Osteomyelitis

Osteomyelitis
Other namesBone infection
Osteomyelitis of the 1st toe
SpecialtyInfectious disease, orthopedics
SymptomsPain in a specific bone, overlying redness, fever, weakness[1]
ComplicationsAmputation[2]
Usual onsetYoung or old[1]
DurationShort or long term[2]
CausesBacterial, fungal[2]
Risk factorsDiabetes, intravenous drug use, prior removal of the spleen, trauma to the area[1]
Diagnostic methodBlood tests, medical imaging, bone biopsy[2]
Differential diagnosisCharcot's joint, rheumatoid arthritis, infectious arthritis, giant cell tumor, cellulitis[1][3]
TreatmentAntimicrobials, surgery[4]
PrognosisLow risk of death with treatment[5]
Frequency2.4 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]

  1. ^ a b c d e f g h i "Osteomyelitis". NORD (National Organization for Rare Disorders). 2005. Archived from the original on 11 February 2017. Retrieved 20 July 2017.
  2. ^ a b c d e f g h i j "Osteomyelitis". Genetic and Rare Diseases Information Center (GARD). 2016. Archived from the original on 9 February 2017. Retrieved 20 July 2017.
  3. ^ a b Ferri, Fred F. (2017). Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 924. ISBN 978-0-323-52957-0. Archived from the original on 2017-09-10.
  4. ^ a b c d Schmitt, SK (June 2017). "Osteomyelitis". Infectious Disease Clinics of North America. 31 (2): 325–38. doi:10.1016/j.idc.2017.01.010. PMID 28483044. S2CID 257184257.
  5. ^ Bennett, John E.; Dolin, Raphael; Blaser, Martin J. (2014). Principles and Practice of Infectious Diseases. Elsevier Health Sciences. p. 2267. ISBN 978-1-4557-4801-3. Archived from the original on 2017-09-10.
  6. ^ a b Hochberg, Marc C.; Silman, Alan J.; Smolen, Josef S.; et al. (2014). Rheumatology E-Book. Elsevier Health Sciences. p. 885. ISBN 978-0-7020-6303-9. Archived from the original on 2017-09-10.
  7. ^ a b c d e f El-Sobky, T; Mahmoud, S (July 2021). "Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills". EFORT Open Reviews. 6 (7): 584–592. doi:10.1302/2058-5241.6.200155. PMC 8335954. PMID 34377550.
  8. ^ a b El-Sobky, TA; Haleem, JF; Samir, S (2015). "Eumycetoma Osteomyelitis of the Calcaneus in a Child: A Radiologic-Pathologic Correlation following Total Calcanectomy". Case Reports in Pathology. 2015: 129020. doi:10.1155/2015/129020. PMC 4592886. PMID 26483983.
  9. ^ a b van de Sande, Wendy; Fahal, Ahmed; Ahmed, Sarah Abdalla; et al. (10 March 2018). "Closing the mycetoma knowledge gap". Medical Mycology. 56 (suppl_1): S153–S164. doi:10.1093/mmy/myx061. PMID 28992217.
  10. ^ Brackenridge, R. D. C.; Croxson, Richard S.; Mackenzie, Ross (2016). Medical Selection of Life Risks 5th Edition Swiss Re branded. Springer. p. 912. ISBN 978-1-349-56632-7. Archived from the original on 2017-09-10.

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