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Osteomyelitis

Osteomyelitides

Osteomyelitis is a type of disease characterized by inflammation of bones due to either bacterial or fungal infection. Adults and children are susceptible to contract such a kind of disease condition.


Presentation

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
  • Here, we describe an epidemiologically atypical patient who initially presented with fever and altered mental status and later found to have calvarial osteomyelitis, intracranial abscess (empyema) and meningoencephalitis as a result of Mohs surgery.[ncbi.nlm.nih.gov]
  • We highlight here the case of a 53-year-old man presenting to hospital 4 years postliver transplant with fever, acute renal failure and a medial thigh lesion.[ncbi.nlm.nih.gov]
  • A 2-day-old mature male suddenly complained by parents about minimal swelling around the left knee, decreased left extremity motion and no fever.[ncbi.nlm.nih.gov]
  • A 38-year-old man presented with high-grade fever, productive cough, and chronic joint pain of the limbs.[ncbi.nlm.nih.gov]
  • Osteomyelitis Symptom Fever The definition of fever is an elevation in body temperature or a high body temperature.[medicinenet.com]
Chills
  • 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]
  • 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]
  • The area is tender to touch, and individuals may also experience fever, chills, nausea and malaise as secondary signs of infection.[symptoma.com]
  • They may also have fever, chills, and redness at the site of the infected area.[medicinenet.com]
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]
  • […] chills and shivering Pain in the affected bone that can be intense Tenderness and swelling 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[news-medical.net]
  • Surgery 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
  • [Crossref] Lonergan GJ, Cline DB, Abbondanzo SL (2001) Sickle cell anemia. Radiographics 21: 971-994.[oatext.com]
  • 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]
  • 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]
  • 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]
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]
  • Osteomyelitis symptoms If you have osteomyelitis, you may experience: high fever pain in the affected bones swelling, redness and warmth in the affected area general discomfort.[healthdirect.gov.au]
  • 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[cedars-sinai.edu]
  • 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 Pain and tenderness in the affected area Redness in the affected area Swelling of the affected area Trouble bearing[urmc.rochester.edu]
Erythema
  • 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.[clinicaladvisor.com]
Bone Pain
  • 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]
  • 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]
  • Chronic osteomyelitis causes intermittent (months to many years) bone pain, tenderness, and draining sinuses.[merckmanuals.com]
  • Common symptoms are localized bone pain and tenderness with constitutional symptoms (in acute osteomyelitis) or without constitutional symptoms (in chronic osteomyelitis). Diagnosis is by imaging studies and cultures.[msdmanuals.com]
  • 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. Antibiotic treatment is necessary to prevent destruction of bone tissue.[stanfordhealthcare.org]
Bone Disorder
  • Phase 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]
  • However, a bone scan cannot always distinguish infections from other bone disorders.[merckmanuals.com]
  • It is generally accepted that neuropathic bone disorders, which are frequent among patients with diabetes, may cause radiograph abnormalities [ 10, 11, 17–19 ].[doi.org]
Heel Pain
  • Physicians should note that this rare infection should be considered in patients with refractory heel pain.[ncbi.nlm.nih.gov]
Hip Pain
  • A 70-year-old male presented to our emergency room with fever, right hip pain, and purulent drainage from a right greater trochanter stage IV decubitus ulcer.[ncbi.nlm.nih.gov]
Leg Pain
  • Children may present with poorly localized chest (thoracic vertebra) abdominal or leg pain (lumbar vertebra).[rheumatologyadvisor.com]
Distractibility
  • The distraction force permits tissue fibers and cells to become oriented in the same direction as the distraction vector, which is thought to mimic the process of natural bone growth. [40] Nonunions, malunions, or defects of any length can be treated[emedicine.medscape.com]
  • The 3 stages were (1) active debridement and Ilizarov stabilization, (2) further strengthening of Ilizarov fixator and active osteosynthesis consisting of strategies like arthrodesis, osteotomy distraction, bone transport, or combination thereof, (3)[ncbi.nlm.nih.gov]
  • However, the fibula was unable to be lengthened to 22 cm during the lower leg distraction process because of blood flow disturbance. We could only lengthen the femur to salvage the limb in this situation.[ncbi.nlm.nih.gov]
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 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]
  • The most common symptoms of osteomyelitis include: Difficulty moving joints near affected area and/or bearing weight Fever that may be high when osteomyelitis occurs as the result of a blood infection Irritability Redness, swelling, warmth, pain, and[utswmedicine.org]
  • People affected by osteomyelitis may experience: [1] [2] [3] Bone pain Fever and chills Excessive sweating Malaise Open wound Local swelling, redness, and warmth Irritability or lethargy (especially in young children) Last updated: 10/20/2016 Osteomyelitis[web.archive.org]

Workup

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].

Treatment

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].

Prognosis

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].

Etiology

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.

Epidemiology

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].

Sex distribution
Age distribution

Pathophysiology

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]. 

Prevention

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.

Summary

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].

Patient Information

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.

References

Article

  1. Lew DP, Waldvogel FA. Osteomyelitis. N Engl J Med 1997; 336:999.
  2. Calhoun JH, Manring MM. Adult osteomyelitis. Infect Dis Clin North Am. Dec 2005;19(4):765-86.
  3. Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004; 364:369.
  4. Weber EJ. Plantar puncture wounds: a survey to determine the incidence of infection. J Accid Emerg Med. Jul 1996;13(4):274-7.
  5. Newman LG, Waller J, Palestro CJ, et al. Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline. JAMA 1991; 266:1246.
  6. Belthur MV, Birchansky SB, Verdugo AA, et al. Pathologic Fractures in Children with Acute Staphylococcus aureus Osteomyelitis. J Bone Joint Surg Am. Jan 4 2012;94(1):34-42.
  7. Howard CB, Einhorn M, Dagan R, Yagupski P, Porat S. Fine-needle bone biopsy to diagnose osteomyelitis.J Bone Joint Surg Br. Mar 1994;76(2):311-4.
  8. Khatri G, Wagner DK, Sohnle PG. Effect of bone biopsy in guiding antimicrobial therapy for osteomyelitis complicating open wounds. Am J Med Sci 2001; 321:367.
  9. Lazzarini L, Lipsky BA, Mader JT. Antibiotic treatment of osteomyelitis: what have we learned from 30 years of clinical trials? Int J Infect Dis 2005; 9:127.
  10. Abiri MM, Kirpekar M, Ablow RC. Osteomyelitis: detection with US. Radiology. Aug 1989;172(2):509-11.

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Last updated: 2019-07-11 22:09