Osteomyelitis
Published by Bupa's health information team, February 2008.
This factsheet is for people who have osteomyelitis or who would like information about it.
Osteomyelitis is an infection of the bone, which can result in destruction of bone and deformity if not treated.
- About osteomyelitis
- Symptoms
- Complications
- Causes
- Diagnosis
- Treatment
- Questions and answers
- Related topics
- Sources
About osteomyelitis
Osteomyelitis is an infection of the bone and the bone marrow - the part of the bone where new blood cells are made. If it's not treated, the infection gradually destroys the bone and can eventually cause an abscess (a ball of pus).
In the past, osteomyelitis was a major cause of disability and even death. Nowadays, although it's serious, it can normally be treated and cured with antibiotics or surgery.
In adults, osteomyelitis most commonly happens after an operation, particularly if something man-made (such as a metal hip) has been inserted. However, osteomyelitis can also come on suddenly and for no apparent reason. This is more common in children than in adults and can usually be successfully treated.
Symptoms
If you have osteomyelitis, you may have:
- severe pain in the area where you have the infection
- swelling of the affected area
- a warm feeling in the affected area
- a feeling of being unable to move the limb where you have the infection
- a fever and feel generally unwell
- a feeling of pain in your lower back, if your spine is affected, or a twisted feeling in your neck
Although not necessarily a result of osteomyelitis, if you have these symptoms, you should visit your GP.
If you have a chronic infection, you may also notice a discharge of pus at the location of your infection. If you have this symptom, you should see your GP.
Complications
Chronic osteomyelitis
When you first develop osteomyelitis, it's called acute osteomyelitis. An acute illness is typically over quite quickly. The term acute refers to the length of time a person has had a condition, not how serious it is.
If the infection isn't treated properly or quickly enough however, it can become more serious and may persist for several months or even years. This is called chronic osteomyelitis. A chronic illness is one that lasts a long time, sometimes for the rest of the affected person's life. Chronic osteomyelitis may cause flare-ups of symptoms, such as pain and fever, many years after the initial infection.
When an infection lasts for such a long time, it can cause severe damage and possible deformity of your bones.
MRSA and osteomyelitis
Osteomyelitis that is resistant to treatment with the common and widely available antibiotics (such as penicillin) is becoming more frequent. You may have heard of this type of infection: it's called MRSA, which stands for methicillin-resistant Staphylococcus aureus. If you have osteomyelitis caused by MRSA, it means that your infection will be difficult to treat and you may need treatment with a combination of various medicines.
Septic arthritis
Osteomyelitis can sometimes develop into a condition called septic arthritis. This happens if the pus caused by the infection discharges into a joint, rather than coming out through your skin. If untreated, your joint will become infected and damaged, which will limit its movement.
Causes
Osteomyelitis is normally caused by bacteria called Staphylococcus aureus. This type of bacteria is quite common in daily life - for instance, spots or acne on the skin are generally caused by a type of Staphylococcus bacteria. Occasionally osteomyelitis can also be caused by other bacteria, or a fungus - such as Candida albicans.
You may be more at risk of getting osteomyelitis if you fall into one of the following groups.
- You have broken a bone or have had surgery involving a bone.
- You have had a joint replacement (such as a hip or knee replacement).
- You have had an infection somewhere else in your body. The infection then spreads to your bone through your bloodstream. This happens most often in children and the elderly.
- You have diabetes - you will be at an increased risk of getting an infection in your feet, which may then spread to your bone.
- You have a weakened immune system (for example, if you are having chemotherapy for the treatment of cancer or if you have HIV).
Diagnosis
You may already be in hospital when you get osteomyelitis. For instance, you might be recovering from surgery or having treatment for a broken bone. An orthopaedic surgeon (a doctor specialising in bone surgery) at the hospital will carry out a number of tests to check whether it's osteomyelitis that's causing your symptoms.
You may also be referred to an orthopaedic surgeon, if your GP thinks that you might have osteomyelitis. Your GP will first ask you about your symptoms and examine you. He or she may also ask you about your medical history.
Imaging tests
The orthopaedic surgeon will confirm whether you have osteomyelitis by taking images of your bones. This may include having:
- an X-ray - although X-ray images don't always show problems in the early stages of the infection
- an MRI (magnetic resonance imaging) scan - this uses magnets and radiowaves to produce images of the inside of your body
- a CT (computerised tomography) scan - this uses X-rays to make a three-dimensional picture of the body or part of the body
- a bone scan - this detects active areas of bone in the body, where infection may be occurring
Bacteria tests
Your doctor will also want to do some tests to find out the exact type of bacteria or fungus that's causing your infection. This is important in order to work out which treatment is best for you. These tests may involve blood tests or an operation where a small sample of your infected bone is taken (this is called a bone biopsy).
If you have a wound (eg following an injury or operation), your doctor will take a swab from the wound, which will be sent to a laboratory. The laboratory will investigate which bacteria are causing your infection, and decide whether it can be treated with an antibiotic.
You will be given an anaesthetic if you have a bone biopsy. This may be a general anaesthetic, which means you will be asleep during the operation and feel no pain. Or it may be a local anaesthetic that completely blocks feeling from the infected area, but you will be awake during the operation. The biopsy will be sent to a laboratory for testing.
Treatment
Medicines
If you have been diagnosed with osteomyelitis, you will probably need to be treated with antibiotics to get rid of your infection. The antibiotics will be given to you intravenously at first (injected into your vein), while you stay in hospital. If your symptoms have started to improve after this time, you may be able to carry on taking your antibiotics by mouth, at home. You will normally need to take your antibiotics for at least six weeks.
Surgery
In some cases of osteomyelitis, you may need surgery in addition to, or instead of treatment with antibiotics. This is carried out in order to remove any destroyed or infected bone, and to drain away any pus that has built up in your bone. You are more likely to need this surgery if you have chronic or severe osteomyelitis. You will have either a general or local anaesthetic when you have this surgery, so you won't feel any pain.
If a lot of your bone has to be removed, you may also need to have some plastic surgery, including a bone graft. This means that bone is taken from one of your other, uninfected, bones to replace the bone that has been destroyed.
If your infection has been caused by a new joint, this will normally have to be removed before any other treatment can be started. You will then have a new joint put in, once your infection has gone.
Related topics
Sources
- Dandy DJ, Edwards DJ. Essential orthopaedics and trauma. 3rd ed. New York: Churchill Livingstone, 1998
- Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2005
- Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004; 364:369-379
- Healy B, Freedman A. ABC of wound healing: infections. BMJ 2006; 332:838-841
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Mr Roger Tillman, Royal Orthopaedic Hospital, Birmingham, and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: February 2008.
Rate this page
