Bone Infection

OM or osteomyelitis

Human skin serves as the body's first defense against the outside world. When there is a break in the skin, such as a cut or an open sore, bacteria and other organisms can enter the body and cause infections of the skin, muscles, and bones. OM can also occur when an infection from another part of the body travels through the blood stream and invades the bones. OM can occur suddenly (acute) or be present for a long time (chronic).

Varies with the bone involved
Acute OM:

High Fever if acute OM (>102 degrees Fahrenheit or 40 degrees Celsius).
In children and infants, one can see irritability, poor appetite, malaise, or loss of movement.
Chills, sweating, nausea, vomiting, and diarrhea.
Pain, redness, and swelling over the bone is common.
Diabetics and the elderly may have little or no pain.

Chronic OM:

Pain -- back pain may actually be OM of the vertebral bone of the spine.

A low-grade fever.

Non-healing wounds, Bed Sores, or ulcers may be seen.

There may be an open canal from the bone to the skin that drains Pus (yellowish discharge).

There is pain when walking if the bones of the feet are involved.

There may be localized swelling, redness, and pain over a site where an artificial device (hip etc.) was implanted recently.

Bacteria:

Staphylococcus aureus is the most common cause of OM.
Streptococcus, Hemophilus influenzae, Coagulase negative staphylococcus, and gram negative bacteria are the less common causes of OM.
Mycobacterium Tuberculosis and fungi can also cause OM
Mixed infections with multiple bacteria can occur.

It should be noted that when the body's immune system breaks down as in AIDS, cancers, cancer therapy, and diabetes, or if the bone is damaged from any other cause, there is a greater risk of developing all types of infections including OM.

Difficult to diagnose without tests
Test include:

Blood is taken from the veins in the arm, and sent for a complete count of red and white blood cells, Blood cultures (find bacteria in the blood), ESR and CRP, and full chemical panel.

Cultures of urine, and any pus or open wounds are also sent, but not reliable, since they may be contaminated.

Best test for diagnosing OM is done in the hospital where an orthopedics surgeon (bone surgeon) uses a needle or a sharp surgical knife to remove a very tiny piece of the infected bone (bone biopsy), then sends it to the laboratory where the exact type of the bacteria can be identified in 48-72 hours (some bacteria such as Mycoplasma may take weeks).

X-Rays of the infected bones can be done, but are not too helpful in diagnosing OM.

Bone scan -- done by injecting a radioactive dye into the blood, which is carried to the infected bone. An X-Ray is then taken. This is better than a simple X-Ray, and can rule out cancer lesions as well.

A CAT scan or a MRI are imaging techniques that can provide a detailed picture of the bones without the need for an injection of dye, but are much more expensive, and are not available everywhere.

Sickle cell anemia -- blood supply to the bone is compromised and the bone is susceptible to infections.

Diabetes Mellitus -- diabetes causes sensory nerve damage (Neuropathy), which results in numbness of the skin (feet and hands etc.). A cut in the skin is often missed until it is infected. Neuropathy comes from other causes of nerve damage, such as Multiple Sclerosis or Vasculitis.

Local trauma -- cuts, erosions, wounds, and Pressure Sores (decubiti) from lying in bed or a wheel chair for a long time (elderly as in nursing home).

Drug abuse -- intravenous heroin or cocaine abuse.

Poor circulation -- from smoking or diseased arteries as with atherosclerotic vascular disease.

Dialysis -- in patients with kidney failure, the blood is filtered of waste and water. Infections can occur during the procedure.

Open fractures

Prosthetic implants such as an artificial knee or hip

Acute cases of OM where the patients are in pain and very sick, require immediate hospitalization and antibiotic therapy.

The patient is put on bed rest and given medications for pain and fever (Tylenol, Motrin , codeine).

Fluids are given orally or through an IV (a plastic cannula placed inside a vein).

A high protein diet is recommended.

Vitamins and minerals tablets can be helpful

Diabetics and patients with heart, kidney, or liver disease need a special diet.

Antibiotics are given for 4-6 weeks, and in chronic OM, may be given as pills for up to six months.

An infectious disease specialist and orthopedic specialist are consulted.

An infected wound or bed sore may need to be cleaned to remove the infected tissue.

An Abscess (a closed sac of infection) may need to be drained

In cases where there is no response to antibiotics, the infected prosthesis (artificial joint or limb) may need to be removed or amputated.

After any surgery, the patient will need long term nursing care and physical therapy.

In the patients where the infection is not so severe, they can be discharged home after the first few days of antibiotic treatment and receive IV's at home, where they are monitored by a home nurse.

One should Quit Smoking, stop abusing drugs, and if diabetic (or other illnesses), eat and live healthy.

The elderly and those with skin numbness due to diseases (diabetes, neuropathy, vascular disorders etc.) should inspect their skin (feet, buttocks, back) on a regular bases.