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$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{}
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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
     [phone]

     The National Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
     Information Clearinghouse
     Box AMS
     Bethesda, MD  20892
     [phone]

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.