The Osteomyelitis: symptoms, treatment of osteomyelitis
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Osteomyelitis Osteomyelitis is an infectious inflammatory disease, in which not only the bone and bone marrow suffers, but the entire body as a whole. To learn to live with such a diagnosis, you need to know all the subtleties of diagnosis, treatment and prevention of this ailment.

Causes of osteomyelitis

Osteomyelitis (Greek osteo - "bone", myelo - "brain", --itis - "inflammation") - an infectious disease in which the bone marrow and all the constituent elements of bone (periosteum, spongy substance, compact substance) are damaged. During a purulent necrotic process in the bone tissues, many toxins are released that cause serious intoxication of the whole organism and are accompanied by a high temperature and severe pain syndrome.

The main cause of the development of this disease are bacterial pathogens:

  • Staphylococcus aureus ,
  • epidermal staphylococcus,
  • streptococci,
  • gram-negative enterobacteria,
  • Pseudomonas aeruginosa,
  • haemophilus influenzae,
  • Mycobacterium tuberculosis (Koch's stick).

Pathogenic microorganisms can enter the body and cause the development of osteomyelitis in several ways:

  • exogenous - when the pathogen enters the bone directly in case of trauma, injury, open fracture, purulent inflammation of nearby tissues or in case of surgical intervention;
  • endogenous (hematogenous) - with a blood flow in the presence of a foci of chronic infection in the body ( tonsillitis , caries ).

Depending on the mechanism of origin of osteomyelitis, distinguish:

  • hematogenous,
  • gunshot,
  • postoperative,
  • posttraumatic,
  • contact.

In most cases, the cause of osteomyelitis is staphylococcus aureus, which is often the cause of tonsillitis, caries or omphalitis in newborns.

Most often, the causative agent of osteomyelitis damages:

  • 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:

  • fractures of bones,
  • joint transplantation,
  • renal and hepatic insufficiency,
  • diseases that cause weakening of the body's defenses (diabetes, AIDS, chemotherapy, organ transplants),
  • avitaminosis,
  • frequent changes in the temperature regime,
  • addiction,
  • diseases of peripheral vessels and nerves.

When bone tissue is damaged by pathogenic microorganisms, leukocytes migrate to inflamed areas, which secrete lysis enzymes that decompose bone. Pus, spreading through the blood vessels, promotes the rejection of necrotic bone tissue, thereby creating favorable conditions for the growth and reproduction of pathological microflora. There is an acute purulent inflammation, which can go to the phase of chronic inflammation.

Gunshot, post-traumatic and post-operative inflammation is a consequence of infection of the bone wound. In this case, the inflammatory process develops in the place of fragmented bone fragments, and not in the closed medullary canal. The bone marrow is infected from infected nearby tissues. Fragments die and become the cause of suppuration and the formation of purulent cavities and fistulas. These pathological processes prevent the formation of normal callus.

Symptoms of osteomyelitis

The clinical picture of osteomyelitis largely depends:

  • from the type of pathogen,
  • from the site 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:

  • septic-piecemic,
  • local,
  • toxic.

The first symptom of septic-piemic osteomyelitis is fever with body temperature up to 39-40 0 , accompanied by symptoms of general intoxication (excessive sweating, weakness, irritability, muscle pain, nausea, vomiting, headache). Symptoms of general intoxication are joined by bone pain. It gradually changes its character from aching to bursting, and pain intensification is observed during movements. There are also changes with proper tissues: redness, local fever, edema, cutaneous-fistulas with purulent discharge.

Almost 48-72 hours after the onset of the disease there is a violation of the acid-base balance of the body (acidosis):

  • hyperkalemia,
  • hypercalcemia,
  • hyponatremia.

There are also changes with the coagulating system of blood: hypercoagulation (increased coagulability) is replaced by hypocoagulation (reduced coagulability), after which the phase of fibrinolysis (cleavage of blood clots and blood clots) occurs.

Osteomyelitis is most common in children and the elderly, in men this disease occurs twice as often as in women. In children, hematogenous osteomyelitis is most common, whereas in adults the cause is an infected trauma or surgical intervention.

In toxic osteomyelitis, the disease develops with lightning speed with a clinical picture of acute sepsis. During the first 24 hours, the symptoms of severe intoxication increase and are accompanied by:

  • high body temperature,
  • meningeal symptoms,
  • convulsions and loss of consciousness,
  • a critical reduction in blood pressure,
  • increasing cardiovascular insufficiency, which often has a lethal outcome.

In this case, there is a difficulty with the diagnosis of osteomyelitis, because the symptoms of general intoxication are increasing, and the appearance of specific signs of the disease is significantly lagging behind the time of appearance.

With local osteomyelitis, the symptoms of the inflammatory process localized in soft and bony tissues are predominant, accompanied by a satisfactory or moderate condition of the patient.

In acute posttraumatic and gunshot osteomyelitis, the clinical picture depends on the localization of the inflammation focus, the timely surgical treatment of the wound, the state of the immune system, and the age of the patient. The clinical picture grows gradually, 10-14 days can disturb the suppuration of the wound and only after 2 weeks the symptoms of general intoxication grow.

Possible complications of osteomyelitis

If untimely or inadequate treatment, such complications are possible:

  • sepsis,
  • pleurisy ,
  • deformities and fractures of bones,
  • violation of the structure and function of the joints,
  • fistula formation and malignancy,
  • the transition of the inflammatory process into a chronic form,
  • death.

Diagnosis of osteomyelitis

From the early correct diagnosis and the timely appointment of treatment depends very much, and even the life of the patient. To identify osteomyelitis at an early stage will help laboratory and instrumental methods of diagnosis:

  • correctly collected anamnesis of the disease (when the first signs of the disease appeared and with what are connected);
  • Electro-radiography is an X-ray method in which an X-ray image is obtained and studied on a charged semiconductor wafer;
  • Thermography - the method of recording the infrared radiation of the human body;
  • puncture of bone with osteotonometry - examination of tissues from the focus of inflammation, which are taken for analysis with a small needle;
  • radionuclide diagnostics - studying the structure of the bone with the help of contrast medium;
  • X-ray diagnostics - X-ray diagnostics;
  • computer tomography - X-ray diagnostics, which are computer-controlled, scanning the body in a horizontal and vertical position;
  • fistulography - X-ray examination of fistula using contrast medium;
  • MRI is a computer diagnostic method using powerful magnets that record and process radio wave information, transforming it into images of internal organs and systems;
  • Ultrasound is a diagnostic method in which high-frequency waves are used;
  • a general analysis of blood and urine - helps to identify inflammatory processes in the body with the help of indicators of hemodynamics.

Treatment of osteomyelitis

It should be noted that osteomyelitis is very difficult to treat. Sometimes the course of antibiotic therapy last 4-5 months. But even after the disappearance of clinical symptoms and improve the patient's condition, a relapse of the disease is possible.

Treatment of osteomyelitis, as well as its diagnosis, should be conducted by an experienced specialist, a surgeon or traumatologist in a hospital. Treatment of this disease should be comprehensive:

  • sanation of the focus 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 a properly prescribed antibiotic. Antibiotic therapy can last from several weeks to several months and has many side effects. But the drugs of this group are able to return the patient to a full life. In particularly severe cases, surgical treatment is indicated, the purpose of which is to clean and sanitize the wound, remove dead tissue and drainage.

With untimely and incorrect treatment, acute osteomyelitis can go on into a chronic form, periodically reminding oneself of relapses in the form of fistulas, ulcers, sequesters, false joints.

After intensive hospital treatment, the patient is prescribed a course of physiotherapeutic procedures and exercise therapy. Therapeutic physical culture is shown for the general toning effect, for restoration of the function of the affected part of the body and stimulation of trophic processes in the tissues. From physiotherapeutic procedures it is shown:

  • UHF therapy,
  • infrared laser therapy,
  • electrophoresis,
  • paraffinotherapy,
  • ozokeritotherapy,
  • high-frequency magnetotherapy.

All these procedures are aimed at restoring the function and nutrition of the damaged part of the body. Equally important in the treatment of osteomyelitis is a healthy lifestyle and a balanced diet. In addition, prescribe vitamins B, C, PP.

For a full recovery recommended sanatorium treatment, which is aimed not only at restoring functions, but also on cleansing the body after prolonged hospital treatment. In the treatment of osteomyelitis, such climacteric and balneal resorts are well recommended:

  • Sochi,
  • Pyatigorsk,
  • Hops,
  • Baden Baden,
  • Nishka-Banya.

As mentioned above, osteomyelitis requires long-term treatment and careful care. Full recovery is possible, but it depends on many factors:

  • age of the patient,
  • severity of defeat,
  • timely diagnosis and treatment.

Prevention of osteomyelitis

It is possible to speak about effective treatment of osteomyelitis only if within 2-3 years after the first detection of the disease it was possible to avoid relapse. But, as one of the main commandments of medicine says: "The disease is easier to prevent than to treat later." To prevent osteomyelitis, you need:

  • to lead a healthy and active lifestyle,
  • provide a full sleep and rest,
  • avoid stress,
  • balanced eating,
  • strengthen the immune system,
  • in time to heal foci of infection (caries, sinusitis ),
  • with injuries or gunshot wounds, you need to seek medical help in a timely manner,
  • with an increase in body temperature and the appearance of other symptoms, you need to go to the hospital, so as not to maim the rest of your life by self-medication.

Osteomyelitis is a serious infectious disease that requires efforts not only from the attending physician, but also from the patient himself. As folk wisdom says: "The salvation of drowning people is the work of the drowning themselves". To defeat such a serious disease, there is insufficient adequate treatment and efforts on the part of medical staff. A full and healthy life directly depends on the moral mood and belief in his recovery of the patient.

| 4 December 2014 | | 4 637 | Uncategorized