Table of Contents
Blood tests could help locate signs of infection and identify the germ. The x-rays of the affected limb may be helpful if there is bone damage. However, in the very early stages there may be no abnormalities on x-rays as diagnostic method for osteomyelitis. In early osteomyelitis, intravenous antibiotic treatments alone may be effective enough. Even when the temperature and pain has settled, oral therapy should go on for 3 to 6 weeks. Once the infection is established, any pus in the bone may need drainage. This requires an operation under general anesthesia. After this, antibiotics will drip by infusion into a vein.
In more severe or chronic cases, an operation may be necessary to remove dead bone. This dead bone will commonly occur as a result either of the fracture or of the infection. The operation may require a bone graft from the hip to fill the cavity that was left, and the limb may have to rest in a plaster. In the early stages of osteomyelitis in children, the child will be hospitalized. The doctor should observe the child to ensure that the antibiotic treatment is effective and that the infection is adequately controlled. After discharge from hospital, recurrence of pain and any signs of swelling or redness in the limb should be reported to the doctor directly.
The patient must take the full course of antibiotics as prescribed, to prevent the infection returning. After surgical drainage of bone infection in either children or adults, you should watch the area of drainage for any change in the discharge from the wound or from holes close to the wound. Should this happen, contact your doctor immediately.
In the majority of children, after adequate treatment of osteomyelitis with antibiotics or surgery, the infection settles completely and does not recur. However, it is important to watch for any change in the affected limb or other limbs, and contact your doctor immediately if anything is noted. In chronic osteomyelitis, especially in adults after fractures, there may be a recurring discharge from the region of the damaged bone. Intervals of up to several years may separate each event. Redness and swelling near the old fracture will often settle quite quickly with antibiotic treatment if is recognized and treated early. However, you may still need operation if left untreated for too long.
Causes of osteomyelitis
Bones, which are usually well protected against infection, can become infected through three routes. First, through the bloodstream an infection from another part of the body can be carried into the bones. A direct invasion of infection is also possible, and finally, an infection from an adjacent bone or soft tissues can be carried over. Osteomyelitis usually occurs in the ends of leg and arm bones in children, and in the spine in adults. It happens particularly in older people.
Infections of the leg and arm bones and those of the vertebrae are usually acquired through the bloodstream. Infections of the vertebrae are referred to as vertebral osteomyelitis. People who undergo kidney dialysis and those who inject illegal drugs are particularly susceptible to vertebral osteomyelitis.
Bacteria or fungal spores may infect the bone directly through open fractures, during bone surgery, or from contaminated objects that pierce bone. Staphylococcus aureus is the bacteria most commonly responsible for osteomyelitis. Mycobacterium tuberculosis is one of the bacteria that cause tuberculosis that can infect the vertebrae and cause osteomyelitis. Moreover, bacteria or fungal spores may also infect the space around an artificial joint. The organisms will transmit into the area of bone surrounding the artificial joint during the operation, or the infection may occur later. Any artificial device in the body may serve as a focus for bone infection.
Osteomyelitis may also result from an infection in an adjacent soft tissue, and the infection spreads to the bone after several days or weeks. This type of spread is particularly likely to occur in older people, and such an infection may start in an area damaged by an injury, radiation therapy, or cancer, or in a skin ulcer. It could happen anywhere the skin has poor circulation. A sinus, gum, or tooth infection may spread to the skull and other bone infection as well.
Diagnosis, prevention and prognosis of bone infection
Symptoms and findings during a physical examination may suggest osteomyelitis, where doctors may suspect it in a person who has persistent bone pain with or without a fever, and feels tired much of the time. As with any other chronic infection, blood tests usually indicate elevated levels of white blood cells, an elevated erythrocyte sedimentation rate, and an elevated level of C-reactive protein. This protein circulates in the blood and dramatically increases in level at times of inflammation. An x-ray may also show changes suspicious of osteomyelitis, where the infected area always appears abnormal on bone scans.
However, these tests cannot always distinguish infections from some other bone disorders. To diagnose a bone infection and identify the organisms causing it, doctors may take samples of blood, pus, joint fluid, or the bone itself to test the patient. People who have artificial joints or metal components attached to a bone should take preventive antibiotics before surgery. This includes dental surgery as well, because these people have an increased risk of infection from bacteria normally found in the mouth and other parts of the body.
The prognosis for people with osteomyelitis is usually good with early and proper treatment but sometimes, chronic osteomyelitis develops, so bone abscess may recur weeks, months, or even years later. Usually neurologic signs are not present until late in the disease course when there can be destruction and collapse of the vertebral body during bone infection. Other symptoms variably present include chills, weight loss, dysuria, photophobia, and drainage from a wound or incision if there has been prior surgery.
The causative agent is usually Staphylococcus aureus, where long-term antibiotic therapy is required. It lasts up to six weeks of intravenous antibiotics sometimes followed by oral antibiotics for another six-week period. With a common variety of the problem called vertebral osteomyelitis, surgery may be indicated, particularly when ongoing vertebral destruction is identified. Although rare, the doctor should also consider typical diseases such as tuberculosis of the spine when faced with spinal infections.