a department of traumatic surgery were examined for staphylococcal alpha-antitoxin-titres. In comparison to a group of normal controls the following changes were found: 1. Patients, had significantly raised titres, if they had undergone surgery because of closed fractures, pseudarthrosis and luxations and even if the postoperative course was uneventful. This can be explained through the wide-spread occurrence of staphylococci in hospitals, which can invade the organisms through an incision, the skin or mucous membranes. These findings should be kept in mind while estimating staphylococcal antitoxin-titres in patients hospitalized over a long period. 2. Patients suffering from surgical infections and also paraplegics showed still more significantly raised antitoxin-titres in comparison to the normal controls or to patients, who had undergone aseptic surgery. Increased titres were found even in the sera of patients, whose wounds did not drain staphylococcus aureus. Patients suffering from chronic staphylococcal osteomyelitis showed the highest mean values of antitoxin-titres; these patients, however, had also the greatest variations with high and low levels. The question arouse whether a high or a low level corresponds to the severity of the disease. It was found that it is necessary to titrate different antibodies against staphylococcal toxins. In a second paper the results of the simultaneous determination of alpha-antitoxin and anti-PV-leucocidin in patients with posttraumatic bone infections will be presented.