Table 1 Clinical features of reported cases of Aggregatibacter actinomycetemcomitans osteomyelitis and septic arthritis
Case no. (Ref) | Age/sex of patient | Infectious syndrome (additional pathogens) | Symptoms | Duration of symptoms | Predisposing factors | Inflammatory markers | Diagnosis | Management |
|---|---|---|---|---|---|---|---|---|
1 [15] | 38 years male | Osteomyelitis of mandible | Pus discharge from mandible afebrile | 20 days | Mandibular fracture 2 months prior | Not reported | Culture of pus | Debridement Ampicillin Tetracycline |
2 [16] | 45 years male | Vertebral osteomyelitis | Back pain, axillary lymphadenitis afebrile | 2 months | Dental caries | WCC normal ESR 31, 45 mm/h | Culture of bone biopsy | Ampicillin 6/52 |
3 [17] | 72 years male | Vertebral osteomyelitis and epidural abscess | Lower limb weakness, urinary retention, fever | 2 days | Severe periodontal disease | WCC 12.6 × 109/L ESR 90 mm/h CRP 27.7 mg/L | Culture of pus | Ceftriaxone 6/52 |
4 [18] | 16 years female | Vertebral osteomyelitis, mediastinal and pulmonary abscesses (Actinomyces isralii, B. corodens) | Not reported | 7 months | Dental caries, teeth extractions | Not reported | Not reported | Penicillin 4/52 |
5 [19] | 47 years male | Osteomyelitis of tibia, lung abscess, skin abscesses (Actinomyces meyeri) | Knee effusion, subcutaneous nodules, fever | 3 weeks | Caries, dental stumps | WCC 13.3 × 109/L ESR 117 | Biopsy of subcutaneous abscess | Debridement, penicillin 1 year |
6 [12] | 66 years male | Vertebral osteomyelitis (organism intermediate between A. actinomycetemcomitans and Haemophilus aphrophilus) | Lumbar pain, sciatica, rigors | 4 days | Nil | WCC 12.7 × 109/L ESR 84 mm/h | Culture of bone biopsy | Flucloxacillin 4/52, cefotaxime 4/52, amoxicillin 4/52 |
7 [13] | Adult male | Chronic osteitis of fifth metacarpal, associated drainage sinus (pure growth A. actinomycetemcomitans) | Recurrent abscesses after tooth was surgically removed from hand | 6 months | Tooth embedded in hand during an assault | Not reported | Culture of pus | Debridement Ampicillin |
8 [20] | 45 years male | Chronic osteomyelitis of distal femur, septic arthritis | Pain and swelling of medial aspect of knee | 3 months | Open fracture of knee 20 years prior | WCC 8.2 × 109/L | Culture of synovial fluid. Bone culture negative | Debridement Cefotaxime Amoxicillin |
9 [our patient] | 12 years male | Osteomyelitis of proximal phalanx of the great toe | Intermittent toe pain 2/52 discharging pus | 12 months | Nil | WCC 6.4 × 109/L CRP < 0.4 mg/L | Culture of bone biopsy | Debridement Cefotaxime 1/52 Amoxicillin 12/52 |