Букет непонятных проявлений... 😡😡

S aureus, mainly non-encapsulated variants, can be internalised by chick osteoblasts 37 and endothelial cells 38 in vitro and survive intracellularly, protected from host defence mechanisms and antibiotics. This might explain the known problem of a flare up of osteomyelitis with no identifiable causative organism. Furthermore, staphylococci can also acquire a very slow metabolic rate, in a phenotypic alteration named small colony variant. Slow growing bacteria have been known to be resistant to antibiotics since 1942, active cell wall synthesis being necessary for penicillin to be bactericidal.39 40 Small colony variants of S aureus were described for the first time in 1932 by Hoffstadt and Youmans as minuscule bacterial colonies (less than 1 mm) that grew very slowly and often required magnification to be seen.41 Small colony variants were found to be resistant to penicillin one year after its discovery by Fleming.39 Small colony variants may indeed account for the frequent failure to identify the causative micro-organism in chronic osteomyelitis: these strains may be easily missed or overgrown in a busy laboratory. They may also account for the frequent clinical presentation of chronic osteomyelitis as a slow, indolent infection that causes little inflammatory response and persists despite prolonged antimicrobial therapy.

Chronic osteomyelitis is often a lifelong disease. Late reactivation up to 80 years after the primary episode has been reported.
Bacteria can also elude host defence mechanisms by hiding intracellularly and by developing a protective slimy coat.
By acquiring a very slow metabolic rate, bacteria become less sensitive to antibiotics.
For all the above reasons, operative treatment should be considered whenever possible.
 
"Indium-111 White Blood Cell Imaging:
Chemistry and Pharmacology:
Indium-111 has a physical half-life of 67 hours. It decays by electron capture with gamma emissions of 173 and 247 keV. Indium-111 oxine is a highly lipophilic ligand which diffuses across leukocyte membranes. Once inside the cell, it dissociates into oxine (8-hydroxyquinoline, which diffuses out of the cell [7]) and In-111 which is retained in the cytoplasm by binding to intracellular proteins. A white blood cell rich fraction is separated from the other blood components by both gravity sedimentation and centrifugation. The percentage of contamination with other cell types is very low. The resultant white cell rich pellet is resuspended in saline for labeling. Indium oxine cannot be used to label the cells if they are still suspended in plasma as 90% of the radiopharmaceutical binds to transferrin rapidly and irreversibly. (There was some controversy as to whether WBC's maintain adequate function after they have been removed from plasma for labeling although years of clinical experience would argue to the contrary.) All cellular blood components are labeled including lymphocytes, platelets, and red blood cells in proportion to their total available cell membrane surface area. Although a mixed population of cells is labeled, the majority are neutrophils- hence, the procedure is most useful for detecting neutrophil-mediated inflammatory processes [32]. The critical organ is the spleen which receives approximately 9 to 14 rads per 0.5 mCi dose (but as high as 60 rads to the spleen in an infant [29]). An individual neutrophil receives about 750-1500 [7] rads from a 0.5 mCi dose of 111-In. This dose has not been shown to have any adverse effect on leukocyte migration or chemotaxis. Lymphocytes incidentally labeled with 111-In in mixed leukocyte preparations are killed by the radiation and pose no long term cancer risks. If there is fragmentation of the labeled white blood cells, indium- transferrin complexes are formed and more activity will be seen within the liver and bone marrow.

Technique:
Approximately 60cc of the patient's blood is removed. After gravity sedimentation to remove the majority of red cells, centrifugation is performed to obtain a white blood cell rich pellet. The plasma is set aside for later resuspension of the cells after labeling is complete. For an adult, 500uCi of 111In is used when labeling the WBC's. Incubation of the cells and the 111In-oxine takes place at room temperature for approximately 30 minutes, during which labeling occurs. It is CRUCIAL that the patient receive his/her own cells back. Many clinics therefore require that the person who draws the blood for labeling also re-inject the labeled cells. Following injection, the labeled neutrophils are cleared from the circulation rapidly with a half-time of 6 to 7 hours. Although transient pulmonary activity is seen up to about 4 hours following injection, by 24 hours the normal distribution of activity is to the liver (10-20%), the spleen (20-40%) which has the highest intensity, and the bone marrow (30-60%) [1]. The pulmonary activity is due to the cells' having contacted the extracorporeal glass surfaces during labeling. As a result they tend to marginate in the lungs as is the case in the transient neutropenia of dialysis. 111-In WBC's may aggregate, and upon injection, become trapped in the capillary bed of the lungs producing one or more pulmonary foci. Occasionally significant blood pool activity remains- this may indicate that a large number of erythrocytes have also been labeled [7]."

Картинки. http://www.auntminnie.com/default.asp?sec=ref&sub=ncm&pag=inf&itemid=55026&d=1
 
"chronic osteomyelitis, the sensitivity of In-111 WBC imaging varied by location: Peripheral skeleton-94%, Axial skeleton-53%."

53% что засекут в аксиалн. скелете
 
Vertebral Osteomyelitis:
The most common sources for vertebral osteomyelitis are infections of the urinary, skin, or respiratory system [30]. The most common organisms are S. aureus and E. coli [30]. In children, the infection typically involves the lumbar spine and often produces systemic complaints such as fever and irritability [30]. Abdominal pain, anorexia, and ileus may also be seen.

Дант, с Алексом, читайте, не пугайтесь только сильно.
 
Vertebral Osteomyelitis:
The most common sources for vertebral osteomyelitis are infections of the urinary, skin, or respiratory system [30]. The most common organisms are S. aureus and E. coli [30]. In children, the infection typically involves the lumbar spine and often produces systemic complaints such as fever and irritability [30]. Abdominal pain, anorexia, and ileus may also be seen.

Глянь Алекс твое.
 
Кстати у меня спина часто болит, но я относил это к травме полученной в 1996 если не ошибаюсь году.

"Люмбар спайн" - поясничный отдел.
 
Кстати у меня спина часто болит, но я относил это к травме полученной в 1996 если не ошибаюсь году.
 
"111In leukocyte imaging is not as sensitive for infection of the spine as for other musculoskeletal infections and may be falsely negative in up to 80% of cases"
 
кстати ольга, LAL тест мог среагировать не только на грамм-отрицательных.
реагирует на протозойных еще. у вас может быть и протозойная инфекция.

Recently, the clinical utility of the LAL test has been disputed. Elin (57) performed a statistical analysis of 17 different studies in humans with LAL and blood and concluded that the clinical utility of the LAL test for the diagnosis of gram-negative septicemia is marginal. Further studies by Tubbs (58) and Galloway et al. (59), respectively, showed that plasma from patients infected with Plasmodium falciparum and plasma from patients infected with Borrelia recurentis reacted positively with the LAL test.
 

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