What is osteomyelitis?

Osteomyelitis is infection in the bone. Osteomyelitis can occur in infants,children, and adults. Different types of bacteria typically affect the different age groups. In children, osteomyelitis most commonly occurs at the ends of the long bones of the arms and legs, affecting the hips, knees, shoulders, and wrists. In adults, it is more common in the bones of the spine (vertebrae) or in the pelvis.

What causes osteomyelitis?
There are several different ways to develop osteomyelitis. The first is for bacteria to travel through the bloodstream (bacteremia) and spread to the bone, causing an infection. This most often occurs when the patient has an infection elsewhere in the body, such as pneumonia or a urinary tract infection, that spreads through the blood to the bone. An open wound over a bone can lead to osteomyelitis. An open fracturewhere the bone punctures through the skin is also a potential cause. A recent surgery or injection around a bone can also expose the bone to bacteria and lead to osteomyelitis. Patients with conditions or taking medications that weaken their immune system are at a higher risk of developing osteomyelitis. These include patients with cancer, chronic steroid use, sickle cell disease, human immunodeficiency virus (HIV), diabetes, hemodialysis, intravenous drug users, and the elderly.

What are the symptoms and signs of osteomyelitis?
Symptoms of osteomyelitis can vary greatly. In children, osteomyelitis most often occurs more quickly. They develop pain or tenderness over the affected bone, and they may have difficulty or inability to use the affected limb or to bear weight or walk due to severe pain. In adults, the symptoms often develop more gradually. Other symptoms include fever,chills, irritability, swelling or redness over the affected bone, stiffness, and nausea.

How is osteomyelitis diagnosed?
The diagnosis of osteomyelitis begins with a complete medical history and physical examination. During the medical history, the doctor may ask questions about recent infections elsewhere in the body, past medical history, medication usage, and family medical history. The physical examination will look for areas of tenderness, redness, swelling, decreased or painful range of motion, and open sores. Your doctor may then order various tests to help diagnose osteomyelitis. Several blood tests can be used to help determine if you have an infection in your body. These include a complete blood count (CBC), the erythrocytesedimentation rate (ESR), C-reactive protein (CRP), and blood cultures. None of these is specific for osteomyelitis but rather they can suggest that there may be some infection in the body.

bone scans. . this may need to be opened. and the culture of this can indicate the best choice for antibiotic treatment. the affected area will be immobilized with a brace to reduce the pain and speed the treatment. or tendons next to the bone. What is the prognosis for osteomyelitis? With early diagnosis and appropriate treatment. Osteomyelitis can occur in any age group. These can include plain radiographs (Xrays). muscles. splinting. If bone needs to be removed. the prognosis for osteomyelitis is good. or surgery. surgery may be necessary. Sometimes. If there is an area of localized bacteria (abscess). patients can make a full recovery without longstanding complications. this may need to be removed. washed out. a biopsy of the bone may be obtained to help determine precisely which bacteria are involved. A delay in diagnosis or treatment of osteomyelitis can lead to permanent deficits. If there is damaged soft tissue or bone. Commonly. These imaging studies can help identify changes in the bones that occur with osteomyelitis. In some cases. Treatment of osteomyelitis can include antibiotics.Imaging studies may be obtained of the involved bones. it may need to be replaced with bone graft or stabilized during surgery. What is the treatment for osteomyelitis? In many cases. The infection that causes osteomyelitis can also start in another part of the body and spread to the bone through the blood. there can be severe damage to the bone or surrounding soft tissues that can lead to permanent deficits. If there is a long delay in diagnosis or treatment. Osteomyelitis At A Glance y y y y Osteomyelitis is infection of bone. y y Infection may spread to a bone from infected skin. and drained. osteomyelitis can be effectively treated with antibiotics and pain medications. Bone infection can be caused by bacteria (more common) or fungi (less common). computed tomography (CT) scans. this can help guide the choice of the best antibiotic. If a biopsy is obtained. and ultrasounds. as in osteomyelitis that occurs under a chronic skin ulcer (sore).magnetic resonance imaging (MRIs). After an area of bone is identified with possible osteomyelitis.

redness. and legs Exams and Tests A physical examination shows bone tenderness and possibly swelling and redness. Symptoms y y y y Bone pain Fever General discomfort. In children. the long bones are usually affected. or ill-feeling (malaise) Local swelling. and warmth Other symptoms that may occur with this disease: y y y y Chills Excessive sweating Low back pain Swelling of the ankles. and the hips (pelvis) are most commonly affected. spine bones (vertebrae). uneasiness. especially if the surgery is done after an injury or if metal rods or plates are placed in the bone.y 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. In adults. feet. Tests may include: y y y y y y y y y 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 . Risk factors are: y y y y y Diabetes Hemodialysis Injected drug use Poor blood supply Recent trauma People who have had their spleen removed are also at higher risk for osteomyelitis. the feet.

A new prosthesis may be implanted in the same operation. Other complications include: y y y Need for amputation Reduced limb or joint function Spread of infection to surrounding tissues or the bloodstream When to Contact a Medical Professional Call your health care provider if . Infection of an orthopedic prosthesis. pus is produced in the bone. which may result in an abscess. they may need to be removed. even with surgery. it will need to be well controlled. If there are problems with blood supply to the infected area. in part. Surgery may be needed to remove dead bone tissue if you have an infection that does not go away. More often. Antibiotics are given to destroy the bacteria causing the infection. Often. The lost blood supply can result in a complication called chronic osteomyelitis. The open space left by the removed bone tissue may be filled with bone graft or packing material that promotes the growth of new bone tissue. meaning through a vein) rather than by mouth. sometimes longer. The outlook is worse for those with long-term (chronic) osteomyelitis. If you have diabetes. Amputation may be needed. surgery to improve blood flow may be needed. If there are metal plates near the infection. The abscess steals the bone's blood supply. on: y y y The patient's health The type of infection Whether the infected prosthesis can be safely removed Possible Complications When the bone is infected. doctors wait to implant the prosthesis until the infection has gone away. such as the foot. the outcome for acute osteomyelitis is usually good. This chronic infection can cause symptoms that come and go for years. the antibiotics are given through an IV (intravenously. Antibiotics are taken for at least 4 .Treatment The goal of treatment is to get rid of the infection and reduce damage to the bone and surrounding tissues. may need surgery to remove the prosthesis and infected tissue around the area. The outlook for those with an infection of an orthopedic prosthesis depends. such as an artificial joint. You may receive more than one antibiotic at a time.6 weeks. especially in those with diabetes or poor blood circulation. Outlook (Prognosis) With treatment.

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.y y You develop symptoms of osteomyelitis You have osteomyelitis and the symptoms continue despite treatment Prevention Prompt and complete treatment of infections is helpful. .

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