Osteomyelitis is an infection of the bone that can often be difficult to diagnose and treat.  The usual cause is bacteria, but fungal infections may occur as well. 
 
Bones can become infected either through the bloodstream, by direct invasion, or from attached soft tissue infection.  Osteomyelitis is not common because bones are generally well insulated from these type of infections.  However, the bloodstream may carry an infection from another part of the body to the bone. 
 
Different infections are most common at variable ages depending on the circumstances involved.  The growing and vascular ends of long bones are common sites in children.  Adults are more likely to get osteomyelitis in a vertebra.  Drug users who inject drugs into their system where bacterial contamination can occur are also quite likely to have vertebral infections.  Infections can also occur adjacent to foreign bodies, such as the placement of metal or steel used in hip replacements or bone fractures.
 
Bacteria can also invade the bone directly through an open fracture, through bone surgery, or from a contaminated object that pieces the bone substance.  Sometimes infections are acquired during surgery, particularly when an artificial joint is being placed.
 
Early on, there are not a lot of symptoms of osteomyelitis except for some pain and localized swelling at the sight of the affected area.  Early on blood testing will be normal and there may not be generalized symptoms.  After a while, if the infection spreads, contiguous tissue will be involved and fever and chills may present.  Still, pain over the involved area is the most consistent finding.
 
A simple X-ray is the most readily available procedure to diagnose osteomyelitis, but it may be negative early on in the infective process.  An erosion of bone that an x-ray can pick up may not be present for weeks.  MRI, CT and nuclear medicine bone scans are more sensitive and can pick up the presence of infection earlier, but require a high index of suspicion, usually because of complaints of pain on the part of the individual.  Aspirating the affected area with a needle is the most effective way of identifying the bacteria or fungus that is the cause and then developing a treatment plan.  When a systemic infection is diagnosed, the bacteria may be easier to identify.
 
If allowed to persist, recurrent bone infection can cause anemia, weight loss, weakness, and even the loss of a limb or bone when severe enough and not adequately treated.  A systemic process may also cause morbidity and mortality if it is the primary cause of the osteomyelitis, and underlying disease such as diabetes has its own mortality implications.

The treatment is debridement, or careful cutting and draining of the infected tissue, accompanied by prolonged courses of antibiotic or antifungal medication.  The treatment can range from 4 weeks up to months.  Sometimes surgery is necessary to properly drain and remove the infective focus.

The information contained on this page is not intended to provide medical advice, which should be obtained directly from your physician.