Osteomyelitis occurs as either Acute osteomyelitis: Patients typically have bony tenderness, fever, fatigue, weight loss, and localized warmth and redness; or Chronic osteomyelitis: Months to years of bone pain and draining sinuses;
CASES/YEAR
165,000 (US); 3,300,000 (Global)
INCUBATION
Estimated: days to weeks;
INITIAL SYMPTOMS
Acute osteomyelitis: Patients typically have bony tenderness, fever, fatigue, weight loss, and localized warmth and redness; Chronic osteomyelitis: Months to years of bone pain and draining sinuses; [Merck Manual, p. 298-9]
COMMENTS
Cases result from direct spread or hematogenous seeding. "30-40% of adults with diabetes develop osteomyelitis after a foot puncture." Other risk factors are orthopedic hardware, obesity, trauma, bacteremia, poor circulation, and older age. In some developing countries, tuberculosis is still the dominant infection, and brucellosis is not uncommon. Leukocytosis is a sign of acute infection and anemia a sign of chronic infection. [Harrison ID, 2nd Ed, p. 259-62] 80% of osteomyelitis results from contiguous spread or wounds; Most cases are polymicrobial; Children tend to have gram-positive bacteria, and the most common sites are tibia, femur, and humerus. In adults with hematogenous spread, the vertebrae are commonly affected; risk factors include debilitation, hemodialysis, sickle cell disease, and IV drug use. [Merck Manual, p. 298-9] Typical sites are vertebrae (adults > children), long bones (children > adults), and sternoclavicular and sacroiliac joints (IV drug users). Chronic osteomyelitis is >3 weeks, but the hallmark is necrotic bone. [ABX Guide] Vertebral infections may cause sensory and motor deficits. [5MCC-2020] Hematogenous spread, most commonly from cellulitis, urinary tract infection, or pneumonia, typically causes osteomyelitis in the elderly with involvement of two or more vertebrae and intervening disc spaces. MRI is the most sensitive technique in the absence of orthopedic hardware. Gallium scans are more sensitive than other nuclear scans for the diagnosis of vertebral osteomyelitis. Squamous cell cancer of sinus tract and bone cancer are complications of chronic osteomyelitis. [Cecil, p. 1766-7] The three types of osteomyelitis in terms of causation are hematogenous, contiguous, and vascular insufficiency. Septic arthritis is associated with osteomyelitis of long bones in drug addicts. [ID, p. 1225, 1228] Chest or abdominal pain occurs in patients with vertebral osteomyelitis and nerve root irritation or compression. Headache and cranial neuropathy are findings in skull-base osteomyelitis from malignant otitis externa. Osteomyelitis is a complication of decubitus ulcers. [Cohen, p. 391-3]
DIAGNOSTIC
Plain x-rays become abnormal in 2-4 weeks (periosteal elevation, bone destruction & soft tissue swelling); CT, MRI & bone scan show changes earlier; [Merck Manual, p. 299] Cultures of blood and bone biopsy to determine microbes; [ABX Guide]
SIGNS & SYMPTOMS
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>fatigue, weakness
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>fever
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G abdominal pain
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H anemia
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H leukocytosis
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N headache
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N muscle weakness
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R chest pain
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S pustule
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S ulcer of skin
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*arthritis
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*cancer
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*cranial neuropathy
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*endocarditis
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*osteomyelitis
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*paralysis
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*sepsis
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*weight loss
ENTRY
Inhalation, Ingestion, Needle (Includes Drug Abuse), Scalpel or Transfusion, Skin or Mucous Membranes (Includes Conjunctiva), Animal Bite, Swimming, Sexual Contact
VECTOR
Biting Flies, Lice, Mosquitoes, Ticks
SOURCE
Person-to-Person, Human Fecal-Oral, Fecally Contaminated Soil, Animal Excreta, Animal Tissue, Soil or Dust (Ingesting or Inhaling), Eating Contaminated Food, Eating Contaminated or Infected Meat, Eating Infected or Toxin-Containing Fish, Eating Contaminated Mollusks or Crustacean, Eating Unpasteurized Milk or Cheese, Eating Contaminated Produce, Waterborne (Ingesting, Inhaling, or Swimming)
RESERVOIR
Birds and Poultry, Cattle, Goats and Sheep, Cats, Deer, Elk and Antelope, Dogs, Fish and Shellfish, Horses, Monkeys, Rabbits, Rodents, Swine, Human, Wild Animals
REFERENCES FOR CASES/YEAR
1. (US) 10-100 per 100,000; [Gorbach, p. 296] Calculate: 55 x 3000 = 165000 (US); 165000 x 20 = 3,300,000 (worldwide);
2. (Global) 20 X US cases/yr;