Osteomyelitis: Symptoms, Causes & Treatment!

Osteomyelitis is an infectious condition of the bone, affecting the arms, feet, hips, legs & spine.

The condition is usually more common in children but can occur in adults too.

CLASSIFICATION OF OSTEOMYELITIS

  • Suppurative osteomyelitis
    • Acute suppurative osteomyelitis
    • Chronic suppurative osteomyelitis
      • Primary (no preceding phase)
      • Secondary (follows an acute phase)
  • Non-suppurative osteomyelitis
    • Diffuse sclerosing
    • Focal sclerosing (condensing osteitis, inflammatory condition that arises from reaction to dental related infection)
    • Proliferative periostitis (periostitis ossificans)
    • Osteoradionecrosis, serious complication of radiation therapy.

SIGNS & SYMPTOMS

  • Pain in the bone
  • Inflammation of the bone
  • Tenderness, redness & warmth in the localized infected area.
  • Swelling around the bone
  • Back pain/especially in the night
  • Gradual or sudden onset of fever.
  • Fatigue & irritability
  • Nausea
  • Enlarged lymph nodes
  • Limited range of motion

COMPLICATIONS ARISING FROM OSTEOMYELITIS

  • Arthritis in children
  • Sepsis
  • Garre’s sclerosing osteomyelitis
  • Sclerosis, hardening of the tissue surrounding the bone.
  • Amputation & removal of infected bone in severe cases.

CAUSES

  • The infection most commonly occurs in children younger than 4 years old.
  • Bacteria that cause the infection are;
  • S Aureus
  • Enterobacteria
  • Haemophilus influenzae
  • Group A Streptococcus
  • Salmonella in people that have sickle cell anemia
  • Pseudomonas
  • E.Coli
  • Also some fungi that can infect the bones.

RISK FACTORS

  • Compromised host resistance
  • Intravenous drug abuse
  • Infected teeth that have undergone root canal surgery.
  • Drugs like immunosuppressive drugs that can weaken the immune system.
  • Long term use of steroids.
  • Sickle Cell Anemia
  • Diabetes
  • Tuberculosis
  • HIV or AIDS
  • Rheumatoid Arthritis
  • Alcoholism
  • Hemodialysis
  • Poor blood supply to the bones
  • Trauma or fracture of the bones.
  • Prior removal of the spleen.

DIAGNOSIS

  1. Laboratory marker tests that detect high WBC count & fever, although imaging tests along with it are also necessary for confirmation.
  2. CT scans can show the superficial damage to the bones in advanced osteomyelitis.
  3. MRI scans done show the damage to the cortical structure of the bone & bone marrow, similarly the presence of edema/fluid accumulation is also detected.
  4. For patients that may have metal implants and cannot undergo MRI, a contrast medium can be injected for imaging.
  5. Nuclear medicine procedures that utilize Gallium for contrasting are useful for effective diagnosis of the damage & infection to the bone.
  6. Culture or biopsy of the bone are also taken by sampling methods for distinguishing between the different pathogens that cause osteomyelitis.

TREATMENT & MANAGEMENT FOR OSTEOMYELITIS

  • Antibiotic therapy for weeks or even months.
  • Long term IV administration of medicine through a catheter.
  • Hyperbaric oxygen therapy in patients with refractory osteomyelitis.
  • In severe conditions, surgery is performed to removed dead tissue & amputation of the infected bone & joints.
  • Calcium supplements
  • Prevention is by treating deep wounds, disinfecting them, use of antibiotics & covering them.