Symptoms | Osteomyelitis

Symptoms

Endogenous hematogenous osteomyelitis is usually a disease of the entire body in infants and small children and usually manifests itself with a fever of up to about 40° C. In addition, depression and shivering become noticeable. Areas affected by the bone inflammation become noticeable by strong redness, swelling and pressure pain. The symptoms mentioned above are usually less severe in adults.

Typical symptoms here are also depression, pain and functional limitations in the affected areas. The inflammation of the corresponding area can become noticeable by a slight overheating (possibly also redness), but these types of symptoms are much less pronounced in relation to infants and toddlers. As already mentioned several times, such a disease can become chronic under certain circumstances.

In this case, the pain in the affected areas, including functional limitations, is the main focus. In the case of acute hematogenic infant osteomyelitis, the chances of recovery are good with early therapy. In cases in which the disease has already progressed and has caused destruction of the growth plate, sometimes considerable growth disturbances can occur.

Even in the case of acute hematogenic osteomyelitis in childhood, the prognosis is significantly dependent on the damage to the growth plate.Here, too, considerable bone damage can sometimes occur, which can lead to shortened extremities under certain circumstances. –> More about Osteomyelitis DiagnosticsEbenso applies to acute endogenous – hematogenic osteomyelitis in adults:If the disease is diagnosed in time and treated consistently, healing is usually possible without permanent damage. There is, however, a risk that the disease – if not detected early and treated appropriately – will turn into chronic osteomyelitis.

In comparison to the acute form, chronic osteomyelitis is difficult to treat and tends to flare up even in the case of successful healing (renewed infection of the bone). Exogenous osteomyelitis is an inflammation of the bone marrow, which is either caused by an open wound after an accident (= post-traumatic) or during an operation (= postoperative). In both cases, germs penetrate from the outside and spread in the wound area in such a way that a local inflammation initially develops within the bone.

As in endogenous hematogenic osteomyelitis, the main pathogens include Staphylococcus aureus, but also Escherichia coli and Proteus. Other bacterial pathogens can also be considered as disease triggers. The course of the disease is very individual and depends on various factors.

The extent to which pathogens can spread into and from bone depends primarily on the individual immune defense of a patient. This means that especially patients with reduced immune defenses (for example after a transplantation, caused by a so-called immunosuppressive therapy) are affected by acute, but also chronic disease progression of osteomyelitis. In addition, patients with a deficient blood supply to the bone are also at risk.

This is the case, for example, with patients suffering from diabetes mellitus (= diabetes) or arteriosclerosis (= hardening of the arteries). Due to the history of development (post-traumatic, postoperative) of exogenous osteomyelitis, it is understandable that this disease occurs predominantly in adults. Statistical data show that men tend to be more frequently affected by accidents than women, so that it can be concluded that men are also more frequently affected by this disease than women.

In the acute form of exogenous postoperative osteomyelitis, the first symptoms can be seen as early as three to four days after surgery. The patient usually reacts with fever, swelling and redness of the affected area and possible wound secretion. Patients also often complain of pain and depression.

Comparable symptoms are seen in posttraumatic osteomyelitis. In such cases, rapid intervention is required to prevent the transition to secondary chronic osteomyelitis. The occurrence of the above mentioned symptoms in combination with a traumatic experience or as a result of an operation already allows the conclusion of the presence of exogenous osteomyelitis.

As a rule, a further diagnosis is made by means of blood analysis. In this process, the CRP value is measured as an inflammation barometer, as is the blood sedimentation rate (BSG), which is significantly increased in the case of osteomyelitis. Typical for inflammations in the body is also the increase in the white blood cell concentration (= leukocytes; leukocytosis).

However, these diagnostic measures are only of importance in the case of an acute form, since in the case of chronic osteomyelitis both values show only a moderate increase. Bone changes are usually only visible two to three weeks after the onset of the disease. Then, however, visible changes (cf.

X-ray) in the form of calcifications (= ossifications), lighter spots and/or detachment of periosteum from the bone become apparent. If the osteomyelitis is chronic, blood vessel occlusion can lead to reduced blood flow to the bone, which may even lead to a bone infarction. The result of a bone infarction is the death of certain bone parts, which then remain as residual bodies (= sequesters) in the infected area.

This can be recognized as a light-colored border in X-ray diagnostics, since dead bone tissue is usually answered by the formation of new bone tissue. The light-colored border is therefore connective tissue. Furthermore, sonography (= ultrasound examination) can be used for diagnosis.On the positive side, it should be mentioned that, for example, the detachment of periosteum from the bone, which is caused by the formation of abscesses, can be seen earlier than in the X-ray image.

As a further diagnostic measure, the so-called skeletal scintigraphy can be used. This diagnostic method enables the detection of inflammatory processes by means of very weak radioactive preparations (= radiopharmaceuticals). Therapeutically, both conservative and surgical measures can be taken.

Due to the frequently existing poor local blood circulation conditions, conservative antibiotic therapy has little chance of cure, since only an insufficient concentration of active ingredient can be achieved at the intended location. For this reason, an exogenous osteomyelitis is usually treated surgically. There are different ways to proceed, for example: exogenous acute osteomyelitis can degenerate into a severe disease of the entire body and – in undetected cases – even lead to sepsis (= blood poisoning), which in turn can have serious consequences, such as organ damage.

Rapid intervention is required in the case of exogenous acute osteomyelitis, as the transition to secondary chronic osteomyelitis is fluid. Chronic osteomyelitis has far less chance of healing and can lead to pronounced bone remodeling processes up to bone stability disorders as a result of bone infarctions. It is also possible that the disease can spread to adjacent joints, resulting in considerable restrictions of movement.

In severe cases, even stiffening and limb shortening (amputations) can occur as a consequence.

  • The surgical radical removal of the focus of inflammation, possibly combined with cancellous bone grafting (= transplantation of bone substance from another, autologous, healthy bone), irrigations and drains.
  • The insertion of irrigation – suction – drainage .
  • Systemic antibiotic therapy over a period of one to about one and a half months.

If the disease osteomyelitis is detected early, there is a chance of healing without any remaining damage. As already mentioned, the therapy is usually carried out surgically, since conservative antibiotic therapy is rarely effective due to the poor blood supply to the bones.

Since the transition to the secondary – chronic form of osteomyelitis is fluid, healing often proves difficult (see above). Chronic osteomyelitis tends to form recurrences even after possible healing successes, so that the disease can flare up again and again.