Osteomyelitis (cont.)
John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Osteomyelitis facts
- What is osteomyelitis?
- What causes osteomyelitis?
- What are osteomyelitis symptoms and signs?
- How is osteomyelitis diagnosed?
- What is the treatment for osteomyelitis?
- What is the prognosis for osteomyelitis?
What are osteomyelitis symptoms and signs?
Symptoms of osteomyelitis can vary greatly. In children, osteomyelitis most often occurs more quickly. They develop pain or tenderness over the affected bone, and they may have difficulty or inability to use the affected limb or to bear weight or walk due to severe pain. They may also have fever, chills, and redness at the site of infection.
In adults, the symptoms often develop more gradually and include fever, chills, irritability, swelling or redness over the affected bone, stiffness, and nausea. In people with diabetes, peripheral neuropathy, or peripheral vascular disease, there may be no pain or fever. The only symptom may be an area of skin breakdown that is worsening or not healing.
Acute osteomyelitis occurs with a rapid onset and is usually accompanied by the symptoms of pain, fever, and stiffness. It generally occurs after a break in the skin from injury, trauma, surgery, or skin ulceration from wounds.
Chronic osteomyelitis is insidious (slow) in onset. It may be the result of a previous infection of osteomyelitis. Despite multiple courses of antibiotics, it may reoccur. Symptoms of chronic osteomyelitis are subtle but may include fever, pain, redness, or discharge at the site of infection.
How is osteomyelitis diagnosed?
The diagnosis of osteomyelitis begins with a complete medical history and physical examination. During the medical history, the doctor may ask questions about recent infections elsewhere in the body, past medical history, medication usage, and family medical history.
The physical examination will look for areas of tenderness, redness, swelling, decreased or painful range of motion, and open sores.
The doctor may then order tests to help diagnose osteomyelitis. Several blood tests can be used to help determine if there is an infection present. These include a complete blood count (CBC), the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and blood cultures. None of these is specific for osteomyelitis but they can suggest that there may be some infection in the body.
Imaging studies may be obtained of the involved bones. These can include plain radiographs (X-rays), bone scans, computed tomography (CT) scans, magnetic resonance imaging (MRIs), and ultrasounds. These imaging studies can help identify changes in the bones that occur with osteomyelitis.
After an area of bone is identified with possible osteomyelitis, a biopsy of the bone may be obtained to help determine precisely which bacteria are involved, and the culture of this can indicate the best choice for antibiotic treatment.
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