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Why salmonella causes osteomyelitis in sickle cell anemia?

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Also which is the commonest etiology of osteomyelitis?

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People with sickle cell disease are susceptible to infections including osteomyelitis due to:
1. Hyposplenism
2. Impaired complement activity
3. Presence of infarcted or necrotic bone (due to microvascular occlusion caused by increased adhesiveness of sickled erythrocytes, leukocytes and platelets)

The peculiar susceptibility of patients with sickle cell anemia to osteomyelitis caused by salmonella and gram negative enteric bacteria is due to spread of bacteria from intestine facilitated by patchy microinfarction of bowel caused by intravascular sickling. The infarcts in bone become infected either by transient bacteremia or by activation of dormant foci of salmonella in bone marrow when tissues are infected.

answered Jun 14, 2012 by Sulabh Shrestha Doctor of Medicine (5,553 points)
selected Jun 14, 2012 by Mike
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commented Jun 14, 2012 by Sulabh Shrestha Doctor of Medicine (5,553 points)
The commonest etiology of Osteomyelitis is Staphylococcus aureus.
commented Jun 14, 2012 by Mike Junior Resident (2,007 points)
Thanks for the detailed answer. But which is the most common cause of osteomyelitis in Sickle cell disease?
commented Jun 14, 2012 by Sulabh Shrestha Doctor of Medicine (5,553 points)
There is controversy in this thing. Different studies have shown different results but still many accept Staphylococcus aureus as the commonest cause in both the population with and without sickle cell disease.
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Here is a simple picture demonstrating osteomyelitis pathogenesis:
Osteomyelitis pathogenesis

answered Jul 7, 2012 by Steven Medical student (529 points)
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