A Novel Element in the Management of Chronic Granulomatous Disease (CGD)? – Treatment of Osteomyelitis with Additional Hyperbaric Oxygen Therapy (HBO)

Abstract

Chronic granulomatous disease (CGD) is caused by malfunctioning of the phagocyte NADPH oxidase responsible for the generation of microbicidal reactive oxygen species. It is characterized by severe recurrent infections with catalase positive bacteria. Bacterial or fungal osteomyelitis is a common complication which often does not respond sufficiently to intravenous antibiotic treatment. We report the case of a four year old boy with CGD and osteomyelitis of the mandible refractory to intravenous antibiotic therapy. Introduction of hyperbaric oxygen therapy (HBO) was well tolerated and led to resolution of the osteomyelitis.

Zusammenfassung

Die septische Granulomatose wird durch einen Defekt in der Phagozyten-NADPH-Oxidase verursacht, die für die Produktion antimikrobieller Sauerstoffradikale verantwortlich ist. Die septische Granulomatose ist durch schwere rekurrierende Infektionen durch katalase-positive Bakterien charakterisiert. Osteomyelitiden durch Bakterien oder Pilze sind eine häufige Komplikation, welche oft nicht hinreichend auf eine intravenöse antibiotische Therapie ansprechen. Wir berichten über einen vierjährigen Jungen mit septischer Granulomatose und einer Antibiotika-refraktären Osteomyelitis der Mandibula. Der Einsatz der hyperbaren Sauerstofftherapie wurde vom Patienten gut vertragen und führte zu einer eindrucksvollen Befundbesserung.

hyperbaric oxygen therapy - refractory osteomyelitis - chronic granulomatous disease

hyperbare Sauerstofftherapie - therapierefraktäre Osteomyelitis - septische Granulomatose

Literatur

• 1 Aitasalo K, Niinikoski J, Grenman R. et al . A modified protocol for early treatment of osteomyelitis and osteoradionecrosis of the mandible.  Head Neck. 1998;  20 411-417
• 2 Beuerlein M, Nelson RN, Welling DB. Inner and middle ear hyperbaric oxygen-induced barotrauma.  Laryngoscope. 1997;  107 1350-1356
• 3 Blanshard J, Toma A, Bryson P. et al . Middle ear barotrauma in patients undergoing hyperbaric oxygen therapy.  Clin Otolaryngol. 1996;  21 400-403
• 4 Calhoun JH, Cobos JA, Mader JT. Does hyperbaric oxygen have a place in the treatment of osteomyelitis?.  Orthop Clin North Am. 1991;  22 467-471
• 5 Curnutte JT, Kipnes RS, Babior BM. Defect in pyridine nucleotide dependent superoxide production by a particulate fraction from the granulocytes of patients with chronic granulomatous disease.  New Eng J Med. 1975;  293 628-632
• 6 Dinauer MC, Orkin SH, Brown R. et al . The glycoprotein encoded by the x-linked chronic granulomatous disease locus is a component of the neutrophil cytochrome b complex.  Nature. 1987;  327 717-720
• 7 Evanger K, Haugen OH, Irgens A. et al . Ocular refractive changes in patients receiving hyperbaric oxygen administered by oronasal mask or hood.  Acta Ophthalmol Scand. 2004;  82 449-453
• 8 Hopkinson WI, Towers AG. Effect of hyperbaric oxygen on some common pathogenic bacteria.  Lancet. 1963;  28 1361-1362
• 9 Klebanoff SJ, White LR. Iodination defect in the leukocytes of a patient with chronic granulomatous disease of childhood.  N Engl J Med. 1969;  280 460-466
• 10 Lentrodt S, Lentrodt J, Kübler N. et al . Hyperbaric oxygen for adjuvant therapy for chronically recurrent mandibular osteomyelitis in childhood and adolescence.  J Oral Maxillofac Surg. 2007;  65 186-191
• 11 Louge P, Cantais E, Palmier B. Acute respiratory distress syndrome after prolonged hyperbaric oxygen therapy: a case of pulmonary oxygen toxicity?.  Ann Fr Anesth Reanim. 2001;  20 559-562
• 12 Mader JT, Adams KR, Wallace WR. et al . Hyperbaric oxygen as adjunctive therapy for osteomyelitis.  Infect Dis Clin North Am. 1990;  4 433-440
• 13 Manson PN, Im MJ, Myers RA. et al . Improved capillaries by hyperbaric oxygen in skin flaps.  Surg Forum. 1980;  31 564-566
• 14 Marciano BE, Wesley R, Carlo ES De. et al . Long-term interferon-gamma therapy for patients with chronic granulo-matous disease.  Clin Infect Dis. 2004;  39 692-699
• 15 Marx RE, Ehler WJ, Tayapongsak P. et al . Relationship of oxygen dose to angiogenesis induction in irradiated tissue.  Am J Surg. 1990;  160 519-524
• 16 Maurer P, Meyer L, Eckert AW. et al . Measurement of oxygen partial pressure in the mandibular bone using a polarographic fine needle probe.  Int J Oral Maxillofac Surg. 2006;  35 231-236
• 17 MacAllister TA, Stark JM, Norman JN. et al . Inhibitory effects of hyperbaric oxygen on bacteria and fungi.  Lancet. 1963;  16 1040-1042
• 18 Park MK, Myers RA, Marzella L. Oxygen tensions and infections: modulation of microbial growth, activity of antimicrobial agents, and immunologic responses.  Clin Infect Dis. 1992;  14 720-740
• 19 Parkos CA, Dinauer MC, Walker LE. et al . Primary structure and unique expression of the 22-kilodalton light chain of human neutrophil cytochrome b.  Proc Natl Acad Sci USA. 1988;  85 3319-3323
• 20 Plafki C, Peters P, Almeling M. et al . Complications and side effects of hyperbaric oxygen therapy.  Aviat Space Environ Med. 2000;  71 119-124
• 21 Slack WK, Thomas DA, Perrins D. Hyperbaric oxygenation chronic osteomyelitis.  Lancet. 1965;  14 1093-1904
• 22 Roos D, Bruggen R van, Meischl C. Oxidative killing of microbes by neutrophils.  Microbes Infect. 2003;  5 1307-1315
• 23 Verklin RM, Mandell GL. Alteration of effectiveness of antibiotics by anaerobiosis.  J Lab Clin Med. 1977;  89 65-71
• 24 Waisman D, Shupak A, Weisz G. et al . Hyperbaric Oxygen Therapy in the Pediatric Patient: The Experience of the Israel Naval Medical Institute.  Pediatrics. 1998;  102 e53
• 25 Winkelstein JA, Marino MC, Johnston  Jr  RB. et al . Chronic granulomatous disease. Report on a national registry of 368 patients.  Medicine (Baltimore). 2000;  79 155-169
• 26 Yildiz S, Aktas S, Cimsit M Ay. et al . Seizure incidence in 80,000 patient treatments with hyperbaric oxygen.  Aviat Space Environ Med. 2004;  75 992-994

Correspondence