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

  Osteomyelitis Symptom Fever The definition of fever is an elevation in body temperature or a high body temperature. [medicinenet.com]

  A sprained ankle won't cause a child to have a fever and become unwell. If a child is in pain and also has a fever and is unwell, they should always see a GP. Will my child's bone be weaker and more prone to breaking after osteomyelitis? No. [rch.org.au]

  For example, doctors may suspect osteomyelitis in a person who has persistent pain in part of a bone, who may or may not have a fever, and who feels tired much of the time. [msdmanuals.com]

• Chills

  They may also have fever, chills, and redness at the site of the infected area. [medicinenet.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]

  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. Drainage of pus from the wound. [stanfordhealthcare.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

  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]

  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]

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

• 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]

  Chronic infections can cause general weakness, weight loss, anemia, kidney disease, and other disorders. A severe chronic infection that does not get better with treatment may require removal of the infected part of the body (amputation). [summitmedicalgroup.com]

  Osteomyelitis may occur as a complication of many diseases, such as typhoid, syphilis, tuberculosis, or sickle cell anemia. In the middle-aged, spinal osteomyelitis may be associated with urinary bladder infection. [britannica.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]

• Gangrene

  We have found distal Syme hallux amputation to be an effective treatment when used judiciously for distal hallux gangrene and osteomyelitis associated with neuropathic ulceration. [ncbi.nlm.nih.gov]

  Authors: Kawashima, M Tamura, H Nagayoshi, I Takao, K Yoshida, K Yamaguchi, T Keywords: Congresses Crush Syndrome/therapy Diabetic Foot/therapy Fasciitis, Necrotizing/therapy Gas Gangrene/therapy human Hyperbaric Oxygenation Japan Orthopedics Osteomyelitis [web.archive.org]

  Considerations for Osteomyelitis Osteomyelitis requires long-term care to prevent further complications, including care to prevent the following: Fractures of the affected bone Stunted growth in children (if the infection has involved the growth plate) Gangrene [hopkinsmedicine.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. [cancertherapyadvisor.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]

  It is usually seen in people over 50 years old and is characterized by pain and redness of the affected area (erythema), swelling, ulcerations, and drainage of pus. [rarediseases.org]

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

• Bone Pain

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

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

  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]

• 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]

  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]

  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. [msdmanuals.com]

• 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]

• Knee Pain

  (OBQ14.138) A 5-year-old boy presents with temperature of 104 degrees Fahrenheit and painful weight bearing on the left lower extremity for one day. Hip motion is painless, but knee motion is painful. [orthobullets.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]

  In adults, the symptoms of osteomyelitis include fever, chills, irritability, swelling or redness over the infected bone, drainage of pus, stiffness, and nausea. [medicinenet.com]

  […] in the affected area The condition usually affects the long bones in the legs, but other bones such as those in the arms can also be affected General feeling of malaise Restricted movement of the affected area Swollen lymph nodes near affected area Irritable [news-medical.net]

• Confusion

  Erosive arthritis in Behcet's disease (BD) is rare and confused with infectious diseases such as osteomyelitis. Clinical course and imaging may be similar in BD-related arthritis and osteomyelitis. [ncbi.nlm.nih.gov]

  This group may have the appearance of “onion-skinning” and thus be confused with Ewing’s sarcoma. Type V: Epiphyseal radiolucency that may appear similar to a chondroblastoma. [posna.org]

  After eliminating most of these confusion factors, we found only 28% concordance between non-bone and bone specimens. [web.archive.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].

• 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]

• 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.14Laboratory tests Acute infections are often associated with leukocytosis and neutrophilia [bjid.org.br]

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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