Salmonella osteomyelitis in sickle cell disease

Salmonella osteomyelitis

GL Carrington in 1925, first identified the association of Salmonella osteomyelitis in sickle cell anemia patients. There are several sickle cell hemoglobinopathies, namely, HbSS, HbSC, and HbSthalassemia.

Sickle cell anemia leads to intravascular sickling in the bowel. This causes ischemia of the bowel and devitalization and transient mucosal barrier breakdown. This leads to repeated bactermia and susceptibility to Salmonella and other gram negative infections.

Further, sluggish flow in the long bones, due to sickling permit direct invasion of Salmonella, causing the most dangerous disease for orthopaedicians.

There is a long lasting debate regarding which organism is most common in osteomyelitis in sickle cell patients. Articles emphasize Staphylococcus aureus, the main culprit of osteomyelitis, to be the commonest organism even in sickle cell patients.

Loa Thani, concluded that Staph aureus was the most common cause of osteomyelitis in sickle cell patients in Nigeria.

Salmonella, as an aetiological agent in osteomyelitis (0.8% in all infections) is essentially rare. It is the causative organism in 0.45% of osteomyelitis

Salmonella osteomyelitis
Pic depicting Salmonella. Picture courtesy of livescience

Oorthopaedics view about Salmonella and osteomyelitis:

  1. Osteomyelitis in sickle cell is common
  2. Through Staphylococcus aureus is the most common causative organism of osteomyelitis, sickle cell patients often present with diaphyseal osteomyelitis, attributed to Salmonella infections
  3. Non-salmonella typhi (Salmonella typhimuriumSalmonella enteritidisSalmonella choleraesuis and Salmonella paratyphi B ) infections, leading to osteomyelitis are common



  1.  Carrington G L, Davison W C. Multiple osteomyelitis due to bacillus paratyphosus B. Demonstration of bacillus in fresh blood preparation. Johns Hopkins Med J 1925; 36: 428-30.
  2. Anand AJ, Glatt AE. Osteomyelitis and arthritis in sickle cell disease. Seminars in Arthritis and Rheumatism. 1994 Dec 1;24(3):211–21.
  3. Thanni L. Bacterial osteomyelitis in major sickling haemoglobinopathies: geographic difference in pathogen prevalence. Afr Health Sci. 2006 Dec;6(4):236–9.
  4. McAnearney S, McCall D.  Osteomyelitis. Ulster Med J. 2015 Oct;84(3):171–2.

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