Osteomyelitis

Definition
Osteomyelitis is an infection of the bone, a rare but serious condition.
Bones can become infected in a number of ways: Infection in one part
of the body may spread through the bloodstream into the bone, or an
open fracture or surgery may expose the bone to infection.
Epidemiology
• Approximately 20% of adult cases of osteomyelitis are hematogenous,
which is more common in males for unknown reasons.
• The incidence of spinal osteomyelitis was estimated to be 1 in
450,000 in 2001. In subsequent years, however, the overall incidence
of vertebral osteomyelitis is believed to have increased as a
consequence of intravenous drug use, increasing age of the
population, and higher rates of nosocomial infection due to
intravascular devices and other instrumentation. The overall
incidence of osteomyelitis is higher in developing countries.
Etiology
• In most cases, a bacteria called Staphylococcus aureus, a type of
staph bacteria, causes osteomyelitis. Certain chronic conditions like
diabetes may increase your risk for osteomyelitis.
Pathophysiology
Bone is normally resistant to infection. However, when microorganisms
are introduced into bone hematogenously from surrounding structures
or from direct inoculation related to surgery or trauma, osteomyelitis
can occur. Bone infection may result from the treatment of trauma,
which allows pathogens to enter bone and proliferate in the
traumatized tissue. When bone infection persists for months, the
resulting infection is referred to as chronic osteomyelitis and may be
polymicrobial. Although all bones are subject to infection, the lower
extremity is most commonly involved.
Some important factors in the pathogenesis of osteomyelitis include
the virulence of the infecting organism, underlying disease, immune
status of the host, and the type, location, and vascularity of the bone.
Bacteria may possess various factors that may contribute to the
development of osteomyelitis. For example, factors promoted by S
aureus may promote bacterial adherence, resistance to host defense
mechanism, and proteolytic activity.
• Hematogenous osteomyelitis
• Contiguous-focus and posttraumatic osteomyelitis
• Vertebral osteomyelitis
• Osteomyelitis in children
Symptoms
Acute osteomyelitis develops rapidly over a period of seven to 10 days.
The symptoms for acute and chronic osteomyelitis are very similar and
include:
• Fever, irritability, fatigue
• Nausea
• Tenderness, redness, and warmth in the area of the infection
• Swelling around the affected bone
• Lost range of motion
• Osteomyelitis in the vertebrae makes itself known through severe
back pain, especially at night.
Diagnosis
Figuring out if a person has osteomyelitis is the first step in treatment. It's also
surprisingly difficult. Doctors rely on X-rays, blood tests, MRI, and bone scans to
get a picture of what's going on. A bone biopsy is necessary to confirm a
diagnosis of osteomyelitis. This also helps determine the type of organism,
typically bacteria, causing the infection so the right medication can be
prescribed. Such as
• Computerized tomography (CT) scan. A CT scan combines X-ray images taken from
many different angles, creating detailed cross-sectional views of a person's internal
structures.
• Magnetic resonance imaging (MRI). Using radio waves and a strong magnetic field,
MRI scans can produce exceptionally detailed images of bones and the soft tissues
that surround them.
• Blood tests : Blood tests may reveal elevated levels of white blood cells and other
factors that may indicate that your body is fighting an infection. If your
osteomyelitis was caused by an infection in the blood, tests may reveal what
germs are to blame. No blood test exists that tells your doctor whether you do or
do not have osteomyelitis. However, blood tests do give clues that your doctor
uses to decide what further tests and procedures you may need.
• Imaging tests : X-rays. X-rays can reveal damage to your bone. However, damage
may not be visible until osteomyelitis has been present for several weeks. More-
detailed imaging tests may be necessary if your osteomyelitis has developed
more recently.
• Bone biopsy : A bone biopsy is the gold standard for diagnosing osteomyelitis,
because it can also reveal what particular type of germ has infected your bone.
Knowing the type of germ allows your doctor to choose an antibiotic that works
particularly well for that type of infection. An open biopsy requires anesthesia
and surgery to access the bone. In some situations, a surgeon inserts a long
needle through your skin and into your bone to take a biopsy. This procedure
requires local anesthetics to numb the area where the needle is inserted. X-ray or
other imaging scans may be used for guidance.
Treatment
• Treatment focuses on stopping infection in its tracks and preserving
as much function as possible. Most people with osteomyelitis are
treated with antibiotics, surgery, or both.
• Antibiotics help bring the infection under control and often make it
possible to avoid surgery. People with osteomyelitis usually get
antibiotics for several weeks through an IV, and then switch to a pill
form.
• More serious or chronic osteomyelitis requires surgery to remove the
infected tissue and bone. Osteomyelitis surgery prevents the infection
from spreading further or getting so bad that amputation is the only
remaining option.
Prognosis
• Inadequate therapy may lead to relapsing infection and progression
to chronic infection. Because of the relative avascularity of bone,
chronic osteomyelitis is curable only with radical resection or
amputation. These chronic infections may recur as acute
exacerbations, which can be suppressed by debridement followed by
parenteral and oral antimicrobial therapy. Rare complications of bone
infection include pathologic fractures, secondary amyloidosis, and
squamous cell carcinoma at the sinus tract cutaneous orifice.