Osteomyelitis | |
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Other names | Bone infection |
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Osteomyelitis of the 1st toe | |
Specialty | Infectious disease, orthopedics |
Symptoms | Pain in a specific bone, overlying redness, fever, weakness[1] |
Complications | Amputation[2] |
Usual onset | Young or old[1] |
Duration | Short or long term[2] |
Causes | Bacterial, fungal[2] |
Risk factors | Diabetes, intravenous drug use, prior removal of the spleen, trauma to the area[1] |
Diagnostic method | Blood tests, medical imaging, bone biopsy[2] |
Differential diagnosis | Charcot's joint, rheumatoid arthritis, infectious arthritis, giant cell tumor, cellulitis[1][3] |
Treatment | Antimicrobials, surgery[4] |
Prognosis | Low risk of death with treatment[5] |
Frequency | 2.4 per 100,000 per year[6] |
Osteomyelitis (OM) is an infection of bone.[1] Symptoms may include pain in a specific bone with overlying redness, fever, and weakness.[1] The long bones of the arms and legs are most commonly involved in children e.g. the femur and humerus,[7] while the feet, spine, and hips are most commonly involved in adults.[2]
The cause is usually a bacterial infection,[1][7][2] but rarely can be a fungal infection.[8] It may occur by spread from the blood or from surrounding tissue.[4] Risks for developing osteomyelitis include diabetes, intravenous drug use, prior removal of the spleen, and trauma to the area.[1] Diagnosis is typically suspected based on symptoms and basic laboratory tests as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). This is because plain radiographs are unremarkable in the first few days following acute infection.[7][2] Diagnosis is further confirmed by blood tests, medical imaging, or bone biopsy.[2]
Treatment of bacterial osteomyelitis often involves both antimicrobials and surgery.[7][4] Treatment outcomes of bacterial osteomyelitis are generally good when the condition has only been present a short time.[7][2] In people with poor blood flow, amputation may be required.[2] Treatment of the relatively rare fungal osteomyelitis as mycetoma infection entails the use of antifungal medications.[9] In contrast to bacterial osteomyelitis, amputation or large bony resections is more common in neglected fungal osteomyelitis (mycetoma) where infections of the foot account for the majority of cases.[8][9] About 2.4 per 100,000 people are affected by osteomyelitis each year.[6] The young and old are more commonly affected.[7][1] Males are more commonly affected than females.[3] The condition was described at least as early as the 300s BC by Hippocrates.[4] Prior to the availability of antibiotics, the risk of death was significant.[10]