{{infobox disease | name | Osteomyelitis | Image Ostermyelitis Tibia.jpg | Caption Osteomyelitis of the tibia of a young child. Numerous abscesses in the bone show as radiolucency. | ICD10 | ICD9 | ICDO | OMIM | DiseasesDB 9367 | MedlinePlus 000437 | eMedicineSubj ped | eMedicineTopic 1677 | MeshID D010019 }} |
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Chronic osteomyelitis may be due to the presence of intracellular bacteria (inside bone cells). Also, once intracellular, the bacteria are able to escape and invade other bone cells. In addition, once intracellular, the bacteria becomes resistant to some antibiotics. These combined facts may explain the chronicity and difficult eradication of this disease. This results in significant costs and disability and may even lead to amputation. Intracellular existence of bacteria in osteomyelitis is likely an unrecognized contributing factor to its chronic form.
In infants, the infection can spread to the joint and cause arthritis. In children, large subperiosteal abscesses can form because the periosteum is loosely attached to the surface of the bone.
Because of the particulars of their blood supply, the tibia, femur, humerus, vertebra, the maxilla, and the mandibular bodies are especially susceptible to osteomyelitis. Abscesses of any bone, however, may be precipitated by trauma to the affected area. Many infections are caused by ''Staphylococcus aureus'', a member of the normal flora found on the skin and mucous membranes. In patients with sickle cell disease, the most common causative agent remains Staphylococcus aureus, but Salmonella species become proportionally more common pathogens than in healthy hosts.
Age group | Most common organisms |
Newborns (younger than 4 mo) | ''S. aureus'', ''Enterobacter'' species, and group A and B ''Streptococcus'' species |
Children (aged 4 mo to 4 y) | ''[[Staphylococcus aureus |
Children, adolescents (aged 4 y to adult) | ''S. aureus'' (80%), group A ''Streptococcus'' species, ''H. influenzae'', and ''Enterobacter'' species |
Adult | |
Sickle Cell Anemia Patients | ''Salmonella'' species |
In children, the long bones are usually affected. In adults, the vertebrae and the pelvis 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 in 1–3% of patients with pulmonary tuberculosis. In this case, the bacteria, in general, spread to the bone through the circulatory system, first infecting the synovium (due to its higher oxygen concentration) before spreading to the adjacent bone. In tubercular osteomyelitis, the long bones and vertebrae are the ones that tend to be affected.
''Staphylococcus aureus'' 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''. In infants, ''S. aureus'', Group B streptococci (most common) and ''Escherichia coli'' are commonly isolated; in children from 1 to 16 years of age, ''S. aureus'', ''Streptococcus pyogenes'', and ''Haemophilus influenzae'' are common. In some subpopulations, including intravenous drug users and splenectomized 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 the most common organism seen in osteomyelitis, seeded from areas of contiguous infection. But anaerobes and Gram-negative organisms, including ''Pseudomonas aeruginosa'', ''E. coli'', and ''Serratia marcescens'', are also common. Mixed infections are the rule rather than the exception.
Systemic mycotic (fungal) infections may also cause osteomyelitis. The two most common are Blastomyces dermatitidis and Coccidioides immitis.
In osteomyelitis involving the vertebral bodies, about half the cases are due to ''Staphylococcus aureus'', and the other half are due to tuberculosis (spread hematogenously from the lungs). Tubercular osteomyelitis of the spine was so common before the initiation of effective antitubercular therapy that it acquired a special name, ''Pott's disease''.
Following laboratory analysis of clinical data and studied literature, we can say that the bone pathological changes are induced by several interrelated mechanisms the drug components, produced clandestinely. The ''Burkholderia cepacia complex'' have been implicated in vertebral osteomyelitis in intravenous drug users.
Factors that may commonly complicate osteomyelitis are fractures of the bone, amyloidosis, endocarditis, or sepsis.
In 1875, American artist Thomas Eakins depicted a surgical procedure for osteomyelitis at Jefferson Medical College, in a famous oil painting titled ''The Gross Clinic''.
Prior to the widespread availability and use of antibiotics, blow fly larvae were sometimes deliberately introduced to the wounds to feed on the infected material, effectively scouring them clean.
Hyperbaric oxygen therapy has been shown to be a useful adjunct to the treatment of refractory osteomyelitis.
Open surgery is needed for chronic osteomyelitis, whereby the involucrum is opened and the sequestrum is removed or sometimes saucerization can be done
Category:Bacterial diseases Category:Osteopathies
ar:التهاب العظم والنقي cs:Osteomyelitida de:Osteomyelitis el:Οξεία οστεομυελίτιδα es:Osteomielitis eu:Osteomielitis fa:استئومیلیت fr:Ostéomyélite it:Osteomielite he:דלקת העצם kk:Остемиелит nl:Osteomyelitis ja:骨髄炎 no:Osteomyelitt pl:Zapalenie kości i szpiku pt:Osteomielite ru:Остеомиелит uk:ОстеомієлітThis text is licensed under the Creative Commons CC-BY-SA License. This text was originally published on Wikipedia and was developed by the Wikipedia community.
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