Osteomyelitis

Symptoms of osteomyelitis are often nonspecific and may include redness, swelling and pain surrounding the affected area. In acute osteomyelitis, symptom onset may occur more rapidly, such as over a few days and may commonly include fever. and for adults are the feet, spine, and hips. Complications Factors that may commonly complicate osteomyelitis are fractures of the bone, amyloidosis, endocarditis, or sepsis. ==Cause==

Staphylococcus aureus is the organism most commonly isolated from all forms of osteomyelitis. Tubercular osteomyelitis is a secondary complication in 1–3% of patients with pulmonary tuberculosis. In adults, vertebral osteomyelitis is commonly caused by S. aureus, but may be caused by Mycobacterium tuberculosis (Pott's disease). Risk Factors • Diabetic neuropathy • Surgical operation duration over 3 hours • Surgical incision over 10 cm • Polymicrobial infections • Trauma resulting in open fractures or open repair of closed fractures • Injection drug use • Hemodialysis ==Pathogenesis==

In general, microorganisms may infect bone through one or more of the following mechanisms: • Via the bloodstream (hematogenous) to a distant site – the most common method The proliferation of bacteria leads to an inflammatory reaction in the acute phase which progresses to death of bone cells and marrow in the first 48 hours. Bacteria continue to spread to the periosteum and in children a subperiosteal abscess may form due to the loose attachment of the periosteum. Once intracellular, the bacteria are able to spread to adjacent bone cells. At this point, the bacteria may be resistant to certain antibiotics. In chronic osteomyelitis, Staphylococcus aureus can persist by forming biofilms and invading the osteocyte lacuno‑canalicular network, which contributes to antibiotic tolerance and difficulty eradicating infection. ==Diagnosis==

osteomyelitis and soft tissue infection. Computed tomography scan of the right lower extremity of a 21-year-old patient, showing abscess formation adjacent to nonunion of a right femur fracture. Diagnosis of OM is complex and relies on clinical findings as well as labs and imaging. MRI is often indicated following plain films and contrast may be utilized to evaluate for other concerns, though is not necessary for the diagnosis of OM. Confirmation is most often by MRI, though PET scans can also be used to diagnose OM. alternative sampling methods such as needle puncture or surface swabs are easier to perform, but cannot be trusted to produce reliable results. A probe to bone test is indicative of OM in patient's with OM of the lower extremity secondary to vascular insufficiency. • Suppurative osteomyelitis • Acute suppurative osteomyelitis • Chronic suppurative osteomyelitis • Primary (no preceding phase) • Secondary (follows an acute phase) • Non-suppurative osteomyelitis • Diffuse sclerosing • Focal sclerosing (condensing osteitis) • Proliferative periostitis (periostitis ossificans, Garré's sclerosing osteomyelitis) • Osteoradionecrosis ==Treatment==

Treatment of OM can include antibiotics and surgical interventions., native vertebral osteomyelitis, and pediatric acute hematogenous OM (in conjunction with the Pediatric Infectious Diseases Society). Antibiotic regimen is tailored to the specific organism(s) in the positive culture, though hospitalized patients may receive empiric antibiotic coverage. Antibiotic regimens of 4-6 weeks are recommended and for patients continuing with parenteral antibiotics post-discharge, a PICC line may be utilized. Surgical debridement with drainage of associated soft tissue abscesses may be required. can be done. Hyperbaric oxygen therapy has been shown to be a useful adjunct to the treatment of refractory osteomyelitis. There is tentative evidence that bioactive glass may also be useful in long bone infections. Support from randomized controlled trials, however, was not available as of 2015. Due to insufficient evidence it is unclear what the best antibiotic treatment is for osteomyelitis in people with sickle cell disease as of 2019. Hemicorporectomy is performed in severe cases of Terminal Osteomyelitis in the Pelvis if further treatment won't stop the infection. == Prevention or Screening ==

There are no specific vaccinations which prevent OM. Most often, prophylactic antibiotics are not utilized. In patients with diabetes, quality foot care may prevent development of OM. == Epidemiology ==

About 2.4 per 100,000 people are affected by osteomyelitis each year. The young and old are more commonly affected. ==History==

The word is from Greek words ὀστέον osteon, meaning bone, μυελός myelos meaning marrow, and -ῖτις -itis meaning inflammation. In 1875, American artist Thomas Eakins depicted a surgical procedure for osteomyelitis at Jefferson Medical College, in an oil painting titled The Gross Clinic. Canadian politician and premier of Saskatchewan Tommy Douglas suffered from osteomyelitis as a child, and in 1910, underwent several surgeries, which the surgeon performed for free in exchange for allowing his medical students to observe the procedures (which Douglas's parents could not have otherwise afforded). This experience convinced him that medical care should be free for everyone. Douglas became known as the Canadian "Father of Medicare". Before the widespread availability and use of antibiotics, blow fly larvae were sometimes deliberately introduced to the wounds to feed on the infected material, effectively scouring them clean. Fossil record Evidence for osteomyelitis found in the fossil record is studied by paleopathologists, specialists in ancient disease and injury. It has been reported in fossils of the large carnivorous dinosaur Allosaurus fragilis. Osteomyelitis has been also associated with the first evidence of parasites in dinosaur bones. ==See also==