Infectious Costochondritis - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Costochondritis can lead to inflammation of the cartilage that connects the ribs to the sternum, an area known as the costosternal junction. It leads to sharp chest pain, particularly during moving or breathing. It generally gets better with time. The main cause of costochondritis usually includes unknown factors or trauma. However, sometimes, it occurs due to an infection known as infectious costochondritis. This condition arises from bacterial or viral infections affecting the cartilage, leading to distinct symptoms requiring specialized treatment.

What Are the Causes of Infectious Costochondritis?

Infectious costochondritis is typically triggered by an infection that infiltrates the cartilage of the costosternal junction. The most common culprits include bacteria such as Staphylococcus aureus and Streptococcus species, as well as viruses like Herpes zoster. These pathogens can gain access to the cartilage through various means, including open wounds, surgical procedures, or hematogenous spread, where the infection travels through the bloodstream.

What Are the Triggers or Risk Factors of Infectious Osteochondritis?

The exact reason behind the occurrence of costochondritis is still unknown. Certain studies suggest that small, repeated stress on ribs over time (microtraumas) can eventually lead to costochondritis. Microtraumas might include:

• Injuries in the chest or ribs.

• Excessive coughing or vomiting.

• Infections in the chest.

• Intense physical activity without any rest and recovery.

Anyone can develop costochondritis; however, some individuals have a higher risk:

• Athletes playing contact sports.

• People with physically demanding jobs.

What Are the Symptoms and Clinical Presentation of Infectious Osteochondritis?

The symptoms of infectious costochondritis are similar to those of non-infectious costochondritis, but with the added complexity of an underlying infection. Individuals with this condition may experience:

• Localized Chest Pain: Continuous sharp pain at the costosternal or costovertebral junction is a hallmark symptom. The pain may worsen with movement or palpation.

• Swelling and Tenderness: Swelling and tenderness over the affected area are common, often accompanied by warmth and redness.

• Fever and Malaise: The presence of an infection leads to systemic symptoms, such as fever and a general feeling of unwellness.

• Pain With Breathing or Coughing: The act of breathing deeply or coughing can exacerbate the pain, making it a distinguishing feature from other chest wall conditions.

How Is Infectious Costochondritis Diagnosed?

Diagnosis of a chest wall infection is generally initiated with a physical exam and a review of the patient’s medical history and symptoms. Laboratory tests, including blood cultures, can identify the causative bacteria or virus. Imaging studies such as chest X-rays or CT scans can be performed to rule out other potential causes and to assess the extent of cartilage involvement.

Imaging diagnostic tests such as chest X-rays help examine the body's soft tissue and bones to identify inflammation in the chest wall. These images are also helpful in diagnosing other related conditions, like pneumonia. Blood tests can also be done to check if bacterial or viral infection is causing the condition.

How Is Infectious Costochondritis Managed?

Costochondritis is generally a short-term issue. Most individuals experience symptoms anywhere from a few days to a few weeks. It is rare; however, costochondritis can last for several months. Most patients start to gradually feel better with rest and over-the-counter pain medications. Consult the healthcare provider if the rib pain does not get better in a few weeks after the treatment of costochondritis is initiated. There is a chance that costochondritis comes back (recurs) even after it heals.

The management of infectious costochondritis requires a comprehensive approach, combining antimicrobial therapy and supportive care.

• Antibiotics or Antiviral Medications: The specific choice of antibiotics or antiviral medications depends on the identified pathogen. Staphylococcus aureus and Streptococcus species are commonly treated with antibiotics, while antiviral medications are used for viral infections.

• Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and reduce inflammation. In some cases, stronger medications for pain might be prescribed.

• Rest and Avoidance of Aggravating Factors: Rest is crucial for the healing process. Patients are often advised to avoid activities that worsen the pain, such as strenuous exercise or heavy lifting.

• Heat or Cold Therapy: The application of heat or cold to the affected area can provide symptomatic relief. Heat packs can help relax the muscles, while cold packs can reduce inflammation.

• Physical Therapy: In some cases, physical therapy may be recommended to improve posture, strengthen muscles, and enhance overall chest wall function.

What Are the Prognosis and Complications Involved in Infectious Costochondritis?

With appropriate and timely treatment, infectious costochondritis can be resolved successfully. However, if left untreated or if the underlying infection is not adequately controlled, complications can arise. These can include the spread of infection to surrounding structures, the development of abscesses, or chronic pain and disability.

How Is Infectious Costochondritis Can Be Prevention?

Preventing infectious costochondritis involves minimizing the risk of infections that could affect the cartilage. This includes practicing good hygiene, promptly treating wounds and infections, and following proper surgical and medical procedures to reduce the risk of complications.

The chest wall, called the thoracic wall, helps to protect the heart, lungs, liver, and other important organs. The wall is made up of the sternum, ribs, and cartilage. Together, all these form a protective cavity within the abdomen. The chest wall can be infected by bacteria or viruses. In very rare cases, fungal infections might happen. Infections of the chest wall can lead to inflammation and pain in the affected area.

What Are the Other Chest Wall Infections?

The types of chest wall infections include:

• Pleurisy - Infection of the thin membranes or pleura of the chest wall.

• Empyema - Fluid that develops between the pleura and the inner lining of the chest wall.

• Costochondritis - Cartilage inflammation that connects the upper ribs to the sternum.

Conclusion

Infectious costochondritis is rare; however, it is a significant variant of the more common non-infectious form. Early diagnosis and proper treatment are essential for a favorable outcome. Individuals experiencing persistent chest pain, particularly when associated with fever or signs of infection, should seek medical attention promptly. While infectious costochondritis poses challenges, advancements in medical knowledge and effective treatment strategies contribute to better outcomes for those affected.