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| | __NOTOC__ |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| {{Infobox Disease | | | {{Infobox Disease | |
| Name = Osteomyelitis |
| | Name = Osteomyelitis | |
| Image = Osteomyelitis in cancer.jpg|
| | Image = Ostermyelitis Tibia.jpg | |
| Caption = Osteomyelitis in cancer. <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>|
| | Caption = Osteomyelitis of the [[tibia]] of a young child. Numerous [[abscess]]es in the bone show as radiolucency. | |
| ICD10 = {{ICD10|M|86||m|86}} |
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| ICD9 = {{ICD9|730}} |
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| ICDO = |
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| OMIM = |
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| DiseasesDB = 9367 |
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| MedlinePlus = 000437 |
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| eMedicineSubj = ped |
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| eMedicineTopic = 1677 |
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| MeshName = Osteomyelitis |
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| MeshNumber = C01.539.160.495 |
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| }} | | }} |
| {{Search infobox}} | | {{Osteomyelitis}} |
| {{CMG}} | | {{CMG}}; {{AE}} {{MehdiP}},{{NRM}} |
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| '''Associate Editor-In-Chief:''' {{CZ}}
| | {{SK}} OM |
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| {{Editor Join}}
| | ==[[Osteomyelitis overview|Overview]]== |
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| ==Overview== | | ==[[Osteomyelitis historical perspective|Historical Perspective]]== |
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| '''Osteomyelitis''' is an [[infection]] of [[bone]] or bone marrow, usually caused by [[pyogenic]] [[bacterium|bacteria]] or mycobacteria. It can be usefully subclassifed on the basis of the causative organism, the route, duration and anatomic location of the infection.
| | ==[[Osteomyelitis classification|Classification]]== |
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| == Etiology == | | ==[[Osteomyelitis pathophysiology|Pathophysiology]]== |
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| {| class="wikitable"
| | ==[[Osteomyelitis causes|Causes]]== |
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| | '''Age group'''
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| | '''Most common organisms'''
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| | Newborns (younger than 4 mo)
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| | ''[[Staphylococcus aureus|S. aureus]]'', ''[[Enterobacter]]'' species, and [[Group A streptococcal infection|group A]] and [[Group B streptococcal infection|B]] ''Streptococcus'' species
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| | Children (aged 4 mo to 4 y)
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| | ''[[Staphylococcus aureus|S. aureus]]'', [[Group A streptococcal infection|group A]] ''Streptococcus'' species, ''[[Haemophilus influenzae]]'', and ''[[Enterobacter]]'' species
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| | Children, adolescents (aged 4 y to adult)
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| | ''[[Staphylococcus aureus|S. aureus]]'' (80%), [[Group A streptococcal infection|group A]] ''Streptococcus'' species, ''[[Haemophilus influenzae|H. influenzae]]'', and ''[[Enterobacter]]'' species
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| | Adult
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| | ''[[Staphylococcus aureus|S. aureus]]'' and occasionally ''[[Enterobacter]]'' or ''[[Streptococcus]]'' species
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| In children, the [[long bone]]s are usually affected. In adults, the vertebrae and the [[pelvis]] are most commonly affected.
| | ==[[Osteomyelitis differential diagnosis|Differentiating Osteomyelitis from other Diseases]]== |
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| Acute osteomyelitis almost invariably occurs in children. When adults are affected, it may be because of compromised host resistance due to debilitation, [[intravenous]] drug abuse, infectious root-canaled teeth, or other disease or drugs (''[[e.g.]]'' [[immunosuppressive]] therapy).
| | ==[[Osteomyelitis epidemiology and demographics|Epidemiology and Demographics]]== |
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| Osteomyelitis is a secondary [[complication (medicine)|complication]] in 1-3% of patients with pulmonary [[tuberculosis]]<ref name="Robbins" />. In this case, the bacteria generally spread to the bone through the [[circulatory system]], first infecting the [[synovium]] (due to its higher [[oxygen]] concentration) before spreading to the adjacent bone<ref name="Robbins" />. In tubercular osteomyelitis, the long bones and vertebrae are the ones which tend to be affected<ref name="Robbins" />.
| | ==[[Osteomyelitis risk factors|Risk Factors]]== |
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| ==Presentation== | | ==[[Osteomyelitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| Generally microorganisms may be disseminated to bone hematogenously (''i.e.'', via the blood stream), spread contiguously to bone from local areas of infection, such as [[cellulitis]], or be introduced by penetrating [[Physical trauma|trauma]] including [[iatrogenic]] causes such as joint replacements, internal fixation of fractures or root-canalled teeth. [[Leukocyte]]s then enter the infected area, and in their attempt to [[phagocyte|engulf]] the infectious organisms, release enzymes that lyse bone. [[Pus]] spreads into the bone's blood vessels, impairing the flow, and areas of devitalized infected bone, known as ''sequestra'', form the basis of a chronic infection. Often, the body will try to create new bone around the area of necrosis. The resulting new bone is often called an [[involucrum]].
| | ==Diagnosis== |
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| On [[histology|histologic]] examination, these areas of necrotic bone are the basis for distinguishing between ''acute osteomyelitis'' and ''chronic osteomyelitis''. Osteomyelitis is an infective process which encompasses all of the bone (osseous) components, including the bone marrow. When it is chronic it can lead to bone sclerosis and deformity.
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| Because of the particulars of their blood supply, the [[tibia]], the [[femur]], the [[humerus]], the [[vertebra]], the maxilla and the mandibular bodies are especially susceptible to osteomyelitis. [http://www.emedicine.com/emerg/topic349.htm]
| | [[Osteomyelitis history and symptoms|History and Symptoms]] | [[Osteomyelitis physical examination|Physical Examination]] | [[Osteomyelitis laboratory findings|Laboratory Findings]] | [[Osteomyelitis x ray|X Ray]] | [[Osteomyelitis CT|CT]] | [[Osteomyelitis MRI|MRI]] | [[Osteomyelitis other imaging findings|Other Imaging Findings]] | [[Osteomyelitis other diagnostic studies|Other Diagnostic Studies]] |
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| ==Complete Differential Diagnosis of Associated Conditions==
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| *[[Bacteroides]]
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| *Decubitus
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| *Diabetic angiopathy
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| *[[E.Coli]]
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| *Gastrointestinal infection
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| *[[Klebsiella]]
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| *[[Otitis]]
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| *[[Pneumonia]]
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| *[[Pseudomonas]]
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| *[[Serratia]]
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| *[[Sinusitis]]
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| *Skin infection
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| *[[Staphylococcus aureus]]
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| *[[Staphylococcus epidermidis]]
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| *[[Streptococcus pyogenes]]
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| *[[Streptococcus pneumoniae]]
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| *[[Tonsilitis]]
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| *[[Urinary tract infection]]
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| *[[Vasculitis]] <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
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| ==Diagnostic Findings==
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| *Conventional radiographic evaluation of acute osteomyelitis is insufficient because bone changes are not evident for 14–21 days after the onset of infection.
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| *Although MR imaging is the accepted modality of choice for the early detection and surgical localization of osteomyelitis, in the emergency department, CT is usually more readily available for establishing the diagnosis. <ref>Laura M. Fayad, John A. Carrino, and Elliot K. Fishman. [http://radiographics.rsnajnls.org/cgi/content/abstract/27/6/1723 Musculoskeletal Infection: Role of CT in the Emergency Department.] RadioGraphics 2007 27: 1723-1736.</ref>
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| *At CT, features of bacterial osteomyelitis include overlying soft-tissue swelling, periosteal reaction, medullary low-attenuation areas or trabecular coarsening, and focal cortical erosions.
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| ===MRI===
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| [http://www.radswiki.net Images courtesy of RadsWiki]
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| '''Patient #1 Extensive calcaneal osteomyelitis. Note soft tissue ulceration and [[cellulitis]]'''
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| <gallery>
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| Image:Osteomyelitis MRI 001.jpg|T1
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| Image:Osteomyelitis MRI 002.jpg|STIR
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| Image:Osteomyelitis MRI 003.jpg|T1
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| Image:Osteomyelitis MRI 004.jpg|STIR
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| Image:Osteomyelitis MRI 005.jpg|T1 fat sat contrast
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| Image:Osteomyelitis MRI 006.jpg|T1 fat sat contrast
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| </gallery>
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| ===Bone Scan===
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| '''Patient #2'''
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| [http://www.radswiki.net Images courtesy of RadsWiki]
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| <gallery>
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| Image:Osteomyelitis-102.jpg|Blood pool
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| Image:Osteomyelitis-103.jpg|Delayed
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| </gallery>
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| <br clear="left"/>
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| <youtube v=X2ShDUfeso0/>
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| <br clear="left"/>
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| ==Osteomyelitis and Chondritis of Vertebrae==
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| <youtube v=KTfOwYS1ykY/>
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| ==Treatment== | | ==Treatment== |
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| Osteomyelitis often requires prolonged [[antibiotic]] therapy. IV antibiotics are generally used to combat the infection, with a course lasting a matter of weeks or months. A PICC line or [[central venous catheter]] is often placed for this purpose. Osteomyelitis also may require surgical [[debridement]]. Severe cases may lead to the loss of a limb. Initial first line antibiotic choice is determined by the patient's history and regional differences in common infective organisms. | | [[Osteomyelitis medical therapy|Medical Therapy]] | [[Osteomyelitis surgery|Surgery]] | [[Osteomyelitis prevention|Prevention]] | [[Osteomyelitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Osteomyelitis future or investigational therapies|Future or Investigational Therapies]] |
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| Prior to the widespread availability and use of antibiotics, blow fly larvae were sometimes deliberately introduced to the wounds to feed on the infected material, effectively scouring clean.[http://www.ejbjs.org/cgi/content/abstract/13/3/438]
| | ==Case Studies== |
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| ==References==
| | [[Osteomyelitis case study one|Case #1]] |
| {{Reflist|2}}
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| ==See also== | | ==Related Chapters== |
| *[[Brodie abscess]] | | *[[Brodie abscess]] |
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| ==External Links==
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| * [http://goldminer.arrs.org/search.php?query=Osteomyelitis Goldminer: Osteomyelitis]
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| ==Additional Resources==
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| * {{MerckManual|5|54|b}}
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| * {{Chorus|00298}}
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| {{Diseases of the musculoskeletal system and connective tissue}} | | {{Diseases of the musculoskeletal system and connective tissue}} |
| [[Category:Orthopedics]]
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| [[Category:Bacterial diseases]]
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| [[Category:Skeletal disorders]]
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| {{SIB}}
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| [[de:Osteomyelitis]] | | [[de:Osteomyelitis]] |
| [[fr:Ostéomyélite]] | | [[fr:Ostéomyélite]] |
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| [[pt:Osteomielite]] | | [[pt:Osteomielite]] |
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