Osteomyelitis - Symptoms, causes and treatment

Osteomyelitis is a bone infection that generally caused by bacteria Staphylococcus. Osteomyelitis classified as a rare disease, but it needs to be treated immediately because it can cause a number of serious complications.

Osteomyelitis can be experienced by people of all ages. In children, osteomyelitis commonly occurs in long bones, such as the legs or arms. While in adults, osteomyelitis usually occurs in the hip bones, legs, or spine.

These bone infections can occur suddenly or develop over a long period of time. If not treated promptly, osteomyelitis can cause permanent damage to the bones.

Causes of Osteomyelitis

The main cause of osteomyelitis is bacteria Staphylococcus aureus. These bacteria can be found on the skin or nose and generally do not cause health problems. However, when the immune system is weak due to an illness, these bacteria can cause infection.

The entry of bacteria Staphylococcus to the bone can be through several ways, namely:

• Through the bloodstream

  Bacteria from other parts of the body can spread to the bones through the bloodstream.

• Through infected tissue or joints

  This condition allows the bacteria to spread to the bone near the infected tissue or joint.

• Through open wounds

  Bacteria can enter the body if there is an open wound, such as a broken bone with an open wound or direct contamination during orthopedic surgery.  

Anyone can develop osteomyelitis. However, there are factors that can increase a person's risk of developing this bone infection, namely:

• Suffering from diabetes, sickle cell anemia, HIV/AIDS, rheumatoid arthritis
• Undergoing chemotherapy or hemodialysis (dialysis)
• Have had osteomyelitis before
• Taking corticosteroids for a long time
• Having alcohol addiction
• Recent injury or injury, such as a broken bone
• Having an artificial pelvis or other device in the bone, such as a pen for fractures
• Just had bone surgery

Symptoms of Osteomyelitis

Osteomyelitis can be acute or chronic. Here is the explanation:

• Acute Osteomyelitis

  Osteomyelitis of this type occurs suddenly and develops within 7–10 days.

• Chronic Osteomyelitis

  Chronic osteomyelitis can occur without causing symptoms for months or even years, so it is sometimes difficult to detect. This type of osteomyelitis can also occur as a result of acute osteomyelitis that is difficult to treat and occurs repeatedly for a long time.

Symptoms of acute and chronic osteomyelitis are very similar, including:

• Pain at the site of infection
• The infected area is red and swollen
• The infected area becomes stiff or immobile
• Discharge of pus from the area of ​​infection
• Fever and chills
• Feeling restless or not feeling well
• Nauseous
• Weak
• Fatigue
• Losing weight

People with diabetes, HIV, or vascular disease are more likely to develop chronic bone infections.

When to go to the doctor

Check with your doctor if you experience bone pain that gets worse and is accompanied by a fever. Osteomyelitis can get worse over hours or days and become more difficult to treat.

If you have received treatment but the condition does not improve, check back with your doctor. Your doctor may recommend other treatments for you. 

Diagnosis of Osteomyelitis

To make a diagnosis, the doctor will ask questions regarding the symptoms felt and the patient's medical history, including whether there are recent injuries. Then, the doctor will perform a physical examination of the problematic bone.

Doctors will usually suspect a patient has osteomyelitis if the patient feels pain in the bone accompanied by swelling and bruising of the skin.

The doctor can also perform the following investigations to confirm the presence of infection and its severity:

• blood test

  A complete blood test can detect infection by looking for an elevated white blood cell count. This test can also identify the type of microorganism causing the infection, if the osteomyelitis spreads through the blood.

• Scan

  Scans are performed to determine the presence of bone damage due to osteomyelitis. Scanning can be done with X-rays, ultrasound, CT scan, or MRI which can show the condition of the bone and surrounding tissue in detail.

• Bone biopsy

  Bone sampling is done to identify the bacteria that cause infection in the bone. By knowing the type of bacteria, the doctor can determine the treatment to be given.  

Osteomyelitis Treatment

Treatment of osteomyelitis aims to overcome the infection and maintain normal function of the bone. Treatment is based on the age and health condition of the patient, the severity of the disease, and the type of osteomyelitis experienced.  

The main treatment for osteomyelitis is the administration of antibiotics to control the infection. Initially, antibiotics will be given through an IV and followed by a tablet form for consumption.

Treatment with antibiotics is generally carried out for 6 weeks. However, for more serious cases of infection, antibiotics can be given much longer. In addition to antibiotics, painkillers can also be used to relieve pain that appears.

If the infection is in a long bone, such as a bone in an arm or leg, a splint or brace may be placed on the body to restrict movement.

Meanwhile, if the patient has a smoking habit, the doctor will ask the patient to stop smoking in order to speed up the healing process. 

In cases of severe or chronic osteomyelitis, surgery is needed to treat the condition and prevent the spread of infection. The following are some of the surgeries that can be performed to treat osteomyelitis:

• Remove infected bone and tissuedebridement)

  In this procedure, all bone or tissue affected by the infection is removed, including some of the surrounding healthy bone or tissue to ensure the entire area is clear of infection.

• Take outkfluid from the infected area

  This surgery is done to remove pus or fluid that has accumulated due to infection.

• Restore blood flow to bones

  In this procedure, the doctor will fill in the blanks after debridement with bone or tissue from other parts of the body. These grafts can help form new bone and repair damaged blood flow.

• Lifting foreign objects

  This surgical procedure is intended to remove foreign bodies, tools, or screws that were attached to the bone in previous surgeries.

• Leg amputation

  Amputation of the limb is done as a last resort to prevent the spread of infection.

Complications of Osteomyelitis

If not treated properly, osteomyelitis has the risk of causing the following complications:

• Septic arthritis, i.e. the spread of infection from within the bone to nearby joints
• Osteonecrosis, which is bone death due to obstruction of blood circulation in the bones
• Bone growth becomes abnormal in children, if the infection occurs in the soft part of the bones of the arm or leg called the growth plate (Fig.growth plates)
• Squamous skin cancer

Osteomyelitis Prevention

The best way to prevent osteomyelitis is to avoid the factors that can trigger the occurrence of this disease. The following are some things that can be done to avoid these factors:

• If you have a wound, clean it and cover it with a sterile bandage. If the wound is severe enough, see a doctor for proper treatment.
• If you have a disease that puts you at risk for osteomyelitis, such as diabetes, make sure the disease is under control.
• Always keep your hands clean by washing your hands regularly.
• Use proper footwear, and use protective equipment when exercising.
• Perform periodic vaccinations according to the schedule recommended by the doctor.
• Call your doctor immediately if you experience early signs of infection, such as pain and fever.