Correspondence

Staphylococcus aureus Reactivation Osteomyelitis after 75 Years

N Engl J Med 2012; 366:481-482February 2, 2012

Article

To the Editor:

In 1934, a 10-year-old girl was hospitalized at the Children's Hospital of Boston for 1 1/2 years for Staphylococcus aureus osteomyelitis of the left femur. This was the preantibiotic era, so she did not receive any antibiotic therapy at that time but, instead, underwent multiple orthopedic procedures including “scalloping” (i.e., removal of infected bone). She recovered fully, never underwent any drainage procedures, and did well until she reached 85 years of age, when she felt pain in her left midfemur while rising from a chair. The following day she noted a purulent drainage from her left thigh and presented to our institution.

Radiographic findings identified a pathologic fracture of the left midfemur, scalloping changes, and medullary changes consistent with osteomyelitis. After successful open reduction and internal fixation of the fracture, she recovered without sequelae. During surgery, an old sinus tract that had never drained was found. All cultures of samples from the bone and tract grew only S. aureus; there was no evidence of a malignant condition. As expected, the S. aureus strain was sensitive to all antibiotics tested, including penicillin and oxacillin.

Sequence type 30 (ST30) S. aureus femoral osteomyelitis became reactivated in our patient after 75 years. S. aureus reactivation osteomyelitis occurring many decades after the initial infection has been reported previously.1,2 We performed Multi Locus Sequence Typing of the recovered S. aureus strain in standard fashion,3 and seven S. aureus housekeeping genes (arcC, aroE, glpF, gmk_, pta_, tpi_, and yqiL) were fully sequenced with the use of the Applied Biosystems 3730xl DNA Analyzer. The allelic profile of this S. aureus strain placed it among ST30 S. aureus isolates.3

In the 1950s and 1960s, a penicillin-resistant but methicillin-susceptible ST30 S. aureus clone spread throughout the world.4 More recently, community-acquired and hospital-acquired methicillin-susceptible and methicillin-resistant strains of ST30 S. aureus have been reported to be the prevalent clones in Australia and Oceania.5 Our report suggests that an ST30 S. aureus clone sensitive to all antibiotics was circulating in the eastern United States in 1934.

Daniel H. Libraty, M.D.
Chinmay Patkar, Ph.D.
University of Massachusetts Medical School, Worcester, MA
daniel.libraty@umassmed.edu

Brenda Torres, B.S.
University of Massachusetts Memorial Healthcare, Worcester, MA

Supported by grants from the National Institute of Allergy and Infectious Diseases (UO1AI065654 and R01AI091820).

Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.

5 References

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   Al-Maiyah M, Hemmady MV, Shoaib A, Morgan-Jones RL. Recurrence of chronic osteomyelitis in a regenerated fibula after 65 years. Orthopedics 2007;30:403-404
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   Multi Locus Sequence Typing home page. 2011 (http://saureus.mlst.net).
   

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   Deleo FR, Otto M, Kreiswirth BN, Chambers HF. Community-associated methicillin-resistant Staphylococcus aureus. Lancet 2010;375:1557-1568
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