Osteomyelitis is a condition of bacterial bone infection. In many cases, it occurs following a fracture where the skin is also damaged. When this happens, bacteria easily infect the bones. The first symptom is usually pain. One may feel generally well, without an increased temperature, but later there may be redness or swelling over the bone. If untreated, an abscess of bone infection may form, which eventually bursts, discharging pus. Following a fracture, the area around the affected bone may become painful, red and swollen, which is the most common symptom for osteomyelitis. It should be noted that if the doctor infailed to control an infection in its early stages, it might result in chronic osteomyelitis. The bacteria multiply and the body’s defenses cause pus to form. This eats away the bone and an abscess forms that spreads through the bone and eventually comes to the surface. After a fracture, the bacteria enter the wound directly; settling on the bare ends, and then multiply and cause pus to form. This eventually discharges back through the wound. In some people, the infection may start in another organ, such as the lung, and from here the germs can spread through the bloodstream into the bone. People with diabetes are particularly prone to bone infection. If an ulcer develops on the toe or foot, it is common for the germs responsible to eventually penetrate through to the underlying bone. The symptoms in this case may be quite silent; there could be only some swelling. It is important to note that in some cases especially the newborn; the bacteria may enter the bloodstream after blood tests. It could also happen after an intravenous drip feed. In adults with diabetes, the reduced resistance to infection, poor blood circulation and a frequent loss of pain sensation all lead to a particularly insidious and often chronic osteomyelitis Diagnosis Symptoms and findings during a physical examination may suggest osteomyelitis, where doctors may suspect it in a person who has persistent bone pain with or without a fever, and feels tired most of the time. As with any other chronic infection, blood tests usually indicate elevated levels of white blood cells, an elevated erythrocyte sedimentation rate, and an elevated level of C-reactive protein. This protein circulates in the blood and dramatically increases in level at times of inflammation. An x-ray may also show changes suspicious of osteomyelitis, where the infected area always appears abnormal on bone scans. However, these tests cannot always distinguish infections from some other bone disorders. To diagnose a bone infection and identify the organisms causing it, doctors may take samples of blood, pus, joint fluid, or the bone itself to test the patient. People who have artificial joints or metal components attached to a bone should take preventive antibiotics before surgery. This includes dental surgery as well, because these people have an increased risk of infection from bacteria normally found in the mouth and other parts of the body. Bone surgeon, Dr. Torres Angelo says that the prognosis for people with osteomyelitis is usually good with early and proper treatment but sometimes, chronic osteomyelitis develops, so bone abscess may recur weeks, months, or even years later. Usually neurological signs are not present until late in the disease course when there can be destruction and collapse of the vertebral body during bone infection. Other symptoms variably present include chills, weight loss, dysuria, photophobia, and drainage from a wound or incision if there has been prior surgery. Treatment Blood tests could help locate signs of infection and identify the germ. The x-rays of the affected limb may be helpful if there is bone damage. However, in the very early stages there may be no abnormalities on x-rays as diagnostic method for osteomyelitis. In early osteomyelitis, intravenous antibiotic treatments alone may be effective enough. Even when the temperature and pain has settled, oral therapy should go on for three to six weeks. Once the infection is established, any pus in the bone may need drainage. This requires an operation under general anesthesia. After this, antibiotics will drip by infusion into a vein. Doctor points out that in more severe or chronic cases, an operation may be necessary to remove dead bone. This dead bone will commonly occur as a result either of the fracture or of the infection. The operation may require a bone graft from the hip to fill the cavity that was left, and the limb may have to rest in a plaster. In the early stages of osteomyelitis in children, the child will be hospitalized. The doctor should observe the child to ensure that the antibiotic treatment is effective and that the infection is adequately controlled. After discharge from hospital, recurrence of pain and any signs of swelling or redness in the limb should be reported to the doctor immediately. The patient must take the full course of antibiotics as prescribed, to prevent the infection returning. After surgical drainage of bone infection in either children or adults, you should watch the area of drainage for any change in the discharge from the wound or from holes close to the wound. Should this happen, contact your doctor immediately. In the majority of children, after adequate treatment of osteomyelitis with antibiotics or surgery, the infection settles completely and does not recur. However, it is important to watch for any change in the affected limb or other limbs, and contact the doctor immediately if anything is noted. In chronic osteomyelitis, especially in adults after fractures, there may be a recurring discharge from the region of the damaged bone. Intervals of up to several years may separate each event. Redness and swelling near the old fracture will often settle quite quickly with antibiotic treatment if is recognized and treated early. However, one may still need operation if left untreated for too long. Ends
