Make an Appointment
Talk to DoctorOverview
Osteomyelitis is a bone infection caused by bacteria and fungi. This painful bone infection results in swelling, which can cause swelling and harm bones, leading to bone loss. An infection can spread to a bone through surrounding tissue or the bloodstream, and a wound can make the bone vulnerable to microorganisms.
Osteomyelitis can affect people of all ages and genders, but those over 65, with major medical disorders such as diabetes or kidney failure, and children under 3 are more susceptible. People with foot ulcers due to diabetes are at risk of developing osteomyelitis. There are different types of osteomyelitis:
- Acute: This type has a sudden onset, and patients may experience a fever for a few days before feeling pain in the affected area.
- Chronic: Chronic osteomyelitis does not respond to medical treatment and can results in repeated discharge (pus) and bone pain. In some cases, it can go undiagnosed for months or even years.
- Vertebral: This variety of osteomyelitis affects the spine, and it can result in chronic back pain that exacerbates with movement. Common treatments like rest, heat application, and pain relievers do not provide much relief. Fever rarely accompanies this condition. Spinal bone infections are more likely to occur in people living in nursing homes, misusing intravenous drugs, or undergoing dialysis.
Although osteomyelitis was once considered incurable, it is now effectively treated. Surgical removal of dead bone is necessary in most cases, and strong intravenous antibiotics are typically required after the surgery.
Symptoms
The signs and symptoms of osteomyelitis vary depending on the type and cause. Some patients with chronic osteomyelitis may not exhibit symptoms, or the symptoms may be challenging to distinguish from those of other diseases. Signs and symptoms of osteomyelitis include:
- Fever
- Pus discharge
- Back pain
- Swelling and redness at the infection area.
- Pain at the infection area
- Fatigue or lethargy
- Chills or sweating
Consult a medical professional if the fever and bone discomfort worsen, if symptoms indicate an infection, or if the patient is at risk for infection due to a medical condition, recent surgery, or accident.
Causes
Osteomyelitis develops when germs spread through the blood from surrounding tissue or an open wound and settle in bone, where they multiply. Staphylococcus bacteria, which are commonly found on the skin or in the nose of even healthy individuals, are the primary cause most cases of osteomyelitis cases. The following are ways that the bacteria could enter the bone:
- Bloodstream: Bacteria from other parts of the body, such as those from a urinary tract infection or pneumonia in the lungs, can spread to a weak spot in a bone through the bloodstream. Disease such as sickle cell anemia or blood infection can also cause osteomyelitis.
- Trauma: Bacteria can penetrate deep into the body through severe puncture wounds. If such an injury becomes infected, the infection can spread to an adjacent bone. If the patient has a major bone fracture, and a piece of it protrudes through their skin, bacteria can potentially enter the body. Pressure ulcer or bedsores can also lead to osteomyelitis.
- Surgery: Contaminated surgical procedures can occur during joint replacement or fracture repair surgeries, which can lead to osteomyelitis. Recent bone fractures or bone surgery can also be a cause.
Risk factors
The bones are not commonly affected by infection, but their resistance decreases with age. There are additional factors that can make bones more susceptible to osteomyelitis, such as:
- Injury or bone surgery: Bacteria can infiltrate the bone or surrounding tissue through a severe fracture or a deep wound. Infection can also spread through a deep puncture hole, such as one caused by an animal bite or a nail going through a shoe. Surgery to replace damaged joints or fix broken bones may also create a channel for bacteria to enter the bone, raising the risk of infection, especially with orthopedic hardware implants.
- Intravenous lines or catheters: Medical tubing, such as urinary catheters or dialysis machines, is necessary in many diseases to connect the external environment to internal organs. However, this tubing can also be a route for bacteria to enter the body, increasing the risk of infection in general and the possibility of developing osteomyelitis.
- Circulation problem: When there is damage or blockage to blood vessels, the body may struggle to distribute the necessary infection-fighting cells to prevent a minor infection from becoming more severe. This can result in a small cut progressing into a deep ulcer that exposes deeper tissue and bone to the risk of infection. Other conditions that can impair blood circulation such as uncontrolled diabetes, peripheral artery disease, often caused by smoking, and sickle cell disease.
- Immune system problem: People are at higher risk of developing osteomyelitis if they have a medical condition or are taking medication that weakens their immune system. This can include uncontrolled diabetes or undergoing cancer treatment, which can both compromise the immune system.
- Drug abuse: Those who use illegal drugs through injections are at an increased risk of developing osteomyelitis because of the possibility of using nonsterile needles and a decreased likelihood of sterilizing their skin before injections
Diagnosis
Healthcare provider will perform a physical examination to assess for sign of tenderness, swelling, or warmth around the affected bone. In case of a foot ulcer, the healthcare provider may use a dull probe to locate the underlying bone.
To properly diagnose osteomyelitis and determine the type of bacteria causing the infection, a combination of tests and procedures may be recommended. These may include:
- Imaging tests: The following imaging test will be recommended by the healthcare provider to diagnose osteomyelitis.
- X-rays: X-rays can show damage to bones, but the damage may not be noticeable until osteomyelitis has been present for a few weeks. If the osteomyelitis is recent, more in-depth imaging tests may be required.
- Magnetic resonance imaging (MRI): This procedure uses a powerful magnetic field and radio waves that produce detailed images of bones and surrounding soft tissues.
- Computerized tomography (CT): A CT scan produces a detailed cross-sectional picture of a person’s internal anatomy by combining X-ray images from different angles. A CT scan is typically only performed if an MRI is not an option.
- Bone scan: During an imaging scan, a bone scan uses a small amount of safe, radioactive material to detect infections or fractures in the bones.
- Blood tests: A complete blood count (CBC) is performed to check for indicators of inflammation and infection, while a blood culture is used to detect bacteria in the bloodstream. Osteomyelitis cannot be diagnosed through a blood test alone. However, blood tests can provide information that can help healthcare providers determine if further testing or medical intervention is necessary.
- Bone biopsy: The type of bacteria causing the bone infection can be identified through a bone biopsy. Knowing the type of bacteria allows healthcare providers to select an antibiotic that is highly effective for that particular infection. An open biopsy requires anesthesia and surgery to access the bone. A surgeon may occasionally insert a long needle through the skin and into the bone to obtain a fluid, tissue, or bone sample for biopsy, which may be guided by an X-ray or other imaging scans.
Treatment
Recovery from a bone infection can be a slow process. The most common treatment for osteomyelitis is surgical removal of infected or dead bone tissue, followed by intravenous antibiotics to combat the infection.
Treatment for osteomyelitis may include the following:
- Medication: A bone biopsy will determine the type of germ causing your infection, allowing your doctor to select an effective drug.
- Antibiotic: Antibiotic are used to eliminate bacteria that cause infections. The duration of antibiotic treatment may range from four to eight weeks and may involve a combination of intravenous antibiotics in the hospital for one to two weeks, followed by oral medications for several weeks. In cases of chronic infections, months of antibiotic treatment may be necessary.
- Antifungals: For treatment of fungal infections, oral antifungal medication may be required for an extended period of several months.
- Pain relievers: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are used to relieve pain and reduce inflammation.
Quitting smoking can help improve the healing process. It’s also essential to effectively manage any chronic conditions, such as maintaining proper control of blood sugar levels in individuals with diabetes
- Surgery: The surgery for osteomyelitis may involve several techniques depending on the severity of the infection, including:
- Debridement: During this procedure, a small margin of healthy bone is removed along with as much of the infected bone to ensure that all contaminated areas have been removed. Any nearby tissue that shows symptoms of infection may also be removed.
- Drainage of infection: Expanding the area around your infected bone allows your surgeon to drain any fluid or pus that has built up in response to the infection.
- Restore blood flow to the bone: To fill the gaps left by the debridement procedure, your surgeon may use a piece of bone or other tissue, such as skin or muscle, from another part of your body. In some cases, temporary fillers may be inserted into the area until the patient is in good health for a bone or tissue graft. The graft helps support the healing of damaged blood vessels and the formation of new bone.
- Removal of foreign objects: Foreign objects, such as surgical screws or plates inserted during the previous operations, may need to be removed.
- Amputation: To prevent the spread of the infection to other parts of the body, surgeons may need to amputate the affected limb.
- Spine surgery: Patient with vertebral osteomyelitis may require spine surgery, which can prevent the collapse of vertebrae and protect the spinal cord, nerves, and other nervous system components.
