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Alterations to Bone Mineral Composition as an Early Indication of Osteomyelitis in the Diabetic Foot

Background: This prospective study was designed to evaluate the frequency of surgical site infection in patients treated with foot and ankle surgery. One strategy to mitigate issues with wound healing and infection in diabetic patients is to use a percutaneous technique in which autologous, bone marrow-derived, concentrated cells are injected at the site of non-unions. A prospectively maintained registry of all patients attending OPAT was examined for cases of BJI. Paradoxically, bone loss may occur not only due to HIV/AIDS but also as a consequence of HAART. We confirm previous findings that it is peripheral neuropathy and not diabetes itself that most strongly determines the development of postoperative infections in these surgical patients. Osteoclast number, eroded bone surface, and new bone formation were measured by tartrate-resistant acid phosphatase staining. In the presence of prolonged duration, inpatient management, or CKD, empiric MRSA antibiotic cover should be considered.

Vincent Charity Medical Center and South Pointe Hospital. Clinical and imaging tests show that whole-tissue properties of bone, including hardness and mineralization, are directly affected by diabetic osteomyelitis (1,2). aeruginosa is often found in hospitals. Collection of soft-tissue and bone specimens from infected diabetic foot lesions Culturing of clinically uninfected lesions is not necessary except as part of an MRSA screen. The objective of the present study was to measure bone composition in diabetic osteomyelitis with the use of Raman spectroscopy. This is an ongoing translational study performed at the University of Michigan Health System (UMHS) and the Ann Arbor Veterans Affairs (AAVA) Hospital and has been reviewed and approved by their respective institutional review boards. Bone was obtained from 17 patients with a clinical diagnosis of diabetic osteomyelitis requiring surgical intervention to collect a bone biopsy specimen (n = 6) or to amputate (n = 11).

This may be seeded from a pelvic infection, urinary or bladder infection, pneumonia, or a soft-tissue infection. Bone fragments were prepared separately for microbiological and histopathological analyses. Though rare, prompt medical attention is important when diabetics encounter any signs or symptoms of infection. Risk factors Some of the risk factors that may increase a person’s susceptibility to osteomyelitis include: Long term skin infections. aureus biofilm establishment. Symptoms include pain or tenderness in the bone accompanied by pain on motion, swelling and warmth in the overlying area, fever, nausea and generally feeling unwell. Bone fragments for Raman spectroscopic analysis were transported and stored in gauze soaked with PBS enriched with protease inhibitor (0.1% volume for volume) and sodium azide (0.005% weight for volume) to prevent enzymatic or bacterial digestion of bone collagen and stored at −20°C until examination.


Pattern of bone marrow edema between osteomyelitis and Charcot on MRI may help differentiate the two conditions unless both conditions exist at the same time. Example of an infected left fifth digit with significant amount of purulence and osteomyelitis (A) surgically treated with debridement, arthroplasty of the fifth interphalangeal joint and primary closure (B). Raman spectra were collected with microscopy instrumentation adapted for Raman microspectroscopy as described elsewhere (3). shows the clinical imaging, pathology, microbiology, and Raman spectroscopy data for all study participants. In most cases, multiple clinical imaging modalities (magnetic resonance imaging, X ray, ultrasound, or bone scan) were used for preoperative identification of osteomyelitis. In the case of a periapical abscess, root canal therapy or tooth extraction is indicated. Additional histopathological findings of acute inflammation or fibrosis were found in a few participants in the amputation group.

As expected, bone cultures revealed a mixed population of gram-positive bacteria, with Staphylococcus, Streptococcus, or Enterococcus as the dominant species. Raman spectroscopy of the bone fragments revealed the presence of pathological minerals in addition to normal bone mineral. Two pathological minerals were identified: brushite and uncarbonated apatite. Then they were on back order, plus I had to arrange for a new prescription and stuff. Raman spectra of control bone specimens were consistent with normal bone composition and did not show evidence of pathological mineralization. Storage in enriched PBS did not affect induced compositional changes in a control study of healthy bone fragments. People who have joint replacements, heart valve replacements or who have a pacemaker must be very cautious regarding infections.

He was told that many people who had cancer before were miraculously cured after they practiced Falun Dafa. An unexpected finding was Raman spectral patterns corresponding to dicalcium phosphate dihydrate, also called brushite, and uncarbonated apatite. Compositional changes in bone currently cannot be identified by standard clinical imaging or histopathology but are easily measured by Raman spectroscopy. When pockets of pus are available, or overlaying soft tissue infection exists, these can serve as sources for samples which can be cultured to allow identification of bacteria present. Many mechanisms of bone loss in osteomyelitis have been proposed in the literature (4–6). Blood cultures * or, less commonly, a bone biopsy * may identify the infectious agent. The present results suggest that pathological mineralization accompanies bacterial infection, providing insight into the pathophysiology of osteomyelitis.

13, 2015. Taking a sample of blood, pus, joint fluid, or the bone itself is the best way to make a diagnosis of osteomyelitis. To the best of our knowledge, this is the second report of brushite in mature human bone. Brushite was identified by X-ray absorption and infrared spectroscopy in fibrous dysplasia of the jaw (10). However, this finding has not been reproduced in other studies, and results from only one patient were reported. Poorly carbonated apatite can be found in woven, or immature, bone and is less crystalline than mature bone mineral (11). By contrast, the uncarbonated apatite found in infected bone was more crystalline than immature bone mineral and suggests deposition of a pathological mineral.

Normal serum calcium values in all the participants argue against the possibility that we were observing brushite and uncarbonated apatite as a precursor in normal bone formation or as a nonbone precipitate resulting from systemic hypercalcemia. The likelihood that pathological minerals were formed by an inflammatory response, immune response, or excessive bone remodeling is not supported by our observations and previous studies (12,13). Thus, we hypothesize that a bacteria biofilm is responsible for generating the acidic environment necessary to form brushite. If the localized microenvironment cannot be adequately buffered, then acidic calcium phosphate minerals such as uncarbonated apatite and brushite may precipitate onto the bone surface. This mechanism, although new in its application to diabetic osteomyelitis, is the accepted pathway in microbial degradation of bone postmortem (14).

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