Osteomyelitis

What is osteomyelitis?

Osteomyelitis is infection in the bones. The infection may involve all or just part of a bone. Bones of the legs, arms, spine, and pelvis are most often infected.

How does it occur?

Bacteria can infect bones in 2 ways:

• Bacteria may infect a bone through an open wound, during surgery, or from a bone fracture that has broken the skin. This is the most common cause of osteomyelitis.
• Bacteria from infections in other parts of the body may travel through the bloodstream and infect a bone. Some examples are strep throat, skin infections, and diseases such as tuberculosis, salmonellosis, and typhoid fever.

Osteomyelitis may be acute or chronic. In acute osteomyelitis, the infection is sudden and gets better with treatment. Osteomyelitis may become chronic (long lasting) if antibiotics are not able to kill the bacteria. You have a higher risk for chronic osteomyelitis if you:

• have acute osteomyelitis at the site of a recent injury
• have diabetes
• have sickle cell anemia
• are on dialysis
• have cancer of the skin or soft tissue under the skin
• abuse IV drugs.

What are the symptoms?

In adults the disease may begin as nothing more than pain in a bone. Other symptoms are:

• redness, warmth, and swelling in the area around the bone
• swelling in the ankles, feet, or legs
• tenderness of the bone
• limited movement in the area around the bone if it is near a joint
• chills
• fever
• nausea
• general ill feeling (malaise)
• sweating more than usual.

How is it diagnosed?

Your healthcare provider will ask about your medical history and your possible risks for osteomyelitis. Your provider will examine you. He or she will check for bone tenderness, swelling, and redness.

Tests you may have are:

• blood tests to look for bacteria
• a bone scan to look for areas of infection in the bone, using small amounts of a radioactive substance that are injected into a vein
• X-rays or a CT scan to look for an abscess or other signs of bacterial infection (signs of bone infection may not show on plain X-rays until about 10 to 14 days after symptoms first appear).

You may have a bone biopsy. After you have been given anesthesia, a sample of bone will be taken from the suspected infected area. The sample can be tested to identify the bacteria and to see which antibiotics will work best.

How is it treated?

Antibiotics given into your veins are usually an effective treatment for osteomyelitis. Because it is hard to get the antibiotic into the bone, you may need to take antibiotics for several weeks or months. You may need surgery to remove sections of bone that are slow healing, or to drain abscesses. Damaged sections of bone may grow back normally after the infection is under control.

If you have a chronic infection, a surgeon may remove the dead bone tissue. You may also need to take antibiotics periodically for the rest of your life.

How long will the effects last?

With prompt treatment, only about 5% of cases of acute osteomyelitis become chronic infections.

Chronic infections can cause general weakness, weight loss, anemia, kidney disease, and other disorders. Severe chronic osteomyelitis that does not get better with treatment may require amputation.

How can I take care of myself?

It is important to have regular checkups and to follow your healthcare provider's advice about how to take care of yourself.

• Check with your healthcare provider before taking other medicines, including nonprescription products or other forms of treatment.
• Continue to eat a balanced diet and get regular exercise.
• If you have a sore throat or fever, call your healthcare provider for advice. You may need immediate treatment.

How can I help prevent osteomyelitis?

• See your healthcare provider promptly if you have signs of an infection anywhere in the body.
• Take care of any wounds or injuries right away, especially injuries with broken skin over a bone or joint.

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