Osteomyelitis

Osteomyelitis

National Organization for Rare Disorders, Inc.

Important

It is possible that the main title of the report Osteomyelitis is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

  • Hematogenous Osteomyelitis

Disorder Subdivisions

  • Osteomyelitis, Pyogenic, Acute
  • Osteomyelitis, Pyogenic, Chronic
  • Vertebral Osteomyelitis
  • Anaerobic Osteomyelitis
  • Osteomyelitis due to Vascular Insufficiency

General Discussion

Osteomyelitis is a bone infection, usually caused by bacteria, that can be either acute or chronic. This disorder usually occurs as a result of an infection in one part of the body that is transported through the bloodstream to a bone in a distant location. Among children and teens, the long bones of the legs and arms are most frequently affected. In adults, osteomyelitis most often affects the vertebrae of the spine and/or the hips.

Symptoms

Acute osteomyelitis is a serious bone inflammation that can result from a previous trauma, puncture wound, surgery, bone fracture, abscessed tooth, or infection of soft tissue, the ear or sinus. In children, it usually affects the long bones, especially the growth center (epiphysis) at the end of the shaft. In adults, bones of the spinal column (vertebra) are often affected.



Initially there may be several days of fever and a generalized feeling of ill health (malaise). This may be followed by an increase in fever (104-105 degrees Fahrenheit), deep localized bone pain, chills, sweating, swelling and painful or limited movement of the nearby joints. The skin near the affected bone may be red (erythema) and there may be a purulent buildup (pus), loss of calcium, destruction of the surrounding tissue (necrosis) and bone deterioration or deformity.



Chronic osteomyelitis usually occurs after an acute episode of osteomyelitis when the infection has not been totally cured. There may be bone pain, swelling, redness and tenderness of the affected area. A discharge of pus from an opening to the infected bone is often the first symptom. There may also be destruction of the bone with pieces of the infected bone separating from the healthy bone. When this occurs, surgery to remove the bone fragments may be necessary.



Vertebral osteomyelitis is characterized by chronic back pain not relieved by ordinary treatment such as bed rest, heat or pain relievers. There may be fever, localized tenderness, pain, muscle spasms and limited movement. This form of osteomyelitis usually affects people over 50 years of age, and is usually caused by a previous injury, urinary tract infection, inflammation of the lining of the heart (endocarditis) or drug addiction. (For more information on this disorder, choose "Endocarditis" as your search term in the Rare Disease Database.)



Anaerobic osteomyelitis often affects the lower jawbone (mandible), skull or feet. It is characterized by ulceration and swelling, foul smelling drainage and redness of the affected area.



Osteomyelitis due to vascular insufficiency is more common in people with diabetes mellitus or vascular diseases that affect the extremities, especially the toes and small bones of the feet. It is usually seen in people over 50 years old and is characterized by pain and redness of the affected area (erythema), swelling, ulcerations, and drainage of pus. This type of osteomyelitis is difficult to treat because of the underlying vascular disorder that can impair the therapeutic effect of antibiotic treatment. (For more information on the above disorder, choose "Diabetes" as your search term in the Rare Disease Database.)

Causes

Osteomyelitis is an infection frequently caused by Staphylococcus bacteria. In some cases the cause is unknown, but the infection is usually transmitted through the bloodstream from one area of the body to another. In descending order of frequency, the bacteria most often associated with this disorder are Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes. Bone may be made more vulnerable to infection by recent trauma.



Risk factors include recent trauma, diabetes, hemodialysis, intravenous drug abuse, and having had one's spleen removed.

Affected Populations

Osteomyelitis is a prevalent condition that affects males and females in equal numbers. It is usually more common in children and adults after the age of 50. Hemodialysis patients, drug addicts and those with diabetes are also more susceptible to this infection.

Standard Therapies

Diagnosis

Symptoms of osteomyelitis can resemble those of many other bone disorders. Bone scans, blood tests bone biopsies are tests that help diagnose this disorder so that treatment can be started immediately.



Treatment

After the infectious organism has been identified, osteomyelitis is usually treated with massive doses of the appropriate antibiotic. Treatment with intravenous delivery of antibiotics is not uncommon even though some of the newer antibiotics are effective when administered orally. The antibiotic treatment may last for several days or for a week or two. Depending on the extent of the infection, it may be necessary to drain and clean the infected area surgically and then continue treatment with antibiotic therapy. In some cases, a bone graft may be necessary.



It is most important that diabetics and those with vascular disorders be treated as quickly as possible for suspected osteomyelitis. If left untreated, this disorder can result in destruction of the bone and surrounding tissue and may lead to amputation of the affected toes or foot. Other treatment is symptomatic and supportive.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.



For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:



Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com

References

TEXTBOOKS

Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:459-60.



Berkow R., ed. The Merck Manual-Home Edition, 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003:364-65.



Mandell GL, Bennett JE, Dolan R., eds. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 4th ed. Churchill Livingstone Inc. New York, NY; 1995:1039-52.



Skinner HB., ed. Current Diagnosis and Treatment in Orthopedics. Appleton & Lange. Norwalk, CT; 1995:354-61.



REVIEW ARTICLES

McLaren AC. Alternative materials to acrylic bone cement for delivery of depot antibiotics in orthopedic infections. Clin Orthop. 2004;(427):101-06.



Zalavras CG, Patzakis MJ, Holtom P. Local antibiotic therapy in the treatment of open fractures and osteomyelitis. Clin Orthop. 2004;(427):86-93.



Jude EB, Unsworth PF. Optimal treatment of infected diabetic foot ulcers. Drugs Aging. 2004;21:833-50.



Harden SP, Argent JD, Blaquiere RM. Painful sclerosis of the medical end of the clavicle. Clin Radiol. 2004;59:992-99.



Saigal G. Azouz EM, Abdenour G. Imaging of osteomyelitis with special reference to children. Semin Musculoskelet Radiol. 2004;8:243-53.



Arkun R. Parasitic and fungal diseases of bones and joints. Semin Musculoskelet Radiol. 2004;8:231-42.



Lazzarini L, Mader JT, Calhoun JH. Osteomyelitis in long bones. J Bone Joint Surg Am. 2004;86-A:2305-18.



FROM THE INTERNET

Levy D. Osteomyelitis. Medical Encyclopedia. MedlinePlus. Last Updated: 7/8/2004. 3pp.

www.nlm.nih.gov/medlineplus/ency/article/000437.htm



Osteomyelitis. Cleveland Clinic. Last reviewed on: 2/6/2004. 4pp.

www.clevelandclinic.org/health/health-info/docs/2700/2702.asp?index=9495



Osteomyelitis. Orthopaedics. Lucille Packard Children's Hospital. 2005. 2pp.

www.lpch.org/DiseaseHealthInfo/HealthLibrary/orthopaedics/osteomy.html



Homeier B. Osteomyelitis. TeensHealth. Nemours Foundation. Date reviewed: November 2004. 2pp.

www.kidshealth.org

Resources

NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases

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Internet: http://rarediseases.info.nih.gov/GARD/



For a Complete Report

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