Osteomyelitis – Bad to the Bone

Osteomyelitis is a bone infection produced by bacteria. There are many causes of this infection, which is usually treated with antibiotics and in severe cases it may require surgery. The most common culprit of osteomyelitis is the action of pyogenic bacteria, a specific type of microbe that produces pus. However, it can also be caused by tuberculosis bacillus or even fungi. Bones are normally resistant to infections. However, microorganisms can penetrate the bone through blood or a penetrating wound.

There are two types of osteomyelitis: acute and chronic.

Acute Osteomyelitis

It develops in less than two weeks. The main cause of acute osteomyelitis is the spread of an infection via the blood from another organ (or due to surgery) and into the bone marrow. The origin of the initial infection is not always known.

This type of osteomyelitis occurs mainly in people under 15 years of age and/or older than 50 and in patients with chronic diseases such as cirrhosis or diabetes. It can also be associated with the use of injected drugs.

The symptoms of acute osteomyelitis can vary greatly. These depend more on how severe or acute the infection is, the microorganism responsible and the location of the affected bones. It will also depend on the pre-existing diseases that the patient already has. The most common symptoms are: swelling, limitation of movement of the affected area and intense pain. Cellulitis, an inflammation of the subcutaneous cellular tissue and skin, may also be associated with osteomyelitis. Other less common symptoms might also include fever in conjunction with chills, general discomfort and weight loss.

It is very important to diagnose acute osteomyelitis in a timely manner, this because with proper antibiotic treatment bone necrosis can be avoided and the disease can be avoided to becomes chronic. Some of the exams that your physician or specialist may include are:

-Blood cultures: is a test on the laboratory to check for bacteria or other microorganisms in the blood.

-Bone biopsy: is an exam in which a piece of bone is removed and studied.

-Bone scintigraphy: an imaging test used to diagnose bone diseases.

X-ray of the bones: it is an image examination on the bones.

Complete blood count (CBC): measures the number of red blood cells, white blood cells, the total amount of hemoglobin in the blood and the hematocrit.

Chronic Osteomyelitis

It generally develops in more than four weeks or doesn’t respond to antibiotic treatment, making it a long-term issue. If this is the case, surgery would be the most recommended solution. This type of osteomyelitis is mainly suffered by adults and occurs in tandem with: injuries (especially open fractures), surgical interventions and peripheral vascular pathologies (diabetic foot). Microorganisms that cause this infection are gram positive bacteria such as streptococcus, Staphylococcus aureus and Clostridium botulinum. Other potential risk factors of osteomyelitis are the presence of joint prostheses, pseudomonas, anaerobic bacteria present in bugs bites, open fractures with dirty wounds and ischemia.

Symptomatically, fever from chronic osteomyelitis may be low or even may not occur. Also, local symptoms such as pain, swelling and redness may be less visible at first. In some instances, fistulas may be formed in places where the purulent discharge is drained. Also, if the affected part is the spinal column, an epidural abscess may occur, resulting in compression of the spinal cord if the abscess grows large enough. In rare and more severe cases, the infection can spread to areas closed by the spine, forming what’s called a paravertebral abscess.

The treatment of osteomyelitis consists of halting and killing off the infection as well as reducing possible damage to the bone and adjacent tissues. For this, your physician or specialist may recommend antibiotics to eliminate the bacteria that is causing harm. Keep in mind that you can receive more than one antibiotic at a time. Antibiotics are usually taken for 4 to 6 weeks. At first, they are often administered intravenously, followed by being administered orally. This treatment may be sufficient in many cases of acute osteomyelitis but not all of course, it depends on the severity and other factors determined by the physician. However, in the case of chronic osteomyelitis, it may be necessary to opt for surgery since lots of damage may already be done.

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