Osteomyelitis

A 10-year-old boy presented with fever, swelling, redness, and pain in the middle of his leg. Acute Osteomyelitis is suspected. What is the most common cause of it?

The patient has a history of evening rise in temperature, weight loss, and cough. He has recent exposure to tuberculosis in the family, and has now become bed-bound due to pain in the middle of the back. Tubercular osteomyelitis is suspected. What is the most common location of it?

A 17-year-old boy was diagnosed with sickle cell disease. He has a history of repeated emergency department visits due to pain in the whole body. However, he now presented with pain in the right leg and knee. Investigation confirms acute osteomyelitis. What could be the causative agent in this patient?

A 60-year-old shopkeeper with a 20-year history of poorly controlled type 2 diabetes presents to the Diabetic Foot Clinic for review, one week after starting oral co-amoxiclav for a left heel ulcer. He reports no significant improvement, and the nursing staff shares similar concerns.

On examination, there is a small ulcer over the posterior heel with purulent discharge and surrounding erythema. On probing, the tip of the instrument makes contact with bone. The patient has palpable peripheral pulses and no signs of systemic sepsis.

Investigations:

• Hemoglobin: 12 g/dL
• WBC: 12500
• Platelets: 326000
• CRP: 170 mg/L
• Plain X-ray Foot: Chronic degenerative changes, but no definite bone destruction

Which of the following is the most appropriate next step in management?

A 27-year-old male factory worker from Faisalabad presents to the emergency department with persistent pain and swelling in his right heel. Two weeks earlier, while working in a textile warehouse, he accidentally stepped on a rusty nail that pierced through his rubber slipper into his heel. He cleaned the wound himself and used over-the-counter ointments but did not seek medical care. Over the past week, he has developed intermittent fever and swelling of his feet. He smokes half a pack of cigarettes per day but does not use alcohol or recreational drugs. On examination, temperature is 101 °F, HR 90/min. The right heel is erythematous, warm, swollen, and exquisitely tender with a puncture mark visible.

• TLC: 11900
• Neutrophils: 85%
• Blood sugar random: 80 mg/dl
• The foot X-ray shows lytic bone changes consistent with osteomyelitis.

Which of the following is the most likely causative organism in this patient’s condition?