- Causes of osteomyelitis
- Osteomyelitis symptoms
- Possible complications of osteomyelitis
- Diagnosis of osteomyelitis
- Osteomyelitis treatment
- Prevention of osteomyelitis
Osteomyelitis is an infectious inflammatory disease in which not only bone and bone marrow suffers, but the entire body as a whole. To learn how to live with such a diagnosis, you need to know all the subtleties of diagnosis, treatment and prevention of this disease.
Causes of osteomyelitis
Osteomyelitis (Greek osteo - "bone"; myelo - "brain"; -itis - "inflammation") - an infectious disease that damages the bone marrow and all the constituent elements of the bone (periosteum, spongy substance, compact substance). During the purulent-necrotic process in the bone tissues, many toxins are released, which cause severe intoxication of the whole organism and are accompanied by high fever and severe pain syndrome.
The main causes of this disease are bacterial pathogens:
- Staphylococcus aureus ,
- epidermal staphylococcus,
- gram-negative enterobacteria,
- Pseudomonas aeruginosa,
- hemophilic bacillus,
- Mycobacterium tuberculosis (Koch's wand).
Pathogenic microorganisms can enter the body and cause the development of osteomyelitis in several ways:
- exogenous - with direct contact of the pathogen into the bone in case of injury, injury, open fracture, purulent inflammation of nearby tissues or during surgical intervention;
- endogenous (hematogenous) - with blood flow in the presence in the body of chronic infection ( tonsillitis , caries ).
Depending on the mechanism of osteomyelitis, there are:
In most cases, Staphylococcus aureus becomes the cause of osteomyelitis, which is often the cause of tonsillitis, caries or omphalitis in newborns.
Most often, the pathogen of osteomyelitis affects:
- tubular bones of the upper and lower extremities,
- bones of the upper jaw
- skull bones,
- ribs and spine.
Factors contributing to the development of osteomyelitis:
- bone fractures
- joint transplantation
- kidney and liver failure
- diseases causing weakening of the body’s defenses (diabetes, AIDS, chemotherapy, organ transplants),
- frequent change of temperature,
- diseases of peripheral vessels and nerves.
When bone tissue is damaged by pathogenic microorganisms, leukocytes migrate to inflamed sites, which secrete lytic enzymes that decompose the bone. Pus spreading through the blood vessels contributes to the rejection of necrotic bone tissue, thereby creating favorable conditions for the growth and reproduction of pathological microflora. There is acute purulent inflammation, which can move into a phase of chronic inflammation.
Gunshot, post-traumatic and postoperative inflammation is a consequence of infection of the bone wound. In this case, the inflammatory process develops in the place of fractured bone fragments, and not in a closed bone marrow canal. Bone marrow is infected from infected nearby tissue. Fragments die off and cause suppuration and the formation of purulent cavities and fistulas. These pathological processes prevent the formation of normal callus.
The clinical picture of osteomyelitis largely depends on:
- on the type of pathogen,
- from the place of localization and spread of the inflammatory process,
- on the age and condition of the patient’s immune system.
Acute osteomyelitis can have 3 clinical forms:
The first symptom of septic-pyemic osteomyelitis is fever with a body temperature of up to 39-40 0 , accompanied by symptoms of general intoxication (excessive sweating, weakness, irritability, muscle pain, nausea, vomiting, headache). The pain of the bone joins the symptoms of general intoxication. It gradually changes its character from dull to arching, with an increase in pain observed during movements. Changes also occur with proper tissues: redness, local fever, edema, skin and bone fistula with purulent secretions.
Almost 48-72 hours after the onset of the disease, there is a violation of the acid-base balance of the body (acidosis):
Changes with the blood coagulation system also occur: hypercoagulation (increased clotting) is replaced by hypocoagulation (reduced clotting), after which the fibrinolysis phase begins (splitting of blood clots and blood clots).
Most often they are ill with osteomyelitis in childhood and old age, in men this disease occurs twice as often as in women. In children, hematogenous osteomyelitis is most common, while in adults the cause is an infected injury or surgery.
In toxic osteomyelitis, the disease develops at lightning speed with a clinical picture of acute sepsis. During the first 24 hours, severe intoxication symptoms increase and are accompanied by:
- high body temperature
- meningeal symptoms
- convulsions and loss of consciousness,
- critical decrease in blood pressure
- increasing cardiovascular insufficiency, which is often fatal.
In this case, there is a difficulty in diagnosing osteomyelitis, because the symptoms of general intoxication are increasing, and the appearance of specific signs of the disease lags significantly behind the time of appearance.
When local osteomyelitis is dominated by the symptoms of the inflammatory process, localized in the soft and bone tissues, accompanied by a satisfactory or moderate patient condition.
In acute post-traumatic and gunshot osteomyelitis, the clinical picture depends on the localization of the site of inflammation, the timely surgical treatment of the wound, the state of the immune system and the age of the patient. The clinical picture is growing gradually, 10–14 days may be disturbed by suppuration of the wound, and only after 2 weeks the symptoms of general intoxication increase.
Possible complications of osteomyelitis
In case of late or inadequate treatment the following complications are possible:
- pleurisy ,
- bone deformities and fractures
- violation of the structure and function of the joints,
- fistula formation and their malignancy,
- transition of the inflammatory process to the chronic form,
Diagnosis of osteomyelitis
Very much, and even the patient's life, depends on early correct diagnosis and timely prescription of treatment. Laboratory and instrumental diagnostic methods will help to identify osteomyelitis at an early stage:
- a correctly collected history of the disease (when the first signs of the disease appeared and what they are connected with);
- X-ray - X-ray method in which receive and study the X-ray image on a charged semiconductor wafer;
- thermography - a method of recording infrared radiation of the human body;
- bone puncture with osteotonometry - examination of tissues from the focus of inflammation, which are taken for analysis using a small needle;
- radionuclide diagnostics - the study of the structure of the bone through the introduction of a contrast agent;
- X-ray - diagnosis using X-rays;
- computed tomography - diagnostics using x-rays, which are computer-processed, making a scan of the body in a horizontal and vertical position;
- fistulography is a radiographic method for studying fistulas using a contrast agent;
- MRI is a computerized diagnostic method using powerful magnets that record and process radio wave information, transforming it into images of internal organs and systems;
- Ultrasound - a diagnostic method that uses high-frequency waves;
- complete blood and urine analysis - helps to identify inflammatory processes in the body with the help of hemodynamic parameters.
It should be noted that osteomyelitis is very difficult to treat. Sometimes a course of antibiotic treatment lasts 4-5 months. But even after the disappearance of clinical symptoms and improvement of the patient's condition, a relapse of the disease is possible.
Treatment of osteomyelitis, as well as its diagnosis, should be carried out by an experienced specialist, surgeon or traumatologist in a hospital. Treatment of this disease should be complex:
- rehabilitation of inflammation,
- antibiotic therapy
- anti-inflammatory drugs
- detoxification therapy,
- activation of the body's defenses, immunostimulation,
- immobilization of the affected part of the body.
The effectiveness of treatment depends primarily on the correctly prescribed antibiotic. Antibacterial therapy can last from several weeks to several months and has many side effects. But drugs of this particular group are able to bring the patient back to a full life. In severe cases, surgical treatment is indicated, the purpose of which is to cleanse and rehabilitate the wound, remove dead tissue and drainage.
In case of untimely and incorrect treatment, acute osteomyelitis can turn into a chronic form, occasionally reminding of itself a relapse in the form of fistulas, ulcers, sequesters, false joints.
After intensive inpatient treatment, the patient is prescribed a course of physiotherapy and exercise therapy. Therapeutic physical training is indicated for a general tonic effect, to restore the functions of the affected part of the body and stimulate trophic processes in the tissues. From physiotherapy procedures it is shown:
- infrared laser therapy
- paraffin therapy
- high-frequency magnetic therapy.
All these procedures are aimed at restoring the function and nutrition of the damaged part of the body. A equally important role in the treatment of osteomyelitis is played by a healthy lifestyle and a balanced diet. Additionally prescribe vitamins B, C, PP.
For a full recovery, a spa treatment is recommended, which is aimed not only at restoring functions, but also at cleansing the body after a long inpatient treatment. In the treatment of osteomyelitis, such climacteric and balneotherapy resorts have proven themselves well:
- Baden Baden,
- Nishka Banja.
As mentioned above, osteomyelitis requires long-term treatment and careful care. Full recovery is possible, but it depends on many factors:
- the age of the patient
- the severity of the lesion
- timely diagnosis and treatment.
Prevention of osteomyelitis
It is possible to speak about the effective treatment of osteomyelitis only if a relapse was avoided within 2-3 years after the first detection of the disease. But, as one of the main commandments of medicine says: "The disease is easier to prevent than to cure." To prevent osteomyelitis, you must:
- lead a healthy and active lifestyle
- provide a full sleep and rest,
- avoid stress
- eat balanced
- strengthen the immune system
- time to treat foci of infection (caries, sinusitis ),
- for injuries or gunshot wounds, you should promptly seek medical help,
- if your body temperature rises and other symptoms appear, you need to go to the hospital so that, by self-healing, you do not injure the rest of your life.
Osteomyelitis is a serious infectious disease that requires efforts not only from the attending physician, but also from the patient himself. As popular wisdom says: "The salvation of the drowning is the work of the hands of the drowning." To defeat such a serious disease, inadequate treatment and effort from the medical staff are not enough. A full and healthy life directly depends on the morale and faith in the patient’s recovery.
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