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Osteomyelitis

Osteomyelitis. Reşat ÖZARAS, MD, Prof. Infection Dept. rozaras@yahoo.com. 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.

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Osteomyelitis

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  1. Osteomyelitis Reşat ÖZARAS, MD, Prof. Infection Dept. rozaras@yahoo.com

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

  3. The duration of the disease • Acute osteomyelitis • Subacute osteomyelitis • Chronic osteomyelitis

  4. The way of occurence 1 - Hematogenous osteomyelitis 2 – Osteomyelitis secondary to direct transmission - Any vascular disease may/not associate 3 - Chronic osteomyelitis (necrotic bone)

  5. Anatomical classification • Stage 1: medullary osteomyelitis • Stage 2: superficial osteomyelitis • Stage 3: localized osteomyelitis • Stage 4: diffuse osteomyelitis

  6. SYSTEMICAND LOCAL FACTORS Systemic Local MalnutritionChronic lymphedema Renal, hepatic failure Venous failure Diabetes mellitus Vascular insufficiency Chronic hipoxia Arteritis Alcohol and/or tobacco use Tissue scar Malignant disordersRadiation fibrosis Advanced age Neuropathy Immune suppression HIV/AIDS

  7. 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

  8. EPIDEMIOLOGY • Acute hematogenous osteomyelitis: a disorder of childhood period • A trend to increase: traffic accidents, increasing rates of orthopedic interventions. • Adults– Vertebtal osteomyelitis (Spondylodiscitis)

  9. CLINICAL FEATURES AcuteHematogenousOsteomyelitis - Systemicdisorder - No structural bone changes - A history of lessthan 10 days - No previousepisodes SubacuteHemotogenousOsteomyelitis -Systemicdisorder (not as severe as theacute form) -Bone changes -A history of morethan 10 days - No previousepisodes Chronicosteomyelitis -Systemicdisordermay/not associate -Bone changes -There is/arepreviousepisode(s).

  10. 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

  11. From adjacent tissue; pain, redness, swellings, a draining sinus from the site of trauma, wound, or operation • Dorsal/back pain in vertebral osteomyelitis .

  12. 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

  13. Bone scan • For early diagnosis

  14. Computed tomography Sentitive for soft tissue inflammation as well. Diagnosis and follow-up of the therapy

  15. Magnetic Resonance • Soft tissue and bone marrow inflammation • Early diagnosis

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

  17. 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

  18. Tx • Antibiotics • Surgery • Underlying disorder

  19. Antibiotics Meticilin-sensitive Staph. → Cefazolin or Sulbactam/ampicillin Meticilin-resistant Staph →Vancomycin or teicoplanin Brucella → Rifampin+doxycycline Tuberculosis → INH+RIF+PZA+EMB

  20. Etiology

  21. Pyogenic

  22. Children: Acute hematogenous Adult: Chronic (hematogenous---from adjacent tissues…

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