Effect of Causative Micro-organisms on Patterns of Labeled White Blood Cells in Osteomyelitis

Shorouk Faleh Dannoon 1, Wadha Al-Fouzan 2 3, Saud Ashwee Alenezi 1, Asma'a Alosaimi 3, Mohammad Alhusain 4, Abdelhamid Helmy Elgazzar 1

Affiliations

01 January 2019

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doi: 10.4103/ijnm.IJNM_117_18

Abstract

Objective: The aim of this study is to investigate the effect of microbiological characteristics of causative organisms on the scintigraphic patterns of labeled-white blood cells (WBC) scan in cases of proven osteomyelitis.

Materials and methods: Retrospective analysis of 25 patients referred with suspected osteomyelitis and had both bone and labeled-WBC scans performed and complete records of the microbiological culture of the causative organism. The bone and labeled-WBC scans were retrieved and reviewed by two nuclear medicine physicians. Any definite focal accumulation of labeled WBCs within the bone was considered positive for osteomyelitis. Diagnosis of osteomyelitis in the discharge summary was considered the reference standard and was based on a combination of the clinical scenario, imaging, and laboratory findings including microbiology. Correlation of the pattern of labeled WBC and the type of microorganisms was done.

Results: A total of 16 patients were included in this study, seven females and nine males. Of these, seven patients had Gram-positive whereas nine patients had Gram-negative organisms. The majority (85.7%) of Gram-positive organisms showed increased accumulation of labeled WBCs, whereas only one-third (33.3%) of patients with Gram-negative organisms had such finding.

Conclusion: The pattern observed in this study shows that the false-negative results of labeled-WBC scans were mainly noted in patients with Gram-negative as opposed to Gram-positive infections. This confirms the experimental animal study findings that the secretion of anti-chemotactic factors by Gram-negative organisms, seems to be inhibiting the migration of labeled WBCs to the site of infection. The inhabitation is decreasing the accumulation of labeled WBCs and consequently resulting in a false-negative finding. The study adds to evidence that microbiological characteristics of the causative organisms are another explanation for the false-negative WBC in proven osteomyelitis.

Keywords: Bone scan; Gram-negative bacteria; Gram-positive bacteria; labeled white blood cells; osteomyelitis.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1 A 67-year-old diabetic male patient with a history of left heal trauma. Surgical debridement was done ten days prior to the scan. (a) Selected sequential Single photon emission computed tomography images of the bone scan demonstrating a focal area of increased uptake at the inferior aspect of the calcaneus. (b) Selected sequential Single photon emission computed tomography images of labeled white blood cells scan demonstrating no corresponding uptake. Despite the negative white blood cells scan results, culture results confirmed the presence of Gram-negative infection “Enterobacter sakazakii”

Figure 1 A 67-year-old diabetic male patient with a history of left heal trauma. Surgical debridement was done ten days prior to the scan. (a) Selected sequential Single photon emission computed tomography images of the bone scan demonstrating a focal area of increased uptake at the inferior aspect of the calcaneus. (b) Selected sequential Single photon emission computed tomography images of labeled white blood cells scan demonstrating no corresponding uptake. Despite the negative white blood cells scan results, culture results confirmed the presence of Gram-negative infection “Enterobacter sakazakii”

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References

  1.  
    1. Kumar JV, Robbins SL. Acute and chronic inflammation. In: Cotran RS, Kumar JV, Collins T, Robbins SL, editors. Robbins Pathologic Basis of Disease. 6th ed. Philadelphia: Saunders Elsevier; 1999. pp. 25–46.
  2.  
    1. Carek PJ, Dickerson LM, Sack JL. Diagnosis and management of osteomyelitis. Am Fam Physician. 2001;63:2413–20. - PubMed
  3.  
    1. Kaim AH, Gross T, von Schulthess GK. Imaging of chronic posttraumatic osteomyelitis. Eur Radiol. 2002;12:1193–202. - PubMed
  4.  
    1. Kruskal JB. Can USPIO-enhanced spinal MR imaging help distinguish acute infectious osteomyelitis from chronic infectious and inflammatory processes? Radiology. 2008;248:1–3. - PubMed
  5.  
    1. Gold RH, Tong DJ, Crim JR, Seeger LL. Imaging the diabetic foot. Skeletal Radiol. 1995;24:563–71. - PubMed
  6.  
    1. Hatzenbuehler J, Pulling TJ. Diagnosis and management of osteomyelitis. Am Fam Physician. 2011;84:1027–33. - PubMed
  7.  
    1. Ivancević V, Dodig D, Livaković M, Hancević J, Ivancević D. Comparison of three-phase bone scan, three-phase 99m-Tc-HM-PAO leukocyte scan and 67-gallium scan in chronic bone infection. Prog Clin Biol Res. 1990;355:189–98. - PubMed
  8.  
    1. de Winter F, van de Wiele C, Vogelaers D, de Smet K, Verdonk R, Dierckx RA, et al. Fluorine-18 fluorodeoxyglucose-position emission tomography: A highly accurate imaging modality for the diagnosis of chronic musculoskeletal infections. J Bone Joint Surg Am. 2001;83-A:651–60. - PubMed
  9.  
    1. Palestro CJ, Kim CK, Swyer AJ, Vallabhajosula S, Goldsmith SJ. Radionuclide diagnosis of vertebral osteomyelitis: Indium-111-leukocyte and technetium-99m-methylene diphosphonate bone scintigraphy. J Nucl Med. 1991;32:1861–5. - PubMed
  10.  
    1. Whalen JL, Brown ML, McLeod R, Fitzgerald RH., Jr Limitations of indium leukocyte imaging for the diagnosis of spine infections. Spine (Phila Pa 1976) 1991;16:193–7. - PubMed
  11.  
    1. Hovi I. Complicated bone and soft-tissue infections. Imaging with 0.1 T MR and 99mTc-HMPAO-labeled leukocytes. Ff. Acta Radiol. 1996;37:870–6. - PubMed
  12.  
    1. Elgazzar AH, Dannoon S, Sarikaya I, Farghali M, Junaid TA. Scintigraphic patterns of indium-111 oxine-labeled white blood cell imaging of gram-negative versus gram-positive vertebral osteomyelitis. Med Princ Pract. 2017;26:415–20. - PMC - PubMed
  13.  
    1. Palestro CJ, Love C. Radionuclide imaging of musculoskeletal infection: Conventional agents. Semin Musculoskelet Radiol. 2007;11:335–52. - PubMed
  14.  
    1. Fernandez-Ulloa M, Vasavada PJ, Hanslits ML, Volarich DT, Elgazzar AH. Diagnosis of vertebral osteomyelitis: Clinical, radiological and scintigraphic features. Orthopedics. 1985;8:1144–50. - PubMed
  15.  
    1. Waldvogel FA, Medoff G, Swartz MN. Osteomyelitis: A review of clinical features, therapeutic considerations and unusual aspects. N Engl J Med. 1970;282:198–206. - PubMed
  16.  
    1. Kahn DS, Pritzker KP. The pathophysiology of bone infection. Clin Orthop Relat Res. 1973;96:12–9. - PubMed
  17.  
    1. Kim EE, Pjura GA, Lowry PA, Gobuty AH, Traina JF. Osteomyelitis complicating fracture: Pitfalls of 111In leukocyte scintigraphy. AJR Am J Roentgenol. 1987;148:927–30. - PubMed
  18.  
    1. Kumar JV, Abbas AK, Astor JC, editors. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Philadelphia: Elsevier-Saunders; 2015. Inflammation and repair; pp. 69–112.
  19.  
    1. Torda AJ, Gottlieb T, Bradbury R. Pyogenic vertebral osteomyelitis: Analysis of 20 cases and review. Clin Infect Dis. 1995;20:320–8. - PubMed
  20.  
    1. Song KS, Ogden JA, Ganey T, Guidera KJ. Contiguous discitis and osteomyelitis in children. J Pediatr Orthop. 1997;17:470–7. - PubMed

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