Osteomyelitis is a bone infection, usually caused by bacteria, that can be either acute or chronic. This disorder usually occurs as a result of an infection in one part of the body that is transported through the bloodstream to a bone in a distant location. Among children and teens, the long bones of the legs and arms are most frequently affected. In adults, osteomyelitis most often affects the vertebrae of the spine and/or the hips.
Acute osteomyelitis is a serious bone inflammation that can result from a previous trauma, puncture wound, surgery, bone fracture, abscessed tooth, or infection of soft tissue, the ear or sinus. In children, it usually affects the long bones, especially the growth center (epiphysis) at the end of the shaft. In adults, bones of the spinal column (vertebra) are often affected.
Initially there may be several days of fever and a generalized feeling of ill health (malaise). This may be followed by an increase in fever (104-105 degrees Fahrenheit), deep localized bone pain, chills, sweating, swelling and painful or limited movement of the nearby joints. The skin near the affected bone may be red (erythema) and there may be a purulent buildup (pus), loss of calcium, destruction of the surrounding tissue (necrosis) and bone deterioration or deformity.
Chronic osteomyelitis usually occurs after an acute episode of osteomyelitis when the infection has not been totally cured. There may be bone pain, swelling, redness and tenderness of the affected area. A discharge of pus from an opening to the infected bone is often the first symptom. There may also be destruction of the bone with pieces of the infected bone separating from the healthy bone. When this occurs, surgery to remove the bone fragments may be necessary.
Vertebral osteomyelitis is characterized by chronic back pain not relieved by ordinary treatment such as bed rest, heat or pain relievers. There may be fever, localized tenderness, pain, muscle spasms and limited movement. This form of osteomyelitis usually affects people over 50 years of age, and is usually caused by a previous injury, urinary tract infection, inflammation of the lining of the heart (endocarditis) or drug addiction. (For more information on this disorder, choose “Endocarditis” as your search term in the Rare Disease Database.)
Anaerobic osteomyelitis often affects the lower jawbone (mandible), skull or feet. It is characterized by ulceration and swelling, foul smelling drainage and redness of the affected area.
Osteomyelitis due to vascular insufficiency is more common in people with diabetes mellitus or vascular diseases that affect the extremities, especially the toes and small bones of the feet. 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. This type of osteomyelitis is difficult to treat because of the underlying vascular disorder that can impair the therapeutic effect of antibiotic treatment. (For more information on the above disorder, choose “Diabetes” as your search term in the Rare Disease Database.)
Osteomyelitis is an infection frequently caused by Staphylococcus bacteria. In some cases the cause is unknown, but the infection is usually transmitted through the bloodstream from one area of the body to another. In descending order of frequency, the bacteria most often associated with this disorder are Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes. Bone may be made more vulnerable to infection by recent trauma.
Risk factors include recent trauma, diabetes, hemodialysis, intravenous drug abuse, and having had one’s spleen removed.
Osteomyelitis is a prevalent condition that affects males and females in equal numbers. It is usually more common in children and adults after the age of 50. Hemodialysis patients, drug addicts and those with diabetes are also more susceptible to this infection.
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.
After the infectious organism has been identified, osteomyelitis is usually treated with massive doses of the appropriate antibiotic. Treatment with intravenous delivery of antibiotics is not uncommon even though some of the newer antibiotics are effective when administered orally. The antibiotic treatment may last for several days or for a week or two. Depending on the extent of the infection, it may be necessary to drain and clean the infected area surgically and then continue treatment with antibiotic therapy. In some cases, a bone graft may be necessary.
It is most important that diabetics and those with vascular disorders be treated as quickly as possible for suspected osteomyelitis. If left untreated, this disorder can result in destruction of the bone and surrounding tissue and may lead to amputation of the affected toes or foot. Other treatment is symptomatic and supportive.
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