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    Osteomyelitis

    Osteomyelitis isa bone infection caused by bacteria or other germs.

    Bone infection is most often caused by bacteria. But it can also be caused byfungior other germs. When a person has osteomyelitis:

    • Bacteria may spread to a bone from infected skin, muscles, or tendons next to the bone. This may occur under a skin sore.
    • The infection can start in another part of the body and spread to the bone through the blood.
    • The infection can also start after bone surgery. This is more likely if the surgery is done after an injury or if metal rods or plates are placed in the bone.

    In children, the long bones of the arms or legs are most often involved. In adults, the feet, spine bones (vertebrae), and hips (pelvis) are most commonly affected.

    Risk factors are:

    • Diabetes
    • Hemodialysis
    • Poor blood supply
    • Recent injury
    • Use of illegal injected drugs

    People who have had their spleen removed are also at high riskof osteomyelitis.

    Symptoms

    • Bone pain
    • Excessive sweating
    • Fever and chills
    • General discomfort, uneasiness, or ill-feeling (malaise)
    • Local swelling, redness, and warmth
    • Pain at the site of infection
    • Swelling of the ankles, feet, and legs

    Exams and Tests

    A physical exam shows bone tenderness and possibly swelling and redness.

    Tests may include:

    • Blood cultures
    • Bone biopsy (the sample is cultured and examined under a microscope)
    • Bone scan
    • Bone x-ray
    • Complete blood count (CBC)
    • C-reactive protein (CRP)
    • Erythrocyte sedimentation rate (ESR)
    • MRI of the bone
    • Needle aspiration of the areaof theaffected bones

    Treatment

    The goal of treatment is to get rid of the infection and reduce damage to the bone and surrounding tissues.

    Antibiotics are given to destroy the bacteria causing the infection:

    • You may receive more than one antibiotic at a time.
    • Antibiotics are taken for at least 4to 6 weeks, often at home through an IV (intravenously, meaning through a vein).

    Surgery may be needed to remove dead bone tissue if you have an infection that does not go away:

    • If there are metal plates near the infection, they may need to be removed.
    • The open space left by the removed bone tissue may be filled with bone graft or packing material. This promotes the growth of new bone tissue.

    Infection that occurs after joint replacement may need surgery to remove thereplaced jointand infected tissue around the area. A new prosthesis may be implanted in the same operation. More often, doctors wait until the infection has gone away.

    If you have diabetes, it will need to be well controlled. If there are problems with blood supply to the infected area, such as the foot, surgery to improve blood flow may be needed toget rid ofthe infection.

    Outlook (Prognosis)

    With treatment, the outcome for acute osteomyelitis is usually good.

    Outlook is worse for those with long-term (chronic) osteomyelitis. Symptoms may come and go for years, even with surgery. Amputation may be needed, especially inpersons with diabetes or poor blood circulation.

    Outlook forpersons with an infection ofthe prosthesisdepends, in part, on:

    • The patient's health
    • The type of infection
    • Whether the infected prosthesis can be safely removed

    When to Contact a Medical Professional

    Call your health care provider if:

    • You develop symptoms of osteomyelitis
    • You have osteomyelitis and the symptoms continue despite treatment

    References

    Matteson EL, Osmon DR. Infections of bursae, joints, and bones. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, Pa.: Elsevier Saunders; 2011:chap 280.

    Dabov GD. Osteomyelitis. In: Canale ST, Beaty JH, eds. Campbell’s Operative Orthopaedics. Philadelphia, Pa.: Elsevier Mosby; 2012:chap 21.

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    • Osteomyelitis

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      Tests for Osteomyelitis

        Review Date: 5/19/2013

        Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

        The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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