BONE INFECTION

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Osteomyelitis

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Definition

Osteomyelitis is an acute or chronic bone infection, usually caused by bacteria.

Causes, incidence, and risk factors

Bone infection can be caused by bacteria or by fungus. The infection that causes osteomyelitis often starts in another part of the body and spreads to the bone through the blood. An injury may have made the affected bone more likely to develop the infection.

In children, the long bones are usually affected. In adults, the feet, vertebrae, and the pelvis are most commonly affected.

Risk factors are recent trauma, diabetes, hemodialysis, and IV drug abuse. People who have had their spleen removed are also at higher risk for osteomyelitis.

Osteomyelitis affects about 2 in 10,000 people.

Symptoms

• Bone pain
• Fever
• General discomfort, uneasiness, or ill-feeling (malaise)
• Local swelling, redness, and warmth
• Nausea

Additional symptoms that may be associated with this disease:

• Chills
• Excessive sweating
• Low back pain
• Swelling of the ankles, feet, and legs

Signs and tests

A physical examination shows bone tenderness and possibly swelling and redness.

Tests may include:

• Blood cultures
• Bone lesion biopsy
• Bone scan
• MRI
• Needle aspiration of the area around affected bones

This disease may alter the results of the following tests:

• Bone x-ray
• C-reactive protein (CRP)

Treatment

The objective of treatment is to eliminate the infection and prevent it from getting worse.

Antibiotics will be given to destroy the bacteria that are causing the infection.

Surgery may be needed to remove dead bone tissue if you have an infection that does not go away. The open space left by the removed bone tissue may be filled with bone graft or packing material that promotes the growth of new bone tissue. Antibiotics are continued for at least 6 weeks after surgery.

Infection of an orthopedic prosthesis may require surgical removal of the prosthesis and infected tissue surrounding the area. A new prosthesis may be implanted in the same operation or delayed until the infection has gone away.

Reviewer Info: D. Scott Smith, M.D., MSc, DTM&H, Chief of Infectious Disease & Geographic Medicine, Kaiser Redwood City, CA & Adjunct Assistant Professor, Stanford University. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., 09/03/2008