Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Part I Clinical syndromes: general
- Part II Clinical syndromes: head and neck
- Part III Clinical syndromes: eye
- Part IV Clinical syndromes: skin and lymph nodes
- Part V Clinical syndromes: respiratory tract
- Part VI Clinical syndromes: heart and blood vessels
- Part VII Clinical syndromes: gastrointestinal tract, liver, and abdomen
- Part VIII Clinical syndromes: genitourinary tract
- Part IX Clinical syndromes: musculoskeletal system
- 68 Infection of native and prosthetic joints
- 69 Bursitis
- 70 Acute and chronic osteomyelitis
- 71 Polyarthritis and fever
- 72 Infectious polymyositis
- 73 Iliopsoas abscess
- Part X Clinical syndromes: neurologic system
- Part XI The susceptible host
- Part XII HIV
- Part XIII Nosocomial infection
- Part XIV Infections related to surgery and trauma
- Part XV Prevention of infection
- Part XVI Travel and recreation
- Part XVII Bioterrorism
- Part XVIII Specific organisms: bacteria
- Part XIX Specific organisms: spirochetes
- Part XX Specific organisms: Mycoplasma and Chlamydia
- Part XXI Specific organisms: Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific organisms: fungi
- Part XXIII Specific organisms: viruses
- Part XXIV Specific organisms: parasites
- Part XXV Antimicrobial therapy: general considerations
- Index
- References
70 - Acute and chronic osteomyelitis
from Part IX - Clinical syndromes: musculoskeletal system
Published online by Cambridge University Press: 05 April 2015
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Part I Clinical syndromes: general
- Part II Clinical syndromes: head and neck
- Part III Clinical syndromes: eye
- Part IV Clinical syndromes: skin and lymph nodes
- Part V Clinical syndromes: respiratory tract
- Part VI Clinical syndromes: heart and blood vessels
- Part VII Clinical syndromes: gastrointestinal tract, liver, and abdomen
- Part VIII Clinical syndromes: genitourinary tract
- Part IX Clinical syndromes: musculoskeletal system
- 68 Infection of native and prosthetic joints
- 69 Bursitis
- 70 Acute and chronic osteomyelitis
- 71 Polyarthritis and fever
- 72 Infectious polymyositis
- 73 Iliopsoas abscess
- Part X Clinical syndromes: neurologic system
- Part XI The susceptible host
- Part XII HIV
- Part XIII Nosocomial infection
- Part XIV Infections related to surgery and trauma
- Part XV Prevention of infection
- Part XVI Travel and recreation
- Part XVII Bioterrorism
- Part XVIII Specific organisms: bacteria
- Part XIX Specific organisms: spirochetes
- Part XX Specific organisms: Mycoplasma and Chlamydia
- Part XXI Specific organisms: Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific organisms: fungi
- Part XXIII Specific organisms: viruses
- Part XXIV Specific organisms: parasites
- Part XXV Antimicrobial therapy: general considerations
- Index
- References
Summary
Introduction, epidemiology, and clinical manifestations
Osteomyelitis is a common term for bone infection, although noninfectious inflammation of bones and adherent structures exist. Strictly speaking, osteomyelitis implicates affection of bone and marrow. The term osteitis would be often more appropriate because no one knows how much infection is inside the marrow in a given episode. As for any infection, physicians like to create big groups of disease headed as acute (AO) and chronic osteomyelitis (CO), although this distinction does not much determine daily clinical practice. For physicians, a commonly accepted definition of AO is a recent bone infection with systemic inflammatory response, while CO requires minimal symptom duration of 6 weeks to 3 months. Another classification system is the presence of a sinus tract, sequestra, or involucra, which are anatomico-pathologic hallmarks of chronic infection. Finally, surgeons have their classification schemes, based on practical aspects of the surgical approach, of which the Cierny-Mader classification is one of the most frequent. The terms acute or chronic are not used in this classification. Generally, surgeons understand a CO as infection requiring surgery, with already established sequestra and bone deformities.
AO is a hematogenous infection that occurs mostly in prepubertal children and in the elderly and is usually located in the metaphyseal area of long bones (children) or in the spine (elderly). It is the result of a local proliferation of bacteria within bone after a septicemic storm. Alternatively, AO can originate locally following trauma or orthopedic surgery (surgical site infection). In contrast, CO has two origins. It may result from either a neglected sequel of AO, or from the continuous spreading of chronic ulcers in paraplegics, bedridden patients, or diabetic patients with foot problems. Epidemiology of osteomyelitis is heterogeneous with variability among involved bones, pathogens, and settings. For example, resource-poor countries may reveal a higher proportion of tuberculous osteomyelitis or CO due to post-traumatic origin compared to resource-rich countries, as well as a higher prevalence of foot osteomyelitis among elderly patients.
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- Clinical Infectious Disease , pp. 448 - 453Publisher: Cambridge University PressPrint publication year: 2015
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