HEALTH : Osteomyelitis – infection of the bone

Germs causing infection and disease can affect any part of the body, including the bones, a condition called osteomyelitis. It becomes different from other kind of infections due to atypical features. It often gets confused with infection of overlying skin and soft tissues. It is also resistant to treatment at times and needs longer duration of treatment. Osteomyelitis can be acute. The germ commonly implicated is Staphylococcus aureus. But there can be other germs also like Streptococcus, Salmonella , e.t.c. . Left untreated or if not treated sufficiently, acute infection can become chronic. Chronic infections like T.B. can affect bones also causing chronic osteomyelitis. Infectious germs commonly enter the bone from surrounding overlying parts. An injury, cut or ulcer commonly becomes a source for germs to get into the bones. Infection of the soft tissues and muscles overlying the bones can spread to the bone. Sometimes the infection can come from a distant focus via blood, eg. as in cases of typhoid fever or pneumonia. A person can get osteomyelitis at any age but it is said to be more common in the 2 peaks of life that is children and old people, maybe due to reduced resistance. Other people with reduced immunity like diabetics, persons with renal failure, AIDS, cancer,e.t.c. are also more prone to develop osteomyelitis with any provocative condition like injury. Any bone can become infected in osteomyelitis, but commonly the large bones are involved like the back bone and those of limbs. T.B. germs have a predilection for spine and T.B. of the spine ( Pott’s disease), usually affects the back bone. Acute osteomyelitis may present with high grade fever with chills and pain localized over the site affected. There would also be signs of the precipitating cause for osteomyelitis, an injury, ulcer or soft tissue infection in the form of a fluctuant swelling. Sometimes there may be no localizing physical signs and the only feature present would be a high grade fever with chills. Chronic osteomyelitis is more subtle. Fever is present or absent. Chronic pain in back or one of the limbs, not responding to conventional pain suppressive therapy should raise the suspicion of infection of the bones. It is also confused with degenerative conditions of joints like spondylosis or arthritis, i.e. inflammation of joints. This happens when affected part of bone is at the joint with another bone or near it. Left untreated, infection of the bones causes erosion and necrosis of the bone resulting in aggravation of pain, deformity and reduced movement at affected site. The infection can pass in the blood stream leading to sepsis, i.e. generalized infection in the blood which can be fatal. Locally it can spread to whole of bone thus damaging the unaffected bone also. Germs traveling from bones to distant sites like lungs and brain result in multiple problems, wherein the primary problem is often overlooked. Diagnosis of osteomyelitis needs a high degree of suspicion and is confirmed by relevant tests like X-rays and C.T. scan of affected part. Treatment is by suitable antibiotics preferably by injections to achieve rapid and higher concentration in body to be more effective . Duration of treatment is longer as compared to other infections. The patient needs antibiotics for 4 to 6 weeks. Calcium supplements given along with antibiotics help in strengthening the bones. In case of necrosis or damage of the bone, surgical intervention is needed. Even after finishing the treatment, softening or deformity of the bone may persist as a sequel, causing pain and difficulty in movements. This takes its own time to resolve but light exercises done after relief in pain and swelling help in reducing the disability . Any ulcer or injury over bones should never be left unattended for the risk of developing osteomyelitis. Timely treatment by adequate amounts of drugs, cleaning and dressing of the wound can help prevent osteomyelitis. E-mail –rachna212002@yahoo.co.uk