Osteomyelitis (inflammation of the bone marrow) is a disease of the bone caused by bacteria such as B. Staphylococcus aureus is caused. The focus of inflammation is in the bone marrow and subsequently spreads to the various bone layers. A distinction is made between endogenous and exogenous osteomyelitis, which can occur in both an acute and a chronic form.
What is osteomyelitis?
Osteomyelitis is inflammation of the bone marrow caused by bacteria. The bacterium Staphylococcus aureus is usually responsible for this. Osteomyelitis is divided into endogenous and exogenous. This relates to the development of osteomyelitis. See theinternetfaqs for Hemoglobinopathy Basics.
Endogenous osteomyelitis – also known as haematogenous osteomyelitis – occurs when the bacteria enter the bone marrow via the blood (haematogenous). The bacteria for this usually come from a source of infection inside (endo) the body. Exogenous osteomyelitis occurs as a result of external (exo) injuries. The pathogen enters the bone marrow through the wound.
Acute osteomyelitis is divided into three groups, depending on the age of the person affected. A distinction is made between acute hematogenous osteomyelitis in infants, acute hematogenous osteomyelitis in childhood and acute hematogenous osteomyelitis in adults.
Causes
The main cause of osteomyelitis is bacteria that cause infection in the bone marrow. In addition to Staphylococcus aureus, salmonella, streptococci and Escherichia coli can also be responsible for bone marrow inflammation.
In endogenous osteomyelitis, the bacterium enters the bone marrow via the blood supply. For this, other sources of infection must be present in the body, e.g. B. tonsillitis, inflammation of the paranasal sinuses and inflammation of the teeth and mucous membranes. Since the route of infection is via the blood supply, the bacterium can spread throughout the skeleton and lead to severe sepsis.
In exogenous osteomyelitis, the pathogens enter the bone marrow from the outside. This can happen as a result of an injury or during an operation. The bacteria mainly spread in the area of the wound, so that the bone marrow inflammation is localized. The risk of exogenous osteomyelitis is increased if e.g. B. Diseases such as diabetes mellitus or arteriosclerosis are present and / or the immune system is weakened.
Symptoms, Ailments & Signs
The acute inflammation of the bone marrow initially leads to a general feeling of illness. The patient feels tired and listless, nausea and fever develop, sometimes accompanied by chills. After a short time, the region over the inflamed bone marrow begins to hurt. It is tender and swollen.
The skin turns red and feels warm. The bone may pulsate painfully and the limbs lose strength and muscle tone. A fistula can develop later. Secretions or pus produced by the inflammation must drain away. Therefore, it makes a channel through the skin and exits the fistula opening.
If the infection follows an injury or after surgery, such as having an artificial joint put in, pus may ooze from the unhealed wound. But even after the wound has closed, inflammation can develop long after the procedure, which is known as subacute osteomyelitis.
If a joint is involved, this manifests itself in pain during certain movements. Osteomyelitis can affect any bone, but it is most common in the upper arms or knees. If the disease is not treated, the inflammation can spread further in the body and irreversibly damage the bone marrow.
Diagnosis & History
The diagnosis of osteomyelitis is secured using various diagnostic methods. Since symptoms such as swelling, redness and restricted movement can also have other causes, the following blood values are first examined after a thorough anamnesis (medical history).
Since osteomyelitis is an inflammation, the inflammatory parameters such as leukocytes (white blood cells), CRP (C-reactive protein) and ESR (blood sedimentation rate) are increased. Blood cultures can be used to identify the causative agent.
In addition to laboratory diagnostics, imaging methods such as B. X-ray, ultrasound, magnetic resonance imaging and skeletal scintigraphy. However, these examination methods are only used later, since visible changes in the bone only become apparent after about two to three weeks.
The course of osteomyelitis depends on the type of bone marrow inflammation. Acute endogenous osteomyelitis heals without consequences if it is diagnosed in good time and treated adequately.
In adults, this form of bone marrow inflammation can often be chronic. As bones change over the years, they may not respond as well to treatment. As a result, acute flare-ups occur again and again. Endogenous osteomyelitis takes a chronic course in 10 out of 100 people affected.
In infants or children, endogenous osteomyelitis often takes a severe course and causes permanent damage. Growth disorders are the result and the affected body part is deformed or shortened. Another consequence can be blood poisoning (sepsis).
In the case of exogenous osteomyelitis, early diagnosis and adequate treatment have a positive effect on the course and can therefore heal without consequences. However, a chronic form usually develops from the acute osteomyelitis, which means that the bone changes. Stability and mobility decrease, and inflammation can spread to nearby joints. In about 6 out of 100 people affected, the affected part of the body is amputated as the osteomyelitis progresses.
Complications
As a rule, complications arise with osteomyelitis if the disease is not treated in time. Those affected suffer from a high fever and often also from exhaustion and permanent fatigue. The inflammation can also spread to the other bone layers. There is also swelling and redness on the skin.
The patient may also suffer from various movement restrictions due to the osteomyelitis and thus restrictions in everyday life. In general, the patient’s quality of life is significantly reduced as a result of the disease. The joints and bones also hurt and can lead to irritability in those affected. If osteomyelitis occurs in children, this disease can lead to severe developmental and growth disorders.
In the worst case, it can also lead to blood poisoning, which can be fatal for the patient. The treatment of osteomyelitis is usually relatively uncomplicated and with the help of antibiotics. There are no complications either. The patient’s life expectancy is also not further affected if the treatment is successful.
When should you go to the doctor?
A doctor should be consulted in the event of a general feeling of illness, malaise or exhaustion. If there is a loss of the usual level of performance or a decrease in resilience, a doctor is needed. Flu-like symptoms such as chills, pain or an irregularity of the muscular system must be examined and treated. Symptoms of inflammation, an increased body temperature and nausea are signs of a health impairment that should be presented to a doctor. Discolouration of the skin and a feeling of heat in the skin are considered to be worrying.
If the symptoms persist for a long time or if they increase in intensity, a doctor is needed. Particular care should be taken if pus is formed. In severe cases, the person affected is threatened with sepsis and thus a life-threatening condition. A doctor’s visit is necessary as soon as the redness spreads to the affected area or sterile wound care cannot be guaranteed. Enlargement of a wound should also be reported to a doctor.
If everyday requirements can no longer be met or if there are disturbances in the general movement sequences, a visit to the doctor is advisable. Swelling in the immediate vicinity of the bones and sensory disturbances are other signs of an irregularity. A doctor should be consulted as soon as feelings of numbness or sensitivity to pressure or hypersensitivity to touch occur.
Treatment & Therapy
Osteomyelitis is treated with antibiotics. In the case of acute osteomyelitis, the affected part of the body is also immobilized using a splint or plaster cast. If a lot of tissue has also died, it must be surgically removed.
In exogenous osteomyelitis, healing with antibiotics is limited due to poor blood flow to the bone. Because of this, surgical treatment must take place. Here, the affected and destroyed tissue is removed. Especially in the case of large-area removals, a so-called spongiosaplasty is also carried out, a filling of the bone with bone substance from a healthy bone.
In chronic osteomyelitis, the inflammation is also treated with antibiotics. Surgical treatment is definitely necessary here. Since the tissue is permanently destroyed due to the recurring infections and the inflammation usually spreads uncontrollably, an amputation of the affected extremity is medically advisable in good time.
Outlook & Forecast
In many cases, osteomyelitis or bone marrow inflammation takes a chronic course. The earlier the disease is detected, the better the prognosis. Osteomyelitis is easier to treat in the early stages. A chronic manifestation and the irreversible damage associated with it can sometimes be averted.
Both the type and severity of osteomyelitis affect the prognosis. The age of the patient, his general state of health and the group of pathogens are also decisive factors. In the case of acute osteomyelitis, the person affected has a better chance of recovery than in the case of the chronic form. Acute bone marrow inflammation usually heals completely if treated early. If diagnosed late, it can become chronic. The prognosis in this case is less favorable, the treatment will be lengthy. There is a risk of circulatory disorders in the bone. The joint can only be moved to a limited extent or not at all. In the case of severe disease progression, antibiotic drugs can no longer contain the disease. Here an operation is necessary.
No preventive measures can be taken for osteomyelitis. However, people with a stable immune system were less likely to develop bone marrow inflammation. If a patient has already been treated for osteomyelitis, avoiding overload has a positive effect.
Prevention
Preventive measures can be carried out conditionally for osteomyelitis. Since osteomyelitis is caused by bacteria, antibiotics can be administered prophylactically for injuries and surgical procedures.
Further preventive measures are to be taken by the hospital/doctor’s practice. By following the rules of hygiene, the bacteria that cause it can be prevented from spreading, so that the occurrence of osteomyelitis can be reduced to a minimum.
Aftercare
In the case of osteomyelitis, the affected person usually only has very few and only limited measures of direct aftercare available. For this reason, the patient with this disease should consult a doctor as early as possible so that there are no further complications or symptoms. The sooner a doctor is consulted, the better the further progression of the disease.
Most patients with osteomyelitis are dependent on taking various medications. If anything is unclear or if you have any questions, you should always consult a doctor first to prevent further complications. When taking antibiotics, it should also be noted that they should not be taken together with alcohol.
After treatment of osteomyelitis, regular check-ups by a doctor are necessary in order to identify and treat further inflammation or infections at an early stage. As a rule, this disease does not reduce the life expectancy of the affected person if it is recognized and treated early. Further aftercare measures are usually not available to the person concerned.
You can do that yourself
This disease is mainly caused by different strains of bacteria and patients may need to be treated with antibiotics for months to prevent amputation or blood poisoning. It is therefore important for patients to support the fight against pathogens and to consistently strengthen the body’s immune system.
You should avoid alcohol and nicotine completely, as both are toxins that put unnecessary strain on the body. Passive smoking can also be harmful. In return, the patient is advised to eat a light, healthy diet consisting of plenty of fresh fruit, vegetables, sea fish and lean meat. If the patient is able to leave the house, exercise in the fresh air, especially walking in the woods, would be advisable. They have been proven to support the healing process.
Since eighty percent of all immune cells are located in the intestine, a supplementary dose of probiotics would also be indicated. Probiotics are mixtures of living microorganisms that are intended to settle and multiply in the intestine. There they contribute to the maintenance of the immune system. Probiotics are commercially available as yoghurt, dietary supplements or medicines. The latter contain more microorganisms and are preferable to yoghurt.
Another way to speed up the course of treatment is the so-called “hyperbaric oxygen treatment”. The patient breathes in oxygen in a pressure chamber, which leads to an increased oxygen distribution in the tissue.
