Specialized In

Osteomyelitis

Osteomyelitis is a serious bone infection caused by bacteria or, less commonly, fungi. It can affect any bone in the body, but it most frequently occurs in the long bones of the arms and legs, the spine, and the pelvis. Osteomyelitis can occur at any age and may develop suddenly (acute) or slowly over time (chronic).

Causes of Osteomyelitis:

  • Hematogenous spread: Bacteria or fungi from an infection elsewhere in the body (such as in the skin, lungs, or urinary tract) enter the bloodstream and spread to the bone.
  • Direct inoculation: The infection enters the bone directly from an open wound or surgery, often due to fractures, orthopedic surgery, or trauma.
  • Contiguous spread: The infection spreads from nearby infected tissue or an open wound (e.g., diabetic foot ulcer or pressure sores).

Common Pathogens:

  • Staphylococcus aureus (especially methicillin-resistant Staphylococcus aureus, MRSA) is the most common cause.
  • Streptococcus species and Pseudomonas aeruginosa are also frequently implicated.
  • In immunocompromised individuals, fungi and other atypical organisms can be responsible.

Symptoms of Osteomyelitis:

  • Bone pain: The hallmark symptom, which may be severe and worsen with movement.
  • Swelling, redness, and warmth over the affected area.
  • Fever and chills: Especially in acute osteomyelitis.
  • Fatigue and malaise: General feeling of being unwell.
  • Limited range of motion in the affected limb or joint.
  • Drainage from a sinus tract: In chronic osteomyelitis, a fistula may form, allowing pus to drain from the bone to the skin.

Diagnosis:

Physical Examination: The doctor will check for tenderness, swelling, and redness over the affected area.

Blood Tests:

  • Complete blood count (CBC): Elevated white blood cell count in response to infection.
  • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP): Inflammation markers that are typically elevated in osteomyelitis.
  • Blood cultures: Help identify the bacteria or fungi causing the infection if hematogenous spread is suspected.

Imaging:

  • X-rays: Early in the disease, X-rays may be normal, but over time, they can show bone destruction and new bone formation.
  • MRI: More sensitive than X-rays, can detect early changes in bone and surrounding tissues.
  • CT scan: Useful for evaluating bone destruction in chronic osteomyelitis.
  • Bone scan: A nuclear imaging test that detects areas of increased bone activity, often used when MRI is unavailable.

Bone Biopsy:

  • A bone biopsy is the gold standard for diagnosing osteomyelitis. It involves taking a sample of bone tissue to identify the exact organism causing the infection and determine its antibiotic sensitivity.

Treatment of Osteomyelitis:

Antibiotic Therapy:

  • The cornerstone of treatment, especially for bacterial osteomyelitis.
  • Antibiotics are typically administered intravenously for 4-6 weeks, followed by oral antibiotics.
  • The choice of antibiotics depends on the organism identified by blood cultures or biopsy (e.g., MRSA might require vancomycin).
  • In some cases, long-term oral antibiotics are necessary to prevent recurrence.

Surgical Treatment:

  • Debridement: Removal of infected or dead bone tissue (sequestrum) and soft tissue.
  • Drainage of abscesses: If pus has accumulated, it may need to be drained surgically.
  • Bone grafting: After infected tissue is removed, bone grafts or substitutes may be used to fill defects and promote healing.
  • Stabilization of bones: In some cases, surgical hardware (e.g., plates, screws) may be required to support the affected bone, especially if there is structural weakness.

Chronic Osteomyelitis Management:

  • Requires long-term antibiotics and may involve multiple surgeries to manage recurrences and remove dead tissue.
  • Sinus tracts may need to be surgically removed to prevent re-infection.
  • In extreme cases, amputation of the affected limb may be necessary if infection cannot be controlled.

Hyperbaric Oxygen Therapy (HBOT):

  • Used as an adjunct treatment in certain cases of chronic osteomyelitis or when healing is impaired (e.g., in diabetic foot osteomyelitis).
  • Involves breathing pure oxygen in a pressurized environment, which enhances the ability of blood to deliver oxygen to the infected tissues and promotes healing.