Osteomyelitis

Source: Wikipedia, the free encyclopedia.
Osteomyelitis
Other namesBone infection
Antimicrobials, surgery[4]
PrognosisLow risk of death with treatment[5]
Frequency2.4 per 100,000 per year[6]

Osteomyelitis (OM) is an

bone.[1] Symptoms may include pain in a specific bone with overlying redness, fever, and weakness.[1] The long bones of the arms and legs are most commonly involved in children e.g. the femur and humerus,[7] while the feet, spine, and hips are most commonly involved in adults.[2]

The cause is usually a

radiographs are unremarkable in the first few days following acute infection.[7][2] Diagnosis is further confirmed by blood tests, medical imaging, or bone biopsy.[2]

Treatment of bacterial osteomyelitis often involves both

antimicrobials and surgery.[7][4] In people with poor blood flow, amputation may be required.[2] Treatment of the relatively rare fungal osteomyelitis as mycetoma infection entails the use of antifungal medications.[9] In contrast to bacterial osteomyelitis, amputation or large bony resections is more common in neglected fungal osteomyelitis (mycetoma) where infections of the foot account for the majority of cases.[8][9] Treatment outcomes of bacterial osteomyelitis are generally good when the condition has only been present a short time.[7][2] About 2.4 per 100,000 people are affected each year.[6] The young and old are more commonly affected.[7][1] Males are more commonly affected than females.[3] The condition was described at least as early as the 300s BC by Hippocrates.[4] Prior to the availability of antibiotics, the risk of death was significant.[10]

Signs and symptoms

Symptoms may include pain in a specific bone with overlying redness,

Enlarged lymph nodes may be present.[11]
In fungal osteomyelitis, there is usually a history of walking bare-footed, especially in rural and farming areas. Contrary to the mode of infection in bacterial osteomyelitis, which is primarily
blood-borne, fungal osteomyelitis starts as a skin infection, then invades deeper tissues until it reaches bone.[8]

Cause

Age group Most common organisms
Newborns (younger than 4 mo) Staphylococcus aureus, Enterobacter species, and group A and B Streptococcus species
Children (aged 4 mo to 4 y) S. aureus, group A Streptococcus species, Haemophilus influenzae, and Enterobacter species
Children, adolescents (aged 4 y to adult) S. aureus (80%), group A Streptococcus species, H. influenzae, and Enterobacter species
Adult S. aureus and occasionally Enterobacter or Streptococcus species
Sickle cell anemia patients Salmonella species are most common in patients with sickle cell disease.[12]

In children, the

vertebrae and the pelvis are most commonly affected.[7]

Acute osteomyelitis almost invariably occurs in children who are otherwise healthy, because of rich blood supply to the growing bones. When adults are affected, it may be because of compromised host resistance due to debilitation,

immunosuppressive therapy).[7]

Osteomyelitis is a secondary

synovium (due to its higher oxygen concentration) before spreading to the adjacent bone.[13] In tubercular osteomyelitis, the long bones and vertebrae are the ones that tend to be affected.[13]

Staphylococcus aureus is the organism most commonly isolated from all forms of osteomyelitis.[13]

Osteomyelitis is often caused by Staphylococcus aureus.

enteric bacteria, are significant pathogens.[15]

The most common form of the disease in adults is caused by injury exposing the bone to local infection.

anaerobes and Gram-negative organisms, including Pseudomonas aeruginosa, E. coli, and Serratia marcescens, are also common. Mixed infections are the rule rather than the exception.[15]

Systemic

mycotic infections may also cause osteomyelitis. The two most common are Blastomyces dermatitidis and Coccidioides immitis.[citation needed
]

In osteomyelitis involving the vertebral bodies, about half the cases are due to S. aureus, and the other half are due to tuberculosis (spread hematogenously from the lungs). Tubercular osteomyelitis of the spine was so common before the initiation of effective antitubercular therapy, it acquired a special name, Pott's disease.[citation needed]

The Burkholderia cepacia complex has been implicated in vertebral osteomyelitis in intravenous drug users.[16]

Pathogenesis

In general, microorganisms may infect bone through one or more of three basic methods

The area usually affected when the infection is contracted through the bloodstream is the

sequestra, form the basis of a chronic infection.[13] Often, the body will try to create new bone around the area of necrosis. The resulting new bone is often called an involucrum.[13] On histologic examination, these areas of necrotic bone are the basis for distinguishing between acute osteomyelitis and chronic osteomyelitis. Osteomyelitis is an infective process that encompasses all of the bone (osseous) components, including the bone marrow. When it is chronic, it can lead to bone sclerosis and deformity.[citation needed
]

Chronic osteomyelitis may be due to the presence of intracellular bacteria.[19] Once intracellular, the bacteria are able to spread to adjacent bone cells.[20] At this point, the bacteria may be resistant to certain antibiotics.[21] These combined factors may explain the chronicity and difficult eradication of this disease, resulting in significant costs and disability, potentially leading to amputation. The presence of intracellular bacteria in chronic osteomyelitis is likely an unrecognized contributing factor in its persistence.[citation needed]

In infants, the infection can spread to a joint and cause

subperiosteal abscesses can form because the periosteum is loosely attached to the surface of the bone.[13]

Because of the particulars of their blood supply, the

sickle cell disease, the most common causative agent is Salmonella, with a relative incidence more than twice that of S. aureus.[12]

Diagnosis

Mycobacterium doricum osteomyelitis and soft tissue infection. Computed tomography scan of the right lower extremity of a 21-year-old patient, showing abscess formation adjacent to nonunion of a right femur fracture.
Extensive osteomyelitis of the forefoot
Osteomyelitis in both feet as seen on bone scan

The diagnosis of osteomyelitis is complex and relies on a combination of clinical suspicion and indirect laboratory markers such as a high white blood cell count and fever, although confirmation of clinical and laboratory suspicion with imaging is usually necessary.[23]

Radiographs and CT are the initial method of diagnosis, but are not sensitive and only moderately specific for the diagnosis. They can show the cortical destruction of advanced osteomyelitis, but can miss nascent or indolent diagnoses.[23]

Confirmation is most often by

sickle cell anemia.[25]

Nuclear medicine scans can be a helpful adjunct to MRI in patients who have metallic hardware that limits or prevents effective magnetic resonance. Generally a triple phase

Gallium scans are 100% sensitive for osteomyelitis but not specific, and may be helpful in patients with metallic prostheses. Combined WBC imaging with marrow studies has 90% accuracy in diagnosing osteomyelitis.[26]

Diagnosis of osteomyelitis is often based on

lytic center with a ring of sclerosis.[13] Culture of material taken from a bone biopsy is needed to identify the specific pathogen;[27] alternative sampling methods such as needle puncture or surface swabs are easier to perform, but cannot be trusted to produce reliable results.[28][29]

Factors that may commonly complicate osteomyelitis are fractures of the bone, amyloidosis, endocarditis, or sepsis.[13]

Classification

The definition of osteomyelitis (OM) is broad, and encompasses a wide variety of conditions. Traditionally, the length of time the infection has been present and whether there is

suppuration (pus formation) or osteosclerosis (pathological increased density of bone) are used to arbitrarily classify OM. Chronic OM is often defined as OM that has been present for more than one month. In reality, there are no distinct subtypes; instead, there is a spectrum of pathologic features that reflects a balance between the type and severity of the cause of the inflammation, the immune system, and local and systemic predisposing factors.[citation needed
]

OM can also be typed according to the area of the skeleton in which it is present. For example, osteomyelitis of the jaws is different in several respects from osteomyelitis present in a long bone. Vertebral osteomyelitis is another possible presentation.[citation needed]

Treatment

Osteomyelitis often requires prolonged

intravenous medication administration. Some studies of children with acute osteomyelitis report that antibiotic by mouth may be justified due to PICC-related complications.[30][31] It may require surgical debridement in severe cases, or even amputation. Antibiotics by mouth and by intravenous appear similar.[32][33]

Due to insufficient evidence it is unclear what the best antibiotic treatment is for osteomyelitis in people with sickle cell disease as of 2019.[34]

Initial first-line antibiotic choice is determined by the patient's history and regional differences in common infective organisms. A treatment lasting 42 days is practiced in a number of facilities.

Hyperbaric oxygen therapy has been shown to be a useful adjunct to the treatment of refractory osteomyelitis.[38]

Before the widespread availability and use of antibiotics, blow fly larvae were sometimes deliberately introduced to the wounds to feed on the infected material, effectively scouring them clean.[39][40]

There is tentative evidence that

randomized controlled trials, however, was not available as of 2015.[42]

Hemicorporectomy is performed in severe cases of Terminal Osteomyelitis in the Pelvis if further treatment won't stop the infection.[43]

History

The word is from Greek words ὀστέον osteon, meaning bone, μυελός myelos meaning marrow, and -ῖτις -itis meaning inflammation.

In 1875, American artist

Jefferson Medical College, in an oil painting titled The Gross Clinic.[44]

Canadian politician and premier of Saskatchewan Tommy Douglas suffered from osteomyelitis as a child, and in 1910, underwent several surgeries, which the surgeon performed for free in exchange for allowing his medical students to observe the procedures (which Douglas's parents could not have otherwise afforded). This experience convinced him that medical care should be free for everyone.[45] Douglas became known as the Canadian "Father of Medicare."[46]

Fossil record

Main article: Paleopathology

Evidence for osteomyelitis found in the fossil record is studied by

Allosaurus fragilis.[47] Osteomyelitis has been also associated with the first evidence of parasites in dinosaur bones.[48]

See also

References

  1. ^ a b c d e f g h i j k "Osteomyelitis". NORD (National Organization for Rare Disorders). 2005. Archived from the original on 11 February 2017. Retrieved 20 July 2017.
  2. ^ a b c d e f g h i j "Osteomyelitis". Genetic and Rare Diseases Information Center (GARD). 2016. Archived from the original on 9 February 2017. Retrieved 20 July 2017.
  3. ^
    ISBN 978-0-323-52957-0. Archived
    from the original on 2017-09-10.
  4. ^
    S2CID 257184257
    .
  5. ISBN 978-1-4557-4801-3. Archived
    from the original on 2017-09-10.
  6. ^
    ISBN 978-0-7020-6303-9. Archived
    from the original on 2017-09-10.
  7. ^
    PMID 34377550
    .
  8. ^
    PMID 26483983
    .
  9. ^
    PMID 28992217
    .
  10. ISBN 978-1-349-56632-7. Archived
    from the original on 2017-09-10.
  11. ISBN 978-0-19-508103-9
    .
  12. ^
    PMID 9445507
    .
  13. ^
    ISBN 978-1-4160-2973-1
  14. ^ a b "Osteomyelitis". Mayo Clinic. 8 November 2022. Retrieved 25 July 2023.
  15. ^
    PMID 11430456
    .
  16. PMID 19736393
    .
  17. ^
    ISBN 978-0-7234-3680-5
    .
  18. PMID 28867644
    .
  19. ^ Ellington. "Microbial Pathogenesis" (1999).[page needed]
  20. ^ Ellington Journal of Bone and Joint Surgery (2003).[page needed]
  21. ^ Ellington. Journal of Orthopedic Research (2006).[page needed]
  22. ^ King MD, Randall W, Johnson D (2006-07-13). "Osteomyelitis". eMedicine. WebMD. Archived from the original on 2007-11-09. Retrieved 2007-11-11.
  23. ^
    PMID 22981480
    .
  24. PMID 38223108
    .
  25. S2CID 7362493
    .
  26. PMID 16264122
    .
  27. S2CID 2599315
    .
  28. PMID 12015818
    .
  29. S2CID 28498296
    .
  30. PMID 25506733
    .
  31. PMID 30423035
    .
  32. PMID 29319957
    .
  33. PMID 11871494
    .
  34. PMID 31588556
    .
  35. ^ Putland M.D, Michael S., Hyperbaric Medicine, Capital Regional Medical Center, Tallahassee, Florida, personal inquiry June 2008.
  36. PMID 18298388
    .
  37. ^ "Saucerization".
  38. PMID 15233171
    .
  39. ^ Baer M.D., William S. (1 July 1931). "The Treatment of Chronic Osteomyelitis with the Maggot (Larva of the Blow Fly)". Journal of Bone and Joint Surgery. 13 (3): 438–75. Archived from the original on 22 December 2007. Retrieved 2007-11-12.
  40. PMID 18404291
    .
  41. PMID 26747915
    .
  42. PMID 26504821
    .
  43. ^ Jeffrey, Janis (2009). "A 25-Year Experience with Hemicorporectomy for Terminal Pelvic Osteomyelitis" (PDF).
  44. ^ Floryan, Meg. "Eakins's The Gross Clinic". Smarthistory. Khan Academy. Archived from the original on October 21, 2020. Retrieved February 11, 2013.
  45. ISBN 978-0-88864-070-3
    .
  46. ^ Bryan Eneas. "Tommy Douglas honoured as person of national historic significance". CBC News. Retrieved 19 March 2019.
  47. ISBN 0-253-33907-3
    .
  48. ^ Langlois, Jill (18 Nov 2020). "First Evidence of Parasites in Dinosaur Bones Found". Smithsonian Magazine. Retrieved 2020-11-24.

External links

Wikimedia Commons has media related to Osteomyelitis.


Retrieved from "https://en.wikipedia.org/w/index.php?title=Osteomyelitis&oldid=1216758325"