Osteomyelitis natural history, complications and prognosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Osteomyelitis}} | {{Osteomyelitis}} | ||
{{CMG}} {{AE}} {{NRM}} | {{CMG}} {{AE}} {{NRM}},{{MehdiP}} | ||
==Overview== | ==Overview== | ||
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==Natural History== | ==Natural History== | ||
*Acute | *Acute infection is typically defined as symptoms lasting less than 14 days and if left untreated it may lead to chronic osteomyelitis.<ref name="RiiseKirkhus2008">{{cite journal|last1=Riise|first1=Oystein R|last2=Kirkhus|first2=Eva|last3=Handeland|first3=KaiS|last4=Flato|first4=Berit|last5=Reiseter|first5=Tor|last6=Cvancarova|first6=Milada|last7=Nakstad|first7=Britt|last8=Wathne|first8=Karl-Olaf|title=Childhood osteomyelitis-Incidence and differentiation from other acute onset musculoskeletal features in a population-based study|journal=BMC Pediatrics|volume=8|issue=1|year=2008|pages=45|issn=1471-2431|doi=10.1186/1471-2431-8-45}}</ref> | ||
:*Patients typically develop [[prodromal symptoms]] after several days including: fever, malaise, irritability, lethargy, and chills. | :*Patients typically develop [[prodromal symptoms]] after several days including: fever, malaise, irritability, lethargy, and chills. | ||
:*Local symptoms soon follow the [[prodrome]] and include: [[erythema]], [[edema]], warmth, and pain. | :*Local symptoms soon follow the [[prodrome]] and include: [[erythema]], [[edema]], warmth, and pain. | ||
*Chronic osteomyelitis is defined as presence or recurrence of symptoms for greater than | *Chronic osteomyelitis is defined as presence or recurrence of symptoms for greater than 4 weeks. | ||
:*Patients with chronic osteomyelitis develop sequestra. | :*Patients with chronic osteomyelitis may develop sequestra. | ||
:*Patients may continue presenting with acute symptoms and bearing weight may become increasingly difficult. | :*Patients may continue presenting with acute symptoms and bearing weight may become increasingly difficult. | ||
:*Patients may develop soft tissue [[Ulcer|ulcers]], nonhealing [[Fracture|fractures]], and [[Brodie's abscess]].<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> | :*Patients may develop soft tissue [[Ulcer|ulcers]], nonhealing [[Fracture|fractures]], and [[Brodie's abscess]].<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> | ||
==Complications== | ==Complications== | ||
Chronic osteomyelitis may cause the following complications: | Chronic osteomyelitis may cause the following complications: | ||
*Bone destruction | *Bone destruction | ||
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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
Symptoms begin several days to weeks after infection. Symptoms lasting approximately less than 14 days is considered acute osteomyelitis, while longer lasting symptoms constitute chronic osteomyelitis. Acute symptoms include a prodrome accompanied by local erythema, edema, warmth, and pain. Patients with chronic osteomyelitis develop sinus tracts or sequestra. Bearing weight may become increasingly difficult and patients may develop soft tissue ulcers, nonhealing fractures, and Brodie's abscess. Complications include: bone destruction, amputation, contiguous infection of joints or soft tissue, impaired bone growth in children, neoplasm, or tumor. Prognosis is generally good for acute osteomyelitis but usually poor for patients with chronic osteomyelitis.
Natural History
- Acute infection is typically defined as symptoms lasting less than 14 days and if left untreated it may lead to chronic osteomyelitis.[1]
- Patients typically develop prodromal symptoms after several days including: fever, malaise, irritability, lethargy, and chills.
- Local symptoms soon follow the prodrome and include: erythema, edema, warmth, and pain.
- Chronic osteomyelitis is defined as presence or recurrence of symptoms for greater than 4 weeks.
- Patients with chronic osteomyelitis may develop sequestra.
- Patients may continue presenting with acute symptoms and bearing weight may become increasingly difficult.
- Patients may develop soft tissue ulcers, nonhealing fractures, and Brodie's abscess.[2]
Complications
Chronic osteomyelitis may cause the following complications:
- Bone destruction
- Pathologic fractures[3]
- Limb amputation
- Contiguous infection of joints or soft tissue
- Reduced limb or joint function
- Impaired bone growth in children
- Neoplasm
- Tumor[4]
- Most common: squamous cell carcinoma
- Less common: fibrosarcoma, myeloma, lymphoma, plasmacytoma, angiosarcoma, rhabdomyosarcoma, and malignant fibrous histiocytoma
Prognosis
- With treatment, the outcome for acute osteomyelitis is usually good.[5]
- Prognosis is usually poor for patients with chronic osteomyelitis, even with surgery.
- Amputation may be needed, especially in those with diabetes or poor blood circulation.
- Patients with chronic osteomyelitis may have recurring symptoms after treatment.
- The outlook for those with an infection of an orthopedic prosthesis depends, in part, on:
- The patient's health
- The type of infection
- Whether the infected prosthesis can be safely removed
References
- ↑ Riise, Oystein R; Kirkhus, Eva; Handeland, KaiS; Flato, Berit; Reiseter, Tor; Cvancarova, Milada; Nakstad, Britt; Wathne, Karl-Olaf (2008). "Childhood osteomyelitis-Incidence and differentiation from other acute onset musculoskeletal features in a population-based study". BMC Pediatrics. 8 (1): 45. doi:10.1186/1471-2431-8-45. ISSN 1471-2431.
- ↑ 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.
- ↑ Gelfand MS, Cleveland KO, Heck RK, Goswami R (2006). "Pathological fracture in acute osteomyelitis of long bones secondary to community-acquired methicillin-resistant Staphylococcus aureus: two cases and review of the literature". Am J Med Sci. 332 (6): 357–60. PMID 17170628.
- ↑ Johnston RM, Miles JS (1973). "Sarcomas arising from chronic osteomyelitic sinuses. A report of two cases". J Bone Joint Surg Am. 55 (1): 162–8. PMID 4691654.
- ↑ Osteomyelitis. MedlinePlus (May 01, 2015). https://www.nlm.nih.gov/medlineplus/ency/article/000437.htm Accessed April 15, 2016.