technetium-tc-99m-medronate and Streptococcal-Infections

Cortical septic osteitis is defined as a predominant or exclusive infection of the cortex which may lead to diagnosis pitfalls. With the two cases presented here, principal radiological features allowing a correct diagnosis are recalled.

Topics: Adult; Biopsy; Child; Contrast Media; Diagnostic Imaging; Female; Femur; Gadolinium; Humans; Magnetic Resonance Imaging; Male; Osteitis; Osteolysis; Radiopharmaceuticals; Staphylococcal Infections; Streptococcal Infections; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Ultrasonography

Topics: Aged; Ciprofloxacin; Citrates; False Negative Reactions; Female; Gallium; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Spinal Diseases; Streptococcal Infections; Streptococcus agalactiae; Technetium; Technetium Tc 99m Medronate

Topics: Child; Humans; Kidney; Male; Pyelonephritis; Radionuclide Imaging; Sepsis; Shock, Septic; Streptococcal Infections; Technetium Tc 99m Medronate

We report a retrospective study of 94 infants, ages < 4 months, who underwent investigation for possible osteomyelitis during a 9-year period. Of the 30 babies with proven osteomyelitis (radiographic changes or positive bone cultures or positive blood cultures plus a compatible clinical picture), 17 were preterm artificially ventilated babies and 4 were full term infants receiving intensive care. An etiologic organism was isolated from 28: methicillin-susceptible Staphylococcus aureus, 16; methicillin-resistant S. aureus (MRSA), 7; Escherichia coli, 3; and group B Streptococcus, 2. MRSA occurred exclusively in the preterm group. Osteomyelitis was multifocal in 40% and associated with septic arthritis in 47%. The long bones were frequently affected (80%) whereas the flat bones were often sites of clinically silent disease. Twenty-five (83.3%) of the 30 babies with proven osteomyelitis had focal clinical signs or evidence of disseminated staphylococcal disease. Only 10 were febrile. Four of 27 babies investigated because of positive blood cultures for S. aureus but no focal signs had osteomyelitis, as did only 1 of 27 babies with suspected sepsis but no focal signs. The sensitivity of 99mTc bone scanning was 84%, specificity 89%, positive predictive value 79% and negative predictive value 92%. The addition of gallium scanning (in 39 of the 94 infants) improved the respective figures to 90, 97, 93 and 95% and was useful in interpreting equivocal bone scans.

Topics: Arthritis, Infectious; Bone and Bones; Escherichia coli; Escherichia coli Infections; Female; Gallium Radioisotopes; Humans; Infant; Infant, Newborn; Male; Methicillin; Methicillin Resistance; Osteomyelitis; Radiography; Radionuclide Imaging; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus agalactiae; Technetium Tc 99m Medronate

The scintigraphic manifestations of cellulitis consist of a diffuse increase in activity in the affected soft tissues without a focal increase in activity in the bone. The radionuclide images in two children with Group A streptococcal cellulitis were atypical, as no increased activity was noted in the soft tissues. The false-negative radionuclide images in these children is attributed to the marked amount of edema present at the sites of infection.

Topics: Bone and Bones; Cellulitis; Child, Preschool; False Negative Reactions; Female; Humans; Radionuclide Imaging; Streptococcal Infections; Streptococcus pyogenes; Technetium Tc 99m Medronate

We reviewed 37 cases of septic arthritis in heroin users. Our data confirm the predominance of the fibrocartilaginous joint infections in this group (sacroiliac joint 39%, chondrosternocostal unions 37%). In Spain, Staphylococcus aureus is the most commonly isolated organism (73%). This emphasizes the geographic variations in the causative germs since, in contrast to other reports, we have not identified any gram negative bacillary arthritis in our population of heroin users. Our data show that the 67gallium citrate scintigraphy is positive earlier than the 99mTc-MDP bone scan in the poorly vascularized joints (p less than 0.0005). The early localization of the infectious focus by 67gallium citrate scintigraphy followed by a prompt bacteriologic diagnosis (blood, synovial fluid or tissue cultures) allowed good therapeutic results.

Topics: Adolescent; Adult; Arthritis, Infectious; Candidiasis; Female; Gallium Radioisotopes; Heroin Dependence; Humans; Joints; Male; Radionuclide Imaging; Staphylococcal Infections; Streptococcal Infections; Technetium Tc 99m Medronate

During Tc-99m medronate (MDP) bone scintigraphy, visualization of the synovium during blood flow and blood pool phases was present in a patient with septic arthritis of the left knee. Inflammation with hyperemia of the synovium was the cause for radionuclide localization, which was enhanced by the large photon-deficient effusion distending the suprapatellar bursa. The synovium was not seen on delayed images after redistribution of the radionuclide from blood pool to bone phase.

Topics: Aged; Arthritis, Infectious; Diphosphonates; Humans; Knee; Male; Radionuclide Imaging; Streptococcal Infections; Synovial Membrane; Technetium; Technetium Tc 99m Medronate

Two cases of unilateral septic sacro-iliitis are reported. Importance of the anterior view of sacroiliac joints on the radionuclide bone scan is stressed. Limitation of the posterior view in evaluation of sacroiliac joints may lead to misdiagnosis and false negative results in unilateral sacro-illiac disease.

Topics: Adolescent; Adult; Arthritis, Infectious; Diphosphonates; Female; Humans; Male; Osteomyelitis; Radionuclide Imaging; Sacroiliac Joint; Staphylococcal Infections; Streptococcal Infections; Streptococcus pneumoniae; Technetium; Technetium Tc 99m Medronate