Osteomyelitis (Bone Marrow Inflammation): Causes, Symptoms & Treatment

Osteomyelitis (bone marrow inflammation) is a disease of the bone caused by bacteria such as Staphylococcus aureus. The focus of inflammation is in the bone marrow and spreads to the various bone layers as the disease progresses. A distinction is made between endogenous and exogenous osteomyelitis, which can occur in both an acute and chronic form.

What is osteomyelitis?

Osteomyelitis is an inflammation of the bone marrow, which is caused by bacteria. The bacterium Staphylococcus aureus is usually responsible for this. Osteomyelitis is divided into endogenous and exogenous. This refers to the origin of the osteomyelitis. Endogenous osteomyelitis – also known as hematogenous osteomyelitis – occurs when the bacteria enter the bone marrow via the blood (hematogenously). The bacteria for this usually originate from a focus of infection inside (endo) the body. Exogenous osteomyelitis occurs as a result of external (exo) injury. The pathogen enters the bone marrow via the wound. Acute osteomyelitis is divided into three groups, depending on the age of the affected person. A distinction is made between acute hematogenous infant osteomyelitis, acute hematogenous osteomyelitis in childhood, and acute hematogenous osteomyelitis in adults.

Causes

The main cause of osteomyelitis is bacteria that cause infection in the bone marrow. In addition to Staphylococcus aureus, Salmonella, Streptococcus as well as Escherichia coli can be responsible for bone marrow inflammation. In endogenous osteomyelitis, the bacterium enters the bone marrow via the blood supply. For this to occur, other sources of infection must be present in the body, such as tonsillitis, inflammation of the sinuses, and inflammation of the teeth and mucous membranes. Because the route of infection is through the blood supply, the bacterium can spread throughout the skeleton and lead to severe sepsis. In exogenous osteomyelitis, the pathogens enter the bone marrow from the outside. This can happen through an injury or during a surgical procedure. In this case, the bacteria spread mainly in the area of the wound, so that the bone marrow inflammation is localized. The risk of exogenous osteomyelitis is increased if, for example, diseases such as diabetes mellitus or arteriosclerosis are present and/or the immune system is weakened.

Symptoms, complaints, and signs

Acute inflammation of the bone marrow initially causes a general feeling of illness. The patient feels tired and listless, and there is nausea and fever, sometimes accompanied by chills. After a short time, the region over the inflamed bone marrow begins to ache. It is sensitive to pressure and swollen. The skin turns red and feels warm. The bone may pulsate painfully and the limbs lose strength and muscle tone. As it progresses, a fistula may form. Secretion or pus produced by the inflammation must drain. Therefore, it makes a channel through the skin and exits the fistula opening. If the infection follows an injury or after surgery, such as after the insertion of an artificial joint, pus may ooze from the wound that has not yet healed. But even if the wound has already closed, inflammation can develop long after the procedure, which is called subacute osteomyelitis. If a joint is involved, it manifests as pain during certain movements. All bones can be affected by osteomyelitis, but it most often shows up in the upper arms or knees. If the disease is not treated, the inflammation can spread further in the body and irreversibly damage the bone marrow.

Diagnosis and course

The diagnosis of osteomyelitis is confirmed with the help of various diagnostic procedures. Because symptoms such as swelling, redness, and restricted movement can also have other causes, the following blood values are first examined after a thorough anamnesis (medical history). Since osteomyelitis is an inflammatory condition, inflammatory parameters such as leukocytes (white blood cells), CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) are elevated. Blood cultures can be used to determine the pathogen. In addition to laboratory diagnostics, imaging procedures such asX-rays, ultrasound, magnetic resonance imaging and skeletal scintigraphy are all used. However, these examination methods are only used at a later stage, since visible changes in the bone become apparent after about two to three weeks at the earliest. The course of osteomyelitis depends on the type of osteomyelitis. Acute endogenous osteomyelitis heals without consequences if diagnosed in time and treated adequately. In adults, this form of osteomyelitis can often become chronic. As the bones change over the years, they may no longer respond as well to treatment. As a result, acute relapses occur again and again. In 10 out of 100 affected persons, endogenous osteomyelitis takes a chronic course. In infants or children, endogenous osteomyelitis often takes a severe course, resulting in permanent damage. Growth disorders are the result and the affected body part becomes deformed or shortened. Another consequence can be blood poisoning (sepsis). In the case of exogenous osteomyelitis, early diagnosis and adequate treatment have a positive effect on the course of the disease and it can therefore heal without consequences. However, acute osteomyelitis usually develops into a chronic form, which results in changes in the bone. Stability and mobility decrease and the inflammation can spread to neighboring joints. In approximately 6 out of 100 affected individuals, amputation of the affected body part occurs as osteomyelitis progresses.

Complications

As a rule, complications of osteomyelitis occur when the disease is not treated in time. In this case, the affected person suffers from high fever and not infrequently also from fatigue and permanent tiredness. The inflammation can also spread to the other bone layers. There is also swelling and redness on the skin. The patient may also suffer from various movement restrictions due to the osteomyelitis and thus limitations in everyday life. In general, the quality of life of the affected person is significantly reduced due to the disease. The joints and bones also ache, and this can lead to irritability in the affected person. If osteomyelitis already occurs in children, this disease can lead to severe disturbances in development and also in growth. Likewise, in the worst case, this can lead to blood poisoning, which can be fatal for the patient. The treatment of osteomyelitis is usually relatively uncomplicated and with the help of antibiotics. Complications also do not occur. The patient’s life expectancy is also not further affected if treatment is successful.

When should you go to the doctor?

A physician should be consulted if a general feeling of illness, malaise, or fatigue occurs. If there is a loss of the usual level of performance or a decrease in resilience, a doctor is needed. Flu-like symptoms such as chills, aches, or an irregularity of the muscular system should be investigated and treated. Inflammatory symptoms, elevated body temperature, and nausea are signs of a health condition that should be presented to a physician. Discoloration of the skin and a sensation of warmth in the skin are considered worrisome. If the symptoms persist over a longer period of time or increase in intensity, a physician is needed. Special caution is required in the case of pus formation. In severe cases, the affected person is threatened with sepsis and thus a life-threatening condition. A visit to the doctor is necessary as soon as there is a spread of redness in the affected area or sterile wound care cannot be provided. Enlargement of a wound should also be presented to a doctor. If the daily requirements can no longer be fulfilled or if disturbances of the general movement processes occur, a visit to the doctor is advisable. Swelling in the immediate vicinity of the bones as well as sensory disturbances are further signs of an irregularity. A physician should be consulted as soon as feelings of numbness develop or sensitivity to pressure and hypersensitivity to touch occur.

Treatment and therapy

Osteomyelitis is treated with antibiotics. In acute osteomyelitis, the affected body part is also immobilized with the aid of a splint or cast.If a lot of tissue has also died, this must be surgically removed. In exogenous osteomyelitis, only limited healing occurs with antibiotics due to poor blood supply to the bone. Because of this, surgical treatment must be performed. The affected and destroyed tissue is removed. Particularly in the case of extensive ablation, a so-called spongiosaplasty, a filling of the bone with bone substance from a healthy bone, is also performed. In chronic osteomyelitis, the inflammation is also treated with antibiotics. Surgical treatment is necessary here in any case. Because the tissue is permanently destroyed due to the recurring infections and the inflammation usually spreads uncontrollably, amputation of the affected limb is medically advisable in time.

Outlook and prognosis

Osteomyelitis, or bone marrow inflammation, takes a chronic course in many cases. The earlier the disease is detected, the better the prognosis. Osteomyelitis is easier to treat in the early stages. Chronic manifestation and associated irreversible damage can sometimes be averted. Both the type and the manifestation of osteomyelitis influence the prognosis. The age of the patient, his general state of health and the group of pathogens are also decisive factors. In acute osteomyelitis, the affected person has a better chance of recovery than in the chronic form. Acute osteomyelitis usually heals completely if treated early. If diagnosed late, it can become chronic. In this case, the prognosis is less favorable, and treatment becomes protracted. There is a risk of circulatory disorders in the bone. In this case, the joint can only be moved to a limited extent or not at all. In severe cases, antibiotic medications can no longer contain the disease. In this case, surgery is necessary. The affected bone tissue is removed during the surgical procedure. No preventive measures can be taken for osteomyelitis. However, people with a stable immune system are less likely to contract osteomyelitis. If a patient has already been treated for osteomyelitis, avoiding overuse has a positive effect.

Prevention

Preventive measures can be taken for osteomyelitis to a limited extent. Because osteomyelitis is caused by bacteria, prophylactic antibiotics can be administered for injuries and surgical procedures. Further preventive measures must be taken by the hospital/doctor’s office. Adherence to hygiene rules can prevent the spread of causative bacteria, minimizing the incidence of osteomyelitis.

Follow-up

In osteomyelitis, there are usually very few and also limited measures of direct aftercare available to the affected person. For this reason, the patient should see a doctor as early as possible for this disease to avoid further complications or discomfort. The earlier a doctor is consulted, the better the further course of the disease usually is. Most patients are dependent on taking various medications for osteomyelitis. If there is any uncertainty or if there are any questions, a doctor should always be consulted first in order to prevent further complications. Similarly, when taking antibiotics, it should be noted that they should not be taken together with alcohol. After the treatment of osteomyelitis, regular check-ups by a doctor are necessary in order to detect and treat further inflammations or infections at an early stage. As a rule, this disease does not reduce the life expectancy of the affected person if it is detected and treated at an early stage. Further measures of an aftercare are usually not available to the affected person in this case.

What you can do yourself

This disease is mainly caused by various strains of bacteria, and patients may need to be treated with antibiotics for months to prevent amputation or blood poisoning. It is therefore important for patients to support the fight against the pathogenic germs and consistently strengthen the body’s own immune system. They should completely avoid alcohol and nicotine, as both are toxins that unnecessarily burden the body. Passive smoking can also be harmful.In turn, the patient is advised to eat a light, healthy diet consisting of plenty of fresh fruit, vegetables, sea fish and lean meat. If it is possible for the patient to leave the house, exercise in the fresh air would be advised, especially walks in the forest. They have been shown to support the healing process. Since eighty percent of all immune cells are located in the intestine, supplemental administration of probiotics would also be indicated. Probiotics are mixtures of living microorganisms that are supposed to settle and multiply in the intestine. They contribute to the maintenance of the immune system there. Probiotics are commercially available as yogurt, dietary supplements or medications. The latter contain more microorganisms and are preferable to yogurt. Another way to accelerate the course of treatment is the so-called “hyperbaric oxygen treatment”. Here, the patient breathes oxygen in a pressure chamber, which leads to increased oxygen distribution in the tissues.