Osteomyelitis

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Osteomyelitis

Osteomyelitis is an infection

Infection

An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host resources to multiply ....
of bone

Bone

Bones are rigid organ that form part of the endoskeleton of vertebrates. They function to move, support, and protect the various organs of the body, produce red blood cell and white blood cells and store minerals....
or bone marrow

Bone marrow

Bone marrow is the flexible biological tissue found in the hollow interior of bones. In adults, marrow in large bones produces new blood cells....
, usually caused by pyogenic

Pyogenic

Pyogenic refers to bacterial infections that make pus.The pus is mostly composed of dead neutrophils that are destroyed by bacteria such as Streptococcus pyogenes and Staphylococcus aureus through the release of leukocidins....
bacteria

Bacteria

The Bacteria are a large group of unicellular microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals....
or mycobacteria. It can be usefully subclassified on the basis of the causative organism, the route, duration and anatomic location of the infection.

rally, microorganisms may infect bone through one or more of three basic methods: via the bloodstream, contiguously from local areas of infection (as in cellulitis

Cellulitis

Cellulitis is a diffuse infection of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin. Cellulitis can be caused by normal skin Flora or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, blisters, burn , insect bites, surgical wounds, or sites o...
), or penetrating trauma

Physical trauma

Physical trauma refers to a body injury. A trauma patient is someone who has suffered serious and life-threatening physical injury with the potential for secondary complications such as Shock , respiratory failure and death....
, including iatrogenic causes such as joint replacements or internal fixation of fracture

Bone fracture

A bone fracture is a medical condition in which a bone is cracked or broken. It is a break in the continuity of the bone. While many fractures are the result of high force impact force or Stress fracture, bone fracture can also occur as a result of certain medical conditions that weaken the bones, such as osteoporosis, certain types of cance...
s or root-canaled

Endodontic therapy

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Encyclopedia

Osteomyelitis is an infection

Infection

An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host resources to multiply ....
of bone

Bone

Bone marrow

Bone marrow is the flexible biological tissue found in the hollow interior of bones. In adults, marrow in large bones produces new blood cells....
, usually caused by pyogenic

Pyogenic

Bacteria

Presentation

Generally, microorganisms may infect bone through one or more of three basic methods: via the bloodstream, contiguously from local areas of infection (as in cellulitis

Cellulitis

Physical trauma

Bone fracture

Endodontic therapy

Endodontic therapy is a sequence of treatment for the Pulp of a tooth whose end result is the elimination of infection and protection of the decontaminated tooth from future microbe invasion....
teeth. Once the bone is infected, leukocytes enter the infected area, and in their attempt to engulf

Phagocytosis

File:Phagocytosis in three steps.pngPhagocytosis is the cell process of Phagocytes and Protists of engulfing solid particles by the cell membrane to form an internal phagosome, which is a food vacuole, or pteroid....
the infectious organisms, release enzyme

Enzyme

Enzymes are biomolecules that catalysis chemical reactions. Almost all enzymes are proteins. In enzymatic reactions, the molecules at the beginning of the process are called Substrate , and the enzyme converts them into different molecules, the products....
s that lyse

Lysis

Lysis refers to the death of a cell by breaking of the cellular membrane, often by viral or osmotic mechanisms that compromise its integrity. A solution containing the contents of lysed cells is called a "lysate"....
the bone. Pus

Pus

Pus is a whitish-yellow, yellow or yellow-brown substance produced during inflammatory pyogenic bacteriuml infection. An accumulation of pus in an enclosed tissue space is known as an abscess....
spreads into the bone's blood vessels, impairing their flow, and areas of devitalized infected bone, known as sequestra, form the basis of a chronic infection. Often, the body will try to create new bone around the area of necrosis

Necrosis

Necrosis is the name given to premature death of cell s and living biological tissue. Necrosis is caused by external factors, such as infection, toxins, or trauma....
. The resulting new bone is often called an involucrum

Involucrum

Involucrum is a layer of new bone growth outside existing bone seen in pyogenic osteomyelitis. It results from the stripping off of the periosteum by the accumulation of pus within the bone, and new bone growing from the periosteum....
. On histologic

Histology

Histology is the study of the anatomy of cell and tissue of plants and animals. It is performed by examining a thin slice of tissue under a light microscope or electron microscope....
examination, these areas of necrotic bone are the basis for distinguishing between acute
Acute (medicine)

In medicine, an acute disease is a disease with either or both of:# a rapid onset;# a short course .This adjective is part of the definition of several diseases and is, therefore, incorporated in their name, for instance, severe acute respiratory syndrome, acute leukemia....
osteomyelitis and chronic osteomyelitis. Osteomyelitis is an infective process which encompasses all of the bone (osseous) components, including the bone marrow. When it is chronic it can lead to bone sclerosis

Sclerosis

'Sclerosis' or 'sclerotization' is a hardening of tissue and other anatomical features* Sclerosis *Cyberbrain#Cyberbrain_Sclerosis, a fictional disease introduced in ...
and deformity.

In infant

Infant

An infant or baby is the term used to refer to the young offspring of humans....
s, the infection can spread to the joint

Joint

A joint is the location at which two or more bones make contact. They are constructed to allow movement and provide mechanical support, and are classified structurally and functionally....
and cause arthritis

Arthritis

Arthritis is a group of conditions involving damage to the joints of the body. Arthritis is the leading cause of disability in people older than fifty-five years....
. In child

Child

A child is a human being between the stages of birth and puberty. The legal definition of "child" generally refers to a minor , otherwise known as a person younger than the age of majority....
ren, large subperiosteal abscess

Abscess

An abscess is a collection of pus that has accumulated in a cavity formed by the tissue on the basis of an infection process or other foreign materials ....
es can form because the periosteum

Periosteum

Periosteum is a membrane that lines the outer surface of all bone, except at the joints of long bones. Endosteum lines the inner surface of all bones....
is loosely attached to the surface of the bone.

Because of the particulars of their blood supply, the tibia

Tibia

The tibia, shinbone, or shankbone is the larger and stronger of the two bones in the leg below the knee in vertebrates and connects the knee with the ankle bones....
, femur

Femur

The femur, or thigh bone, is the most proximal bone of the leg in vertebrates capable of walking or jumping, such as most land mammals, birds, many reptiles such as lizards, and amphibians such as frogs....
, humerus

Humerus

The humerus is a long bone in the arm or forelimb that runs from the shoulder to the elbow.Anatomically, it connects the scapula and the ulna, and consists of the following three sections:...
, vertebra

Vertebra

A vertebra is an individual bone in the flexible column that defines vertebrate animals. The vertebral column encases and protects the spinal cord, which runs from the base of the cranium down the dorsal side of the animal until reaching the pelvis....
, the maxilla

Maxilla

The maxilla is a fusion of two bones along the palate fissure that form the upper jaw. This is similar to the mandible, which is also a fusion of two halves at the mental symphysis....
, and the mandibular bodies are especially susceptible to osteomyelitis. However, abscesses of any bone may be precipitated by trauma to the affected area. Many infections are caused by Staphylococcus aureus
Staphylococcus aureus

Staphylococcus aureus is the most common cause of staph infections. It is a spherical Bacteria, frequently found in the nose and skin of a person....
, a member of the normal flora

Flora (microbiology)

In microbiology, flora refers to the collective bacteria and other microorganisms in an ecosystem ....
found on the skin

Skin

The skin is the outer covering of the body, also known as the epidermis. It is the largest organ of the integumentary system made up of multiple layers of epithelial biological tissue, and guards the underlying muscles, bones, ligaments and organ s....
and mucous membrane

Mucous membrane

The mucous membranes are linings of mostly germ layer origin, covered in epithelium, which are involved in absorption and secretion. They line various body cavities that are exposed to the external environment and internal organ ....
s.

Etiology

Age group	Most common organisms
Newborns (younger than 4 mo)	S. aureus Staphylococcus aureus *Staphylococcus aureus* is the most common cause of staph infections. It is a spherical Bacteria, frequently found in the nose and skin of a person.... , Enterobacter Enterobacter *Enterobacter* is a genus of common Gram-negative, Facultative anaerobic organism, bacillus bacteria of the family Enterobacteriaceae. Several strains of the these bacteria are pathogen and cause opportunistic infections in immunocompromised hosts.... species, and group A Group A streptococcal infection The group A streptococcus bacterium is a form of Streptococcus bacteria responsible for most cases of streptococcal illness. Other types may also cause infection.... and B Streptococcus species
Children (aged 4 mo to 4 y)	S. aureus Staphylococcus aureus *Staphylococcus aureus* is the most common cause of staph infections. It is a spherical Bacteria, frequently found in the nose and skin of a person.... , group A Group A streptococcal infection The group A streptococcus bacterium is a form of Streptococcus bacteria responsible for most cases of streptococcal illness. Other types may also cause infection.... Streptococcus species, Haemophilus influenzae Haemophilus influenzae *Haemophilus influenzae, formerly called Pfeiffer's bacillus* or *Bacillus influenzae, is a non-motile Gram-negative coccobacillus first described in 1892 by Richard Friedrich Johannes Pfeiffer during an influenza pandemic.... , and Enterobacter Enterobacter Enterobacter* is a genus of common Gram-negative, Facultative anaerobic organism, bacillus bacteria of the family Enterobacteriaceae. Several strains of the these bacteria are pathogen and cause opportunistic infections in immunocompromised hosts.... species
Children, adolescents (aged 4 y to adult)	S. aureus Staphylococcus aureus *Staphylococcus aureus* is the most common cause of staph infections. It is a spherical Bacteria, frequently found in the nose and skin of a person.... (80%), group A Group A streptococcal infection The group A streptococcus bacterium is a form of Streptococcus bacteria responsible for most cases of streptococcal illness. Other types may also cause infection.... Streptococcus species, H. influenzae Haemophilus influenzae *Haemophilus influenzae, formerly called Pfeiffer's bacillus* or *Bacillus influenzae, is a non-motile Gram-negative coccobacillus first described in 1892 by Richard Friedrich Johannes Pfeiffer during an influenza pandemic.... , and Enterobacter Enterobacter Enterobacter* is a genus of common Gram-negative, Facultative anaerobic organism, bacillus bacteria of the family Enterobacteriaceae. Several strains of the these bacteria are pathogen and cause opportunistic infections in immunocompromised hosts.... species
Adult	S. aureus Staphylococcus aureus *Staphylococcus aureus* is the most common cause of staph infections. It is a spherical Bacteria, frequently found in the nose and skin of a person.... and occasionally Enterobacter Enterobacter *Enterobacter* is a genus of common Gram-negative, Facultative anaerobic organism, bacillus bacteria of the family Enterobacteriaceae. Several strains of the these bacteria are pathogen and cause opportunistic infections in immunocompromised hosts.... or Streptococcus Streptococcus *Streptococcus* is a genus of sphere Gram-positive bacterium belonging to the phylum Firmicutes and the lactic acid bacteria group. Cell division occurs along a single Coordinate axis in these bacteria, and thus they grow in chains or pairs, hence the name — from Greek language st?ept?? streptos, meaning easily bent or twisted,... species

In children, the long bone

Long bone

The long bones are those that are longer than they are wide, and grow primarily by elongation of the diaphysis, with an epiphysis at the ends of the growing bone....
s are usually affected. In adults, the vertebrae and the pelvis

Pelvis

The pelvis or pelvic girdle is the irregular bone structure located at the base of the spine . In the adult human, it is formed by the sacrum and the coccyx, the caudal part of the axial skeleton, and a pair of hip bones, part of the appendicular skeleton or human leg....
are most commonly affected.

Acute osteomyelitis almost invariably occurs in children. When adults are affected, it may be because of compromised host resistance due to debilitation, intravenous drug abuse, infectious root-canaled teeth, or other disease or drugs (e.g. immunosuppressive therapy).

Osteomyelitis is a secondary complication

Complication (medicine)

Complication, in medicine, is an unfavorable evolution of a disease, a health condition or a medical treatment. The disease can become worse in its severity or show a higher number of signs, symptoms or new pathology changes, become widespread throughout the body or affect other organ systems....
in 1-3% of patients with pulmonary tuberculosis

Tuberculosis

Tuberculosis is a common and often deadly infectious disease caused by mycobacterium, mainly Mycobacterium tuberculosis . Tuberculosis usually attacks the lungs but can also affect the central nervous system, the lymphatic system, the circulatory system, the genitourinary system, the gastrointestinal system, bones, joints, and even the...
. In this case, the bacteria generally spread to the bone through the circulatory system

Circulatory system

The circulatory system is an organ that moves nutrients, gases, and wastes to and from cells to help fight diseases and help stabilize body temperature and pH to maintain homeostasis....
, first infecting the synovium

Synovium

Synovial membrane is the soft biological tissue that lines the non-cartilage surfaces within joints with cavities . The word "synovium" comes from a Latin word meaning "with egg ," because the synovial fluid in joints that have a cavity between the bearing surfaces is like egg white....
(due to its higher oxygen

Oxygen

Oxygen no O2 produced; 2) O2 produced, but absorbed in oceans & seabed rock; 3) O2 starts to gas out of the oceans, but is absorbed by land surfaces and formation of ozone layer; 4-5) O2 sinks filled and the gas accumulates]]...
concentration) before spreading to the adjacent bone. In tubercular osteomyelitis, the long bones and vertebrae are the ones which tend to be affected.

Treatment

Osteomyelitis often requires prolonged antibiotic

Antibiotic

In common usage, an antibiotic is a substance or compound that kills or inhibits the growth of bacteria. Antibiotics belong to the group of antimicrobial compounds used to treat infections caused by microorganisms, including fungus and protozoa....
therapy, with a course lasting a matter of weeks or months. A PICC line or central venous catheter

Central venous catheter

In medicine, a central venous catheter is a catheter placed into a large vein in the neck , chest or groin . It is used to administer medication or fluids, obtain blood tests , and directly obtain cardiovascular measurements such as the central venous pressure....
is often placed for this purpose. Osteomyelitis also may require surgical debridement

Debridement

Debridement is the medical removal of a patient's dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue....
. Severe cases may lead to the loss of a limb. Initial first line antibiotic choice is determined by the patient's history and regional differences in common infective organisms.

In 1875, American artist Thomas Eakins

Thomas Eakins

Thomas Cowperthwait Eakins was an United States Realism Painting, photographer, Sculpture, and fine arts educator. He is widely acknowledged to be one of the most important artists in American art history....
depicted a surgical procedure for osteomyelitis at Jefferson Medical College, in a famous oil painting

Oil painting

Oil painting is the process of painting with pigments that are bound with a medium of drying oil ? especially in early modern Europe, linseed oil....
titled The Gross Clinic
The Gross Clinic

The Gross Clinic is an 1875 painting by American artist Thomas Eakins. It is oil painting on canvas and measures by . Dr. Samuel D. Gross, a seventy-year-old professor dressed in a black frock coat, lectures a group of Jefferson Medical College students....
.

Prior to the widespread availability and use of antibiotics, blow fly larvae

Maggot

Maggot is the common name of the larval phase of development in insects of the order Diptera . Sometimes the word is used to denote the larval stage of any insects....
were sometimes deliberately introduced

Maggot therapy

Maggot therapy is a type of biotherapy involving the intentional introduction by a health care practitioner of live, disinfected maggots raised in special facilities into the non-healing skin and soft tissue wound of a human or other animal for the purposes of selectively cleaning out only the necrosis tissue within a wound , disinfection,...
to the wounds to feed on the infected material, effectively scouring them clean.

Hyperbaric oxygen therapy

Hyperbaric oxygen therapy

Hyperbaric medicine, also known as hyperbaric oxygen therapy , is the medical use of oxygen at a level higher than atmospheric pressure....
has been shown to be a useful adjunct to the treatment of refractory osteomyelitis. A treatment lasting 42 days is practiced in a number of facilities.

Causes

Staphylococcus aureus
Staphylococcus aureus

Staphylococcus aureus is the most common cause of staph infections. It is a spherical Bacteria, frequently found in the nose and skin of a person....
is the organism most commonly isolated from all forms of osteomyelitis.

Bloodstream-sourced osteomyelitis is seen most frequently in children, and nearly 90% of cases are caused by Staphylococcus aureus
Staphylococcus aureus

Staphylococcus aureus is the most common cause of staph infections. It is a spherical Bacteria, frequently found in the nose and skin of a person....
. In infants, S. aureus, Group B streptococci (most common) and Escherichia coli
Escherichia coli

'Escherichia coli' , is a Gram negative bacterium that is commonly found in the lower gastrointestinal tract of warm-blooded animals. Most E....
are commonly isolated; in children from 1 to 16 years of age, S. aureus, Streptococcus pyogenes
Streptococcus pyogenes

'Streptococcus pyogenes' is a coccus gram-positive bacteria that grows in long chains and is the cause of Group A streptococcal infections. S....
, and Haemophilus influenzae
Haemophilus influenzae

Haemophilus influenzae, formerly called Pfeiffer's bacillus or Bacillus influenzae, is a non-motile Gram-negative coccobacillus first described in 1892 by Richard Friedrich Johannes Pfeiffer during an influenza pandemic....
are common. In some subpopulations, including intravenous drug users and splenectomized

Splenectomy

A splenectomy is a procedure that involves the removal of the spleen by Surgery means....
patients, Gram-negative bacteria, including enteric bacteria, are significant pathogens.

The most common form of the disease in adults is caused by injury exposing the bone to local infection. Staphylococcus aureus is again the most common organism seen in osteomyelitis seeded from areas of contiguous infection, but anaerobes and Gram-negative organisms, including Pseudomonas aeruginosa
Pseudomonas aeruginosa

Pseudomonas aeruginosa is a common bacterium which can cause disease in animals and humans. It is found in soil, water, and most man-made environments throughout the world....
, E. coli, and Serratia marcescens
Serratia marcescens

Serratia marcescens is a species of Gram-negative, bacillus bacteria in the family Enterobacteriaceae. A human pathogen, S. marcescens is involved in nosocomial infections, particularly Central venous catheter#Infection bacteremia, urinary tract infections and wound infections, and is responsible for 1.4% of nosocomial bacteremi...
, are also common, and mixed infections are the rule rather than the exception.

Systemic mycotic (fungal) infections may also cause osteomyelitis. The two most common pathogens involved in such infections are Blastomyces dermatitidis and Coccidioides immitis

Coccidioides immitis

Coccidioides immitis is a pathogenic fungus that resides in the soil in certain parts of the Southwestern United States United States, northern Mexico, and a few other areas in the Western Hemisphere....
.

In osteomyelitis involving the vertebral bodies, about half the cases are due to Staphylococcus aureus, and the other half are due to tuberculosis

Tuberculosis

Lung

The lung is the essential respiration organ in air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located in the chest on either side of the heart....
s). Tubercular osteomyelitis of the spine

Spine

Spine or Spinal may refer to:...
was so common before the initiation of effective antitubercular therapy that it acquired a special name, Pott's disease
Pott's disease

Pott disease is a presentation of extrapulmonary tuberculosis that affects the spine, a kind of tuberculous arthritis of the intervertebral joints....
, by which it is sometimes still known. The Burkholderia cepacia complex
Burkholderia cepacia complex

Burkholderia cepacia complex , or simply Burkholderia cepacia is a group of catalase-producing, non-lactose-fermentation Gram-negative bacteria composed of at least nine different species, including B....
have been implicated in vertebral osteomyelitis in intravenous drug abusers.

Diagnosis of osteomyelitis is often based on radiologic

Radiology

Radiology is the branch or speciality of medicine that deals with the study and application of imaging technology like x-ray and radiation to diagnosing and treating disease....
results showing a lytic center with a ring of sclerosis

Sclerosis

'Sclerosis' or 'sclerotization' is a hardening of tissue and other anatomical features* Sclerosis *Cyberbrain#Cyberbrain_Sclerosis, a fictional disease introduced in ...
, though bone cultures are normally required to identify the specific pathogen.

Factors that may commonly complicate osteomyelitis are fractures of the bone, amyloidosis

Amyloidosis

In medicine, amyloidosis refers to a variety of conditions in which amyloid proteins are abnormally deposited in organ s and/or Tissue s. A protein is described as being amyloid if, due to an alteration in its secondary structure, it takes on a particular aggregated insoluble form similar to the beta-pleated sheet....
, endocarditis

Endocarditis

Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves . Other structures which may be involved include the interventricular septum, the chordae tendinae, the mural endocardium, or even on intracardiac devices....
, or sepsis

Sepsis

Sepsis, is a serious medicine condition characterized by a whole-body Inflammation state and the presence of a known or suspected infection..

Osteomyelitis

Presentation

Etiology

Treatment

Causes

See also

External links