What is osteomyelitis?

Osteomyelitis is a bone or bone marrow infection that causes inflammation. It can develop if a bacterial or fungal infection from the circulation reaches the bone tissue as a result of an accident or surgery.

An open wound is responsible for around 80% of occurrences. Deep pain and muscular spasms in the inflammatory region, as well as a fever, are common symptoms.

Bone infections are most frequent in the long bones of the leg and upper arm, as well as the spine and pelvis. Osteomyelitis used to be difficult to cure, but now, with vigorous therapy, it may be possible to salvage the diseased bone and stop the infection from spreading.

In the United States, osteomyelitis is expected to affect 2 out of every 10,000 individuals at some point. In this article, we cover the treatment, symptoms, causes, and more.

Causes

When a bacterial or fungal infection develops within a bone or enters the bone from another part of the body, osteomyelitis develops.

bone infection
A bone infection can cause pain, redness, and swelling.

The immune system will strive to destroy an infection that has developed inside the bone. To eliminate the bacteria or fungus, neutrophils, a kind of white blood cell, will be sent to the source of the infection.

If the infection is not treated, dead neutrophils will build up inside the bone, causing an abscess (a pus-filled pocket).

The abscess might cut off blood flow to the affected bone. The bone may perish as a result of persistent osteomyelitis.

Infection is typically resistant to bones, although infection can penetrate a bone under specific circumstances.

An infection in the bloodstream, consequences from trauma or surgery, or pre-existing disorders like diabetes all lower a person’s capacity to fight infection.

How can bone infections begin?

Bone infections can manifest themselves in a variety of ways.

The infection in hematogenous osteomyelitis may begin as a minor upper respiratory or urinary tract infection and spread via the circulation. Children are more likely to have this kind.

After a complex fracture, a shattered bone that breaches the skin, an open wound to the surrounding skin and muscle, or surgery, especially if metal pins, screws, or plates are used to stabilize damaged bones, post-traumatic osteomyelitis can develop.

A slight scratch or cut on the feet can lead to infection due to vascular insufficiency, or inadequate blood circulation. White blood cells are unable to reach the ulcer site due to poor circulation, resulting in deep ulcers. Infection can spread to the bone and deep tissue as a result of these procedures.

Vertebral osteomyelitis is a kind of osteomyelitis that affects the spine. An infection in the circulation, a urinary or respiratory tract infection, endocarditis (infection of the inner lining of the heart), or an infection in the mouth or at an injection site are the most common causes.

Osteomyelitis of the jaw

Caries or periodontal disease can cause osteomyelitis of the jaw, which is extremely painful. Because the teeth provide a direct entrance route for infection, the jawbone is uncommon.

The risk of osteomyelitis of the jaw is increased by cancer, radiation treatment, osteoporosis, and Paget’s disease.

An infection of the sinuses, gums, or teeth can spread to the skull.

Symptoms and signs

The symptoms and indications of osteomyelitis differ depending on the kind.

Among the most frequent are:

  • Drainage from an open wound near the infection site or through the skin
  • Fever, chills, and sweating
  • Irritability, lethargy, or fatigue
  • Pain, which can be severe, and swelling, redness, and tenderness in the affected area

Swelling of the ankles, feet, and legs, as well as alterations in walking pattern, such as a limp, are possible signs.

Chronic osteomyelitis symptoms aren’t always clear, and they might be mistaken for those of an injury.

This can make proper diagnosis more challenging, particularly in the hip, pelvis, or spine.

Children and adults with osteomyelitis

Osteomyelitis is frequently acute in children, and it emerges within two weeks of a pre-existing blood infection. Hematogenous osteomyelitis is a kind of osteomyelitis caused by methicillin-resistant Staphylococcus aureus (S. aureus) (MRSA).

Diagnosis might be challenging, but it’s critical to receive one as soon as possible because waiting too long can result in growth problems or deformity. It has the potential to be deadly.

Adults are more likely to develop subacute or chronic osteomyelitis, especially following an accident or trauma, such as a fractured bone. Contiguous osteomyelitis is the medical term for this condition. Adults over the age of 50 are most commonly affected.

Treatment

The kind of osteomyelitis determines the treatment.

Acute osteomyelitis

Within two weeks of an accident, initial infection, or the onset of an underlying condition, infection occurs in acute osteomyelitis. The agony can be excruciating, and the disease can be fatal.

Antibiotics or antifungal medications are usually successful. This is generally a 4- to 6-week treatment of intravenous or oral antibiotics or antifungals for adults. Some individuals require inpatient therapy, while others may be able to get injections as an outpatient or at home if they are capable of injecting themselves.

Antibiotics can cause diarrhea, vomiting, and nausea as adverse effects. There is a possibility of an allergic response.

If the infection is caused by MRSA or another drug-resistant bacteria, the patient may require a prolonged treatment period and a variety of treatments.

Hyperbaric oxygen treatment (HBOT) may be advised in specific circumstances.

Sub-acute osteomyelitis

Within 1–2 months of an injury, initial infection, or the onset of an underlying condition, infection develops in subacute osteomyelitis.

Treatment is determined on the severity of the condition and whether or not there is any bone damage.

If there is no bone injury, therapy is identical to acute osteomyelitis; however, if there is bone damage, treatment is comparable to chronic osteomyelitis.

Chronic osteomyelitis

In chronic osteomyelitis, infection begins at least two months after an accident, an initial infection, or the onset of an underlying condition.

Antibiotics and surgery are typically required to treat any bone damage.

The following procedures may be performed during surgery:

  • Draining: The surgeon may need to open up the region around the affected bone to drain any pus or fluid that has grown up in reaction to the infection.
  • Debridement:To ensure that all contaminated regions are gone, the surgeon removes as much diseased bone as possible while leaving a small margin of good bone. Any infected tissue in the vicinity may also need to be removed.
  • Restoring blood flow to the bone: Debridement may leave an empty region that must be replaced with bone tissue, skin, or muscle from another section of the body. Until the patient is well enough for a bone or tissue graft, temporary fillers might be employed. The graft aids in the healing of damaged blood arteries and the formation of new bone.
  • Removal of foreign objects: Foreign items, such as surgical plates or screws, that were implanted during earlier surgery may be removed if necessary.
  • Stabilizing the affected bone: To support the damaged bone and the new graft, metal plates, rods, or screws may be placed into the bone. This can be done at a later stage. External fixators are occasionally utilized to stabilize the damaged bone.

If the patient is unable to withstand surgery due to sickness, the doctor may prescribe antibiotics for a longer period of time, potentially years, to suppress the infection. If the infection continues, the affected limb may need to be amputated whole or partially.

Complications

In most cases, the infection may be treated successfully, although problems might ensue.

Chronic osteomyelitis may appear to be gone for a while before reappearing, or it may be unnoticed for years. This can result in the death of bone tissue and the collapse of the bone.

People with difficult-to-treat illnesses, such as severe diabetes, HIV, poor circulation, or a damaged immune system, are especially at more risk.

Risk factors

Osteomyelitis is more common in certain people than in others.

People who are at a higher risk may experience the following symptoms:

  • Bone replacement or repair surgery
  • A severe puncture wound or a skin-breaking fracture
  • Chemotherapy or radiation therapy, malnutrition, dialysis, a urinary catheter, injecting illicit drugs, and so on all impair the immune system.
  • Diabetes, peripheral arterial disease, or sickle cell disease can all cause circulatory problems.

Acute osteomyelitis is more prevalent in youngsters, whereas spinal osteomyelitis is more common in people over 50 years old and in men.

Diagnosis

The doctor will look for indicators of osteomyelitis, such as soreness and swelling, in the afflicted body area. They’ll inquire about any recent medical history, particularly any recent accidents, surgeries, or infections.

Tests may include:

  • Imaging tests: An x-ray, MRI, or CT scan can reveal any bone damage.
  • Blood tests: High levels of white blood cells usually indicate infection.
  • Biopsy: The physician takes a small piece of tissue to test which type of pathogen – bacteria or fungi – is causing bone infection. This helps find a suitable treatment.

If the accident is recent, more comprehensive MRI or CT scans are advised since the damage may not be seen on an X-ray for up to two weeks.

Preventive tips

Patients with a compromised immune system should avoid using antibiotics.

Cleaning and dressing an open wound
Infection can be avoided by cleaning and treating an open wound.
  • Smoking impairs the immune system and contributes to impaired circulation, therefore avoid it.
  • Maintain appropriate hygiene, which includes adequate handwashing on a regular basis.
  • Have all of the shots that are advised
  • To strengthen the immune system, eat a well-balanced, nutritious diet and exercise regularly

Patients with weak circulation should do the following:

  • Improve your circulation by exercising on a regular basis.
  • Avoid drinking too much alcohol on a regular basis since it increases the risk of hypertension (high blood pressure) and high cholesterol.
  • Follow a nutritious diet to maintain a healthy body weight.
  • Smoking is bad for your circulation, so avoid it.

People who are sensitive to infections should avoid wounds and scrapes at all costs. Any wounds or scrapes should be cleansed right once and covered with a clean dressing.

Wounds should be checked for symptoms of infection on a regular basis.

Sources

  • http://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/infections-of-joints-and-bones/osteomyelitis
  • https://rarediseases.org/rare-diseases/osteomyelitis/
  • https://www.medicalnewstoday.com/articles/178819
  • http://www.hopkinsmedicine.org/healthlibrary/conditions/bone_disorders/osteomyelitis_bone_infection_134,150/
  • http://www.nhs.uk/conditions/Osteomyelitis/Pages/Introduction.aspx
  • http://www.nhs.uk/Conditions/Osteomyelitis/Pages/Symptoms.aspx
  • http://www.nhs.uk/Conditions/Osteomyelitis/Pages/Diagnosis.aspx
  • http://www.nhs.uk/Conditions/Osteomyelitis/Pages/Prevention.aspx
  • http://www.nhs.uk/Conditions/Osteomyelitis/Pages/Treatment.aspx
  • https://www.researchgate.net/figure/47520718_fig2_Figure-4-Axial-cone-beam-CT-slice-through-the-mandible-multiple-dehiscences-of-the-left
  • http://www.bmj.com/content/348/bmj.g66