- Human skin serves as the body's first defense against the outside world. When there is a break in the skin, such as a cut or an open sore, bacteria and other organisms can enter the body and cause infections of the skin, muscles, and bones. Osteomyelitis (OM) can also occur when an infection from another part of the body travels through the blood stream and invades the bones. OM can occur suddenly (acute) or be present for a long time (chronic).
- Varies with the bone involved
- Acute OM:
- High Fever if acute OM (> 102 degrees Fahrenheit or
40 degrees Celsius)
- In children and infants, one can see irritability,
poor appetite, malaise, or loss of movement.
- Chills, sweating, nausea, vomiting, and Diarrhea
- Pain, redness, and swelling over the bone is
- Diabetics may have little or no pain.
- Pain -- back pain may actually be OM of the
vertebrae of the spine.
- A low-grade fever
- Non-healing wounds, bedsores, or ulcers may be
- There may be an open canal from the bone to the skin
that drains pus (yellowish discharge).
- There is pain when walking if the bones of the feet
- There may be localized swelling, redness, and pain
over a site where an artificial device (hip, etc.) was
- Staphylococcus aureus is the most common cause of OM.
- Mycobacterium Tuberculosis
- Mixed infections with multiple bacterias can
- Haemophilus influenzae in children less than 3 years
- Group B Streptococcus and coliforms in neonates
- Neisseria gonorrhoeae in sexually active
- Difficult to diagnose without tests
- Test includes:
- Blood is taken from the veins in the arm, and sent for a complete count of red and white blood cells, Blood cultures (find bacteria in the blood), ESR and CRP, and full chemical panel.
- Cultures of urine, and any pus or open wounds are also sent, but not reliable, since they may be contaminated.
- Best test for diagnosing OM is done in the hospital where an orthopedic surgeon (bone surgeon) uses a needle or a sharp surgical knife to remove a very tiny piece of the infected bone (bone biopsy), then sends it to the laboratory where the exact type of the bacteria can be identified in 48-72 hours (some bacteria such as mycoplasma may take weeks).
- X-rays of the infected bones can be done, but are not too helpful in diagnosing OM.
- Bone scan -- done by injecting a radioactive substance into the blood, which is carried to the infected bone. An X-ray is then taken. This is better than a simple X-ray, and can rule out cancer lesions as well.
- A CAT scan or MRI are images that can provide a
detailed picture of the bones without the need for an
injection of dye, but are much more expensive than plain
x-rays, and are not available everywhere.
- Newborns who have undergone
procedures such as heel punctures and fetal scalp monitoring
- Sickle cell anemia -- blood supply
to the bone is compromised and the bone is susceptible to
- Diabetes Mellitus --
diabetes causes sensory nerve damage (Neuropathy), which
results in numbness of the skin (feet and hands etc.). A cut
in the skin is often missed until it is infected. Neuropathy
comes from other causes of nerve damage, such as multiple
sclerosis or vasculitis.
- Local Trauma -- cuts,
erosions, wounds, and pressure sores (decubiti) from lying
in bed or sitting in a wheel chair for a long time
(elderly as in nursing home).
- Drug abuse -- intravenous heroin or
- Poor circulation -- from smoking or
diseased arteries as with atherosclerotic vascular disease.
- Dialysis -- in patients with kidney
failure, the blood is filtered of waste and water.
Infections can occur during the procedure.
- Open Fractures
- Prosthetic implants an artificial
knee or hip
It should be noted that when the body's immune system breaks down as in AIDS, cancer, cancer
therapy, and diabetes, or if the bone is damaged from any
other cause, there is a greater risk of developing all types
of infections including OM.
- Acute cases of OM where the patients is in pain and very sick, require immediate hospitalization and antibiotic therapy.
- The patient is put on bed rest and given medications for pain (Tylenol, Motrin, codeine) and fever (Tylenol).
- Fluids are given orally or through an IV (a plastic cannula placed inside a vein).
- A high protein diet is recommended.
- Vitamins and minerals tablets can be helpful
- Diabetics and patients with heart, kidney, or liver disease need a special diet.
- Antibiotics are given for 4-6 weeks, and in chronic OM, may be given as pills for up to six months.
- An infectious disease specialist and orthopedic specialist are consulted.
- An infected wound or bed sore may need to be cleaned to remove the infected tissues.
- An abscess (a closed sac of infection) may need to be drained
- In cases where there is no response to antibiotics, the infected Prostheses (artificial joint) or the limb may need to be removed or amputated.
- After any surgery, the patient will need long term nursing care and physical therapy.
- Patients in whom the infection is not so severe, can be discharged home after the first few days of antibiotic treatment and receive IV's at home (where they are monitored by a home nurse).
- One should quit smoking, stop abusing drugs, and if diabetic (or other illnesses), eat and live healthy.
- The children (or parents of children) with skin numbness due to diseases (diabetes, neuropathy, vascular disorders etc.) should inspect their skin (feet, buttocks, back) on a regular basis.
If your child has a fever and pain in the bones, or any other symptoms mentioned, get him/her immediate medical attention and do not delay treatment.
- Aseptic bone infarction -- the circulation to the bone may be compromised but not infected.
- Gout and other types of arthritis
- Infections of the blood (septicemia) or skin.
- Neuropathic joint disease -- the nerves to the joint if damaged by disease over time can lead to joint or bone destruction.
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