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Osteomyelitis

Definition and Epidemiology

  • Osteomyelitis is an infection of bone and bone marrow, either acute or chronic in nature.
  • It can occur at any age, with different bacteria predominant in different age groups.
  • Commonly caused by Staphylococcus aureus, but can be due to a variety of organisms depending on the route of infection.

Pathophysiology

  • Infection typically reaches the bone through one of three pathways: hematogenous spread, contiguous spread from adjacent tissue, or direct inoculation (e.g., trauma, surgery).
  • Hematogenous osteomyelitis is more common in children, often affecting the metaphyseal areas of long bones.
  • In adults, contiguous spread from soft tissue infections or diabetic foot ulcers is more common.
  • The infection leads to an inflammatory response, bone necrosis, and new bone formation (involucrum).

Clinical Features

  • Localised bone pain, swelling, redness, and warmth.
  • Systemic symptoms: fever, chills, malaise.
  • In chronic osteomyelitis, symptoms are more insidious, including persistent pain and sinus tract formation.
  • In diabetic patients, often presents in the feet with neuropathic ulcers.

Diagnosis

  • High clinical suspicion based on history and physical examination.
  • Laboratory findings: Elevated white blood cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP).
  • Imaging: X-rays, MRI, and CT scans can identify bone changes.
  • Bone biopsy and culture for definitive diagnosis and antibiotic sensitivity.

Management

  • Early and aggressive antibiotic therapy, initially intravenous followed by oral.
  • Antibiotic choice based on suspected or confirmed causative organism.
  • Surgical intervention may be necessary for debridement of necrotic bone, abscess drainage, or to address any source of contiguous spread.
  • In chronic cases, long-term antibiotic therapy and multiple surgeries may be required.

Complications

  • Chronic infection leading to bone destruction and deformity.
  • Systemic spread of infection, potentially leading to sepsis.
  • Amputation in severe cases involving the extremities.

Prognosis

  • Early treatment in acute osteomyelitis generally leads to good outcomes.
  • Chronic osteomyelitis has a more protracted course and can be challenging to eradicate completely.

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