Osteomyelitis

The progression of disease in localized osteomyelitis is characterized by a cycle of microbial invasion, vascular disruption, necrosis and sequestration. The host inflammatory response, discussed in detail below, results in obstruction of small vessels due to coagulopathy and oedema. As a result of this, cortical bone undergoes necrosis and is detached from surrounding live bone, creating an area known as a sequestrum. This provides a fertile environment for further bacterial invasion and progression continues.

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Contiguous-Focus Osteomyelitis Even when diagnosed early, contiguous-focus osteomyelitis usually requires surgery in addition to 4–6 weeks of appropriate antibiotic therapy because of underlying soft tissue infection or damage to bone from an injury or surgery. A 2-week course of antibiotics after thorough debridement and soft tissue coverage has yielded adequate results in the treatment of superficial osteomyelitis involving only the outer cortex of bone.

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Harrison's Internal Medicine Chapter 120. Osteomyelitis Osteomyelitis: Introduction Osteomyelitis, an infection of bone, is caused most commonly by pyogenic bacteria and mycobacteria. As a useful framework for evaluating a patient and planning treatment, cases are classified on the basis of the causative agent; the route by which organisms gain access to bone; the duration of infection; the anatomic location of infection; and the local and systemic host factors that have a bearing on pathogenesis and outcome.

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Vertebral Osteomyelitis The vertebrae are the most common sites of hematogenous osteomyelitis in adults. Organisms reach the well-perfused vertebral body via spinal arteries and quickly spread from the end plate into the disk space and then to the adjacent vertebral body. Sources of bacteremia include the urinary tract (especially among men over age 50), dental abscesses, soft tissue infections, and contaminated IV lines, but the source of bacteremia is not evident in more than half of patients.

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Microbiology S. aureus is a pathogen in more than half of cases of contiguous-focus osteomyelitis. However, in contrast to hematogenous osteomyelitis, these infections are often polymicrobial and are more likely to involve gram-negative and anaerobic bacteria. Hence a mixture of staphylococci, streptococci, enteric organisms, and anaerobic bacteria may be isolated from a diabetic foot infection or pelvic osteomyelitis underlying a decubitus ulcer.

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Osteomyelitis of the thoracic spine demonstrated on a sagittal, fatsuppressed T1-weighted magnetic resonance image after the administration of IV gadolinium. At T8–T9, there is involvement of the adjacent vertebral bodies and intervening disk. Abnormally enhancing inflammatory tissue extends from the disk space anteriorly (white arrow) as well as posteriorly into the epidural space, compressing the thecal sac (black arrow).

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Table 120-2 Selection of Antibiotics for Treatment of Acute Osteomyelitis Suggested Regimena Organism Primary Alternativesb Staphylococcus aureus Penicillin- Nafcillin or oxacillin, 2 g Cefazolin, 1 g IV resistant, methicillin- IV q4h q8h; ceftriaxone, 1 g IV q24h; clindamycin, 900 mg IV q8hc sensitive (MSSA) Penicillinsensitive Penicillin, 3–4 million U IV q4h Cefazolin, ceftriaxone, clindamycin (as above) Methicillinresistant (MRSA) Vancomycin, 15 mg/kg Clindamycinc (as IV q12h; rifampin, 300 mg PO above); linezolid, 600 q12h (see text) mg IV or PO q12hd; daptomycin,...

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Tham khảo sách 'osteomyelitis edited by mauricio s. baptista and joão paulo tardivo', y tế - sức khoẻ, y học thường thức phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả

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Melioidosis is a systemic infectious disease caused by Burkholderia pseudomallei. It produces overlapping clinical manifestations which is indistinguishable from other diseases. Melioidosis of the bone and joint infections present chronically with relapses and recurrences. It is most of the time misdiagnosed as tuberculosis due to overlapping clinical, histopathological and radiological features. We have presented here a case report of an elderly Malaysian driver, who was a diabetic and presented with features of osteomyelitis. It was initially diagnosed as tubercular osteomyelitis.

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Osteomyelitis is an infection of the bone caused by bacteria. Osteomyelitis is one of the most severe complications that can arise following trauma or surgical treatment of bone. The present study was conducted in the Department of Microbiology, Government Medical College, Thrissur from April 2010 to March 2011and the objective of this study was to determine the prevalence of different aerobic bacteria causing post-traumatic osteomyelitis and the antibiotic susceptibility pattern of the isolates.

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Chronic Non-Infectious Osteomyelitis (CNO) is a chronic, relapsing, self-limiting inflammation of the bone. Although it is rare, CNO has been associated with inflammatory bowel disease and frequently precedes the initial diagnosis.

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Actinomycosis is a rare, chronic granulomatous disease caused by Gram-positive anaerobic bacteria that colonize the oral cavity. Cervicofacial actinomycosis is the most frequent clinical presentation of actinomycosis, but hematogenous osteomyelitis at distant sites can occur in rare instance in immunocompromised or pediatric patients, only a few cases have been reported in healthy patients.

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Chronic nonbacterial osteomyelitis (CNO) is a rare chronic autoinflammatory syndrome affecting mainly children and young adults. The natural history of the disease is marked by recurrent pain as the mainstay of inflammatory outbreaks. Typical radiographic findings are osteosclerosis and hyperostosis of the medial clavicle, sternum and first rib. Compression of the brachial plexus is exceedingly rare and one of the few surgical indications.

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Managing with diabetic foot osteomyelitis (DFO) is challenging. Even after infective bone resection and thorough debridement, DFO is still difficult to cure and has a high recurrence rate. This retrospective study aims to compare the outcomes of two treatment methods, infected bone resection combined with adjuvant antibiotic-impregnated calcium sulfate and infected bone resection alone, for the treatment of diabetic foot osteomyelitis.

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Chronic hematogenous osteomyelitis often results from the improper treatment of acute hematogenous osteomyelitis. At present, there is lack of uniform standards for the treatment, and the clinical features of the disease are unclear.

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Chronic recurrent multifocal osteomyelitis (CRMO) is an idiopathic inflammatory disease. The initial lesions are typically found in the metaphyses, generally without periosteal reaction.

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The objective of this study was to evaluate the effectiveness of the treatment of fibular osteomyelitis by Ilizarov bone transport. Our study suggested that Ilizarov bone transport may be a good choice for the treatment of fibular osteomyelitis, especially for the patient with distal fibular loss.

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Pleural involvement by non-tuberculous mycobacteria (NTM) in patients without distinct pulmonary disease is extremely rare. Vertebral osteomyelitis (VO) with or without pulmonary disease is also a rare clinical presentation of NTM infection, and pleural spread of NTM from VO has not been reported.

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The pathogenesis of osteomyelitis is a complex process involving interactions between a host and an infectious agent. The host’s inflammatory response to a pathogen can further the physical spread of disease by clearing space in bone. Predisposing genetic differences in immune function are increasingly seen as an aetiological factor in some cases of osteomyelitis. Acquired factors such as diseases causing immune or vascular compromise and implantation of foreign materials are frequently involved in the disease process as well. ...

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Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Successful treatment of Mycobacterium ulcerans osteomyelitis with minor surgical debridement and prolonged rifampicin and ciprofloxacin therapy: a case report

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