Osteomyelitis ( OM ) is a bone infection. Symptoms may include pain in certain bones with redness on it, fever, and weakness. The long bones of the arms and legs are most common in children, while the legs, spine, and hips are most common in adults.
The cause is usually a bacterial infection; rare, fungal infections. This can happen by spreading from the blood or from surrounding tissue. Risks for developing osteomyelitis include diabetes, intravenous drug use, previous splenic removal, and trauma to the area. Diagnosis is usually suspected based on symptoms. This is then supported by blood tests, medical imaging, or bone biopsy.
Treatment often involves antimicrobials and surgery. In those with poor blood flow, amputation may be necessary. With treatment outcomes are often generally good when conditions are only present in a short period of time. About 2.4 per 100,000 people are affected one year. Young and old are affected more often. Men are more affected than women. This condition is described at least as early as 300s BC by Hippocrates. Before the availability of antibiotics the risk of death was significant.
Video Osteomyelitis
Signs and symptoms
Symptoms may include pain in certain bones with redness on it, fever, and weakness. Onset may be sudden or gradual.
Maps Osteomyelitis
Cause
In children, long bones are usually affected. In adults, the spine and pelvis are most commonly affected.
Acute osteomyelitis almost always occurs in children because of the rich blood supply to the growing bone. When an adult is affected, it may be because host resistance is compromised because of weakness, intravenous drug abuse, injected teeth, or other diseases or drugs (eg, immunosuppressive therapy).
Osteomyelitis is a secondary complication in 1-3% of patients with pulmonary tuberculosis. In this case, bacteria, in general, spread to the bone through the circulatory system, first infecting the synovium (due to higher oxygen concentrations) before spreading to adjacent bone. In tuberculous osteomyelitis, long bones and spine are likely to be affected.
Staphylococcus aureus is the most commonly isolated organism from all forms of osteomyelitis.
Osteomyelitis originates from the bloodstream most often seen 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 usually isolated; in children from one to 16 years of age, S. aureus , Streptococcus pyogenes , and Haemophilus influenzae are common. In some sub-populations, including intravenous drug users and splenectomy patients, Gram-negative bacteria, including enteric bacteria, are significant pathogens.
The most common form of disease in adults is caused by injuries that expose bones to local infections. Staphylococcus aureus is the most common organism seen in osteomyelitis, which is favored from adjacent infection areas. But anaerobes and Gram-negative organisms, including Pseudomonas aeruginosa , E. coli , and Serratia marcescens , are also common. Mixed infections are a rule rather than an exception.
Systemic mycotic infections can also cause osteomyelitis. The two most common are Blastomyces dermatitidis and Coccidioides immitis .
In osteomyelitis involving the vertebral body, about half the cases are caused by S. aureus , and the other half is caused by tuberculosis (spread hematogenously from the lungs). Tuberculous osteomyelitis of the spine is very common before the start of effective antitubercular therapy, it gets its special name, Pott's disease.
The complex Burkholderia cepacia has been involved in vertebral osteomyelitis in intravenous drug users.
Pathogenesis
In general, microorganisms can infect bone through one or more of three basic methods
- Through the bloodstream ( hematogen ) - the most common method
- From the nearest infection area (as in cellulitis), or
- Translucent trauma, including iatrogenic causes such as joint replacement or internal fixation of fractures or periapical secondary periodontitis in the tooth.
The area usually affected when the infection contracted through the bloodstream is metaphysical of the bone. Once the bone is infected, the leukocytes enter the infected area, and, in their attempt to ingest the infectious organism, release enzymes that lyse the bone. Pus is spread to bone veins, disrupts the flow, and the area of ​​infected bone known as sequestra forms the basis of chronic infection. Often, the body will try to create new bone around the necrotic area. The resulting new bone is often called involucrum. On histologic examination, this area of ​​necrotic bone is the basis for distinguishing between acute osteomyelitis and chronic osteomyelitis. Osteomyelitis is an infective process that includes all bone components (osseous), including bone marrow. When it is chronic, it can lead to bone sclerosis and deformity.
Chronic osteomyelitis may be caused by the presence of intracellular bacteria (within the bone cells). Also, after intracellular, bacteria can escape and attack other bone cells. At this point, bacteria may be resistant to some antibiotics. These combined facts can explain the difficult chronicity and eradication of the disease, which results in significant costs and disability, potentially causing amputation. The presence of bacteria in intracellular osteomyelitis may be an unknown contributory factor in its chronic form.
In infants, the infection can spread to joints and cause arthritis. In children, large subperiosteal abscesses can form because the periosteum is loosely attached to the bone surface.
Because the special things of their blood supply, the tibia, the femur, the humerus, the vertebrae, the maxilla, and the mandibular body are particularly susceptible to osteomyelitis. Bone abscess, however, can be triggered by trauma to the affected area. Many infections are caused by Staphylococcus aureus , a member of the normal flora found in the skin and mucous membranes. In patients with sickle cell disease, the most common causative agent is Salmonella , with a relatively more than double incidence of S. aureus.
Diagnosis
The diagnosis of osteomyelitis is complex and relies on a combination of clinical suspicion and indirect laboratory markers such as high white blood cell count and fever, although confirmation of clinical and laboratory suspicion with imaging is usually necessary.
Radiography and CT are the earliest methods of diagnosis, but are insensitive and are only mildly specific for diagnosis. They may show further cortical destruction of osteomyelitis, but may lose a newborn or indolent diagnosis.
Confirmation is most often done by MRI. The presence of edema, diagnosed as a signal increase in the T2 sequence, is sensitive, but not specific, because edema may occur as a reaction to adjacent cellulitis. Confirmation of bone marrow and cortical damage by looking at the T1 sequence significantly improves the specificity. Intravenous gadolinium-based contrast-based administration enhances further specificity. In certain situations, such as severe Charcot arthropathy, diagnosis with MRI is still difficult. Similarly, it is limited in distinguishing bone infarction from osteomyelitis in sickle cell anemia.
Scanning of nuclear drugs may help to supplement the MRI in patients who have metallic hardware that limits or prevents effective magnetic resonance. Generally, a three phase scan of technetium 99 will show an increase in absorption in all three phases. Gallium scanning is 100% sensitive to osteomyelitis but not specific, and may be helpful in patients with metal prostheses. The combined WBC imaging with marrow study has a 90% accuracy in diagnosing osteomyelitis.
The diagnosis of osteomyelitis is often based on radiological results suggesting a lytic center with a sclerosis ring. Cultural material taken from bone biopsy is needed to identify specific pathogens; Alternative sampling methods such as needle puncture or surface swabs are easier to perform, but do not produce reliable results.
Factors that usually complicate osteomyelitis are bone fracture, amyloidosis, endocarditis, or sepsis.
Classification
The OM definition is broad, and covers a wide range of conditions. Traditionally, the length of time the infection has been present and whether there is pus (formation of pus) or sclerosis (increased bone density) is used to arbitrarily classify OM. Chronic OM is often defined as an OM that has been in existence for more than a month. In fact, there are no different subtypes; instead there is a spectrum of pathological features that reflect a balance between the type and severity of the causes of inflammation, the immune system and local and systemic predisposing factors.
- Supurative Osteomyelitis
- Acute suppurative osteomyelitis
- Chronic suppurative osteomyelitis
- Primary (no previous phase)
- Secondary (following acute phase)
- Non-suppurative osteomyelitis
- Diffuse spread
- Focal sclerosing (compressing osteitis)
- proliferative periostitis (periostitis ossificans, osteomyelitis sclerosis Garrà ©  ©)
- Osteoradionecrosis
OM can also be typed according to the frame area in which it is present. For example, osteomyelitis of the jaw differs in some ways from osteomyelitis present in long bones. Vertebral osteomyelitis is another possible presentation.
Treatment
Osteomyelitis often requires prolonged antibiotic therapy for weeks or months. PICC lines or central venous catheters may be placed for long-term intravenous drug administration. May require surgical debridement in severe cases, or even amputations.
The first choice of first-line antibiotics is determined by patient history and regional differences in common infectious organisms. Treatments that lasted for 42 days were performed at a number of facilities. The availability of local and sustainable drugs has proven to be more effective in achieving prophylactic and therapeutic outcomes. Open surgery is necessary for chronic osteomyelitis, where open involucrum and sequestrum are removed or occasionally a cup can be performed. Hyperbaric oxygen therapy has been shown to be a useful adjunct to the treatment of refractory osteomyelitis.
Before the widespread availability and use of antibiotics, fly catch larvae are sometimes deliberately inserted into the wound to eat infected material, and effectively clean it. In 1875, the American artist Thomas Eakins described the surgical procedure for osteomyelitis at Jefferson Medical College, in a famous oil painting entitled The Gross Clinic.
There is transient evidence that bioactive glass may also be useful in long bone infections. Support from randomized controlled trials, however, is not available by 2015.
History
The word comes from the Greek word ?????? osteon , which means bone, ????? - myelo - means marrow, and - ???? -itis means inflammation.
Fossil record
Evidence for osteomyelitis is found in the fossil record studied by paleopathologists, ancient disease specialists and injuries. It has been reported in large carnivorous dinosaur fossils Allosaurus fragilis .
See also
- Tommy Douglas
- Brodie's Absence
- Chronic, recurrent multifocal osteomyelitis
- SAPHO syndrome
- Garre's osteomyelitis sclerosis
- Mickey Mantle, who suffered from osteomyelitis in his youth with football injuries and whose condition shortened his baseball career
References
External links
Media terkait dengan Osteomyelitis di Wikimedia Commons
- 00298 di CHORUS
-
Acosta, Chin; et al. (2004). "Diagnosis dan manajemen osteomyelitis pyogenic dewasa dari tulang belakang leher" (PDF) . Fokus Neurosurg . 17 (6): E2. doi: 10.3171/foc.2004.17.6.2. PMID 15636572.
Source of the article : Wikipedia
0 Comments