Osteomyelitis (OM) is a bone or bone marrow disease that causes bone inflammation. Commonly, a bacterial infection causes OM, but it can also be caused by a fungal infection. In some cases, complications from surgery and injury can also be the cause of OM (Carek et al., 2001). Sometimes, the infection in the bloodstream may enter the bone. OM was not treatable many years ago, but today it can be diagnosed, treated and managed as well as prevented from spreading.
Etiology and Clinical Features
Pathogens commonly associated with OM usually depend on the age of the patient, and the different types of OM are related to various kinds of pathogens. According to Hatzenbuehler and Pulling (2011), for both adults and children, the most common cause of chronic and acute OM is Staphylococcus aureus. The second most common microbes in children are Kingella kingae, group A Streptococcus and Streptococcus pneumonia (Hatzenbuehler & Pulling, 2011). In newborns, the most common infection is the group B streptococcal (Kaplan, 2005). Aragón-Sánchez et al., (2009) explains that S. aureus commonly causes bone infections in adults. As a result, it's important that the patient's age is carefully determined and the specific pathogen identified for effective OM management.
Diagnosis and Treatment
There are few diagnosis techniques and studies of OM; the diagnosis is primarily dependent on physical examination, laboratory tests and initial medical history. One of the techniques includes bone palpation, where bone palpation of a diabetic patient has higher chances of exposing the underlying OM if he or she is positive (Carek et al., 2001). The others include bone microbiologic examination and histopathologic, ultrasound examination, nuclear imaging and bone radiography (Carek et al., 2001).
Afterward, a microbial etiology diagnosis and treatment process follows. Osteomyelitis treatment includes stabilization of bone, dead space debridement and antimicrobial therapy (Carek et al., 2001). Therefore, other techniques ought to be considered in the diagnosis of OM since there are other conditions with similar circumstances such as malignant bone tumors (Osteosarcoma, Ewing's sarcoma), cellulitis and leukemia.
There are very few studies that have considered OM treatment (Norden et al., 1986). According to one review, only five studies involved one hundred and fifty-four patients with osteomyelitis (Norden et al., 1986). As a result, OM treatment depends on the opinion of experts rather than blind trials results.
Acute OM is seeded hematogenous, and it mainly affects children. It is chronic in adults and primarily caused by bone and adjacent soft tissue injury. The infection is related to clinical aspects (i.e., recent surgery or trauma) and the patient's age. Mostly acute hematogenous OM is associated with Staphylococcus aureus, while chronic osteomyelitis is related to Escherichia coli, Serratia marcescens, Pseudomonas aeruginosin, S. aureus and Staphylococcus epidermidis. Antibiotic therapy must be introduced at an early stage for best treatment results; this should run simultaneously with antimicrobial agent administration for not less than six weeks. OM treatment includes assessment, staging, assurance of microbial-etiology and susceptibilities, antimicrobial treatment and, if essential, debridement, stabilization of bone and dead-space management.