Osteomyelitis: The Importance of Prompt Diagnosis
A painful bone disease transmitted by microbes, osteomyelitis is usually treatable with relative ease if diagnosis is timely. At most, therefore, antibiotic therapy should commence within five days of infection. That way, the patient concerned will benefit from the most favourable outcome possible.
Why timely detection is critical
Although anyone can develop osteomyelitis, the main causes and risk factors include:
- Artificial hips.
- Bone fractures.
- Diabetes, especially where an ankle or foot ulcer is present.
- Open wounds.
- A previous patient history of the disease.
- Surgery on a bone, including screws and prostheses.
- A weakened immune system, such as following chemotherapy or other serious illness.
Apart from pain in the affected bone, symptoms include weakness and redness of the surrounding skin. While paediatric cases commonly involve the long bones of the arms and legs, adults suffering from osteomyelitis often experience infection in the back, hips and feet.
If infection occurs through the bloodstream, the most common route, it usually clusters around the metaphysis of the long bones. The metaphysis is the neck portion that contains the growth plate, i.e. the part of the bone that lengthens during childhood.
When infection sets in, the body releases natural defences. White blood cells or leukocytes enter the infected area to try to engulf the infectious organisms. However, in breaking down the microbes’ cellular membranes, pus tends to spread into the bone’s blood vessels. As a result, the area suffers from impaired circulation. Areas of devitalised bone, termed sequestra, then form a base for chronic infection.
To prevent further deterioration, prompt intervention is essential. If left untreated, osteomyelitis can cause permanent damage and ongoing pain in the bones. Significantly, chronic patients can suffer deformity through bone sclerosis, especially if the infection pervades into the marrow. In the worst cases, there is a risk of sepsis and septic shock.
Crucially, while treatment of the bacterial or fungal infection involves antibiotics, healthcare practitioners should also check blood flow in the affected area. It might be necessary to relieve the pressure if an abscess is pressing against something else inside the body, such as internal organs or the spinal cord, to prevent aggravation of the symptoms.
In many cases, the body attempts to regrow bone in the affected area. Histology tests can determine whether the osteomyelitis is acute or chronic, depending on the detection and analysis of endotoxins. Debridement could become necessary to remove any damaged bone and prevent the patient’s condition from worsening.
Prevention of hypovolaemia, sepsis and shock
Hypovolaemia may also be present, which is a lack of blood volume due to a deficiency of cellular fluid in the body. Distinct from conventional dehydration as a cause, it is potentially life-threatening just the same.
If not dealt with swiftly, mortality can result in as many as four in ten patients. Hospital care involves maintaining arterial blood pressure and circulating a saline infusion to begin rehydrating the cells.
Characteristically, the treatment of severe infections involves intravenous antibiotics. In cases where the condition has set in, the course of antibiotics may need to last between four and six weeks. As the patient recovers, the medical team will decide when to progress from intravenous to oral administration of medication.