Internal Medicine

0521779407-16 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

Osteomalacia and Rickets Osteomyelitis 1103

be achieved; normal growth and full predicted height difficult to

attain

■HVDRR most difficult syndrome to treat; may require months of IV

calcium infusions; rickets can be improved after calcium and phos-

phate return to normal

■Alopecia does not respond to normalization of calcium

■All patients must be observed for hypercalcemia

■High urinary calcium x phosphate product indicates increased risk

of renal stones

OSTEOMYELITIS

RICHARD A. JACOBS, MD, PhD

history & physical

History

■Acute osteomyelitis results from hematogenous dissemination; most

common organismStaphylococcus aureus; long bones and vertebrae

most common sites; in IV drug users unusual organisms (Serratia,

Pseudomonas, andCandida albicans) infect unusual sites (clavicles

and symphysis pubis); sickle cell disease predisposes toSalmonella

osteomyelitis

■Spread of infection to bone from contiguous site seen in open frac-

tures, post-operatively in joint replacement surgery or from an adja-

cent chronic skin infection; S. aureus most common organism, but

S. epidermidis(with prosthetic devices), Gram-negative bacilli and

anaerobes also involved

■Osteomyelitis in association with diabetes and vascular insufficiency

polymicrobial and includesS. aureus, enterococci, anaerobes and

Gram-negative bacilli

■Inability to control initial infection may lead to chronic osteomy-

elitis; often polymicrobial

■Other organisms less commonly involved includeM. tuberculosis,

atypical mycobacteria, Coccidioides immitis, Histoplasma capsula-

tum and Blastomyces dermatitidis

Signs & Symptoms

■Hematogenous osteomyelitis presents either acutely with fever,

chills and localized pain, or more chronically over a period of months

with fatigue, malaise and poorly localized pain.