The pathogenesis of osteomyelitis is linked to both environmental and genetic factors.
Smokers and people with chronic health conditions, such as diabetes or kidney failure, are more at risk of developing osteomyelitis. People who have diabetes may develop osteomyelitis in their feet if they have foot ulcers.
Bacteria or other germs may spread to a bone from infected skin, muscles, or tendons next to the bone. This may occur under a skin sore. The infection can start in another part of the body and spread to the bone through the blood. The infection can also start after bone surgery.
Osteomyelitis can occur in children of any age, but it's more common in premature infants and babies born with complications.
Osteomyelitis is most common in young kids under age 5. But it can happen at any age. Boys get it almost twice as often as girls do.
Chronic: Chronic osteomyelitis is a bone infection that doesn't go away with treatments. It causes bone pain and recurring drainage (pus). Rarely, chronic osteomyelitis doesn't have symptoms. The infection may go undetected for months or even years.
In adults, the vertebrae are the most common site of hematogenous osteomyelitis, but infection may also occur in the long bones, pelvis, and clavicle. Primary hematogenous osteomyelitis is more common in infants and children, usually occurring in the long-bone metaphysis.
It characterizes osteomyelitis as being in one of four anatomic stages. In stage 1, or medullary, osteomyelitis is confined to the medullary cavity of the bone. Stage 2, or superficial, osteomyelitis involves only the cortical bone and most often originates from a direct inoculation or a contiguous focus infection.
Chronic osteomyelitis is a relatively common infection and is often a lifelong disease.
The duration of follow-up for patients with nonfatal cases ranged from 2 days to 38 years (median, 6.5 years). The outcome of 255 episodes was recovery in 146 (57%), qualified recovery in 80 (31%), and death in 29 (11%). The 1-year cumulative mortality rate was 11.3% ± 2.0% (95% CI, 7.4–15.2).
Acute osteomyelitis presents within 2 weeks after disease onset, subacute osteomyelitis within one to several months, and chronic osteomyelitis after a few months.
Osteomyelitis may also result from an infection in nearby soft tissue. The infection spreads to the bone after several days or weeks. This type of spread is particularly likely to occur in older people.
Outlook (Prognosis)
With treatment, the outcome for acute osteomyelitis is often good. The outlook is worse for those with long-term (chronic) osteomyelitis. Symptoms may come and go for years, even with surgery. Amputation may be needed, especially in people with diabetes or poor blood circulation.
Long-term Considerations for Osteomyelitis
Fractures of the affected bone. Stunted growth in children (if the infection has involved the growth plate) Gangrene infection in the affected area.
Although osteomyelitis is a difficult problem, certain conditions make it even more difficult to address. Diabetes, peripheral vascular disease, and radiation are all comorbidities that interfere with wound healing and therefore make the treatment of osteomyelitis challenging.
Chronic pain, an area of erythema around the affected bone, swelling and bone tenderness, impaired wound healing often associated with tissue necrosis, increased drainage or persistent sinus tracts, chills, low grade fever and general malaise are some of the most commonly reported clinical symptoms (Fig. 1).
Staphylococcus aureus is the most common cause of acute and chronic hematogenous osteomyelitis in adults and children. [1][5] Increasingly isolated from patients with osteomyelitis is methicillin-resistant Staphylococcus aureus (MRSA). In some studies, MRSA accounted for over one-third of all staphylococcal isolates.
Acute - Acute osteomyelitis occurs suddenly and will show in diagnostic tests or procedures about two weeks after infection. This type of osteomyelitis is usually easier to treat. However, if left untreated, it can progress into chronic osteomyelitis.
The subacute and chronic forms of osteomyelitis usually occur in adults. Generally, these bone infections are secondary to an open wound, most often an open injury to bone and surrounding soft tissue.
Is Osteomyelitis Contagious? No, bones infections aren't contagious.
The most common treatments for osteomyelitis are surgery to remove portions of bone that are infected or dead, followed by intravenous antibiotics given in the hospital.
Noninfectious mimics of infectious discitis-osteomyelitis include Modic type 1 endplate edema, acute Schmorl node, Andersson lesion pseudarthrosis in ankylosing spondylitis, radiation osteitis, longus colli calcific tendinitis, Paget disease, and SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome.
The most common complication in children with osteomyelitis is recurrence of bone infection.
7, 8 The prevalence of malignant transformation in the setting of chronic osteomyelitis ranges from 1.6% to 23%, and the most commonly affected bones are the tibia and femur. The most frequently observed malignant transformation is squamous cell carcinoma of the skin.