A Family Doctor's Tale - OSTEOMYELITIS

DOC I HAVE OSTEOMYELITIS

Osteomyelitis is generally rarely seen in a family practice because most cases need to be hospitalized. The disease is most common among diabetic patients where the skin infection has spread to the bones. A consequence of this happening is often amputation for diabetic patients. Other cases may be injuries to the bones due to accidents resulting in open wounds and fractures. 
 
Osteomyelitis is an infection of the bone substance by pyogenic bacteria and fungus.

The most causes of Osteomyelitis is
1.Staphylococcus aureus bacteria(80%).

Other bacteria involved are:
2.Streptococci Group A & B

3.Enterobacter species

4.Haemophilus influenzae

5.Pneumococci

6.Salmonellae

Systemic mycotic (fungal) infections may also cause osteomyelitis.
1.Blastomyces dermatitidis

2.Coccidioides immitis.

In children,
1.the long bones are usually affected in children.

2.Spread of bacteria  occurs from the bloodstream from a skin boil, dental abscess, direct injury to the bone.

3.Acute osteomyelitis almost invariably occurs in children.

In adults
1.injury to the bone is the most common cause.

The bone injury is exposed to local infection in the skin or environment.

Staphylococcus aureus is the most common bacteria in osteomyelitis resulting from bone injury and infection.

Other bacteria such as Pseudomonas aeruginosa, E. coli, and Serratia marcescens, are also common.

2.The vertebrae and the pelvis are the bones most commonly affected in adults.

For osteomyelitis of the vertebral bodies,
50% are due to Staphylococcus aureus,
and the remaining 50%f are due to tuberculosis usually from the lungs.

3.Bone infection in adults are usually due to their lower resistance from
debilitation,
intravenous drug abuse,
infectious root-canal teeth,
other disease or drugs (e.g. immunosuppressive therapy).

Symptoms:
1.pain and swelling of the bone 

2.fever

3.toxemia

Signs:
1.Hot tender bones

2.Throbbing pain of bones

3.Abscess and swelling

Diagnosis of osteomyelitis is often based on
1.radiologic results showing a lytic center with a ring of sclerosis,

2.Blood and bone cultures are normally required to identify the specific pathogen

The complications of Osteomyelitis are:
1.fractures of the bone,

2.amyloidosis,

3.endocarditis,

4.sepsis

Treatment is by:
1.antibiotic therapy  - usually as prolonged treatment lasting a matter of weeks or months.

2.Hyperbabaric oxygen therapy has helped in the treatment of refractory osteomyelitis.

3.Immobilization of the bone affected(bed rest, plaster casts,splints)

4.Osteomyelitis may also need surgical debridement to remove pus and damaged bone tissues.

5.Severe cases may lead to the loss of a limb.

Prognosis depends on the rapidity of onset of treatment.
The faster the treatment the faster thee cure.

Otherwise the condition may become a chronic illness requiring multiple surgical procedures.