|SSM Cardinal Glennon Children's Medical Center|
If you're like most teens you're probably pretty active and aren't always really careful, so you end up getting bruises and cuts. Sometimes a bad cut that gets infected can lead to even worse things, like a bone infection. The medical term for a bone infection is osteomyelitis.
What Is Osteomyelitis?
Osteomyelitis (pronounced: os-tee-oh-my-uh-LY-tus) is a bone infection often caused by bacteria called Staphylococcus aureus (pronounced: sta-fuh-low-KAH-kus ARE-ee-us). Depending on how the bone becomes infected and the age of the person, other types of bacteria can cause it, too. In kids and teens, osteomyelitis usually affects the long bones of the arms and legs.
Bacteria can infect bones in a number of ways. Bacteria can travel into the bone through the bloodstream from other infected areas in the body. This is called hematogenous (pronounced: heh-meh-TAH-gen-us) (hema refers to the blood) osteomyelitis, and is the most common way that people get bone infections.
Another way is by direct infection, when bacteria enter the body's tissues through a wound and travel to the bone (like after an injury). Open fractures — breaks in the bone with the skin also open — are the injuries that most often develop osteomyelitis.
A bone also can become infected when the blood supply to that area of the bone is disrupted. This can happen in older people with atherosclerosis (pronounced: ath-uh-row-skluh-ROE-sis), which is a narrowing of the blood vessels, or in association with diabetes. Most infections of this kind occur in the toes or feet.
What Are the Signs and Symptoms?
People with osteomyelitis often feel severe pain in the infected bone. They might have fever and chills, feel tired or nauseated, or have a general feeling of not being well. The skin above the infected bone may be sore, red, and swollen. It's sometimes difficult to diagnose osteomyelitis in infants and young children because they don't always show pain or specific symptoms in the area of the infection. Also, older people with diabetes or another problem with their blood vessels don't always show signs of fever or pain. For teenagers, it's frequently a preceding accident or injury that leads to the infection.
If the osteomyelitis developed after an injury, the injured area may begin to hurt again after initially seeming to get better.
What Do Doctors Do?
If you have symptoms such as fever and bone pain, you should see your doctor. It's a good idea to go as soon as possible because osteomyelitis can quickly get worse and become much more difficult to get rid of.
The doctor probably will do a physical examination and ask questions about any recent injuries to the area where you have pain. It's likely, too, that the doctor will perform blood tests to see whether your white blood cell count is elevated (a sign of infection) and to look for signs of possible inflammation or infection in the body. The doctor will take your medical history by asking about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues.
Often, the doctor will take a bone X-ray, which may show whether an infection in the bone is present. However, X-rays may not show signs of infection if someone has had osteomyelitis for only a short while. If the doctor strongly suspects osteomyelitis, he or she may suggest a test called a bone scan that provides a more detailed look at the bone. A doctor might also recommend an MRI (magnetic resonance imaging), which produces much more detailed images than X-rays. MRIs not only can diagnose osteomyelitis, but also can help establish how long the bone has been infected.
Treatment of osteomyelitis depends on the severity of the infection and whether it is acute (recent) or chronic (has been present for a longer period of time). The doctor may use a needle to remove a bacteria sample from the bone to help identify the bacteria responsible for the infection. This is called needle aspiration. The doctor will then be able to choose the correct antibiotic to treat that particular infection.
In some cases, osteomyelitis can become severe and a cavity or hole may develop in the bone. Pus — a large collection of bacteria and white blood cells — may have formed in this cavity. If this happens, the doctor can perform a surgical procedure to help drain the pus out of the bone so that the bone can heal properly.
Osteomyelitis can be difficult to treat. After being diagnosed with osteomyelitis, you may be admitted to the hospital for a short stay so that intravenous (IV) antibiotics can be given (directly into a vein) to fight the infection. Once the condition improves, you will be allowed to go home but you may continue to need IV or oral (taken by mouth) antibiotics at home for several more weeks.
Most teens recover completely from osteomyelitis.
Can I Prevent Osteomyelitis?
The easiest way to prevent yourself from getting osteomyelitis is to practice good hygiene. If you get a cut or a wound — especially a deep wound — make sure you clean it thoroughly. Wash it with soap and water, holding it under running water for at least 5 minutes to flush it out.
To keep the wound clean afterward, you should cover it with sterile gauze or a clean cloth. You can apply an over-the-counter antibiotic cream, too, but the most important thing is to keep the injury clean. Be sure to see your doctor, especially if you have a wound that's not healing or if you're continuing to have pain.
Reviewed by: Catherine L. Lamprecht, MD