Post by Aileen Norgell, MD
OsteomyelitisOsteomyelitis is an infection of a bone. Symptoms incorporate pain and tenderness over the affected area of bone, and feeling unwell. It is a serious infection which requirements prompt treatment with antibiotics. Surgery is normally required if the infection becomes severe or persistent.
What is osteomyelitis?
Osteomyelitis is an infection of a bone. Several distinct varieties of bacteria can cause osteomyelitis. Nonetheless, infection with a bacterium called Staph. aureus is the most frequent cause. Infection with a fungus is a rare trigger.
How do you get osteomyelitis?
If some bacteria settle on a little section of bone, they can multiply and cause infection. Bacteria can get to bone:
* Via the bloodstream. This is the widespread cause in young children. Bacteria occasionally get into the blood from an infection in an additional part of the body and then travel to a bone. Even if you are healthy, bacteria can at times get into the blood from the nose or bowel (gut). * Following an injury. Bacteria can spread to bone if you have a deep cut on the skin. In particular, if you have a broken bone which you can see via the cut skin.
Who is at risk of creating osteomyelitis?
Anybody at any age can develop osteomyelitis. Even so, you have an increased risk if you:
* Have recently fractured (broken) a bone. * Have a bone prosthesis (such as an artificial hip, a screw in a bone following surgery, and so on). * Have recently had surgery to a bone. * Have a poor immune system. For example, if you have AIDS if you are taking chemotherapy if you are seriously ill with an additional disease etc. * Inject street drugs which can be contaminated with bacteria. * Have had a prior episode of osteomyelitis. * Have certain varieties of blood disorders. For example, sickle cell illness. * Have reduced skin sensation. This can lead to harm and infection of the skin which can spread to the blood or to nearby bone. For example, some men and women with diabetes have decreased sensation in their feet. * Have normal kidney dialysis.
Which bones can be affected?
The lengthy bones of the leg (femur, tibia and fibula) are the most generally affected. Even so, osteomyelitis can impact any bone (even though it is quite rare in some bones).
What are the symptoms of osteomyelitis?
* Discomfort and tenderness over an region of bone. * A lump may develop over a bone which is generally extremely tender. * Redness of overlying skin may possibly then develop. * Feeling usually unwell with fever (high temperature) is widespread as the infection develops.
If osteomyelitis develops following a fracture to a bone then the symptoms include increasing redness, swelling, and pain around the fracture web site. Pus could come out from a skin wound over a fracture.
Are any tests necessary?
Tests to confirm the diagnosisIf you have typical symptoms coming from an infection of a leg bone then the diagnosis might be fairly clear. Even so, discomfort coming from 'deeper' bones such as the spine or pelvis can be due to a number of causes. A scan of the bone will help to confirm the diagnosis. (A plain x-ray is not so valuable in the early stages of osteomyelitis as an x-ray can be normal for up to a week or so right after the infection starts.)
Tests to find which bacterium is causing the infectionThe blood frequently contains some bacteria from the bone infection. Samples of blood are sent to the 'lab' to identify which type of bacterium is causing the infection. This is important as it will support to decide which is the best treatment. (Some bacteria are 'resistant' to some antibiotics.)
If the blood tests do not show any bacteria, then a biopsy (small sample) of the affected bone is required to send to the lab.
What is the outlook (prognosis)
If the infection is treated promptly, then there is a excellent opportunity of a complete cure. (In the days prior to antibiotics, osteomyelitis was a really serious illness which at times caused death, and typically caused severe disability.)
Achievable complications are listed below. As a rule, there is more risk of creating complications if the infection develops soon after a serious bone injury, or soon after surgery to a bone.
* If the infection is left untreated, an abscess (ball of pus) might develop in the bone and surrounding tissue. In time, this may burst onto the skin and leave a track (sinus) between the infected bone and surface of the skin. * Blood infection (septicaemia) which can trigger severe illness. * If the infection follows a bone fracture, then there is a chance that the fracture will not heal ('non-union of fracture'). * Compression of other structures next to the infection. * Some bone infections are caused by a bacterium referred to as MRSA (Methicillin Resistant Staph. Aureus) which is difficult to clear with antibiotics. * Persistent infection of the bone ('chronic osteomyelitis') often develops which can be tough to clear.
When you have had one episode of osteomyelitis, your risk of a recurrence is higher than average. Consequently, if you have had a prior episode of osteomyelitis, see a physician speedily if you develop the symptoms described above.
What is the treatment for osteomyelitis?
AntibioticsAn antibiotic is generally started as soon as probable. The initial antibiotic chosen is 1 that is likely to kill the bacteria which commonly causes osteomyelitis. Nevertheless, the antibiotic is often changed to a diverse 1 when the results of the tests confirm which bacterium is causing the infection. (Some bacteria are resistant to some antibiotics.)
The symptoms may possibly settle fairly rapidly right after you commence taking an antibiotic. Even so, you will need to continue taking the antibiotic for a number of weeks. This is to make sure all infection has gone from the bone.
SurgeryYou will normally require an operation if:
* An abscess develops. The pus in an abscess wants to be drained. * The infection presses on other important structures. For example, an infection in the spine may possibly press on the spinal cord. * The infection has turn out to be 'chronic' (persistent) and some bone has been destroyed. Dead and infected bone may possibly want to be removed to allow the infection to clear. At times plastic surgery is needed at the same time to cover any wound to give the greatest opportunity of cure.
Rarely, amputation of a foot or leg is required if infection persists in a leg bone and does not clear with any other treatment.
Hyperbaric oxygenThis may be regarded as if the infection does not clear. It entails going into a chamber where the pressure of oxygen you breathe is higher than regular. This raises the quantity of oxygen in your blood which assists in numerous conditions. Some evidence suggests that surgery and antibiotics combined with hyperbaric oxygen could assist in instances of persistent (chronic) osteomyelitis that have not been helped by surgery and antibiotics alone. Further study is needed to clarify this.
About the Author
Aileen Norgell is a Board Certified main care physician, practicing in Orlando, Florida
