OSTEOMYELITIS Edited by Mauricio S. Baptista and João Paulo Tardivo Osteomyelitis Edited by Mauricio S. Baptista and João Paulo Tardivo Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Bojan Rafaj Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published March, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Osteomyelitis, Edited by Mauricio S. Baptista and João Paulo Tardivo p. cm. ISBN 978-953-51-0399-8 Contents Preface VII Part 1 Etiology and Pathogenesis 1 Chapter 1 Pathophysiology and Pathogenesis of Osteomyelitis 3 Mayank Roy, Jeremy S. Somerson, Kevin G. Kerr and Jonathan L. Conroy Part 2 Diagnosis and Types of Osteomyelitis 27 Chapter 2 Role of Nuclear Medicine in Infection Imaging 29 Baljinder Singh, Sarika C.N.B. Harisankar, B.R. Mittal and Bhattacharya Anish Chapter 3 Skull Osteomyelitis 45 Myoung Soo Kim Chapter 4 Chronic Non-Bacterial Osteitis/Chronic Recurrent Multifocal Osteomyelitis 89 Paivi M.H. Miettunen Part 3 Methods of Approach to Treat the Disease 119 Chapter 5 Photodynamic Therapy in the Treatment of Osteomyelitis 121 João Paulo Tardivo and Mauricio S. Baptista Chapter 6 Antibiotic Loaded Acrylic Bone Cement in Orthopaedic Trauma 131 Sumant Samuel Chapter 7 Management of Bone Bleeding During Surgery and Its Impact on the Incidence of Post-Operative Osteomyelitis 153 Tadeusz Wellisz Preface We hope this book will help interested readers to have a general perspective of osteomyelitis as well as to know recent advances in this field. What caught much attention is the diversity of osteomyelitis types, i.e., in skull bones, in childhood, in diabetes, non-bacterial, post-trauma, and the range of diagnosis and treatment tools that are available. In the first chapter Mayank Roy and co-workers explore the basic fundamentals of the pathophysiology and pathogenesis of this disease. In what follows the book brings a section of diagnosis and specific types of osteomyelitis. Singh Baljinder and co-workers compare the merits and disadvantages of several diagnosis techniques starting from the relatively poor results obtained with the conventional imaging modalities and how nuclear medicine, especially bone scintillography in combination with some labeling protocols (gallium, for example), can make a difference in terms of sensitivity and specificity of the diagnosis. Myoung Soo Kim addresses skull osteomyelitis describing its history, and the development of diagnosis, treatment and preventive methods. Paivi MH Miettunen reports on the rare but not less important chronic non-bacterial osteitis, which is an impressive mimic of infectious osteomyelitis. The last section of the book assembles chapters focusing in new treatment modalities. Starting with the chapter by Tardivo and Baptista, which describes how light and photoactivable drugs (photosensitizers) can be combined to treat and cure difficult cases of osteomyelitis. The chapter of Samuel Sumont describes the use of acrylic bone cement loaded with antibiotics as a strategy to perform local and efficient delivery of antibiotics making a good impact in the management of osteomyelitis. In the last chapter Tadeusz Wellisz discuss the importance of blood management during bone surgery specifically comparing the use of wax and some synthetic materials, which could be used to control bleeding and to also deliver local antibiotics. Mauricio S. Baptista Department of Biochemistry, University of Sao Paulo João Paulo Tardivo Center for the Treatment of Diabetic Foot in the Faculdade de Medicina do ABC Brazil Part 1 Etiology and Pathogenesis [...]... understanding of predisposition and altered pathophysiology of osteomyelitis in patients with these underlying illnesses is required for prompt diagnosis and appropriate treatment 2.4 Implanted materials and osteomyelitis Surgically implanted devices in and around bone represent a risk factor for the development of osteomyelitis Due to the high global rate of total hip and knee replacement, endoprostheses... fibronectin, fibrinogen, albumin, vitronectin, and collagen Host cell adhesion, migration, proliferation, and differentiation are all influenced by the composition and structural organization of the surrounding ECM Interaction between host cells and the ECM is known to be mediated by specific receptors such as integrins, which are composed of  and ß units and link many ECM proteins to the eukaryotic... local infection An Pathophysiology and Pathogenesis of Osteomyelitis 23 experimental study of solid and slotted nails in rabbits J Bone Joint Surg Br, Vol 76, No 6, pp (955-959), 0301-620X Meredith, D O., Eschbach, L., Wood, M A., Riehle, M O., Curtis, A S., & Richards, R G (2005) Human fibroblast reactions to standard and electropolished titanium and Ti-6Al-7Nb, and electropolished stainless steel... Aetiological association Pathophysiology and Pathogenesis of Osteomyelitis 17 Osteomyelitis in patients with immunocompromise, both congenital and acquired, can be caused by an extremely wide range of conventional and opportunistic pathogens including fungi (See section 2.3) Examples of other aetiological associations are shown in Table 2 5 References Adams, C S., Antoci, V., Jr., Harrison, G., Patal,... chronic courses and involves a range of contributory host and pathogen factors A commonly used aetiological classification distinguishes between three types of osteomyelitis: acute or chronic haematogenous disease seeded by organisms in the bloodstream, local spread from a contiguous source of infection and secondary osteomyelitis related to vascular insufficiency 1.1 Acute haematogenous osteomyelitis. .. Somayaji, S N., Ritchie, S., Sahraei, M., Marriott, I., & Hudson, M C (2008) Staphylococcus aureus induces expression of receptor activator of NF-kappaB ligand and prostaglandin E2 in infected murine osteoblasts Infect Immun, Vol 76, No 11, pp (5120-5126), 1098-5522 Pathophysiology and Pathogenesis of Osteomyelitis 25 Swisher, L A., Roberts, J R., & Glynn, M J (1994) Needle licker's osteomyelitis Am J Emerg... vascular anatomy of the spine and its relationship to pyogenic vertebral osteomyelitis The Journal of Bone and Joint Surgery British Volume, Vol 41-B, No., pp (796-809) Wilson, W A., & Thomas, E J (1979) Activation of the alternative pathway of human complement by haemoglobin Clinical and Experimental Immunology, Vol 36, No 1, pp (140-144) Wong, J S., Seaward, L M., Ho, C P., Anderson, T P., Lau, E O.,... associated with the protein ‘adhesin’ and is inhibited by the presence of a capsule on the bacterium The latter has been demonstrated by experiments utilizing S aureus strains Cowan and Wood Strain Cowan (originally isolated from a patient with septic arthritis) lacks a capsule and demonstrates extensive binding to purified type I collagen Strain Wood is encapsulated and demonstrated very poor binding... ligand (TRAIL) produced by S aureus-infected osteoblasts induces caspase-8 activation and apoptosis in cultured osteoblasts (Alexander, et al., 2003) (Fig 4) TRAIL can induce apoptosis in human osteoclasts via TRAIL receptor 2, and also inhibits osteoclast differentiation (Colucci et al., 2007) It is therefore possible that apoptosis of bone cells infected with S aureus, and potentially of neighbouring...1 Pathophysiology and Pathogenesis of Osteomyelitis Mayank Roy1, Jeremy S Somerson1, Kevin G Kerr2 and Jonathan L Conroy2 1University of Texas Health Science Centre, San Antonio, Texas 2Harrogate District Hospital, North Yorkshire 1USA 2UK 1 Introduction The term osteomyelitis encompasses a broad group of infectious diseases characterized by infection of the bone and/ or bone marrow The pathogenesis . OSTEOMYELITIS Edited by Mauricio S. Baptista and João Paulo Tardivo Osteomyelitis Edited by Mauricio S. Baptista and João Paulo. receptor, expressed by osteoclast precursors, and its cognate ligand, RANKL, expressed by osteoblasts is essential for osteoclastogenesis (Matsuo & Irie,