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Suffering from skull bone infection near mastoid. Can it be MRSA osteomyelitis?

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Dr. Saurabh Gupta

Orthopaedic Surgeon, Joint Replacement

Practicing since :2004

Answered : 5930 Questions

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Posted on Mon, 10 Dec 2012 in Bones, Muscles and Joints
Question: Hi,

I am sufferering from skull bone infection near my mastoid. I have been given AKT-4 thinking it is bone TB. But I am not getting much benefit after 3 weeks of treatment. My TB PCR blood test came to be negative.
I have the following questions:
1. Can it be MRSA osteomyelitis? I am suffering from 10 months. My bone scan is positive. My friend got such an infection and was misdiagnosed as TB. I don't have any fever or pus coming out of ear but I have great pain around my ear and temple and bone scan shows a black spot there in the skull.
2. What blood test should I undergo for MRSA osteomyelitis infection?
3. Can I take any other drug along with rifampin (given with AKT-4) like vancomycin? I saw in the internet that vancomycin is the choice of drug for such bone infection. Is it safe for me to take and if so in what doses.
Kindly help me.
Regards,
XXXXXXX
doctor
Answered by Dr. Saurabh Gupta 2 hours later
Hello XXXXXXX


Thanks for posting your query.

It seems less likely to be tuberculous infection. It can be Methicillin resistance staph aureus osteomyelitis.

You should undergo blood test like c-reactive protein (CRP), complete blood count (CBC), Erythrocyte sedimentation rate (ESR), blood culture to reach the diagnosis.

Fine needle aspiration cytology (FNAC) or bone biopsy can be done by your doctor to confirm the diagnosis.

Appropriate antibiotic have to be started after culture and sensitivity to the organism. So discuss with your doctor before starting vancomycin.

Hope I was able to address your concern. Let me know if you need any more help.

Please accept my answer in case you do not have further queries.

Wishing you good health....

Regards

Above answer was peer-reviewed by : Dr. Mohammed Kappan
doctor
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Follow up: Dr. Saurabh Gupta 1 hour later
Hello,

Few months back I had a mastoidectomy where they sent the mastoid glue for culture. But nothing was found. However, no bone biopsy was done.
My CRP is 15, ESR 9, CBC is 8700.
Blood culture did not reveal anything. What specific blood test should I do for MRSA?

Regards,
XXXXXXX
doctor
Answered by Dr. Saurabh Gupta 16 hours later
Hi,
Given these parameters its unlikely to be MRSA. Else the mastoid glue culture or the blood culture would have been positive. Also, the rest of the parameters like CBC, CRP and ESR are normal.
MRSA would generally cause a very severe infection and I dont think we need to worry about it.
Please continue the AKT-4. Bone TB takes a while to respond.
There is no specific blood test apart from a blood culture ( which has already been done) that we need to do.
Hope that helps
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Saurabh Gupta 10 hours later
Hi

Should I go for a bone biopsy? or is already done mastoid glue and blood culture sufficient?

Kindly tell me how useful will be bone biopsy for detecting infection? I already had a mastoidectomy.
doctor
Answered by Dr. Saurabh Gupta 18 hours later
Hi XXXXXXX
I do not think we need to do a bone biopsy done at this junction. I do not expect this investigation to yield any useful results. The cultures done are sufficient. Believe me, your symptoms would have been much more severe if you did have a MRSA infection
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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