Osteomyelitis infection. The presence of this pathology is

Osteomyelitis is an
infection of the bone caused by microorganisms and accompanied by bone
destruction. Osteomyelitis often results in amputation of the infected area to
prevent the spread of infection. The presence of this pathology is frequently
found in the long bones of the body and can be spread if not treated
immediately after diagnosis. Osteomyelitis can occur either as acute or
chronic, but treating these different types may cause a variation in treatment
depending on severity and progression of the infection.  Osteomyelitis can occur in many ways and the
chance of osteomyelitis occurring depends on several factors.

            Osteomyelitis is
caused bacteria that enters the bone through the bloodstream or by infected
tissue. Bones can become susceptible when damage to the part or the body in
general occurs. The risk of developing osteomyelitis can be increased in many
ways. Recent injury, such as an open fracture, can allow bacteria to easily
access the bone and allow the area to become infected. Also, if an orthopedic
surgery was performed and the sterile field was broken or the prosthesis was
not sterile, this could increase the risk of infection. Because osteomyelitis
is caused by a bacteria, a weakened immune system can also increase the chance
of development because the body is more susceptible to infection. Procedures
such as catheters and intravenous lines insertion can also possibly introduce
infection into the body which can eventually spread into the bone causing
osteomyelitis.   

            Osteomyelitis is caused by Staphylococcus aureus
bacteria. Staphylococcus aureus bacteria can be commonly found on the skin and
in the nose. Generally, the human body is able to defend from this bacteria
unless the body has become susceptible. The severity of osteomyelitis depends
on how the body reacts to the exposure to staphylococcus bacteria. For staphylococcus
bacteria to attach to extracellular matrix proteins, bacterial adhesions are
required. If the bacteria is unable to adhere to bone or soft tissue then the
development of osteomyelitis will not take place. Staphylococcus bacteria also
must be able to escape the host’s defenses which is easily done if the host’s
immune system is compromised. If the bacteria is able to escape the host’s
defense, then it is able to begin the process of invading the cells and if the
infection is able to invade, then the bone or tissue becomes infected causing
osteomyelitis. Osteomyelitis creates many complications for the infected host.

            Symptoms can occur that may alert physicians of
infection. One symptom is warmth of the affected area. When infection occurs
the body produces heat around the area of infection which should alert physicians
of the possibility of osteomyelitis. If there was an open wound that allowed
the infection to enter the host’s body then there could be pus leaking from the
wound showing that it is infected. Pain in the bone is also a common symptom
that occur because essentially the bone is being broken down by infection.
Swelling and tenderness generally occur over the site of infection. The patient
may also begin to run a fever because the body is attempting to fight off the bacteria.

            Osteonecrosis, also known as bone death, caused by lack
of blood supply to the area is one of the most common complications associated
with osteomyelitis. Depending on the location of the infection, septic
arthritis can also occur. Septic arthritis occurs when the infection of the bone
spreads to the joint. This is common when osteomyelitis occurs due to an orthopedic
joint replacement surgery. When osteomyelitis occurs in children it generally
occurs near the growth plate. After this infection has taken place and has been
cured it can affect the future growth and development of the affected area.  When a case of osteomyelitis includes an open
sore or wound, then the chance of skin cancer may be increased for the patient.
Because of these complications, it is important to diagnose osteomyelitis as
soon as possible.

`           The best method overall for diagnosing osteomyelitis is magnetic
resource imaging (MRI). The benefit of MRI imaging is that it can distinguish
between bone and soft tissue infections. MRI also shows bony oedema providing
images of inflammatory signs showing infection. Computer tomography can also be
useful during diagnosis because it shows increased bone marrow density in early
stages of infection and demonstrates the possible involvement of nearby tissues.
Nuclear medicine is helpful by using technetium Tc 99m methylene diphosphonate
as a pharmaceutical during an exam. This pharmaceutical binds to areas of increased
activity in the bone destruction. Nuclear medicine is more commonly used for
diagnosis of acute osteomyelitis. Ultrasound may be used, but only to show the
area of infection in soft tissue. Conventional radiography can be used for
diagnosis, but is not the best option because it takes 10 to 21 days of the
infection taking place before it will be visible on a plain film radiograph.
Blood test are helpful, but are not a complete way to fully diagnose the
condition. Blood test may show an increase white blood cell count which can
show that the body is fighting infection. After the result show this increase
imaging procedures should be performed. Bone biopsy is also a great option for
diagnosis osteomyelitis because it allows doctors to specifically identify the
germ cell involved and allows the doctor to choose the best antibiotic for
treatment.

            Treatment of osteomyelitis will depend on the advancement
and severity of the pathology. Antibiotics can be tried, but in most cases
amputation is required to stop the spread of infection to other parts of the
body. Operative treatments may also be used. Antibiotics are generally more
effective in treating acute osteomyelitis. The timeframe for antibiotics is
normally four to six weeks. Antibiotics are also more effective in treating
pediatric cases of osteomyelitis because bone of children are more vascular
than those of adults. The effectiveness of an operative procedure relies on efficiency
of the treatment. The infection must be completely drained from the area and
all infected bone and tissue must be removed. This removal can create dead
space in the body which must be eliminated to prevent infection from reoccurring.
Soft tissue must then be grafted to effectively cover the area so that it is
not exposed to infection again. Blood supply must be adequate to the area to
insure correct healing of the site. Vacuum assisted closure may be used to
apply negative pressure to the area. Depending on the area of infection bone
stabilization may be required using plates and screws to help with recovery.
External fixation is generally chosen so that no chance of infection occurs
internally from the foreign parts of the fixator. If osteomyelitis in not able
to be cured with these options amputation of the part may be required in hopes
that the infection has not spread to other areas of the body.

            Osteomyelitis occurs more frequently in developing countries
due to lack of medical treatment. If a patient is living in a developed country
with adequate medical care osteomyelitis may be able to be cured. Often amputation
is required to completely remove the infected area. After osteomyelitis is
cured, the patient is required to receive conventional radiography imaging
routines to continue to monitor the area where the infection was present. Once
treatment occurs and is successful then a patient may continue to live their normal
lives with minimal affects from the infection. For Patients with chronic osteomyelitis
multiple treatments and amputations may be required to completely remove the
infection form the body.

            Osteomyelitis can be difficult to treat, but if it is
caught early treatment is generally able to fight off the infection. Specific
imaging procedures are required to properly diagnose this pathology and other
procedures may be helpful to allow the correct treatment for the specific
bacteria involved. Symptoms may be able to help determine the possibility of
osteomyelitis, but ultimately imaging procedures are necessary for proper
diagnosis. The severity of osteomyelitis depends on the bacteria’s ability to
attach to host cells of bone and soft tissues. Infection may require amputation
of limbs or antibiotic treatments to efficiently cure osteomyelitis.