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Osteomyelitis
Osteomyelitismeansaninfectionofbone,whichcaneitherbeacute(ofrecentonset)orchronic (longstanding).Bacteriaaretheusualinfectiousagents.Thetwolikelyaccessmethodsareby primaryinfectionofthebloodstream(includingsecondaryinfectionviathebloodfollowingan infectionsomewhereelseinthebody),andawoundorinjurythatpermitsbacteriatodirectly reachthebone.Inadults,thepelvisandthespinalvertebraearemostvulnerable,whilebone infectionsinchildrentendtotargetthelongbonesofthearmsandlegs.Withouttreatment,the infectionandinflammationblockbloodvessels.Thelackofoxygenandnutrientscausethebone tissuetodie,whichleadstochronicosteomyelitis.Otherpossiblecomplicationsincludeblood poisoningandboneabscesses.Treatmentoptionsincludeintravenousandoralantibiotics,and surgicaldrainingandcleaningoftheaffectedbonetissue.

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Symptoms
Thesymptomsofosteomyelitisinclude: Localisedbonepain Reducedmovementoftheaffectedbodypart Theoverlyingskinmaybered,hotandswollen Theoverlyingskinmaycontainpus Spasmsofassociatedmuscles Unexplainedweightloss Generalmalaise Hightemperature Excessivesweating Chills.

Events that can cause osteomyelitis

Bonesareinfectedbyblood-bornemicro-organisms.Inmostcases,themicro-organismsare bacteriasuchasStaphylococcus aureus,butfungicanalsocauseosteomyelitis.Someofthe conditionsandeventsthatcanleadtoosteomyelitisinclude: Bacteriaintroducedduringbonesurgery. Bacteriaintroducedbytraumatobone. Infectionofbonefractures. Infectionofprostheticimplants(suchasanartificialhipjoint). Infectionselsewhereinthebodythatreachthebonesviathebloodstream. Aprimaryinfectionoftheblood(septicaemia).

Risk factors
Someoftheriskfactorsthatmayincreaseapersonssusceptibilitytoosteomyelitisinclude: Longtermskininfections. Inadequatelycontrolleddiabetes. Poorbloodcirculation(arteriosclerosis). Riskfactorsforpoorbloodcirculation,whichincludehighbloodpressure,cigarette smoking,highbloodcholesterolanddiabetes. Immunesystemdeficiency. Prostheticjoints. Theuseofintravenousdrugs.

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Sicklecellanaemia. Cancer.

Acute osteomyelitis
Themaincategoriesofacuteosteomyelitisinclude: Haematogenous osteomyelitis-primaryinfectionofthebloodorinfectionfrom somewhereelseinthebodyisdeliveredtotheboneviathebloodstream.Childrenareat increasedrisk.Thebacteriaaredrawntoareasofrichbloodsupply,whichiswhythe infectiontendstotargetthegrowingpartsattheendsofthelongbones. Direct inoculation osteomyelitis-bacteriaaredelivereddirecttothebonetissuevia surgeryortrauma.

Chronic osteomyelitis
Anacuteattackofosteomyelitiscanleadtochronicosteomyelitis,characterisedbydeadareasof bone.Thisconditioncanfailtorespondtotreatmentandrecurforalongtime.Inmanycases, chronicosteomyelitisispolymicrobial,whichmeansmorethanoneinfectiousagentisinvolved.

Complications
Someofthecomplicationsofosteomyelitisinclude: Boneabscess(pocketofpus) Bonenecrosis(bonedeath) Spreadofinfection Inflammationofsofttissue(cellulitis) Bloodpoisoning(septicaemia) Chronicinfectionthatdoesntrespondwelltotreatment.

Diagnosis methods
Osteomyelitisisdiagnosedusinganumberoftestsincluding: Physicalexamination Medicalhistory Bloodtests X-rays Bonescan Computedtomography(CT)scan Magneticresonanceimaging(MRI) Bonetissuebiopsy.

Treatment methods
Treatmentforosteomyelitisdependsontheseveritybutmayinclude: Hospitalisationandintravenousantibiotics. Alongterm(fourtosixweeksormore)courseofantibiotics,eitheroralorintravenous. Pain-killingmedication. Lifestylechanges,suchasquittingcigarettestoimprovebloodcirculation. Treatmentforunderlyingcause,suchasdiabetes. Replacementoftheinfectedprostheticpart,ifneeded. Surgerytocleanandflushouttheinfectedbone(debridement). Skingrafts,ifnecessary. Amputation,inseverecases.

Long term outlook

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Acuteosteomyelitisiseasiertotreatthanchronicosteomyelitis.Theearlierthediagnosisandstart oftreatment,thebettertheoutlook.Ifdeadanddiseasedtissueneedstobesurgicallyremoved, theboneregeneratesinamatterofweeks.Preventionofacuteosteomyelitisincludesproper managementofwounds,andpromptmedicalattentionforinfections.

Where to get help

Yourdoctor

Things to remember
Osteomyelitismeansaninfectionofbone,whichcaneitherbeacuteorchronic. Bacteriaarethemostcommoninfectiousagents. Thetwolikelyaccessmethodsincludeprimarybloodinfectionorsecondaryinfection followinganinfectionsomewhereelseinthebody,andawoundorinjurythatpermits bacteriatoreachthebone. Treatmentoptionsincludeantibioticsandsurgerytocleanandflushouttheinfectedbone (debridement).

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NorthEastValleyDivisionofGeneralPractice
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Osteomyelitis

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