HEMATOGENOUS PELVIC OSTEOMYELITIS CAUSED BY STAPHYLOCOCCUS AUREUS IN ATHLETES

Abstract

Athletes are prone to iterated traumatic straining of sacroiliac joints and insertion of muscles in pelvic bones.

The aim of our study was to show the connection between iterated trauma and staphylococcal infection in athletes.

A compilation of data concerning 22 patients, all high-ranking athletes in Sweden, with pelvic skeletal infection (symphysitis, sacroiliitis and acetabular necrosis) is presented. Most of them were ball-players, 2 females and 20 males with an average age of 21 years. The onset was acute or subacute and the disease was commonly misinterpreted, mainly as an acute abdominal disease. Four patients erroneously underwent laparotomy for suspected appendicitis. Eight patients had skin lesions (5 purulent and 3 uninfected) at the onset and thus had a portal for possible entry for a bacterial impact in the pelvic skeleton.

The only verified bacterial aetiology was Staphylococcus aureus in 19 cases (culture of blood and/or aspirated samples in 18 and serology only in 1). An early scintigraphy was of greater value than X-ray for diagnosis and was positive in 8/10 evaluable cases. In all, 12/18 had early positive plain radiological findings. Another patient (#22) had, except skeletal infection, a psoas abscess, diagnosed by Magnetic Resonance Imaging (MRI).

Antistaphylococcal drugs administered parenterally for 1–2 weeks followed by oral drugs for a few months comprised a successful treatment and no patient had serious sequelae or relapse.

The occurrence of abdominal and/or lower back pains concomitant to fever in young persons engaged in elite team sports should lead to a suspicion of pelvic pyogenic infection. Early scintigraphy and cultures of blood and aspirated material from the infection site was essential for the diagnosis. MRI has also been shown to be valuable.