Osteomyelitis history and symptoms: Difference between revisions
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==Overview== | ==Overview== | ||
The patient's history is important in establishing a diagnosis of osteomyelitis. Common history findings include [[intravenous drug use]], [[bacteremia]], recent open [[fracture]] or [[surgery]], and [[diabetes]]. Common symptoms include [[chills]], [[fever]], [[malaise]], local pain and warmth, [[edema]], and [[erythema]]. Fever is typically absent in diabetic patients with osteomyelitis secondary to vascular insufficiency and in patients with infected [[prosthesis]]. The presence of a '''draining sinus tract''' is pathognomonic of chronic osteomyelitis. | |||
The presence of a '''draining sinus tract''' is | |||
==History and Symptoms== | ==History and Symptoms== | ||
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:*[[Prosthesis]] | :*[[Prosthesis]] | ||
*Osteomyelitis | *Osteomyelitis secondary to vascular insufficiency: | ||
:*[[Diabetes]]<ref name="CaputoCavanagh1994">{{cite journal|last1=Caputo|first1=Gregory M.|last2=Cavanagh|first2=Peter R.|last3=Ulbrecht|first3=Jan S.|last4=Gibbons|first4=Gary W.|last5=Karchmer|first5=Adolf W.|title=Assessment and Management of Foot Disease in Patients with Diabetes|journal=New England Journal of Medicine|volume=331|issue=13|year=1994|pages=854–860|issn=0028-4793|doi=10.1056/NEJM199409293311307}}</ref> | :*[[Diabetes]]<ref name="CaputoCavanagh1994">{{cite journal|last1=Caputo|first1=Gregory M.|last2=Cavanagh|first2=Peter R.|last3=Ulbrecht|first3=Jan S.|last4=Gibbons|first4=Gary W.|last5=Karchmer|first5=Adolf W.|title=Assessment and Management of Foot Disease in Patients with Diabetes|journal=New England Journal of Medicine|volume=331|issue=13|year=1994|pages=854–860|issn=0028-4793|doi=10.1056/NEJM199409293311307}}</ref> | ||
:*Diabetic patients with soft-tissue inflammation or skin [[ulcers]] in the feet | :*Diabetic patients with soft-tissue inflammation or skin [[ulcers]] in the feet | ||
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===Common symptoms=== | ===Common symptoms=== | ||
*Systemic:<ref name="LewWaldvogel2004">{{cite journal|last1=Lew|first1=Daniel P|last2=Waldvogel|first2=Francis A|title=Osteomyelitis|journal=The Lancet|volume=364|issue=9431|year=2004|pages=369–379|issn=01406736|doi=10.1016/S0140-6736(04)16727-5}}</ref><ref name="pmid11880745">{{cite journal |vauthors=Vazquez M |title=Osteomyelitis in children |journal=Curr. Opin. Pediatr. |volume=14 |issue=1 |pages=112–5 |year=2002 |pmid=11880745 |doi= |url=}}</ref> | *Systemic:<ref name="LewWaldvogel2004">{{cite journal|last1=Lew|first1=Daniel P|last2=Waldvogel|first2=Francis A|title=Osteomyelitis|journal=The Lancet|volume=364|issue=9431|year=2004|pages=369–379|issn=01406736|doi=10.1016/S0140-6736(04)16727-5}}</ref><ref name="pmid11880745">{{cite journal |vauthors=Vazquez M |title=Osteomyelitis in children |journal=Curr. Opin. Pediatr. |volume=14 |issue=1 |pages=112–5 |year=2002 |pmid=11880745 |doi= |url=}}</ref> | ||
:*Chills | :*[[Chills]] | ||
:*[[Headache]] | :*[[Headache]] | ||
:*[[Fatigue]] | :*[[Fatigue]] | ||
| Line 39: | Line 38: | ||
===Special Considerations=== | ===Special Considerations=== | ||
*Diabetic patients with osteomyelitis secondary to vascular insufficiency typically do not have fever or inflammation.<ref name="pmid1908030">{{cite journal |vauthors=Newman LG, Waller J, Palestro CJ, Schwartz M, Klein MJ, Hermann G, Harrington E, Harrington M, Roman SH, Stagnaro-Green A |title=Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline |journal=JAMA |volume=266 |issue=9 |pages=1246–51 |year=1991 |pmid=1908030 |doi= |url=}}</ref> | *Diabetic patients with osteomyelitis secondary to [[vascular insufficiency]] typically do not have fever or inflammation.<ref name="pmid1908030">{{cite journal |vauthors=Newman LG, Waller J, Palestro CJ, Schwartz M, Klein MJ, Hermann G, Harrington E, Harrington M, Roman SH, Stagnaro-Green A |title=Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline |journal=JAMA |volume=266 |issue=9 |pages=1246–51 |year=1991 |pmid=1908030 |doi= |url=}}</ref> | ||
*Diabetic patients with advanced [[neuropathy]] may not feel pain. | *Diabetic patients with advanced [[neuropathy]] may not feel pain. | ||
*Fever is typically absent in patients with infected prosthesis. | *Fever is typically absent in patients with infected prosthesis. | ||
*Patients with vertebral osteomyelitis may have generalized neck and back pain. | *Patients with vertebral osteomyelitis may have generalized neck and back pain. | ||
*The presence of a '''draining sinus tract''' is ''' | *The presence of a '''draining sinus tract''' is '''pathognomonic''' of chronic osteomyelitis. | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category: | [[Category:Emergency mdicine]] | ||
[[Category: | [[Category:Disease]] | ||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
Latest revision as of 23:28, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nate Michalak, B.A.,Seyedmahdi Pahlavani, M.D. [2]
Overview
The patient's history is important in establishing a diagnosis of osteomyelitis. Common history findings include intravenous drug use, bacteremia, recent open fracture or surgery, and diabetes. Common symptoms include chills, fever, malaise, local pain and warmth, edema, and erythema. Fever is typically absent in diabetic patients with osteomyelitis secondary to vascular insufficiency and in patients with infected prosthesis. The presence of a draining sinus tract is pathognomonic of chronic osteomyelitis.
History and Symptoms
Patient History
A detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient based on specific types of osteomyelitis include:
- Hematogenous Osteomyelitis:
- Contiguous-focus Osteomyelitis:
- Recent open fracture
- Recent surgery, especially orthopedic surgery
- Prosthesis
- Osteomyelitis secondary to vascular insufficiency:
Common symptoms
- Local:
Special Considerations
- Diabetic patients with osteomyelitis secondary to vascular insufficiency typically do not have fever or inflammation.[5]
- Diabetic patients with advanced neuropathy may not feel pain.
- Fever is typically absent in patients with infected prosthesis.
- Patients with vertebral osteomyelitis may have generalized neck and back pain.
- The presence of a draining sinus tract is pathognomonic of chronic osteomyelitis.
References
- ↑ Lew, Daniel P.; Waldvogel, Francis A. (1997). "Osteomyelitis". New England Journal of Medicine. 336 (14): 999–1007. doi:10.1056/NEJM199704033361406. ISSN 0028-4793.
- ↑ Caputo, Gregory M.; Cavanagh, Peter R.; Ulbrecht, Jan S.; Gibbons, Gary W.; Karchmer, Adolf W. (1994). "Assessment and Management of Foot Disease in Patients with Diabetes". New England Journal of Medicine. 331 (13): 854–860. doi:10.1056/NEJM199409293311307. ISSN 0028-4793.
- ↑ Lew, Daniel P; Waldvogel, Francis A (2004). "Osteomyelitis". The Lancet. 364 (9431): 369–379. doi:10.1016/S0140-6736(04)16727-5. ISSN 0140-6736.
- ↑ Vazquez M (2002). "Osteomyelitis in children". Curr. Opin. Pediatr. 14 (1): 112–5. PMID 11880745.
- ↑ Newman LG, Waller J, Palestro CJ, Schwartz M, Klein MJ, Hermann G, Harrington E, Harrington M, Roman SH, Stagnaro-Green A (1991). "Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline". JAMA. 266 (9): 1246–51. PMID 1908030.