Osteomyelitis history and symptoms

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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

Patient history is important to establish a diagnosis of osteomyelitis. Common histories 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 patients with an infected prosthesis.

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:

Diabetes^[2]
Diabetic patients with soft-tissue inflammation or skin ulcers in the feet

Common symptoms

Systemic:^[3]

Chills
Fever
Malaise

Local:

Pain
Edema
Erythema
Warmth

Special Considerations

Diabetic patients with osteomyelitis secondary to vascular insufficiency typically do not have fever or inflammation.
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.

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.

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[LewWaldvogel1997-1] Lew, Daniel P.; Waldvogel, Francis A. (1997). "Osteomyelitis". New England Journal of Medicine. 336 (14): 999–1007. doi:10.1056/NEJM199704033361406. ISSN 0028-4793.

[CaputoCavanagh1994-2] 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.

[LewWaldvogel2004-3] 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.

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