Osteomyelitis

Osteomyelitis is a rare but serious infection of the bone. Early detection and prompt treatment are crucial to prevent permanent bone damage and other severe complications. The infection can result from bacteria spreading through the bloodstream or from an open injury. If not treated effectively, it can lead to chronic pain, reduced mobility, and even bone loss.

What is Osteomyelitis (Bone Infection)?

Osteomyelitis is a bone infection that occurs due to bacterial or fungal infection spreading to the bones. It can affect any bone in the body and can happen to anyone. Children may develop osteomyelitis due to a wound or fracture in their legs or arms. Adults usually develop it in their hip bones or spinal vertebrae. 

Osteomyelitis can manifest in different forms, each with its own characteristics and implications.

Types of Osteomyelitis (Bone Infections)

There are a few types of infection of the bone, osteomyelitis, infections:

• Acute Osteomyelitis: Acute osteomyelitis is the type of bone infection that occurs after the infection has spread to the bones. It is the most common type of bone infection disease.
• Chronic Osteomyelitis: Chronic bone infection occurs when a previous infection that wasn't completely cured comes back or recurs months or years later. However, it can be prevented by taking proper antibiotics and prescription medications the first time the infection occurs.
• Vertebral Osteomyelitis: This type of osteomyelitis affects the vertebrae in the spine.

What are the Symptoms of Osteomyelitis?

Osteomyelitis symptoms may vary depending on the bone infection type that has developed or which bones are affected. Bone pain is often one of the most prominent osteomyelitis signs. The most common bone infection symptoms may include the following:

• Fever
• Feeling generally unwell
• Chills
• Sweating 
• Nausea and vomiting 
• Swelling or inflammation 
• Skin discolouration 
• Pus or discharge at the site of a wound or surgery site
• A feeling of heat or warmth in the skin 

A person suffering from vertebral osteomyelitis usually experiences lower back pain in addition to the above symptoms. In some cases, people with chronic osteomyelitis may not have symptoms. 

Causes of Osteomyelitis

Osteomyelitis is caused by an infection that spreads to the bones. This is often a result of an infection that occurs on the surface of the skin, such as a wound or a surgery site, that enters the bloodstream. Once the infection causing germs reach the bloodstream, they can spread to the bone marrow. 

Risk Factors of Osteomyelitis 

Osteomyelitis, or bone infection disease, can occur in anyone, but certain people may have a predisposition to this type of infection. These risk factors may include:

• Being younger than 20 years or older than 50 years 
• Having an open wound after an injury or trauma 
• Having pressure injuries (bedsores)
• Experiencing puncture injuries 
• Having undergone surgery recently, especially arthroplasty or other procedures where the surgeons implant pieces into the body, including pins and screws to repair bone fractures

People with certain health conditions or who require treatments that weaken their immune system are also more likely to develop osteomyelitis. These conditions include:

• Sickle cell anaemia 
• Diabetes
• People requiring haemodialysis 
• People who take immunosuppressants

What are the Complications Associated with Osteomyelitis?

People with osteomyelitis may develop certain complications, which may include:

• Abscesses: Bone infections on the skin may cause pus filled pockets to burst and break through the skin. 
• Osteonecrosis: Osteonecrosis or bone death may occur if swelling and inflammation from the infection cut off blood flow to the bone. Although rare, it may require an amputation. 
• Slowed growth: Osteomyelitis developing in children may cause their bones to grow slowly and develop slower than usual.

Diagnosis of Osteomyelitis 

Osteomyelitis diagnosis requires a physical examination by a doctor along with some tests and gathering information about the onset and range of symptoms experienced. People seeking osteomyelitis diagnosis should let their treating doctor know about any recent injury or surgery that they may have undergone or any new treatment that they may have started.

Among the array of tests, the following may be recommended to diagnose osteomyelitis:

• Blood tests
• X-ray
• Magnetic resonance imaging (MRI) scan 
• Computed tomography (CT) scan
• Ultrasound
• Bone scan
• Bone marrow biopsy

Treatment of Osteomyelitis

The goal of bone infection treatment is to destroy the infection and prevent permanent bone damage. Thus, for osteomyelitis treatment, an orthopaedic doctor may recommend the following set of treatments:

• Antibiotics: Antibiotics help inhibit bacterial infection. They can be given in the form of oral pills or intravenously.
• Antifungals: Antifungal medications help destroy and prevent fungal infection. Antifungal medications can be taken orally for a few months, as prescribed.
• Over-the-counter pain relievers: Over-the-counter medicines or NSAIDs help to alleviate pain and inflammation. It's best to take prescription OTC medicines for osteomyelitis.
• Needle aspiration: For any pus or abscesses that may have developed, a surgeon may need to drain out the pus or fluid using a needle.
• Surgery: For osteomyelitis treatment, surgery is recommended as an option if the bone infection is severe or if a patient has a high risk of complications. Surgery is usually recommended for people with vertebral osteomyelitis.

When to See a Doctor?

It is important to consult a healthcare provider if there are signs of any infection, especially if there is pus or discharge from a wound or at the site of surgery.

Preventing Osteomyelitis 

Here are a few things to do in order to prevent osteomyelitis:

• Cleaning any new wounds or cuts 
• Keeping a surgical site sterile
• Washing hands frequently when handling wounds and cuts 
• Cleaning cuts and scrapes with warm, soapy water.

It's important to seek medical attention if there is a deep cut or puncture wound or trauma.

Conclusion

The sooner osteomyelitis is treated, the better it will be for preventing permanent bone damage and other complications. Proper treatment and following hygiene practices to keep a wound clean can help prevent chronic osteomyelitis. 

FAQs 

1. How common is osteomyelitis?

Osteomyelitis is not common and actually quite rare, with fewer than 25 people per 1,00,000 people experiencing it every year.

2. Who Gets Osteomyelitis?

Osteomyelitis is uncommon but may develop in people with certain risk factors, including:

• Diabetes 
• Sickle cell disease 
• HIV or AIDS 
• Rheumatoid arthritis
• Intravenous drug use
• Alcohol consumption 
• Long-term use of steroids
• Hemodialysis
• Poor blood supply
• Recent injury

People who have had bone surgery, including hip and knee replacements, also have an increased risk of developing osteomyelitis.

3. Can osteomyelitis cure itself?

Unfortunately, osteomyelitis doesn't get better or cured on its own. Thus, it is important to see a healthcare provider to treat it.

4. How serious is osteomyelitis?

Osteoporosis is a serious condition that requires immediate treatment to prevent complications. It usually responds well to treatment, but it is important to start treatment early.

Dr. Hari Chaudhari

MBBS, MS (Orthopaedics)
United CIIGMA Hospitals (A unit of CARE Hospitals), Chh. Sambhajinagar

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