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Osteomyelitis: causes, symptoms and treatment

Osteomyelitis is infection of the bones. Infections can reach a bone by traveling through the bloodstream or by spreading from nearby tissue. Infections can also start in the bone itself if an injury exposes the bone to germs.

Smokers and people with chronic illnesses, such as diabetes or kidney failure, are at higher risk of developing osteomyelitis. People who have diabetes can develop osteomyelitis in the feet if the feet have ulcers.

Although once considered incurable, osteomyelitis can now be successfully treated. Most people need to have surgery to remove the areas of bone that have died. After surgery, strong intravenous antibiotics are usually needed.

Symptoms

Signs and symptoms of osteomyelitis include the following:

Fever
Swelling, warmth, and redness in the area of ​​infection
Pain in the area of ​​infection
Fatigue

Sometimes osteomyelitis causes no signs or symptoms or is difficult to distinguish from other diseases. This is especially true for babies, older adults, and people with compromised immune systems.

When should you see a doctor?

See your doctor if you experience worsening bone pain along with a fever. If you are at risk for an infection due to a medical condition, recent surgery, or injury, see your doctor immediately if you notice signs and symptoms of an infection.

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In the event of any discomfort, it is best to see a doctor (Getty Images)

Risk factor’s

Bones are normally resistant to infection, but this protection diminishes as you age. Other factors that can make bones more vulnerable to osteomyelitis may include the following:

recent injury or orthopedic surgery

A severe bone fracture or deep puncture wound gives bacteria an avenue to enter nearby bone or tissue. A deep puncture wound, such as an animal bite or a nail piercing through footwear, can also provide a pathway for infection.

Surgery to repair broken bones or replace worn joints can also open a pathway for germs to enter the bone. An orthopedic implant is a risk factor for infection.

Circulation disorders

When blood vessels are damaged or blocked, the body has a hard time distributing infection-fighting cells and keeping small infections from spreading. What starts as a small cut can progress into a deep ulcer that exposes the underlying tissue and bone to infection.

Diseases that impair blood circulation include the following:

poorly controlled diabetes
Peripheral arterial disease, often related to smoking
sickle cell disease

Problems that require intravenous lines or catheters

There are a number of conditions that require the use of medical tubes to connect the outside world with internal organs. However, these tubes can also serve as a way for germs to enter the body, which increases the risk of infection in general and this can lead to osteomyelitis.

Some examples of when this type of tubing might be used include the following:

Dialysis machine tubing
urinary catheters
Extended-use intravenous tubes, sometimes called central lines

Conditions that impair the immune system

If your immune system is compromised by a medical disorder or medication, you are at increased risk of osteomyelitis. Factors that can suppress the immune system include the following:

cancer treatment
poorly controlled diabetes
Need to take corticosteroids or medicines called tumor necrosis factor inhibitors

Illicit drugs

People who inject illegal drugs are more likely to develop osteomyelitis because they may use unsterile needles and may not sterilize their skin before giving injections.

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Each disease has one or more treatments to follow to combat it (FERNANDO CARRANZA GARCIA/CUARTOSCURO)

Diagnosis

The doctor will feel the area near the affected bone for tenderness, swelling, or warmth. If you have a foot ulcer, your doctor may use an opaque probe to determine the proximity of the underlying bone.

Your doctor may order a series of tests and procedures to diagnose osteomyelitis, as well as to determine the germ causing the infection. Studies may include the following:

Blood test

Blood tests can reveal elevated levels of white blood cells and other factors that may indicate that the body is fighting an infection. If osteomyelitis is caused by a blood infection, tests can reveal which germs are responsible.

No blood test can tell your doctor if you have osteomyelitis or not. However, blood tests can provide clues to help your doctor decide what additional tests and procedures you may need.

Imaging studies

X-rays. X-rays can reveal damage to the bone. However, the lesion may remain hidden until after osteomyelitis has been present for several weeks. If the osteomyelitis started recently, more detailed imaging tests may be needed.
Magnetic resonance imaging (MRI). Using radio waves and a strong magnetic field, MRI scans can produce remarkably detailed images of bone and surrounding soft tissue.
Computed tomography (CT). A CT scan combines X-rays taken from different angles to create cross-sectional views of a person’s internal structures. CT scans are usually done only when a person cannot perform an MRI.

bone biopsy

A bone biopsy can reveal what type of germ infected the bone. Knowing the type of germ allows the doctor to choose an antibiotic that works particularly well for that type of infection.

An open biopsy requires anesthesia and surgery to access the bone. In some situations, a surgeon inserts a long needle through the skin and into the bone to perform a biopsy. This procedure requires local anesthesia to numb the area where the needle will be inserted. X-rays and other imaging scans can be used as a guide.

Treatment

The most common treatments for osteomyelitis are surgery to remove infected or dead parts of the bone and subsequent administration of intravenous antibiotics in the hospital.

Surgery

Depending on the severity of the infection, surgery for osteomyelitis may include one or more of the following procedures:

Drainage of the infected area. Opening the area around the infected bone allows the surgeon to drain any pus or fluid that has accumulated from the infection.
Removal of diseased bone or tissue. In a procedure called “debridement,” the surgeon removes as much of the diseased bone as possible and takes a small margin of healthy bone to make sure that all infected areas have been removed. Surrounding tissue that shows signs of infection may also be removed.

Restoration of blood flow to the bone. The surgeon may fill in the empty spaces left by the debridement procedure with a piece of bone or other tissue, such as skin or muscle, obtained from another part of the body.

Sometimes temporary fillings are placed until the patient is healthy enough to receive a bone or tissue graft. The graft helps the body repair damaged blood vessels and build new bone.

Removal of foreign objects. In some cases, foreign objects, such as plates or screws placed in previous surgery, may need to be removed.
Limb amputation. As a last resort, surgeons may amputate the affected limb to prevent further spread of the infection.

Medicines

A bone biopsy will reveal the type of germ causing the infection so that the doctor can determine the antibiotic that will be most effective in fighting that type of infection. Antibiotics are usually given through a vein in your arm for about six weeks. Another course of antibiotics may be needed if the infection is more severe.

If you smoke, quitting can speed healing. It’s also important to take steps to manage any chronic conditions you have, such as controlling your blood sugar if you have diabetes.

With information from Mayo Clinic

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