In many cases, patients with osteomyelitis may not present with any signs and symptoms. In conditions when they do, the following are experienced:

• Pain and tenderness in the affected area
• Fever accompanied by chills
• Signs of inflammation, such as local pain, redness or swelling may develop
• Changes in gait that represents painful walking
• Pain in the lower back region in case the spine is involved
• Swelling of the feet, legs, and ankles, when lower extremities are involved
• Pus can drain from the site of infection
• In addition to the above mentioned symptoms, individuals can also experience other signs due to infection. Affected individuals, also complain of nausea, feeling of general weakness and excessive sweating [6].

• Fever

  If any constitutional findings (eg, fever, malaise, weight loss) persist or if large areas of bone are destroyed, necrotic tissue is debrided surgically. [msdmanuals.com]

  Systemic signs, such as fever and chills, are more indicative of an acute infection. Diagnosis of clinically suspected cases is supported via laboratory tests, biopsy, and/or imaging. [amboss.com]

  Both conditions should be suspected when a child presents with fever, reduced use of a joint or limb, and localised tenderness. [starship.org.nz]

• Chills

  Systemic signs, such as fever and chills, are more indicative of an acute infection. Diagnosis of clinically suspected cases is supported via laboratory tests, biopsy, and/or imaging. [amboss.com]

  Signs and symptoms vary but may include bone pain, fever, chills, excessive sweating, malaise, or an open wound. People with the condition may also experience local swelling, redness, and warmth at the site of the infection. [web.archive.org]

  Patients with osteomyelitis often present with limb pain, a limp or a hesitancy to bear weight, and sometimes a fever or chills. The patient may also not experience any symptoms. Osteomyelitis is caused by a bacterial infection. [paleyinstitute.org]

  Over the next 24 hours, he developed fever, chills, and left lower quadrant pain. He received IV antibiotics and was discharged from the hospital after clinical improvement. [ncbi.nlm.nih.gov]

• Malaise

  If any constitutional findings (eg, fever, malaise, weight loss) persist or if large areas of bone are destroyed, necrotic tissue is debrided surgically. [msdmanuals.com]

  Signs and symptoms vary but may include bone pain, fever, chills, excessive sweating, malaise, or an open wound. People with the condition may also experience local swelling, redness, and warmth at the site of the infection. [web.archive.org]

  There may be nonspecific systemic malaise attributed to a viral illness and suspicions are only raised as the symptoms localise after several days. [patient.info]

  Symptoms may include: A general feeling of illness (malaise). Fever, chills, and sweating. Deep bone pain. Pain that is worse when pressing on the infected area or when standing. Swollen and red skin (sometimes) over the affected bone. [stanfordhealthcare.org]

• Anemia

  (due to anemia of chronic disease, sickle cell anemia etc which may give rise to non-healing ulcers.) Full blood count. Assessment of anemic status. [medicaljoyworks.com]

  [Crossref] Lonergan GJ, Cline DB, Abbondanzo SL (2001) Sickle cell anemia. Radiographics 21: 971-994. [oatext.com]

  Predisposing factors include poor hygiene, anemia, malnutrition, and a coexisting infectious disease burden (parasites, mycobacteria, acquired autoimmune deficiency syndrome), or any other factors that decrease immune function. [global-help.org]

  Keeley K, Buchanan GR (1982) Acute infarction of long bones in children with sickle cell anemia. J Pediatr 101:170–175 CrossRef PubMed Google Scholar 6. [doi.org]

  […] chance of osteomyelitis include: Trauma or injury to the bone and skin Broken bones, especially if open to or sticking through the skin Soft tissue infection Diabetes Kidney dialysis IV drug abuse Weakened immune system Poor circulation Sickle cell anemia [uvahealth.com]

• High Fever

  The combination of a relevant history, pubic pain, high fever, and skin lacerations should alert the physician to the possibility of pubic osteomyelitis. [ncbi.nlm.nih.gov]

  Symptoms of Osteomyelitis Pain, often excruciating, in the affected bone Heat, swelling, tenderness, redness and restricted movement in the affected area High fever Fatigue and malaise Drainage of pus through the skin Nausea following infection Irritability [healthcommunities.com]

  These are the most common: A new limp A stiff back, if the spine is affected Feeling ill Fever (high fever with blood infection) Irritability Lethargy or fatigue Weight loss Pain in the affected area Redness in the affected area Swelling of the affected [massgeneral.org]

• Jaw Pain

  Symptoms such as jaw pain, tooth mobility, gingival swelling and oral ulcers or fistulae should prompt consideration of this diagnosis. B. History Part 2: Prevalence Prevalence varies with the particular subtype of osteomyelitis. [clinicaladvisor.com]

• Erythema

  Clinical diagnosis may be complicated by the absence of local signs of infection, such as purulent drainage and local erythema, warmth, and tenderness. [patient.info]

  Patients were followed up until the infection resolved (ie, no cutaneous signs of infection, including pain, erythema, or swelling). At a mean of 24 months, 10 of 13 infections had successful one-stage treatment. [ncbi.nlm.nih.gov]

  […] diagnosis of chronic osteomyelitis include: Local symptoms- pain, erythema. [clinicaladvisor.com]

• Skin Ulcer

  Of the 5 cases that did not demonstrate the typical T1 features associated with pedal osteomyelitis, 4 were considered to have a hematologic mechanism of infection given the absence of surgery, skin ulceration, or a penetrating injury. [ncbi.nlm.nih.gov]

  peritonitis, pneumonia, pyelonephritis, sepsis, septic arthritis, sinusitis, skin infection, skin ulcer, urinary tract infection, vasculitis, and wound infection lt Klausimas Nr. #, kurį pateikė E. [lt.glosbe.com]

  ulceration, abscesses, and pathologic fractures Disadvantages Provides less osseous detail than CT Expensive Time consuming Requires significant patient cooperation to minimize motion artifact Sensitivity/specificity decreases in setting of coexistent [clinicaladvisor.com]

  Such an infection may start in an area damaged by an injury or surgery, radiation therapy, or cancer or in a skin ulcer (particularly a foot ulcer) caused by poor circulation or diabetes. A sinus, gum, or tooth infection may spread to the skull. [merckmanuals.com]

• Angioedema

  Patients with allergic reactions (eg, itching, rash) to intravenous contrast and more severe allergic reactions (eg, angioedema of the throat, anaphylaxis) should be pretreated with steroids and antihistamines for a minimum of 13 hours prior to CT imaging [clinicaladvisor.com]

• Pruritus

  खाज/खुजली (Pruritus/Scabies) 2. छाजन (Eczema) H. विषाक्तता (Poisoning) 1. आहार विषाक्तता (Food Poisoning) 2. मदिराजनित विषाक्तता (Alcohol Poisoning) 3. विषाक्तताओं के लक्षण एवम उपचार (Clinical Features and Management of Common Poison) I. [rhmp.org]

• Bone Pain

  Chronic osteomyelitis causes intermittent (months to many years) bone pain, tenderness, and draining sinuses. [msdmanuals.com]

  Home Diseases Osteomyelitis Osteomyelitis is the medical term for an infection in a bone. Signs and symptoms vary but may include bone pain, fever, chills, excessive sweating, malaise, or an open wound. [web.archive.org]

  MAIN BODY: CNO is characterized by insidious onset of bone pain with local swelling. Systemic symptoms such as fever, skin involvement and arthritis may be sometimes present. [ncbi.nlm.nih.gov]

  Chronic osteomyelitis, a rare and stubborn form of the condition, causes persistent bone pain for years. [healthcommunities.com]

• Bone Disorder

  When a bone ... Chronic Non-bacterial Osteomyelitis Treated With Pamidronate Chronic non-bacterial osteomyelitis is a multifocal inflammatory bone disorder. The pathogenesis is unknown. The disease is mainly diagnosed in childhood. [centerwatch.com]

  Discussion CRMO is an idiopathic inflammatory bone disorder seen mainly in children and adolescents 1 ; however, it has already been described in older patients up to 55 years. 2, 3 This is a rare variant of osteomyelitis, corresponding to 2–5% of the [ncbi.nlm.nih.gov]

  The infected area almost always appears abnormal on bone scans, except in infants because scans do not reliably indicate abnormalities in growing bones. However, a bone scan cannot always distinguish infections from other bone disorders. [merckmanuals.com]

  Diagnosis Symptoms of osteomyelitis can resemble those of many other bone disorders. Bone scans, blood tests bone biopsies are tests that help diagnose this disorder so that treatment can be started immediately. [rarediseases.org]

• Neuropathic Arthropathy

  In contrast, neuropathic arthropathy tends to involve multiple bones of the midfoot. [ncbi.nlm.nih.gov]

• Leg Pain

  Primary symptoms include fever, back pain and stiffness, weakness, and generalized malaise. Children may present with poorly localized chest (thoracic vertebra) abdominal or leg pain (lumbar vertebra). [cancertherapyadvisor.com]

• Musculoskeletal Pain

  Advantages Quick Can reliably exclude common causes of musculoskeletal pain, such as fracture, arthropathy, or neoplasm Can strongly suggest osteomyelitis given the appropriate clinical history, laboratory findings, and positive pertinent radiographic [clinicaladvisor.com]

  Symptoms and signs in some patients are limited to blue sclerae (due to a deficiency in connective tissue allowing the underlying vessels to show through) and musculoskeletal pain due to joint hypermobility. [msdmanuals.com]

• Renal Insufficiency

  Markedly diminished in the setting of arthropathy, surgical change (ie, prosthesis), trauma, and noninfectious processes (ie, Paget’s disease, fibrous dysplasia, etc) Lacks anatomic detail afforded by CT and MR Limited in patients with renal insufficiency [clinicaladvisor.com]

  Renal insufficiency Antibiotic dosing will need to be adjusted for renal insufficiency. B. Liver insufficiency No change in standard management. C. Systolic and diastolic heart failure No change in standard management. D. [cancertherapyadvisor.com]

  Precautions Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis Drug Name Vancomycin (Vancocin) -- Potent antibiotic directed against gram-positive organisms and [web.archive.org]

  Linezolid inhibits ribosomal protein synthesis and can be administered parenterally or orally at a dose of 600 mg twice daily, without adjustment for renal insufficiency. [oncologynurseadvisor.com]

• Irritability

  These are common symptoms of osteomyelitis: Fever Fussiness or irritability Tiredness The following may happen in the area of the infected bone: Tenderness or pain Not using the affected arm, leg or other part of the body Swelling Redness Seek medical [urmc.rochester.edu]

  When symptoms do occur, they can include: Fever or chills Irritability or extreme exhaustion (in young children) Pain, swelling, warmth, and redness in the area of the infection Why Choose UHealth? Advanced, specialized care to fight infections. [umiamihealth.org]

  Irritability. Limping. Joint stiffness. Fatigue. Decreased use of an infected arm or leg. Because the infection can reduce blood circulation within the bone, the condition can cause bone death (also known as osteonecrosis). [gillettechildrens.org]

• Stroke

  Clinical Presentation: While a history of prior stroke was reported, imaging revealed the brain parenchyma to be intact. [ajnr.org]

  ब्रेन स्ट्रोक (Brain Stroke) 2. अवसाद (Depression) 3. मिर्गी/अपस्मार (Epilepsy) 4. सिर दर्द (Headache) 5. मेनिन्जाइटिस/दिमागी बुखार (Meningitis) 6. रेबीज (हाइड्रोफोबिया) (Rabies/Hydrophobia) 7. साइजोफ्रेनिया/अंतराबन्ध (Schizophrenia) 8. [rhmp.org]

• Sciatica

  Pain may radiate (eg, sciatica ) or travel into other parts of the body (eg, arm, leg) depending on the affected level of the spine. [spineuniverse.com]

A combination of tests would be required to diagnose osteomyelitis. The following methods would be employed:

• Blood work: Elevated levels of white blood cells (WBCs) may indicate presence of infection. It can also help reveal the causative organism responsible for the bone infection. However, there are no blood tests that would confirm the development of osteomyelitis. These are done so that further tests can be carried out in the direction of the results obtained.
• Imaging: At the preliminary level, X-rays are done to evaluate the damage to the bone. However, X-ray alone would not be sufficient to provide knowledge about the extent of damage to the bone, more so when oseomyelitis has set in recently. In such cases, advanced imaging studies such as CT scan and MRI are indicated [7].
• Bone biopsy: The method of bone biopsy is considered as the gold standard in diagnosing osteomyelitis. Such a type of test can also provide information on the type of organism that has caused the infection. Based on the findings, specific type of antibiotics can be prescribed. Bone biopsy is a small surgical procedure, requiring inserting of fine needle into the affected area to draw samples for analysis [8] [9].

• Neutrophilia

  […] usually absent and the local symptoms, such as hyperemia, heat, edema and fistulization, often appear intermittently, or even years after the beginning of bone infection.14 Laboratory tests Acute infections are often associated with leukocytosis and neutrophilia [bjid.org.br]

• Leukocytes Increased

  Tissue hyperoxygenation causes specific therapeutic effects, including stimulation of bacterial lysis by leukocytes, increase in proliferation of fibroblasts and collagen, and neovascularization of ischemic or irradiated tissues. [bjid.org.br]

• Leukocytosis

  […] thickening and elevation "Codman triangle" Magnetic resonance imaging indication considered when radiography is unrevealing findigs may reveal bone necrosis, abscess, and sinus tracts Studies Labs ↑ C-reactive protein ↑ erythrocyte sedimentation rate leukocytosis [step2.medbullets.com]

  […] swallowing, difficulty breathing, and possible respiratory failure Vertebral collapse and spinal instability → cord compression → paraplegia References:[3][10] Diagnostics Clinical approach Laboratory tests Inflammatory markers ↑ CRP, ↑ ESR Possible leukocytosis [amboss.com]

  Laboratory studies may reveal peripheral leukocytosis and an elevated erythrocyte sedimentation rate (ESR). [emedicine.medscape.com]

  Leukocytosis and elevations of the ESR and C-reactive protein support the diagnosis of osteomyelitis. [msdmanuals.com]

The primary and major goal of treatment of osteomyelitis is curing the infection and correcting the diseased part of bone. This is achieved through combination of a strict antibiotic regime, along with surgical procedures to remove the infected bone and surrounding tissues.

• Medications: Antibiotics are either administered intravenously, or orally, depending on the overall health of the patient. Combination of antibiotics is given for 4 to 6 weeks to treat the infection.
• Drainage: This method is the treatment of choice in cases when there is an open wound. The pus is drained with the help of needle aspiration.
• Surgery: Surgery is the method of choice when the infection has turned severe and the diseased part of the bone needs to be removed. The candidates for surgery include those who have developed infection after joint replacement, implantation of prosthesis and people with diabetes. Through surgery, the diseased part of the bone is removed and new prosthesis is implanted in that area. This is done during the same operation; but in many cases the prosthesis is implanted after the infection gets corrected. Individuals with diabetes would also require surgical procedures to improve the blood supply to the affected area [10].

The prognosis is favorable for patients with acute osteomyelitis. However, those with the chronic form, often suffer from debilitating symptoms even after surgery. In severe cases, amputation would be the last resort in patients in whom the blood circulation is poor or diabetes is the underlying cause.

In cases of patients with prosthesis, the prognosis would largely depend on the age of the individual and his overall health. The type of infection that has set in would also determine the outlook of the condition [5].

In most cases, bacterial infections by Staphylococcus aureus are the cause of osteomyelitis. Infections generally occur in population who have suffered trauma due to vehicle accidents or sports injuries. In about 47% of cases, osteomyelitis occurs in posttraumatic patients [2]. The condition can even aggravate existing puncture wounds of the foot. Individuals with diabetes, sickle cell anemia and weakened immune profile are at high risk of developing osteomyelitis.

About 20% cases of osteomyelitis that affect adults are hematogenous in nature. Spinal osteomyelitis occurs in about 1 in every 450,000 population. The incidence of such a kind of bone infection is found to be higher in the developing countries. The worldwide prevalence of osteomyelitis is thought to be about 2 in every 10,000 individuals [3].

Under normal conditions bone is resistant to any type of infections. However, conditions such as surgery or trauma can introduce microorganisms causing development of infections. There are 2 ways through which bones are exposed to microorganisms: Hemotogenously from the neighboring structures, or during surgical treatments to correct certain diseases of the bone or trauma. Severe puncture wounds may also carry the microorganism into the system and infect the bones. Several factors such as immunity status of the host, underlying disease conditions, and virulence of the organisms, are all involved in the pathogenesis of osteomyelitis. Osteomyelitis can be both acute and chronic in nature [4]. 

Various steps can be taken to prevent the onset of infection. Individuals are advised to take necessary precautions to avoid cuts and wounds. In cases when they get one, it is necessary to immediately clean the wound with antiseptic solution and cover with dressing. Individuals with diabetes are advised to keep their diet under control, in order to prevent blood glucose levels from increasing. This would in turn aid in speedy recovery from surgery or wounds.

The long bones of the legs and upper arms in children and the spine in adults are most likely to be affected by osteomyelitis. In the past, osteomyelitis had no cure; however, today the disease can be successfully treated with surgery and medications. Early initiation of treatment is essential for preventing development of chronic conditions. Individuals with open fractures are highly vulnerable to contract osteomyelitis [1].

Definition

Osteomyelitis is a condition characterized by development of infection of the bone due to bacteria such as Staphylococcus aureus. The bones can get infected, when bacteria travel through the bloodstream, and affect the bone or the neighboring tissues. In many instances, the condition can primarily originate in the bone, if an injury to the bone has exposed it to germs.

Cause

Most often, Staphylococcus aureus causes infection of the bone. However, in certain instances viral or fungal agents can also play foul. Individuals with prosthesis or, diabetic individuals, who have undergone surgery, are at high risk of developing osteomyelitis.

Symptoms

Symptoms of osteomyelitis include swelling, along with redness of the affected area. The area is tender to touch, and individuals may also experience fever, chills, nausea and malaise as secondary signs of infection.

Diagnosis

Osteomyelitis is diagnosed through blood tests, that reveal type of infection, and bone scans to evaluate the extent of damage to the bone. In addition, bone biopsy is also required and considered as gold standard in diagnosis of osteomyelitis.

Treatment

Individuals are given antibiotics to treat the infection, followed by surgery to correct the diseased part of the bone.

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