Osteomyelitis Reşat ÖZARAS, MD, Prof. Infection Dept. [email protected] [email protected].

Osteomyelitis

Reşat ÖZARAS, MD, Prof. Infection Dept. [email protected]

OSTEOMYELITIS• Infection of bone marrow and and adjacent bone Several classifications

The duration of the disease

• Acute osteomyelitis• Subacute osteomyelitis• Chronic osteomyelitis

The way of occurence

1 - Hematogenous osteomyelitis2 – Osteomyelitis secondary to direct transmission

- Any vascular disease may/not associate 3 - Chronic osteomyelitis (necrotic bone)

Anatomical classification

• Stage 1: medullary osteomyelitis• Stage 2: superficial osteomyelitis• Stage 3: localized osteomyelitis• Stage 4: diffuse osteomyelitis

SYSTEMIC AND LOCAL FACTORS Systemic Local

Malnutrition Chronic lymphedema Renal, hepatic failure Venous failure Diabetes mellitus Vascular insufficiency Chronic hipoxia Arteritis Alcohol and/or tobacco use Tissue scar Malignant disorders Radiation fibrosis Advanced age Neuropathy Immune suppression HIV/AIDS

ETIOLOGY

• Babies (<1 year)• Group B streptococci • S. aureus• E. coli

• Children (1 - 16 years)• S. aureus• S. pyogenes• H. influenzae

• Adult(> 16 years)• S. epidermidis• S. aureus• P. aeruginosa

EPIDEMIOLOGY

• Acute hematogenous osteomyelitis: a disorder of childhood period

• A trend to increase: traffic accidents, increasing rates of orthopedic interventions.

• Adults– Vertebtal osteomyelitis (Spondylodiscitis)

CLINICAL FEATURESAcute Hematogenous Osteomyelitis - Systemic disorder - No structural bone changes - A history of less than 10 days - No previous episodes

Subacute Hemotogenous Osteomyelitis -Systemic disorder (not as severe as the acute form) -Bone changes -A history of more than 10 days - No previous episodes

Chronic osteomyelitis -Systemic disorder may/not associate -Bone changes - There is/are previous episode(s).

Clinical Features• Depends on the way of development (hematogenous,

direct, from adjacent tissues), patient's characteristics and the period of the disorder

• Hematogenous osteomyelitis – fever, fatigue, restlessness – Tenderness, pain, and edema on the affected site – Decreased mobility of the affected extremity – Muscle spasms

• From adjacent tissue; pain, redness, swellings, a draining sinus from the site of trauma, wound, or operation

• Dorsal/back pain in vertebral osteomyelitis .

RADIOLOGICAL FINDINGS

Plain X-ray;

• Diagnosis and the course of the disease • Increase in density of the surrounding soft

tissues (first 10 days)• Periostal reaction (after 10 days)• Bone loss in subacute period

Bone scan

• For early diagnosis

Computed tomography

Sentitive for soft tissue inflammation as well.

Diagnosis and follow-up of the therapy

Magnetic Resonance • Soft tissue and bone marrow

inflammation• Early diagnosis

Differential Diagnosis• Rheumatic fever• Cellulitis• Ewing’s sacroma • Septic arthritis• Osteosarcoma• Eosinophilic granuloma• Thrombophlebitis

Vertebral Osteomyelitis

• Frequent etiology: – S. aureus, – M. tuberculosis, – Brucella

• Gram-negative bacilli (Gastrointestinal or urinary system)• Postoperative • Pain and disability• May be indolent and fever may not be

seen

Tx

• Antibiotics • Surgery• Underlying disorder

Meticilin-sensitive Staph. → Cefazolin or Sulbactam/ampicillin

Meticilin-resistant Staph →Vancomycin or teicoplanin

Brucella → Rifampin+doxycycline

Tuberculosis → INH+RIF+PZA+EMB

Antibiotics

Etiology

N (%)

Pyogenic 44

Post-op 10

Others 34

Brucella 24

Tuberculosis 32

Total 100

Pyogenic

Microorganism Cases (%)

Gram-positive Staphylococcus aureus

(endocarditis)

Gram-negative Pseudomonas aeruginosa Enterobacter cloacae Salmonella enteritidis Escherichia coli

Fungus

13

1112

1

Children: Acute hematogenousAdult: Chronic (hematogenous---from adjacent tissues…