Osteomyelitis

 

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Original Editors -Nathan McCauley from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

Osteomyelitis, or bone infection, is an inflammation of bone caused by an infectious organism such as bacteria. However, fungi, parasites, or viruses can also cause osteomyelitis. Acute osteomyelitis is the clinical term for a new infection in bone that can develop into a chronic reaction when intervention is delayed or inadequate. Osteomyelitis can occur from a variety of reasons and can affect all populations but is most common in infants, children, and older adults. Individuals with compromised immune systems, a history of IV drug abuse, or alcohol abuse are more susceptible to developing this rapidly progressing pyogenic infection. The pathophysiology of osteomyelitis is complex and poorly understood. There are several key factors contributing to the infection including: the virulence of the infectious organism, the individual’s immune status, any underlying disease, and the type, location, and vascularity of the involved bone.1

Prevalence

• The incidence of vertebral osteomyelitis has been estimated at 2.4 cases per 100,000, with the risk increasing with age (0.3/100,000 among individuals <20 years of age to 6.5/100,000 among individuals >70 years of age).2
• Osteomyelitis of the spine is rare, accounting for only about 2-4% of all cases.3

Characteristics/Clinical Presentation

Individuals presenting with osteomyelitis may have the following symptoms:

• Pain and/or tenderness in the infected area
• Inflammation, redness, and warmth in the infected area
• Fever, chills, and excessive sweating
• Nausea and generalized feeling of being ill
• Lower back pain (if the vertebrae are involved)
• Swelling of the legs, ankles, and feet

Associated Co-morbidities

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Medications

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Diagnostic Tests/Lab Tests/Lab Values

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Etiology/Causes

• Osteomyelitis can occur in a variety of bones in different areas of the body. The area affected often depends on the causative agent, the individuals’ age, and previous medical history as certain types of osteomyelitis can affect different populations. The bones commonly involved in children are long bones (adjacent to growth plates) such as the femur, tibia, humerus, and radius due to the amount of bone marrow present in long bones. Osteomyelitis in adults usually affects the vertebral column, in particular the lumbar spine, the sacrum, and the pelvis.
• Staphylococcus aureus is the usual causative agent of acute osteomyelitis. Once bound to cartilage, the organism produces a protective glycocalyx and stimulates the release of endotoxins. Other organisms such as group B streptococcus, pneumococcus, Pseudomonas aeruginosa, Haemophilus influenza, and Escherichia coli are also capable of producing bone infection. In individuals diagnosed with sickle cell anemia, Salmonella infection can be associated with osteomyelitis.1
• Surgical procedures, open fractures, and implanted orthotic devices are also causative agents of acute osteomyelitis. A form of osteomyelitis, exogenous osteomyelitis, occurs when bone extends out from the skin allowing a potentially infectious organism to enter from an abscess or burn, a puncture wound, or other trauma such as an open fracture. These examples of osteomyelitis secondary to infection are common in immunocompromised individuals and in those diagnosed with diabetes mellitus or severe vascular insufficiency.1
• Hematogenous osteomyelitis is acquired from the spread of organisms from preexisting infections such that occurs in impetigo; furunculosis (persistent boils); infected lesions of varicella (chickenpox); and sinus, ear, dental, soft tissue, respiratory, and genitourinary infections. Genitourinary infections can lead to osteomyelitis of the sacrum or iliac.1

Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

1. Goodman CC, Fuller KS. Pathology: Implications for the Physical Therapist. 3rd ed. St. Louis, MO: Saunders; 2009.

2. Zimmerli W. Vertebral osteomyelitis. N Engl J Med. 2010;362:1022-1029.

3. Boeglin ER. Vertebral osteomyelitis presenting as lumbar dysfunction: a case study. JOSPT. 1995;22:(8):267-271.

4. The Cleveland Clinic Foundation Staff. Osteomyelitis. The Cleveland Clinic Foundation. http://my.clevelandclinic.org/disorders/osteomyelitis/hic_osteomyelitis.aspx. Accessed March 16, 2011.

Recent Related Research (from Pubmed)

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