What Is Osteomyelitis?
Bacteria and fungi travel through the bloodstream or from the adjacent tissues infecting the bone and causing a condition known as osteomyelitis. In some cases where the bone is exposed to microorganisms due to an injury, the infection can begin in the bone itself.
Initially, osteomyelitis was thought to be incurable. However, through recent developments, osteomyelitis can be treated successfully. The majority of the patients require surgery to remove the dead bone associated with osteomyelitis. The surgery is followed by intravenous administration of antibiotics.
Who Is More Prone to Develop Osteomyelitis?
Osteomyelitis shows equal predilection among all age groups and genders. The population that is at the highest risk of developing osteomyelitis are those who smoke, infants and elderly, and chronically ill patients, like those with diabetes or kidney failure. Diabetic patients often develop osteomyelitis through the non-healing foot ulcers that they may develop. The condition more commonly affects long bones in children and the spine in adults.
Other people associated with a risk for osteomyelitis are:
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People with prosthetic joints like those who have undergone a hip replacement and those with metal implants.
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Those with infections of the blood or hematological conditions like sickle cell anemia.
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Those with pressure injuries like bedsores.
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Those who had recent trauma and an associated fracture or surgery.
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Those with weakened immune systems.
What Are the Types of Osteomyelitis?
The different types of osteomyelitis include:
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Acute Osteomyelitis: The onset of this form is sudden and may be associated with fever and pain that develops in the infected region a few days later.
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Chronic Osteomyelitis: The symptoms of chronic osteomyelitis do not recede easily with treatment. The patient presents with chronic bone pain and recurring drainage of pus. In rare circumstances, a patient with chronic osteomyelitis does not show symptoms where the infection cannot be undetected for months or even years.
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Vertebral Osteomyelitis: This particular type of osteomyelitis affects the spine causing chronic back pain that gets worse on movement. This condition mostly develops in people who have the habit of drug abuse and those on dialysis.
What Are the Causes of Osteomyelitis?
Osteomyelitis occurs when bacteria from an infected tissue or an open wound enter the blood circulation and reach and multiply in the bone. The most commonly associated bacteria with osteomyelitis is Staphylococcus aureus. Other organisms like fungi or other microorganisms causing a bone infection may be associated as well.
What Are the Symptoms of Osteomyelitis?
The symptoms and signs of osteomyelitis vary from person to person, depending on the type of presentation and the causative agent. A few patients do not show any signs or symptoms. Patients can present with symptoms of pain, redness, warmth, inflammation, and tenderness to touch.
Other signs of osteomyelitis include:
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Drainage of yellow-colored pus.
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Irritability or lethargy.
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Fever.
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Loss of appetite.
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Nausea and vomiting.
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Limited and painful movement.
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Sweating or chills.
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Lower back pain.
How Is Osteomyelitis Diagnosed?
Once the symptoms are assessed and the physical examination is performed, the diagnosis is made with the help of the following tests:
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Blood Tests: Blood tests like complete blood count (CBC) and blood culture are performed. A CBC detects the signs of inflammation and infection like erythrocyte sedimentation rate (ESR) and the count of different blood cells. A blood culture aims to detect a particular species of bacteria in the bloodstream.
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Radiographic Tests: Different radiographic modalities may be used. The bone generally shows an inflamed bone marrow area with a combination of dead and newly formed bone giving rise to a typical “onion peel appearance.”
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Biopsy: A needle biopsy can be used to obtain samples of the infected tissue, bone, or fluid to confirm the diagnosis further.
What Are the Complications of Osteomyelitis?
Complications associated with osteomyelitis can include:
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Formation of Abscess: In people with chronic osteomyelitis, the infection can spread from the bones to muscles and soft tissue, leading to the formation of an abscess. People with chronic osteomyelitis are more likely to have recurring abscesses. Treatment to drain these abscesses may slightly increase the risk of skin cancer.
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Death of Bone: The inflammation associated with the infection reduces the blood supply to the bone leading to the death of bone tissues.
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Stunted Growth: If osteomyelitis occurs in the long bones of children, it can lead to stunting of growth.
What Is the Treatment of Osteomyelitis?
Treatment options include:
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Antibiotics: Antibiotic therapy destroys the bacteria that cause osteomyelitis. The medications need to be taken for four to eight weeks, and in incase of intravenous (IV) antibiotics, they might need to be taken for one to two weeks. Depending on the severity of the disease, the treatment duration is deduced. Chronic infections may require treatment for weeks, if not months.
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Antifungals: If the infection has a fungal etiology, then the patient might be required to take antifungal medication over a few days or months to cure the condition.
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Needle Aspiration: A needle aspiration may be prescribed to drain the infectious fluid or pus from the abscess.
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Analgesics: Pain relievers like nonsteroidal anti-inflammatory drugs (NSAIDs), may be prescribed to treat the pain and inflammation.
Surgery is considered in advanced cases when medications do not work.
The surgical treatments are:
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Bone Surgery: During this process, the dead bone is removed, but it may result in the formation of bone deformities.
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Spine Surgery: Patients with osteomyelitis of the spine may require surgery of the spine. This surgery protects the spinal cord by preventing the vertebral bones from damage and collapsing and thereby protecting the nerves as well.
Conclusion:
In osteomyelitis, the organism can infect the tissues due to an injury, frequent injections, surgery, or the use of a prosthesis. The infection of bone due to osteomyelitis can take a long time to heal. However, if the symptoms are noticed early and the treatment is commenced, the symptoms recede much earlier. The prognosis of the disease is good with early treatment as well. Chronic osteomyelitis and untreated osteomyelitis have the ability to damage muscles, bones, and tissues permanently. The majority of patients with osteomyelitis recover on prompt treatment.