cholecalciferol and Osteomyelitis

Turkey osteomyelitis complex (TOC) is defined by the US Food Safety Inspection Service (FSIS) to include normal-appearing processed turkey carcasses that contain lesions including green discoloration of the liver, arthritis/synovitis, soft-tissue abscesses, and osteomyelitis of the proximal tibia. The lesions are associated with many different opportunistic organisms, mainly Staphylococcus aureus and Escherichia coli, suggesting that TOC incidence may be influenced more by deficiencies in the host immune response rather than by the virulence of any one organism. This syndrome is primarily a disease of adolescent male turkeys, and birds with TOC lesions have decreased indices of cell-mediated immunity, leading to the hypothesis that defects in the immune response of individuals within flocks of male turkeys may be responsible for the occurrence of these opportunistic infections. We have developed an experimental model for this disease in which treatment with dexamethasone (DEX), either with or without air sac inoculation with Escherichia coli, produces all of the lesions associated with TOC. These studies suggest that TOC is a result of stress-induced immunosuppression in a subpopulation of male turkeys that respond to the stressors in modern poultry production in a detrimental manner. Supplemental vitamin D3 treatment protected male turkeys from the immunosuppression induced by multiple treatments with DEX and resulted in decreased incidence of mortality, TOC, green liver, and isolation of bacteria from tissues, lower air sacculitis scores, and lower heterophil to lymphocyte ratios than nonsupplemented controls. Vitamin D3 also protected BW; relative weights of the liver, heart, spleen, and bursa; and clinical chemistry values from the effects of DEX treatment. The ability of vitamin D3 supplementation to protect turkeys from the immunosuppressive effects of severe stress emphasizes its role as a prohormone that affects health and disease resistance in turkeys and suggests that variation in the vitamin D receptor genotype may be involved in this disease process. This model has potential value in the identification of other nutritional and physiological immunomodulators that can decrease TOC incidence and will provide a means for the divergent selection of birds more resistant to the stressors of turkey production. In addition, this model will provide justification for management options designed to minimize stress.

Topics: Animals; Cholecalciferol; Dexamethasone; Escherichia coli Infections; Female; Glucocorticoids; Immunosuppression Therapy; Male; Osteomyelitis; Poultry Diseases; Staphylococcal Infections; Turkeys

Chronic non-bacterial osteomyelitis (CNO) is a rare and difficult-to-diagnose disease, especially when limited to the jaws. We report the case of a 5-year-old girl with spontaneous jaw pain and a large pre-auricular facial swelling overlying the angle of the mandible that was non-responsive to previous antibiotic and non-steroidal anti-inflammatory treatment. The diagnosis was confirmed as CNO following evaluation and workup by a multidisciplinary team. The patient exhibited a favourable response to oral alendronate sodium plus vitamin D3 combination treatment. We believe that alendronate sodium is an effective second-line drug for CNO.

Topics: Administration, Oral; Alendronate; Child, Preschool; Cholecalciferol; Female; Humans; Mandible; Osteomyelitis

Bone and soft tissue infections are difficult problems in orthopedic surgery. Infections resulting in chronic osteomyelitis if established are difficult to eradicate. The delivery of local antibiotics for the treatment of open infected wounds of the musculo skeletal system is a more logical approach to treat these infections. Antibiotics given systemically are unable to achieve minimum inhibitory concentration in areas of infected wounds which are ischemic or relatively avascular. And also these antibiotics given over a prolonged period lead to significant toxicity and side effects and emergence of resistant bacteria. The author has been treating difficult cases of infected wounds sustained in road accidents, wounds (diabetic ulcers) in Diabetes Mellitus with necrotizing fasciitis and post operative infections with discharging sinuses with infected implants inside by his own innovative method of antibiotic delivery. The infected open wounds have been treated by application of Vitamin D3 granules impregnated with Tobramycin or Tobramycin and Vancomycin combined. All the patients responded successfully to this novel method of treatment which is extremely simple, effective, low cost, without any complications or side effects and has shown excellent results. Not only the Vitamin D

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Cholecalciferol; Cohort Studies; Drug Carriers; Female; Fractures, Open; Humans; Male; Middle Aged; Osteomyelitis; Prognosis; Retrospective Studies; Risk Assessment; Severity of Illness Index; Soft Tissue Infections; Staphylococcal Infections; Tobramycin; Vancomycin; Wound Healing; Wound Infection

Male turkeys immunosuppressed by injection with dexamethasone (DEX) were given supplemental vitamin D3 in their drinking water in two experiments. In Experiment 1, vitamin D3 was supplemented at a dosage of either 2,064 IU/kg (low level) or 4,128 IU/kg (high level) in drinking water provided ad libitum only from Days 1 through 5 after hatch. In Experiment 2, vitamin D3 was provided at the low dosage for the first 5 d after hatch, followed by treatment with the high dosage for 12 h before and 12 h after each stressful event, which included weekly weighings and two DEX treatments. In both experiments, at 5 wk of age half of the birds were given intramuscular injections of 2 mg/kg DEX on 3 alternating d. In Experiment 1, 100 cfu of Escherichia coli was inoculated into the left thoracic airsac at the time of the third DEX injection. All mortalities were examined, and 10 birds per pen were necropsied 2 wk after treatment and examined for lesions of airsacculitis and turkey osteomyelitis complex (TOC). Four birds per pen were bled before necropsy, and white blood cell total counts, differential white blood cell counts, and clinical chemistry values were determined. In Experiment 2, healthy surviving birds were grown for an additional 5-wk period, after which the DEX-treated birds were given a second series of DEX injections and were bled and necropsied 2 wk later. There were no significant effects of vitamin D3 treatment in combined general linear models analysis of Experiment 1; however, when birds not treated with DEX or E. coli were compared with those treated with both DEX and E. coli, supplementation with the low level of vitamin D3 significantly decreased TOC incidence. There were no significant effects of vitamin D3 treatment in birds treated with DEX at 5 wk of age in Experiment 2. However, when surviving birds were given a second DEX treatment at 12 wk, vitamin D3 treatment resulted in significantly lower incidence of mortality, TOC, green liver, isolation of bacteria from tissues, and lower airsacculitis scores and heterophil-to-lymphocyte ratios than controls. Vitamin D3 also improved BW, relative weights of the liver and heart, and serum levels of glucose and alanine aminotransferase (ALT) of birds receiving two treatments with DEX. The ability of vitamin D3 supplementation to protect turkeys from the immunosuppressive effects of multiple DEX treatments emphasizes the role of vitamin D3 as a prohormone that affects health and disease resistance in t

Topics: Alanine Transaminase; Alkaline Phosphatase; Animals; Aspartate Aminotransferases; Blood Glucose; Body Weight; Cholecalciferol; Creatine Kinase; Dexamethasone; Escherichia coli; Escherichia coli Infections; Glucocorticoids; Least-Squares Analysis; Leukocyte Count; Linear Models; Liver; Lymphocyte Count; Lymphocyte Subsets; Male; Osteomyelitis; Poultry Diseases; Random Allocation; Stress, Physiological; Turkeys; Uric Acid