$Unique_ID{BRK04071} $Pretitle{} $Title{Osteomyelitis} $Subject{Osteomyelitis Osteitis Hematogenous Osteomyelitis Osteomyelitis Pyogenic Acute Osteomyelitis Pyogenic Chronic Vertebral Osteomyelitis Anaerobic Osteomyelitis Osteomyelitis due to Vascular Insufficiency Rheumatoid Arthritis Rheumatic Fever Arthritis Infectious Giant Cell Tumor Cellulitis Amyloidosis Sickle Cell Disease} $Volume{} $Log{} Copyright (C) 1989, 1991 National Organization for Rare Disorders, Inc. 742: Osteomyelitis ** IMPORTANT ** It is possible that the main title of the article (Osteomyelitis) is not the name you expected. Please check the SYNONYM listing to find the alternate names and disorder subdivisions covered by this article. Synonyms Osteitis Hematogenous Osteomyelitis Disorder Subdivisions: Osteomyelitis, Pyogenic, Acute Osteomyelitis, Pyogenic, Chronic Vertebral Osteomyelitis Anaerobic Osteomyelitis Osteomyelitis due to Vascular Insufficiency Information on the following diseases can be found in the Related Disorders section of this report: Rheumatoid Arthritis Rheumatic Fever Arthritis, Infectious Giant Cell Tumor Cellulitis Amyloidosis Sickle Cell Disease General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section of this report. Osteomyelitis is a common inflammation of the bone caused by bacteria, frequently Staphylococcus. This disorder is usually due to an infection in another part of the body that is transported through the bloodstream to a bone in a distant location. It can be an acute or chronic condition. Symptoms Acute Osteomyelitis is a serious bone inflammation that can result from a previous trauma, puncture wound, surgery, bone fracture, abscessed tooth, or infection of soft tissue, the ear or sinus. In children, it usually affects the long bones, especially the growth center (epiphysis) at the end of the shaft. In adults, bones of the spinal column (vertebra) are often affected. Initially there may be several days of fever and a generalized feeling of ill health (malaise). This may be followed by an increase in fever (104-105 degrees Fahrenheit), deep localized bone pain, chills, sweating, swelling and painful or limited movement of the nearby joints. The skin near the affected bone may be red (erythema) and there may be a purulent buildup (pus), loss of calcium, destruction of the surrounding tissue (necrosis) and bone deterioration or deformity. Chronic Osteomyelitis usually occurs after an acute episode of Osteomyelitis when the infection has not been totally cured. There may be bone pain, swelling, redness and tenderness of the affected area. A discharge of pus from an opening to the infected bone is often the first symptom. There may also be destruction of the bone with pieces of the infected bone separating from the healthy bone. In cases where this occurs, surgery to remove the bone fragments may be necessary. Vertebral Osteomyelitis is characterized by chronic back pain not relieved by ordinary treatment such as bed rest, heat or pain relievers. There may be fever, localized tenderness, pain, muscle spasms and limited movement. This form of Osteomyelitis usually affects people over 50 years of age, and is usually caused by a previous injury, urinary tract infection, inflammation of the lining of the heart (endocarditis) or drug addiction. (For more information on this disorder, choose "Endocarditis" as your search term in the Rare Disease Database.) Anaerobic Osteomyelitis often affects the lower jawbone (mandible), skull or feet. It is characterized by ulceration and swelling, foul smelling drainage and redness of the affected area. Osteomyelitis due to Vascular Insufficiency is more common in people with Diabetes Mellitus or vascular diseases that affect the extremities, especially the toes and small bones of the feet. It is usually seen in people over 50 years old and is characterized by pain and redness of the affected area (erythema), swelling, ulcerations, and drainage of pus. This type of Osteomyelitis is difficult to treat because of the underlying vascular disorder that can impair the therapeutic effect of antibiotic treatment. (For more information on the above disorder, choose "Diabetes" as your search term in the Rare Disease Database.) Causes Osteomyelitis is an infection frequently caused by Staphylococcus bacteria. In some cases the cause is unknown, but it is usually transmitted through the bloodstream from another area of the body. Affected Population Osteomyelitis is a prevalent condition that affects males and females in equal numbers. It is usually more common in children and adults after the age of 50. Hemodialysis patients, drug addicts and those with diabetes are also more susceptible to this infection. Related Disorders Symptoms of the following disorders can be similar to those of Osteomyelitis. Comparisons may be useful for a differential diagnosis: Rheumatoid Arthritis is an inflammatory autoimmune disease in which the bodies natural defenses against foreign agents (antibodies & lymphocytes) attack healthy bones and joints. This disorder is characterized by a lack of appetite (anorexia), fatigue, painful and deformed joints, early morning stiffness chiefly in the hands, knees, feet, jaw, and spine. Once affected, a patient's joints remain painful or uncomfortable for weeks, months, or years. (For more information on this disorder, choose "Arthritis" as your search term in the Rare Disease Database). Rheumatic Fever is an inflammatory infectious disease that can occur following streptococcal infections of the throat (strep throat). Patients initially experience moderate fever, a general feeling of ill health (malaise), a sore throat and fatigue. A toe or finger may become swollen and red, mimicking a local infection. Major complications can include heart disease, joint pain and arthritis, involuntary abrupt limb movements with characteristic grimaces (chorea), and possible skin symptoms. Treatment with antibiotics should begin as soon as possible. Rheumatic Fever can be avoided if strep throat is vigorously treated and cured with antibiotics. (For more information on this disorder, choose ""Rheumatic Fever" as your search term in the Rare Disease Database.) Infectious Arthritis occurs as a result of an infection in the tissues of a joint by bacteria, viruses or fungi. It is characterized by fever, chills, general weakness and headaches, followed by inflammation of one or more joints. The affected joint or joints often become very painful, swollen, slightly red and stiff within a few hours or days. (For more information on this disorder, choose "Arthritis, Infectious" as your search term in the Rare Disease Database.) Cellulitis is a bacterial infection of the skin usually caused by a Staphylococcus or Streptococcus bacteria. The infection commonly results from an existing wound of the nose, ears, face or hands. It is characterized by localized pain, swelling and redness of the skin, fever, chills, enlarged lymph nodes (lymphadenitis) and a general feeling of ill health. Giant Cell tumors can be a recurring condition characterized by tumors of the growth areas (epiphysis) of the long bones. These tumors can cause erosion of the bone and may infiltrate into the surrounding tissue. They are usually treated by surgical removal. Sickle Cell Anemia is an inherited blood disease. Symptomatic of this disease are the painful "crisis periods" which can occur in conjunction with other infections. It is characterized by joint pain (arthralgia), fever, severe abdominal pain, and vomiting. (For more information on this disorder, choose "sickle cell" as your search term in the Rare Disease Database.) People with Osteomyelitis may develop the following disorders if the disease is left untreated or inadequately treated. Secondary Amyloidosis is a metabolic disorder resulting from the extracellular accumulation of amyloid (a glycoprotein) in almost any organ system, in quantities sufficient to cause dysfunction. It can be a secondary disorder associated with Osteomyelitis. (For more information on this disorder, choose "Amyloidosis" as your search term in the Rare Disease Database.) Therapies: Standard Symptoms of Osteomyelitis can resemble many other bone disorders. Bone scans, blood tests or a bone biopsy are tests that help diagnose this disorder so that treatment can be started immediately. After the infectious organism has been identified by a blood, pus or fluid culture, Osteomyelitis is usually treated with massive doses of the appropriate antibiotic. Penicillin type drugs such as Oxacillin, Nafcillin, or Ampicillin, either prescribed alone or in combination with Aminoglycoside drugs (gentaminicin, tobramycin, amikacin, or netilmicin) are effective treatments for certain types of Osteomyelitis. Depending on the extent of the infection, it may be necessary to surgically drain and clean the infected area and then continue treatment with antibiotic therapy. In some cases a bone graft may be necessary. It is most important that diabetics and those with vascular disorders be treated as quickly as possible for suspected Osteomyelitis. If left untreated this disorder can result in destruction of the bone and surrounding tissue and may lead to amputation of the affected toes or foot. Other treatment is symptomatic and supportive. Therapies: Investigational At the present time, a study is being conducted on the effectiveness of polymethyl methacrylate antibiotic beads as a treatment for postoperative Osteomyelitis infections. Another treatment with Gentamicin impregnated with PMMA beads on surgical wire (Septopal) has been developed in Germany by E. Merck, Darmstadt. The FDA has given approval for this orphan drug testing. More research must be conducted to determine long-term safety and effectiveness of these treatments. This disease entry is based upon medical information available through March 1991. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Osteomyelitis, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 The National Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse Box AMS Bethesda, MD 20892 (301) 495-4484 References INTERNAL MEDICINE, 2nd Ed.: Jay H. Stein, ed.-in-chief; Little, Brown and Co., 1987. Pp. 1520. THE MERCK MANUAL, 15th Ed.: Robert Berkow, M.D., ed.-in-chief; Merck, Sharp & Dohme Laboratories., 1987. Pp. 1298. POST-TRAUMATIC OSTEOMYELITIS. PATHOPHYSIOLOGY AND MANAGEMENT. M. Roesgen, et al.; ARCH ORTHOP TRAUMA SURG, (1989 issue 108 (1)). Pp. 1-9. ANTIBIOTIC BEADS IN THE MANAGEMENT OF SURGICAL INFECTIONS. J. Calhoun, et al.; AM J SURG (April 1989, issue 157 (4)). Pp. 443-449. ANTIBIOTIC THERAPY OF OSTEOMYELITIS IN OUTPATIENTS. L. Harvey, et al.; MED CLIN NORTH AM, (May 1988, issue 72 (3)). Pp. 723-738. THE DIAGNOSIS OF OSTEOMYELITIS IN PATIENTS WITH PRESSURE SORES. V. Lewis, et al.; PLAST RECONSTR SURG, (February 1988, issue 81 (2)). Pp. 229- 232. OSTEOMYELITIS: OPTIONS FOR DIAGNOSIS AND MANAGEMENT. L. Gentry. J ANTIMICROB CHEMOTHER, (April 1988, issue 21 (Suppl C). Pp. 115-131. PRIMARY EPIPHYSEAL OSTEOMYELITIS IN CHILDREN. REPORT OF THREE CASES AND REVIEW OF THE LITERATURE. T. Sorenson, et al.; BONE JOINT SURG (November 1988, issue 70 (5)). Pp. 818-820.