What is osteomyelitis?
Osteomyelitis is a bone infection caused by bacteria or fungi. It causes painful swelling of bone marrow, the soft tissue inside your bones. Without treatment, swelling from this bone infection can cut off blood supply to your bone, causing bone to die.
What is bone marrow?
Certain bones in your skeletal system, such as the hip and thighbones, contain soft, spongy tissue. This tissue, called bone marrow, makes stem cells that produce blood cells and platelets.
How common is osteomyelitis?
Osteomyelitis affects about 2 to 5 out of every 10,000 people. It’s one of the oldest diseases on record. Scientists have traced it back more than 250 million years.
Who might have osteomyelitis?
Osteomyelitis affects people of all ages and genders. Children younger than 3, the elderly and people with serious medical conditions are more prone to the condition.
In children, the infection is more likely to affect long bones, such as those found in the legs and arms. In adults, bone infections more often target the spine.
What are the types of osteomyelitis?
Types of osteomyelitis include:
- Acute: This infection comes on suddenly. You may have a fever and then develop pain in the infected area days later.
- Chronic: Chronic osteomyelitis is a bone infection that doesn’t go away with treatments. It causes bone pain and recurring drainage (pus). Rarely, chronic osteomyelitis doesn’t have symptoms. The infection may go undetected for months or even years.
- Vertebral: This type affects the spine. It causes chronic back pain that gets worse when you move. Treatments like resting, heating and pain relievers don’t help. It rarely causes a fever. People who live in nursing homes, misuse intravenous drugs or are on dialysis are more prone to spinal bone infections.
Symptoms and Causes
What causes osteomyelitis?
Osteomyelitis occurs when bacteria from nearby infected tissue or an open wound circulate in your blood and settle in bone, where they multiply. Staphylococcus aureus bacteria (staph infection) typically cause osteomyelitis. Sometimes, a fungus or other germ causes a bone infection.
You’re more at risk for getting osteomyelitis if you have:
- Artificial joint, such as a hip replacement.
- Blood infection or conditions like sickle cell anemia.
- Diabetes, especially a diabetes-related foot ulcer.
- Metal implants in bone, such as a screw.
- Pressure injuries (bedsores).
- Recent broken bone or bone surgery.
- Traumatic injury or wound.
- Weak immune system.
What are the symptoms of osteomyelitis?
Osteomyelitis signs vary depending on the type and cause. Some people with chronic osteomyelitis don’t have any symptoms.
In addition to pain, the infected area may be red, warm, swollen and tender to touch. Other signs of osteomyelitis include:
Diagnosis and Tests
How is osteomyelitis diagnosed?
After assessing your symptoms and performing a physical exam, your healthcare provider may order one or more of these tests:
- Blood tests: A complete blood count (CBC) checks for signs of inflammation and infection. A blood culture looks for bacteria in your bloodstream.
- Imaging tests: X-rays, MRIs, CT scans and ultrasounds provide images of your bones, muscles and tissues.
- Bone scan: A bone scan uses a small amount of safe, radioactive material to identify infections or fractures during an imaging scan.
- Biopsy: Your healthcare provider performs a needle biopsy to take samples of fluid, tissue or bone to examine for signs of infection.
Management and Treatment
What are the complications of osteomyelitis?
Complications of osteomyelitis include:
- Abscesses: Infection may spread to muscles and soft tissue, causing abscesses. These pockets of pus can seep through your skin. People with chronic osteomyelitis are more likely to have recurring abscesses. Treatment to drain these abscesses may slightly increase the risk of skin cancer.
- Bone death: Also called osteonecrosis, bone death can occur if swelling from the infection cuts off blood flow to your bone. Very rarely, this may lead to loss of a limb or amputation.
- Stunted growth: Osteomyelitis in a growing child may stunt bone growth.
How is osteomyelitis managed or treated?
A bone infection can take a long time to heal. The infection may clear up faster if you start treatment within three to five days of first noticing symptoms.
- Antibiotics: Antibiotics kill infection-causing bacteria. You may need antibiotics for four to eight weeks, starting with intravenous (IV) antibiotics in the hospital for a week or two. You’ll then take medications by mouth for several weeks. Chronic infections may require months of antibiotics.
- Antifungals: To treat fungal infections, you may need to take oral antifungal medications for months.
- Needle aspiration: Your healthcare provider uses a fine needle to drain fluid and pus from the abscess.
- Pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) treat pain and inflammation.
Surgery is sometimes needed to treat bone infections. You’ll need antibiotics after surgery. Surgical options include:
- Bone surgery: Your healthcare provider surgically removes (debrides) infected dead tissue and bone. This procedure may result in bone deformities.
- Spine surgery: People with vertebral osteomyelitis may need spine surgery. This procedure keeps vertebrae from collapsing and damaging your spinal cord, nerves and other parts of your nervous system.
How can I prevent osteomyelitis?
It’s important to clean and treat wounds to keep out bacteria and prevent infections. If you’ve had a recent bone break or surgery, or have an artificial joint, contact your healthcare provider at the first sign of any infection. But in many instances, there isn’t anything you can do to prevent osteomyelitis.
Outlook / Prognosis
What is the prognosis (outlook) for people who have osteomyelitis?
Most people with osteomyelitis recover with treatment. Your prognosis is better the earlier you catch the infection and start treatment. Untreated or chronic infections may permanently damage bones, muscles and tissues.
When should I call the doctor?
You should call your healthcare provider if you’re at risk for a bone infection and experience:
- Back pain that doesn’t improve with rest or pain relievers.
- Signs of infection, such as fever and yellow discharge (pus).
- Pain that makes movement difficult.
What questions should I ask my doctor?
You may want to ask your healthcare provider:
- Why did I get osteomyelitis?
- What type of osteomyelitis do I have?
- What is the best treatment for this type of osteomyelitis?
- What are the treatment risks and side effects?
- How can I avoid getting osteomyelitis again?
- What type of follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Osteomyelitis is a serious condition that requires immediate treatment. Most bone infections go away when you take antibiotics. Be sure to take all your prescribed medication even if you start feeling better. Stopping medications too soon can allow the infection to return. If you’re at risk for osteomyelitis, talk to your healthcare provider about the warning signs of infection so you know when to seek prompt medical care.
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