1
|
Furgier A, Goutines J, Dobian S, Zappa M, Demar M, Aigoun N, Oubda B, Faye A, Elenga N, Osei L. Bone and Joint Infections in Children With Sickle Cell Disease in French Guiana: A 13-year Retrospective Multicenter Review. Pediatr Infect Dis J 2024:00006454-990000000-00944. [PMID: 38986011 DOI: 10.1097/inf.0000000000004416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Sickle cell disease (SCD) is a genetic disorder with a high infectious morbidity and mortality and a heterogeneous distribution in France. One of the challenges is to differentiate a bone and joint infection (BJI) from a vaso-occlusive crisis. This challenge is particularly prevalent in French Guiana, an overseas territory with the highest incidence of SCD in France. The aim of this study was to describe the epidemiology of BJI in children with SCD in French Guiana. METHOD This was a retrospective multicentric descriptive study of SCD patients living in French Guiana aged under 18 and diagnosed with a BJI between 2010 and 2022. These BJI were divided into 2 groups: those with microbiological documentation (d-BJI) and those without microbiological identification (ud-BJI). RESULTS A total of 53 episodes of BJI in 42 patients (mean age 7.2 years) were reported. Clinical symptoms on arrival were comparable between the d-BJI and ud-BJI groups. Patients in the d-BJI group had longer average hospital stays (40.4 days vs. 16.8 days, P = 0.01) and Salmonella spp. were the most identified bacteria (n = 8/13). White blood cell count was greater in the d-BJI group (30.3 G/L vs. 18.G/L, P = 0.01) and a collection was more frequently identified on imaging (11/13 vs. 16/40, P = 0.01) in this group. Initial in-hospital antibiotic therapy was longer in the d-BJI group (17.2 days vs. 12.8, P = 0.02), as were infection-related complications (9/13 vs. 12/40 P = 0.01). CONCLUSION BJI in children with SCD is not sufficiently microbiologically documented. Progress must be made to improve the documentation of BJI.
Collapse
Affiliation(s)
- Apolline Furgier
- From the Departement of Infectiology Pediatric in Robert Debre, AP-HP
| | - Juliette Goutines
- AP-HP, Department of Infectiology Pediatric in Robert Debre, University of Paris Cite, Paris
| | | | | | | | - Nadjia Aigoun
- Department of Pediatric in Saint Laurent Du Maroni Hospital
| | | | - Albert Faye
- AP-HP, Department of Infectiology Pediatric in Robert Debre, University of Paris Cite, Paris
| | - Narcisse Elenga
- Department of Pediatric in Cayenne Hospital, University of Antilles, French Guiana, France
| | - Lindsay Osei
- Department of Pediatric in Cayenne Hospital, University of Antilles, French Guiana, France
| |
Collapse
|
2
|
Restrepo R, Park HJ, Karakas SP, Cervantes LF, Rodriguez-Ruiz FG, Zahrah AM, Inarejos-Clemente EJ, Laufer M, Shreiber VM. Bacterial osteomyelitis in pediatric patients: a comprehensive review. Skeletal Radiol 2024:10.1007/s00256-024-04639-x. [PMID: 38504031 DOI: 10.1007/s00256-024-04639-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 03/21/2024]
Abstract
Bacterial osteomyelitis, an inflammatory response in the bone caused by microorganisms, typically affects the metaphysis in the skeletally immature. Bacterial osteomyelitis possesses a significant diagnostic challenge in pediatric patients due to its nonspecific clinical presentation. Because the metaphysis is the primary focus of infection in skeletally immature patients, understanding the normal physiologic, maturation process of bones throughout childhood allows to understand the pathophysiology of osteomyelitis. Timely and accurate diagnosis is crucial to initiate appropriate treatment, and prevent long-term sequelae and efforts must be made to isolate the causative organism. The potential causative organism changes according to the age of the patient and underlying medical conditions. Staphylococcus Aureus is the most common isolated bacteria in pediatric pyogenic osteomyelitis whereas Kingella Kingae is the most common causative agent in children aged 6 months to 4 years. Imaging plays a pivotal role in the diagnosis, characterization, evaluation of complications, and follow up of bacterial osteomyelitis. Imaging also plays a pivotal role in the evaluation of potential neoplastic and non-neoplastic mimickers of osteomyelitis. In children, MRI is currently the gold standard imaging modality when suspecting bacterial osteomyelitis, whereas surgical intervention may be required in order to isolate the microorganism, treat complications, and exclude mimickers.
Collapse
Affiliation(s)
- Ricardo Restrepo
- Radiology Department, Nicklaus Children's Hospital, 3100 SW 62nd Ave, Miami, FL, 33155, USA.
| | - Halley J Park
- Radiology Department, Nicklaus Children's Hospital, 3100 SW 62nd Ave, Miami, FL, 33155, USA
| | - S Pinar Karakas
- Radiology Department, Nicklaus Children's Hospital, 3100 SW 62nd Ave, Miami, FL, 33155, USA
| | - Luisa F Cervantes
- Radiology Department, Nicklaus Children's Hospital, 3100 SW 62nd Ave, Miami, FL, 33155, USA
| | | | - Anna Maria Zahrah
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA
| | | | - Marcelo Laufer
- Infectious Disease Department, Nicklaus Children's Hospital, Miami, USA
| | - Verena M Shreiber
- Orthopedic, Sports Medicine, and Spine Institute, Nicklaus Children's Hospital, Miami, USA
| |
Collapse
|
3
|
Ning D, Xu F, Zhang Z, Yang X, Wei J. Early Bone Infarction With Soft-tissue Abscess. J Am Acad Orthop Surg Glob Res Rev 2022; 6:e21.00235. [PMID: 35839454 PMCID: PMC10566929 DOI: 10.5435/jaaosglobal-d-21-00235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
Early bone infarction was rarely reported, and additional research is needed for diagnosis and treatment. This article aims to report the diagnosis and treatment process of a patient with unexplained early bone infarction with soft-tissue abscess and a review of related literature. A 52-year-old male patient with early bone infarction of unknown etiology and soft-tissue abscess was analyzed retrospectively. He sustained right thigh swelling and pain for 5 days and hip and knee joint dysfunction, accompanied by fever, temperature 38°C, no limb numbness, sensory disturbance, and other discomfort. On MR images, early bone infarction with local soft-tissue abscess was found. After incision and drainage of soft-tissue abscess, wound débridement, and suture, the swelling and pain of the affected limb dysfunction gradually recovered. Early bone infarction of unknown etiology with soft-tissue abscess has a low incidence. MRI is the main imaging diagnostic method. Conservative treatment is the main guard against malignant changes and surgical treatment, if necessary.
Collapse
Affiliation(s)
- Dongfang Ning
- From the Department of Bone and Joint Surgery, Liuzhou Municipal Liutie Central Hospital, Liuzhou, Guangxi, China
| | | | | | | | | |
Collapse
|
4
|
Mohzari YA, Alshuraim R, Asdaq SMB, Aljobair F, Alrashed A, Alsowaida YS, Alamer A, Al Munjem MF, Al Musawa MI, Hatata M, Alzaaqi MA, Binrokan A, Alajlan SA, Abraham I, Alamer A. Early oral switch to combined cefixime therapy for management of osteoarticular infections in pediatric sickle cell disease patients: A descriptive analysis. J Infect Public Health 2021; 15:1-6. [PMID: 34852307 DOI: 10.1016/j.jiph.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/31/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The treatment of osteoarticular infections in pediatric patients with sickle cell disease (SCD) is a challenging task for the practitioner. The aim of this study is to evaluate cefixime for the treatment of osteoarticular infections in pediatric SCD patients by retrospective design. METHODS This study was done in the pediatric hospital of King Saud Medical City, Riyadh, Saudi Arabia. The data was obtained from medical records of patients aged 1-16 years admitted between January 2019 to December 2020, diagnosed with SCD and received cefixime for the treatment of OI. A descriptive study for pediatric patients admitted between January 2019 to December 2020 diagnosed with sickle cell disease and diagnosed with osteoarticular infection. All patients were treated with cefixime. Medians and interquartile ranges (IQRs) were used for the descriptive analysis. RESULTS A total of 260 patients were screened, and 51 cases [osteomyelitis (OM), n = 43, and septic arthritis (SA), n = 8] met the inclusion criteria. The median age of OM patients was 7 years, with males making up 67.4% of the cohort. The median length of IV antibiotics and hospital stays were 10 days and 11 days, respectively. The median total duration of antibiotic use was 37 and 25 days for OM and SA, respectively. The treatment success rate was 88% in OM cases and 100% in SA patients. Readmission was noted in 39.5% of the OM patients, while only 25% of the SA patients were recorded for reinfection. CONCLUSION The study's findings revealed that Cefixime is a viable oral alternative for treating osteoarticular infection in pediatric SCD patients. Nonetheless, a prospective investigation is required to corroborate the findings of this study.
Collapse
Affiliation(s)
- Yahya A Mohzari
- Pharmaceutical Care Division, Clinical Pharmacy Section, King Saud Medical City, Riyadh, Saudi Arabia
| | - Renad Alshuraim
- Pharmaceutical Care Division, Clinical Pharmacy Section, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Fahad Aljobair
- Pediatric Infectious Disease Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alrashed
- Pharmaceutical Service Department, Main Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Yazed Saleh Alsowaida
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Amnah Alamer
- Department of Internal Medicine, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | | | - Mohammed I Al Musawa
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
| | - Muhannad Hatata
- Pharmacy Services Administration, Children's hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Meshal A Alzaaqi
- Maternity & Pediatric Hospital, KSMC, Riyadh, Kingdom Saudi Arabia
| | - Aljawharah Binrokan
- Pharmaceutical service Department, Children hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saleh Ahmad Alajlan
- Department of Pediatric Dentistry, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ivo Abraham
- Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA; Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Ahmad Alamer
- Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA; Department of Clinical Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| |
Collapse
|
5
|
Allam MFAB, Samra MFA, Rahman ASMA. The added value of chemical shift imaging in evaluation of bone marrow changes in sickle cell disease. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-020-00384-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The aim of this study was to assess the added value of chemical shift imaging when used with routine MRI study in evaluation of bone marrow changes in SCD. Forty-two patients with SCD and bone pain were included in the study; they underwent CSI and routine MRI study on the symptomatic anatomic part of the skeleton.
Results
Four patterns of diffuse bone marrow changes were recognized; they varied from persistent red marrow to diffuse hypointense patterns with abnormal signal loss percentage on CSI that suggest presence of iron overload (n = 28, 66.6%). Serum ferritin level was increasing in accordance to the degree of signal changes found on CSI with significant high negative correlation between the percentage of signal loss on CSI obtained from IP-OP/IP formula and serum ferritin level. In focal marrow lesions, all T1 hyperintense lesions demonstrated corresponding hyperintensity on IP and OP; the detection frequency on CSI was relatively higher on OP compared with IP images.
Conclusion
CSI has high diagnostic performance in detecting diffuse marrow changes and development of iron overload in SCD. In SCD-related focal marrow lesions, CSI could have a complementary role in detection of T1 hyperintensity and lesion conspicuity.
Collapse
|
6
|
Diagnosis and Management of Osteomyelitis in Children. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00763-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
7
|
Person A, Janitz E, Thapa M. Pediatric Bone Marrow: Normal and Abnormal MRI Appearance. Semin Roentgenol 2021; 56:325-337. [PMID: 34281683 DOI: 10.1053/j.ro.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
8
|
Mallon D, Doig D, Dixon L, Gontsarova A, Jan W, Tona F. Neuroimaging in Sickle Cell Disease: A Review. J Neuroimaging 2021; 30:725-735. [PMID: 33463866 DOI: 10.1111/jon.12766] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/22/2020] [Indexed: 11/28/2022] Open
Abstract
Sickle cell disease is the most common hereditary hemoglobinopathy, which results in abnormally shaped and rigid red blood cells. These sickle-shaped red blood cells cause vaso-occlusion and ischemic phenomena that can affect any organ in the body. As a common cause of disability, the neurological manifestations of sickle cell disease are particularly important. Neuroimaging has a crucial role in the diagnosis, management, and prevention of the complications of sickle cell disease. These complications can affect the brain parenchyma, vasculature, and skull and can be ascribed directly or indirectly to a vasculopathy of small and large vessels. Vaso-occlusion can cause ischemic stroke. Ischemic damage in the absence of an acute neurological deficit, and therefore only apparent on neuroimaging, is termed silent cerebral ischemia. Weakening of the arterial walls can cause aneurysms. In its most severe form, a vasculopathy of the terminal internal carotid arteries can progress to moyamoya syndrome, characterized by steno-occlusive disease and the formation of friable collateral arteries. Rupture of aneurysms or friable collateral arteries is a potential cause of intracranial hemorrhage. The skull and vertebrae may be affected by extra-medullary hematopoiesis, due to severe anemia, or iron deposition, due to chronic red blood cell transfusion. Impaired blood supply to bone is associated with osteomyelitis and osteonecrosis. Fat embolization syndrome is a rare complication of osteonecrosis, which may cause devastating neurological impairment. Awareness and early recognition of the diverse manifestations of sickle cell disease on neuroimaging is crucial to ensure optimal treatment in a complex patient cohort.
Collapse
Affiliation(s)
- Dermot Mallon
- Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | - David Doig
- Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | - Luke Dixon
- Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | | | - Wajanat Jan
- Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
| | - Francesca Tona
- Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
| |
Collapse
|
9
|
Weisman JK, Nickel RS, Darbari DS, Hanisch BR, Diab YA. Characteristics and outcomes of osteomyelitis in children with sickle cell disease: A 10-year single-center experience. Pediatr Blood Cancer 2020; 67:e28225. [PMID: 32065511 DOI: 10.1002/pbc.28225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 01/10/2020] [Accepted: 01/23/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) are at increased risk for osteomyelitis (OM). Diagnosis of OM in SCD is challenging as the clinical presentation is similar to a vasoocclusive crisis (VOC) with no diagnostic gold standard. We report characteristics and outcomes of OM in SCD patients treated at our center over 10-year period. DESIGN/METHOD We conducted a retrospective analysis of patients with SCD who were treated for OM at our center over a 10-year period (2006-2016). Cases were identified utilizing radiology data mining software. Radiology reports and medical charts of potential OM cases were reviewed. RESULTS Twenty-eight children with SCD were treated for OM at our institution. Patients treated for OM were largely similar to patients treated for a VOC. However, patients treated for OM had significantly higher C-reactive protein (10 mg/dL vs 5.58 mg/dL, P = 0.03) and erythrocyte sedimentation rate (60 mm/h vs 47 mm/h, P = 0.02). Magnetic resonance imaging (MRI) findings were consistent with OM in 18 (64%) patients and indeterminate in the remaining. Based on clinical, laboratory, and radiological findings, the diagnosis of OM was considered confirmed in 3 patients, probable in 6 patients, and presumed in 19 patients. Nontyphoidal Salmonella was isolated from cultures in 9 (32%) patients, while no organism was identified in 19 (67%) patients. All patients were treated with antibiotics. Six patients (21%) required surgical interventions. CONCLUSIONS OM continues to pose diagnostic challenges. Most patients are treated for OM without definitive confirmation. Nontyphoidal Salmonella was the only organism identified in our cohort.
Collapse
Affiliation(s)
- Julie K Weisman
- Division of Hematology, Children's National Health System, Washington, DC
| | - Robert Sheppard Nickel
- Division of Hematology, Children's National Health System, Washington, DC.,The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Deepika S Darbari
- Division of Hematology, Children's National Health System, Washington, DC
| | - Benjamin R Hanisch
- The George Washington University School of Medicine and Health Sciences, Washington, DC.,Division of Infectious Disease, Children's National Health System, Washington, DC
| | - Yaser A Diab
- Division of Hematology, Children's National Health System, Washington, DC.,The George Washington University School of Medicine and Health Sciences, Washington, DC
| |
Collapse
|
10
|
Fontalis A, Hughes K, Nguyen MP, Williamson M, Yeo A, Lui D, Gelfer Y. The challenge of differentiating vaso-occlusive crises from osteomyelitis in children with sickle cell disease and bone pain: A 15-year retrospective review. J Child Orthop 2019; 13:33-39. [PMID: 30838073 PMCID: PMC6376437 DOI: 10.1302/1863-2548.12.180094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The paediatric sickle cell disease (SCD) osteomyelitis (OM) incidence is 0.3% to 12%. Differentiating vaso-occlusive crises (VOC) from OM is a diagnostic challenge, with limited evidence guiding management. We present a 15-year review of a paediatric sickle cell cohort. We aim to identify OM incidence and provide a management protocol for these children presenting with bone pain. METHODS A prospective database of children with haemoglobinopathies (2002 to 2017) was analyzed for temperature, C-reactive protein (CRP) and white cell count (WCC) on admission as well as imaging, treatment and cultures. OM diagnosis was supported by imaging and blood cultures. VOC was defined as bone pain that improved without antibiotics. RESULTS Over 15 years, 96 children with SCD presented 358 times to hospital. Empirical antibiotics were given in 308 presentations. There were five cases of OM (1.4%); two acute and three chronic. In all, 50 presentations of VOC were identified. No significant differences in age were noted between the OM and VOC group. Temperature and CRP were significantly elevated in the OM group with no significant difference in WCC. Cultures were only positive in the chronic OM admissions. There were no cases of septic arthritis. No surgical intervention was required. CONCLUSION In children with SCD presenting with persistent bone pain, fever, elevated CRP and WCC, OM should be suspected and prompt antibiotic treatment started. Our treatment pathway was successful avoiding OM in 98.6% and septic arthritis in 100%. Further research on novel biological markers distinguishing OM from VOC should be investigated. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- A. Fontalis
- Trauma and Orthopaedic Department, St George’s Hospital, London, UK
| | - K. Hughes
- Trauma and Orthopaedic Department, St George’s Hospital, London, UK
| | - M. P. Nguyen
- Trauma and Orthopaedic Department, St George’s Hospital, London, UK
| | - M. Williamson
- Trauma and Orthopaedic Department, St George’s Hospital, London, UK
| | - A. Yeo
- Trauma and Orthopaedic Department, St George’s Hospital, London, UK
| | - D. Lui
- Trauma and Orthopaedic Department, St George’s Hospital, London, UK
| | - Y. Gelfer
- Trauma and Orthopaedic Department, St George’s Hospital, London, UK,St George’s University of London, London, UK, Correspondence should be sent to Y. Gelfer, MD PhD FRCS, St Georges Hospitals NHS Foundation Trust, Trauma and Orthopaedic Department, St James Wing Level 5, Blackshaw Rd, London SW170QT, UK. E-mail:
| |
Collapse
|
11
|
T2-blackout effect on DWI as a sign of early bone infarct and sequestration in a patient with sickle cell disease. Clin Imaging 2018; 54:15-20. [PMID: 30500454 DOI: 10.1016/j.clinimag.2018.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/31/2018] [Accepted: 11/14/2018] [Indexed: 11/22/2022]
Abstract
Differentiation of bone infarct from osteomyelitis is one of the most challenging issues in the evaluation of acute bone pain in sickle cell patients. The imaging modalities that are currently being used for assessment of bone marrow in this population have several limitations. We present a case of an 18-year-old male with a history of sickle cell disease, who was transferred to our emergency department with progressively severe headache and jaw pain for one-week. Initial evaluation was concerning for osteomyelitis and epidural abscess formation. Due to the lack of response to the current antibiotic treatment, he was transferred to our institution. On further review of the images, atypical DWI findings that were identified in the early phase of presentation helped to differentiate bone infarct from osteomyelitis. Radiologists should be aware of this phenomenon, as it can help in the differentiation between these two pathologies and can affect the patient's management overall.
Collapse
|
12
|
Hughes M. Rheumatic Manifestations of Haemoglobinopathies. Curr Rheumatol Rep 2018; 20:61. [PMID: 30109514 DOI: 10.1007/s11926-018-0768-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF THE REVIEW To provide a clinically useful literature review on the rheumatic manifestations of haemoglobinopathies, critically analysing the literature from the past 5 years. RECENT FINDINGS There are limited new data to guide the management of rheumatic manifestations of haemoglobinopathies. Data further confirm the wide spectrum of potential rheumatic/MSK involvement in haemoglobinopathies, which poses both a diagnostic and therapeutic challenge. Inflammatory arthritis may be more common than previously believed. Steroid therapy by any route of administration can provocate a potential life-threatening vaso-occlusive crisis. Vitamin D deficiency is common. There are limited data to guide the drug treatment of reduced bone density in haemoglobinopathies. There have been a number of studies examining pain in sickle cell anaemia. Plasma levels of Klotho may represent a novel biomarker in patients with β-Thalassemia. There are little new data on the rheumatic manifestations in haemoglobinopathies and future high-quality research is needed.
Collapse
Affiliation(s)
- Michael Hughes
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, S10 2JF, Sheffield, UK.
| |
Collapse
|
13
|
Abstract
Sickle cell disease (SCD) is an autosomal recessive disorder that results in hemolytic anemia related to abnormal hemoglobin and erythrocyte levels. SCD is characterized by vascular occlusive episodes, visceral sequestration, and aplastic or hemolytic crises. These crises most commonly occur in bone. The orthopaedic manifestations of SCD comprise much of the morbidity associated with this disorder. Osteonecrosis and osteomyelitis are among the most disabling and serious musculoskeletal complications in patients with SCD. Effective management of the bone and joint sequelae requires an accurate diagnosis, an understanding of the pathophysiology of the disease, and knowledge of available medical and surgical treatment alternatives. The major orthopaedic manifestations of SCD are osteonecrosis, osteomyelitis, septic arthritis, and bone infarction. Patients with SCD require close monitoring in the perioperative period because of the risk for vasoocclusive crisis.
Collapse
|
14
|
Kanthawang T, Pattamapaspong N, Louthrenoo W. Acute bone infarction: a rare complication in thalassemia. Skeletal Radiol 2016; 45:1013-6. [PMID: 27105620 DOI: 10.1007/s00256-016-2387-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/07/2016] [Accepted: 04/04/2016] [Indexed: 02/02/2023]
Abstract
Acute bone infarction is a well-described complication in sickle cell hemoglobinopathy but it is rarely reported in patients with thalassemia. This report describes an 18-year-old man with homozygous β-thalassemia presenting with a fever and severe acute bilateral ankle pain. The acute onset of severe pain and fever were clinical mimics of infectious arthritis and osteomyelitis. Magnetic resonance imaging revealed acute bone infarction in the meta-diaphysis of bilateral tibias presenting as central unenhanced devitalized bone with T1-high signal intensity fluid in the subperiosteum and soft tissue. Characteristic imaging features are discussed, emphasizing the benefit of fat suppression pre-and post-intravenous gadolinium T1-weighted images. The etiologies of bone infarction in thalassemia are reviewed.
Collapse
Affiliation(s)
- Thanat Kanthawang
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nuttaya Pattamapaspong
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
| | - Worawit Louthrenoo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| |
Collapse
|
15
|
Hughes M, Akram Q, Rees DC, Jones AKP. Haemoglobinopathies and the rheumatologist. Rheumatology (Oxford) 2016; 55:2109-2118. [PMID: 27018056 DOI: 10.1093/rheumatology/kew042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 02/11/2016] [Indexed: 01/15/2023] Open
Abstract
The haemoglobinopathies are a relatively common, heterogeneous group of inherited conditions that are the result of either a quantitative abnormality (e.g. thalassaemia) or structural [e.g. sickle cell anaemia (SCA)] of the globin part of the haemoglobin molecule. Musculoskeletal (MSK) complications are common in patients with haemoglobinopathies and may affect the whole of the MSK system, in addition to bone, which is the primary site of the disease. Typical MSK complications include painful vaso-occlusive disease and osteomyelitis in SCA and reduced BMD in thalassaemia. Patients may also develop a number of related (e.g. gout) or unrelated rheumatic diseases (e.g. inflammatory arthritis and autoimmune CTDs). Treatment of MSK conditions in patients with haemoglobinopathies may be challenging (e.g. bone marrow suppression from disease-modifying agents) and in particular in SCA, steroid therapy (by any route) may precipitate potentially severe vaso-occlusive complications. Rheumatologists need to be aware of the range of MSK complications, treatment challenges and the need for such patients to be managed as part of a dedicated multidisciplinary team alongside haematology.
Collapse
Affiliation(s)
- Michael Hughes
- Centre for Musculoskeletal Research, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre
| | - Qasim Akram
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, Manchester
| | - David C Rees
- Department of Haematological Medicine, King's College London, King's College Hospital, London and
| | - Anthony Kenneth Peter Jones
- Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, Manchester.,Human Pain Research Group, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| |
Collapse
|
16
|
Thayil N, Chapman MN, Saito N, Fujita A, Sakai O. Magnetic Resonance Imaging of Acute Head and Neck Infections. Magn Reson Imaging Clin N Am 2016; 24:345-67. [PMID: 27150323 DOI: 10.1016/j.mric.2015.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This article discusses the use of MR imaging in various acute infectious diseases of the head and neck, with particular emphasis on situations where MR imaging provides additional information that can significantly impact treatment decisions and outcomes. MR imaging findings of various disease processes are discussed, based on the head and neck compartments from which they originate. Specifically, infectious entities of the orbit, paranasal sinuses, pharynx, oral cavity (including periodontal disease), salivary glands, temporal bone, and lymph nodes are described in detail.
Collapse
Affiliation(s)
- Neil Thayil
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA 02118, USA
| | - Margaret N Chapman
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA 02118, USA; Radiology Service, VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA
| | - Naoko Saito
- Department of Radiology, Saitama International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Akifumi Fujita
- Department of Radiology, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
| | - Osamu Sakai
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA 02118, USA.
| |
Collapse
|
17
|
Delgado J, Bedoya MA, Green AM, Jaramillo D, Ho-Fung V. Utility of unenhanced fat-suppressed T1-weighted MRI in children with sickle cell disease -- can it differentiate bone infarcts from acute osteomyelitis? Pediatr Radiol 2015. [PMID: 26209118 DOI: 10.1007/s00247-015-3423-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at risk of bone infarcts and acute osteomyelitis. The clinical differentiation between a bone infarct and acute osteomyelitis is a diagnostic challenge. Unenhanced T1-W fat-saturated MR images have been proposed as a potential tool to differentiate bone infarcts from osteomyelitis. OBJECTIVE To evaluate the reliability of unenhanced T1-W fat-saturated MRI for differentiation between bone infarcts and acute osteomyelitis in children with SCD. MATERIALS AND METHODS We retrospectively reviewed the records of 31 children (20 boys, 11 girls; mean age 10.6 years, range 1.1-17.9 years) with SCD and acute bone pain who underwent MR imaging including unenhanced T1-W fat-saturated images from 2005 to 2010. Complete clinical charts were reviewed by a pediatric hematologist with training in infectious diseases to determine a clinical standard to define the presence or absence of osteomyelitis. A pediatric radiologist reviewed all MR imaging and was blinded to clinical information. Based on the signal intensity in T1-W fat-saturated images, the children were further classified as positive for osteomyelitis (low bone marrow signal intensity) or positive for bone infarct (high bone marrow signal intensity). RESULTS Based on the clinical standard, 5 children were classified as positive for osteomyelitis and 26 children as positive for bone infarct (negative for osteomyelitis). The bone marrow signal intensity on T1-W fat-saturated imaging was not significant for the differentiation between bone infarct and osteomyelitis (P = 0.56). None of the additional evaluated imaging parameters on unenhanced MRI proved reliable in differentiating these diagnoses. CONCLUSION The bone marrow signal intensity on unenhanced T1-W fat-saturated MR images is not a reliable criterion to differentiate bone infarcts from osteomyelitis in children.
Collapse
Affiliation(s)
- Jorge Delgado
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Maria A Bedoya
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Abby M Green
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diego Jaramillo
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA, 19104, USA
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Victor Ho-Fung
- Department of Radiology, The Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA, 19104, USA
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
18
|
Dhakal LP, Bourgeois K, Barrett KM, Freeman WD. The "starfield" pattern of cerebral fat embolism from bone marrow necrosis in sickle cell crisis. Neurohospitalist 2015; 5:74-6. [PMID: 25829988 DOI: 10.1177/1941874414554300] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sickle cell disease may manifest with cerebrovascular and systemic complications. Sickle crisis that results in avascular necrosis of long bones with resultant cerebral fat embolism syndrome is rare and has a characteristic "starfield" pattern on MRI. This "starfield" MRI pattern should raise suspicion for sickle cell crisis in patients without a known history of the disease, which can lead to earlier sickle cell red blood cell exchange transfusion and treatment. We present a case of a male who presented emergently with acute seizure, coma with a characteristic MRI pattern, which lead to the diagnosis of avascular bone marrow necrosis and cerebral fat embolism syndrome from sickle cell crisis.
Collapse
Affiliation(s)
- Laxmi P Dhakal
- Department of Neurology, Jacksonville, FL, USA ; Department of Neurology, Jacksonville, FL, USA
| | - Kirk Bourgeois
- Department of Laboratory Medicine and Pathology, Jacksonville, FL, USA
| | | | - William D Freeman
- Department of Neurology, Jacksonville, FL, USA ; Department of Critical Care at Mayo Clinic, Jacksonville, FL, USA ; Department of Neurosurgery, Jacksonville, FL, USA
| |
Collapse
|
19
|
Dinan D, Epelman M, Guimaraes CV, Donnelly LF, Nagasubramanian R, Chauvin NA. The current state of imaging pediatric hemoglobinopathies. Semin Ultrasound CT MR 2014; 34:493-515. [PMID: 24332202 DOI: 10.1053/j.sult.2013.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The hemoglobinopathies are a group of genetic disorders with a broad spectrum of clinical manifestations and radiologic findings. The imaging of pediatric hemoglobinopathies, which is influenced by concomitant hemosiderosis and the sequela of chelation therapy, has evolved over the years along with ever-improving technology. This article reviews and illustrates the most common radiographic and cross-sectional imaging findings of the 2 best known and clinically relevant hemoglobinopathies in pediatric patients, sickle cell disease and β-thalassemia.
Collapse
Affiliation(s)
- David Dinan
- Department of Medical Imaging, Nemours Children's Hospital, Orlando, FL
| | - Monica Epelman
- Department of Medical Imaging, Nemours Children's Hospital, Orlando, FL.
| | | | | | | | - Nancy A Chauvin
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA
| |
Collapse
|
20
|
Jaimes C, Chauvin NA, Delgado J, Jaramillo D. MR Imaging of Normal Epiphyseal Development and Common Epiphyseal Disorders. Radiographics 2014; 34:449-71. [DOI: 10.1148/rg.342135070] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
21
|
Abstract
PURPOSE OF REVIEW To summarize the findings of the recent publications on sickle cell bone disease (SBD). RECENT FINDINGS Individuals with sickle cell disease (SCD) are living longer and develop progressive organ damage including SBD with age. Recent studies suggest alternative radiological diagnostics such as ultrasound and scintigraphy can detect and differentiate between different forms of SBD. MRI with or without diffusion-weighted sequences remains the gold standard. Case reports of cranio-orofacial SBD highlight the rarity of this presentation. Vitamin D deficiency is highly prevalent at all ages, but may not be an independent risk factor for avascular necrosis (AVN). Gene polymorphisms of the Annexin A gene may predict AVN in SCD. A recent study demonstrated reduced days with pain and improved physical activity quality of life following high-dose vitamin D therapy. The high rates of osteopenia and osteoporosis in SCD support the need for research addressing this rising public health problem. Lastly, results of total hip arthroplasty for AVN in SCD has improved significantly over time with the use of cementless prosthetic material and improved supportive care. SUMMARY SBD remains poorly studied. Prospective randomized studies targeting predictors, diagnostics, prevention, and treatment options for SBD are sorely needed.
Collapse
Affiliation(s)
- Ifeyinwa Osunkwo
- Children's Healthcare of Atlanta and The Department of Pediatrics Emory University, Atlanta, Georgia, USA
| |
Collapse
|
22
|
Inusa BPD, Oyewo A, Brokke F, Santhikumaran G, Jogeesvaran KH. Dilemma in differentiating between acute osteomyelitis and bone infarction in children with sickle cell disease: the role of ultrasound. PLoS One 2013; 8:e65001. [PMID: 23755165 PMCID: PMC3675051 DOI: 10.1371/journal.pone.0065001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 04/25/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Distinguishing between acute presentations of osteomyelitis (OM) and vaso-occlusive crisis (VOC) bone infarction in children with sickle cell disease (SCD) remains challenging for clinicians, particularly in culture-negative cases. We examined the combined role of ultrasound scan (USS), C - reactive protein and White blood counts (WCC) in aiding early diagnosis in children with SCD presenting acutely with non-specific symptoms such as bone pain, fever or swelling which are common in acute osteomyelitis or VOC. METHODS We reviewed the records of all children with SCD who were discharged from our department from October 2003 to December 2010 with a diagnosis of osteomyelitis based on clinical features and the results of radiological and laboratory investigations. A case control group with VOC who were investigated for OM were identified over the same period. RESULTS In the osteomyelitis group, USS finding of periosteal elevation and/or fluid collection was reported in 76% cases with the first scan (day 0-6). Overall 84% were diagnosed with USS (initial +repeat). 16% had negative USS. With VOC group, USS showed no evidence of fluid collection in 53/58 admissions (91%), none of the repeated USS showed any fluid collection. Mean C-reactive protein (CRP), and white cell count (WCC) were significantly higher in the OM. CONCLUSION The use of Ultrasound in combination with CRP and WCC is a reliable, cost-effective diagnostic tool for differentiating osteomyelitis from VOC bone infarction in SCD. A repeat ultrasound and/or magnetic resonance imaging (MRI) scan may be is necessary to confirm the diagnosis.
Collapse
Affiliation(s)
- Baba P D Inusa
- Department of Paediatrics, Evelina Children's Hospital, Guy's and St. Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom.
| | | | | | | | | |
Collapse
|
23
|
Guillerman RP. Osteomyelitis and beyond. Pediatr Radiol 2013; 43 Suppl 1:S193-203. [PMID: 23478935 DOI: 10.1007/s00247-012-2594-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 11/14/2012] [Accepted: 11/19/2012] [Indexed: 02/08/2023]
Abstract
Musculoskeletal infections are a cause of considerable morbidity in children. Symptoms and signs are often nonspecific, and imaging is needed to define the anatomical location of infected tissue or fluid collections for diagnostic aspiration or biopsy. Prompt diagnosis and precise localization of the infection site has become even more imperative with the emergence and dissemination of highly invasive organisms such as community-acquired Staphylococcus aureus. Although radiography, bone scintigraphy and US continue to play a role, MRI is now the preferred imaging modality for definitive evaluation of pediatric musculoskeletal infections because of its capability of simultaneously assessing the osseous, articular and muscular structures without ionizing radiation exposure. This article focuses on the imaging characteristics of osteomyelitis, septic arthritis and pyomyositis and the differentiating features of potential mimics of infection.
Collapse
Affiliation(s)
- R Paul Guillerman
- E. B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Ste. 470, Houston, TX 77030, USA.
| |
Collapse
|
24
|
|
25
|
van Schuppen J, van Doorn MMAC, van Rijn RR. Childhood osteomyelitis: imaging characteristics. Insights Imaging 2012; 3:519-33. [PMID: 22875760 PMCID: PMC3443272 DOI: 10.1007/s13244-012-0186-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 07/05/2012] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of this review is to illustrate the imaging findings of childhood osteomyelitis. The diagnosis of childhood osteomyelitis can be challenging. Clinical presentation and laboratory results can differ and are relatively unreliable. To date, its role in the assessment of treatment efficacy is not yet clear. Methods This review article provides an overview of the different imaging modalities and imaging characteristics of childhood osteomyelitis. Levels of evidence for different modalities are presented. Results Paediatric radiology plays a pivotal role in the diagnosis of childhood osteomyelitis and can also be used to guide therapy and intervention. Conclusion Although imaging is essential in the diagnostic process, cooperation between the physician and radiologist remains the cornerstone in accurately diagnosing childhood osteomyelitis. Main Messages • Imaging plays a pivotal role in the diagnosis of childhood osteomyelitis. • Cooperation between the clinician and radiologist is a very important aspect of making the diagnosis. • The initial imaging modality in childhood osteomyelitis is conventional imaging. • Normal conventional imaging does not exclude osteomyelitis.
Collapse
Affiliation(s)
- Joost van Schuppen
- Department of Radiology, Academic Medical Center/Emma Children's Hospital, Amsterdam, The Netherlands,
| | | | | |
Collapse
|
26
|
Abstract
Infections of the bone and soft tissue of the limbs need to be diagnosed and treated urgently regardless of the patient's age. Clinical features are often non-specific. MRI and, in some cases, sonography investigations lead to early diagnosis and appropriate management. Computed tomography has limited value. Needle aspiration and biopsy need not be routine. In children, anatomical particularities explain the different morphological manifestations, which vary with age. It is important to both know when to propose the diagnosis of infection, so that appropriate imaging investigations are carried out, and to be aware of the symptomatology of limb infections in children and adults and understand the differential diagnoses for each age group. Clinicians should also be aware of the specific characteristics in children.
Collapse
|
27
|
Saito N, Nadgir RN, Flower EN, Sakai O. Clinical and Radiologic Manifestations of Sickle Cell Disease in the Head and Neck. Radiographics 2010; 30:1021-34. [DOI: 10.1148/rg.304095171] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
28
|
Pain-related behaviors and neurochemical alterations in mice expressing sickle hemoglobin: modulation by cannabinoids. Blood 2010; 116:456-65. [PMID: 20304807 DOI: 10.1182/blood-2010-01-260372] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Sickle cell disease causes severe pain. We examined pain-related behaviors, correlative neurochemical changes, and analgesic effects of morphine and cannabinoids in transgenic mice expressing human sickle hemoglobin (HbS). Paw withdrawal threshold and withdrawal latency (to mechanical and thermal stimuli, respectively) and grip force were lower in homozygous and hemizygous Berkley mice (BERK and hBERK1, respectively) compared with control mice expressing human hemoglobin A (HbA-BERK), indicating deep/musculoskeletal and cutaneous hyperalgesia. Peripheral nerves and blood vessels were structurally altered in BERK and hBERK1 skin, with decreased expression of mu opioid receptor and increased calcitonin gene-related peptide and substance P immunoreactivity. Activators of neuropathic and inflammatory pain (p38 mitogen-activated protein kinase, STAT3, and mitogen-activated protein kinase/extracellular signal-regulated kinase) showed increased phosphorylation, with accompanying increase in COX-2, interleukin-6, and Toll-like receptor 4 in the spinal cord of hBERK1 compared with HbA-BERK. These neurochemical changes in the periphery and spinal cord may contribute to hyperalgesia in mice expressing HbS. In BERK and hBERK1, hyperalgesia was markedly attenuated by morphine and cannabinoid receptor agonist CP 55940. We show that mice expressing HbS exhibit characteristics of pain observed in sickle cell disease patients, and neurochemical changes suggestive of nociceptor and glial activation. Importantly, cannabinoids attenuate pain in mice expressing HbS.
Collapse
|
29
|
Noble J, Schendel S, Weizblit N, Gill HS, DeAngelis DD. Orbital wall infarction versus infection in sickle cell disease—Author reply. Can J Ophthalmol 2009. [DOI: 10.3129/i08-184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
30
|
Mosqueda Peña R, Guillén Fiel G, González Granado LI, Negreira Cepeda S, Giangaspro Corradi E. [Difficult differential diagnosis of bone infarction and osteomyelitis in a girl with drepanocytosis]. An Pediatr (Barc) 2009; 70:99-100. [PMID: 19174133 DOI: 10.1016/j.anpedi.2008.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 08/17/2008] [Indexed: 11/26/2022] Open
|