Osteomyelitis

Definition:
Osteomyelitis (osteo- derived from the Greek word osteon, meaning bone, myelo- meaning marrow, and -itis meaning inflammation) simply means an infection of the bone or bone marrow. It can be usefully subclassified on the basis of the causative organism (pyogenic bacteria or mycobacteria), the route, duration and anatomic location of the infection.

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It is  is an acute or chronic bone infection and the same can reach a bone by traveling through the bloodstream or spreading from nearby tissue. Osteomyelitis can also begin in the bone itself if an injury exposes the bone to germs.

In children, osteomyelitis most commonly affects the long bones of the legs and upper arm, while adults are more likely to develop osteomyelitis in the bones that make up the spine (vertebrae). People who have diabetes may develop osteomyelitis in their feet if they have foot ulcers.

Once considered an incurable condition, osteomyelitis can be successfully treated today. Most people require surgery to remove parts of the bone that have died — followed by strong antibiotics, often delivered intravenously, typically for at least six weeks.

Symptoms:
Signs and symptoms of osteomyelitis include:

*Fever or chills

*Bone pain

*General discomfort, uneasiness, or ill-feeling (malaise)

*Local swelling, redness, and warmth

*Irritability or lethargy in young children

*Pain in the area of the infection

*Swelling, warmth and redness over the area of the infection

*Excessive sweating

*Low back pain

Sometimes osteomyelitis causes no signs and symptoms or has signs and symptoms that are difficult to distinguish from other problems.

Causes:
Most cases of osteomyelitis are caused by staphylococcus bacteria (more common) or fungi (less common), a type of germ commonly found on the skin or in the nose of even healthy individuals.

*Infection may spread to a bone from infected skin, muscles, or tendons next to the bone, as in osteomyelitis that occurs under a chronic skin ulcer (sore).

*The infection that causes osteomyelitis can also start in another part of the body and spread to the bone through the blood.

*A current or past injury may have made the affected bone more likely to develop the infection. A bone infection can also start after bone surgery, especially if the surgery is done after an injury or if metal rods or plates are placed in the bone.

In children, the long bones are usually affected. In adults, the feet, spine bones (vertebrae), and the hips (pelvis) are most commonly affected.

Risk Factors
*Diabetes

*Hemodialysis

*Injected drug use

*Poor blood supply

*Recent trauma

People who have had their spleen removed are also at higher risk for osteomyelitis.

Complications:
When the bone is infected, pus is produced in the bone, which may result in an abscess. The abscess steals the bone’s blood supply. The lost blood supply can result in a complication called chronic osteomyelitis. This chronic infection can cause symptoms that come and go for years.

Other complications include:
*Need for amputation

*Reduced limb or joint function

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*Spread of infection to surrounding tissues or the bloodstream

*Septic arthritis. In some cases, infection within bones can spread into a nearby joint

*Impaired growth. In children, the most common location for osteomyelitis is in the softer areas, called growth plates, at either end of the long bones of the arms and legs. Normal growth may be interrupted in infected bones.

*Skin cancer. If your osteomyelitis has resulted in an open sore that is draining pus, the surrounding skin is at higher risk of developing squamous cell cancer.

Diagnosis:
A physical examination shows bone tenderness and possibly swelling and redness.

Tests may include:

*Blood cultures

*Bone biopsy (which is then cultured)

*Bone scan

*Bone x-ray

*Complete blood count (CBC)

*C-reactive protein (CRP)

*Erythrocyte sedimentation rate (ESR)

*MRI of the bone

*Needle aspiration of the area around affected bones

Treatment:
Osteomyelitis often requires prolonged antibiotic therapy, with a course lasting a matter of weeks or months. A PICC line or central venous catheter is often placed for this purpose. Osteomyelitis also may require surgical debridement. Severe cases may lead to the loss of a limb. Initial first-line antibiotic choice is determined by the patient’s history and regional differences in common infective organisms. A treatment lasting 42 days is practiced in a number of facilities.  Local and sustained availability of drugs have proven to be more effective in achieving prophylactic and therapeutic outcomes.

In 1875, American artist Thomas Eakins depicted a surgical procedure for osteomyelitis at Jefferson Medical College, in a famous oil painting titled The Gross Clinic.

Prior to the widespread availability and use of antibiotics, blow fly larvae were sometimes deliberately introduced to the wounds to feed on the infected material, effectively scouring them clean.

Hyperbaric oxygen therapy has been shown to be a useful adjunct to the treatment of refractory osteomyelitis.

Open surgery is needed for chronic osteomyelitis, whereby the involucrum is opened and the sequestrum is removed or sometimes saucerization  can be done

Prognosis
With treatment, the outcome for acute osteomyelitis is usually good.

The outlook is worse for those with long-term (chronic) osteomyelitis, even with surgery. Amputation may be needed, especially in those with diabetes or poor blood circulation.

The outlook for those with an infection of an orthopedic prosthesis depends, in part, on:

*The patient’s health

*The type of infection

*Whether the infected prosthesis can be safely removed

Prevention:
Prompt and complete treatment of infections is helpful. People who are at high risk or who have a compromised immune system should see a health care provider promptly if they have signs of an infection anywhere in the body.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000437.htm
http://en.wikipedia.org/wiki/Osteomyelitis
http://www.bbc.co.uk/health/physical_health/conditions/osteomyelitis2.shtml
http://www.mayoclinic.com/health/osteomyelitis/DS00759
http://www.medicalook.com/Joint_pain/Osteomyelitis.html
http://www.orthopediatrics.com/docs/Guides/back_pain.html

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