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Ailmemts & Remedies

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

*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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News on Health & Science

The New Bone Cement

New Bone Cement to Prevent Dangerous Injury Infections:-

…..
Osteomyelitis (OM) is a dangerous bacterial bone infection that often occurs in patients with open fractures. So it is not surprising that injured American soldiers serving in Afghanistan and Iraq have been getting OM, with an end result sometimes being a limb amputation. Now researchers from the Center for Musculoskeletal Research in Rochester with help from the Department of Orthopedics at Aarhus University Hospital in Denmark, Infectious Disease Service at Brooke Army Medical Center in San Antonio, and Heraeus Medical GmbH, created a new colistin-infused bone cement that is showing itself to be effective against the variety of bacterial pathogens that cause OM. Interestingly, Stryker already has a bone cement that features colistin, a product called Simplex P with Erythromycin & Colistin.

From a press statement by the University of Rochester Medical Center:
Not common in the United States and not potentially fatal, A. baumannii OM had been largely ignored until recently by physicians and the pharmaceutical industry, which focuses on life-threatening infections that affect millions, not hundreds. Then military outbreaks of the infection started among American soldiers returning from Iraq in 2003, with the number of A. baumannii OM infections seen in field hospitals, and in stateside facilities receiving injured soldiers, growing. At the same time, data began to emerge from hospitals treating soldiers suggesting that easily contracted A. baumannii may be arriving first at the fracture site and “priming” it so that it becomes more vulnerable to methicillin-resistant Staphylococcus aureus (MRSA), which recently surpassed HIV as the most deadly pathogen in the United States despite nearly universal use of the best available antibiotics.
“If you apply the findings from two small studies to the entire U.S. military, which is a leap, perhaps 2,000 soldiers come into field hospitals with compound fractures each year that become infected with A. baumannii,” said Edward Schwarz, Ph.D., professor of Orthopaedics within the Center for Musculoskeletal Research at the University of Rochester Medical Center. “About a third of them go on to get a staph infection after they reach the hospital, with about a third of those, perhaps 200 soldiers, suffering infectious complications that could cost them a limb. Studies already underway in our lab seek to clarify how the initial infections could gradually be replaced by catastrophic MRSA, and to prove that we can save limbs by putting an established antibiotic into bone cement for the first time.”

Approaches commonly used to overcome MDR [multi-drug resistant] infections after orthopaedic injuries include applying a large dose of antibiotic locally to the site of infection via bone cement. Bone cements composed of Plexiglas (polymethyl methacrylate or PMMA) have been used for decades for plastic surgery, to anchor in bone prostheses and to fill in holes in bone caused by trauma. Such materials became even more useful when researchers realized decades ago that they could load them with antibiotics to deliver large doses of drug directly to the injury site without subjecting the whole body to toxic levels of antibiotic. While bone cements laced antibiotics against staph and strep infections are common (e.g. vancomycin), no group had ever developed a bone cement treatment using colistin against A. baumannii.

Schwarz and colleagues developed a group of mice infected with drug resistant A. baumannii strains isolated directly from soldiers wounded in Iran and Afghanistan. The mice were then treated with either colistin by injection, local colistin via PMMA bead bone cement or a bone cement control with no drug.

Researchers measured the amount of bacteria in the mice as they responded to treatment with a new test of parC gene activity, a gene known to be present only in A. baumannii. Experiments confirmed that all study mice were infected with the bacteria, and that 75 percent of the strains were resistant to multiple antibiotics. Importantly, the bone cement containing colistin significantly reduced the infection rate such that only 29.2 percent of mice had detectable levels of parC after 19 days (p<0.05 vs. i.m. colistin and placebo). Colistin via injection failed to control the infection and was no better than placebo.

You may click to see:->

Press release: New Bone Cement May Prevent Amputations

Flashback: Rapid-Sequencing the Superbug

Sources:http://www.medgadget.com/archives/2009/01/new_bone_cement_to_prevent_dangerous_battle_injury_infections.html

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