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Bone Infection: Osteomyelitis

What is osteomyelitis?

A rare but serious condition, osteomyelitis refers to bone infection. Bone can become infected, either through spread of infection from one part of the body to the bone or through an open fracture that exposes bone.

In children, osteomyelitis most commonly occurs in the long bones of legs and upper arm, while adults generally develop osteomyelitis in the bones of the spinal vertebrae. Also, people with diabetes who have foot ulcers can develop osteomyelitis in their feet.

Osteomyelitis was earlier considered an untreatable condition; today it has a successful treatment plan.

What are the causes of the disorder?

As mentioned above, osteomyelitis develops when bones develop an infection. Infection may occur in two ways:

  1. Result of injury (Contiguous osteomyelitis) like during surgery, or from an animal bite or fractured bone; more common in adults.
  2. Through the bloodstream (haematogenous osteomyelitis), which is more common in children. Conditions that affect the blood supply to certain parts of the body (diabetes) or weaken immune system (rheumatoid arthritis) increase the chances of developing osteomyelitis.

The disorder can lead to a chronic form of osteomyelitis if it is not treated quickly because bones become permanently damaged, causing loss of function and persistent pain.

What one needs to know about symptoms or signs?

Symptoms include:

  1. High fever
  2. Bone pain
  3. Swelling, redness and warm sensation in the area

Though bones in the legs are most commonly affected, other bones like those of the arms or back can also be affected.

Which specialist should be consulted in case of signs and symptoms?

People experiencing symptoms similar to those of osteomyelitis should consult an orthopaedic surgeon or a doctor who specializes in infectious diseases.

What are the screening tests and investigations done to confirm or rule out the disorder?

Diagnosis comprises tests to confirm osteomyelitis and also identifying the germ causing the infection. It is done through:

  1. Blood tests – Blood tests cannot confirm osteomyelitis but can check for higher-than-normal levels of white blood cells and other factors that indicate infection, and also reveal the type of germs if the infection is in blood.
  2. Imaging tests – X-rays can detect any damage to the bone though this can be visible if osteomyelitis has been present for several weeks. Computerised tomography (CT) scans and magnetic resonance imaging (MRI) are more detailed tests that look at the bone and surrounding soft tissues for abnormalities.
  3. Bone biopsy – This is by far the most confirmatory test for osteomyelitis as it can specify the type of organism responsible for the condition. This is useful in determining the antibiotic to be prescribed for treatment. An open biopsy is conducted under anaesthesia and surgery to reach the bone. Alternatively, biopsy sample may be taken by inserting a long needle through the skin, using x-rays or other imaging scans to guide through the process.

What treatment modalities are available for management of the disorder?

Common treatment options include antibiotics and surgery to remove portions of the bone that are infected or dead.

  1. Medications – The right antibiotic to be prescribed is determined through the results of the bone biopsy. The antibiotics are injected through the vein in the arm, and the treatment may last for four to six weeks. More serious infections may require a supplemental course of oral antibiotics. Side effects of antibiotics include nausea, vomiting and diarrhoea.
  2. Surgery – In severe cases, surgery may be required. The following procedures may be followed:
  3. Draining the infected area – The area around the infected bone is opened up and fluid or pus accumulated within id drained out.
  4. Removal of the diseased bone and tissue (Debridement) – The surgeon removes the diseased bone part along with a small part of healthy bone and surrounding tissue as a precautionary measure to eliminate all traces of infection.
  5. Restoration of blood flow to bone – The empty space left due to the removal of bone is filled with a piece of bone or tissue like the skin or muscle from another part of the body. Alternatively, temporary fillers are placed in the area till a separate graft is placed.
  6. Amputation of the limb – If the infection cannot be contained, the affected limb may need to be amputated.
  7. Hyperbaric oxygen therapy – Very difficult-to-treatcases of osteomyelitis are given hyperbaric therapy in which excess oxygen is delivered to the bone using a pressure chamber. This is done to promote healing.

What are the known complications in management of the disorder?

Complications during treatment may include:

  1. People with underlying conditions like diabetes (which increases the risk of osteomyelitis) run the risk of recurrent infections.
  2. Amputation of the affected limb may become necessary if the blood supply to the area is severely reduced.

What precautions or steps are necessary to stay healthy and happy during the treatment?

The following measures can ensure that the patient receives the best possible treatment:

  1. Patient must discuss his/her medical history or any current health conditions like diabetes with the doctor. For example, people with diabetes must monitor the feet closely and should contact their doctor at the first signs of infection.
  2. Early treatment of osteomyelitis prevents the condition from becoming chronic. Further, it also ensures better pain management and reduces the risk of recurrent infections.

How can the disorder be prevented from happening or recurring?

Though it is not always possible to prevent osteomyelitis, a person can reduce his/her risk of contracting the infection by

  1. Cleaning all wounds thoroughly and dressing them in clean bandages.
  2. Maintaining good health for a strong immune system.

 

Sources:

 

“Osteomyelitis,” Medline Plus, NLM, NIH, https://www.nlm.nih.gov/medlineplus/ency/article/000437.htm

“Osteomyelitis,” WebMD.com, https://www.webmd.com/pain-management/osteomyeltis-treatment-diagnosis-symptoms

“Osteomyelitis,” MayoClinic.com, Mayo Clinic Staff, https://www.mayoclinic.org/diseases-conditions/osteomyelitis/basics/treatment/con-20025518

“Osteomyelitis,” NHS.uk, https://www.nhs.uk/conditions/osteomyelitis/Pages/Introduction.aspx