FAQ - osteomyelitis
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What is chronic osteomyelitis and how to treat it?

Osteomyelitis, which I had at age tenish, is an infection within the bone. I am not aware of it occuring in a chronic type. Generally it is an acute event the result of stepping on a nail or a migration of infection from elsewhere in the body, etc. I just happen to have gotten it by having an infection in a tooth that made it to my hip.

To treat it, I was kept in the hospital for about a month and on a 4 hour regime of antibiotics and lots of fluids.

Here's a link with more information:  (+ info)

What is the DRG for Diabetes with cellulitis and osteomyelitis? The patient's toe was amputated?

Cellulitis is an acute infection of skin and soft tissues characterized by localized pain, swelling, tenderness, erythema, and warmth.

Cellulitis usually follows a break in the skin, such as a fissure, cut, laceration, insect bite, or puncture wound. Facial cellulitis of odontogenic origin may also occur. Patients with toe web intertrigo and/or tinea pedis and those with lymphatic obstruction, venous insufficiency, pressure ulcers, and obesity are particularly vulnerable to recurrent episodes of cellulitis (Roujeau, 2004; Bjornsdottir, 2005; Roberts, 2005). Organisms on the skin and its appendages gain entrance to the dermis and multiply to cause cellulitis. The vast majority of cases are caused by Streptococcus pyogenes or Staphylococcus aureus. Occasionally, cellulitis may be caused by the emergence of subjacent osteomyelitis. Cellulitis may rarely result from the metastatic seeding of an organism from a distant focus of infection, especially in immunocompromised individuals. This is particularly common in cellulitis due to Streptococcus pneumoniae and marine vibrios.

Cellulitis generally is a localized infection. Most patients treated appropriately recover completely. Mortality is rare (5%) but may occur in neglected cases or when cellulitis is due to highly virulent organisms (eg, Pseudomonas aeruginosa). Factors associated with an increased risk of death are the presence of concurrent illness (eg, congestive heart failure, morbid obesity, hypoalbuminemia, renal insufficiency) or complications (eg, shock) (Carratala, 2003).

No predilection for either sex is usually reported, although a higher incidence among males has recently been reported in one study

The clinical appearance of cellulitis is shown in Images 1-3.

Involved sites are red, hot, swollen, and tender.
Unlike erysipelas, the borders are not elevated or sharply demarcated.
Lymphangitis, regional lymphadenopathy, or both may be present.
Fever is common.
In severe cases, patients may develop hypotension.
Local suppuration may follow if therapy is delayed.
Overlying skin may develop areas of necrosis.
The most commonly involved site is the leg (Ellis Simonsen, 2006; Lazzarini, 2006).
Perianal cellulitis due to group A streptococci is usually observed among children with perianal fissures. It is characterized by perianal erythema and pruritus, painful defecation, and bleeding in the stools (Spear, 1985).
Pneumococcal facial cellulitis occurs primarily in young children who are at risk for pneumococcal bacteremia (Givner, 2000; Parada, 2000). It may manifest as two distinctive clinical syndromes.

Extremity involvement in individuals with diabetes mellitus or substance abuse
Head, neck, and upper torso involvement in individuals with systemic lupus erythematosus, nephrotic syndrome, or hematologic disorders


In immunocompetent individuals, cellulitis is usually due to gram-positive aerobic cocci (eg, S aureus, S pyogenes) (Bisno, 1996; Guay, 2003; Carratala, 2003). Isolation of methicillin-resistant S aureus (MRSA) is steadily increasing (Eady, 2003). Bacterial strains may also show multiple resistance to other standard antibiotic treatments, including erythromycin.
Recurrent staphylococcal cellulitis may occur in patients with nasal carriage of staphylococci and those with Job syndrome. S aureus is also the leading cause of soft tissue infections in persons who abuse injection drugs (Bassetti, 2004).
Recurrent cellulitis due to streptococci may be observed in patients with chronic lymphedema (eg, from lymph node dissection, irradiation, Milroy disease, elephantiasis) (Bisno, 1996; Chmel, 1984). Streptococcal infections are also common in injection drug users (Sierra, 2006).
Non–group A streptococci (ie, groups B, C, and G) are commonly implicated in cellulitis in patients with lymphatic obstruction or venectomy for coronary artery bypass graft (Baddour, 1982; Baddour, 1985).
S pneumoniae is an uncommon cause of cellulitis in adults (Parada, 1999; Parada, 2000; Bachmeyer, 2006). Pneumococcal cellulitis may occur via bacteremia. In a review of pneumococcal skin infection in adults, all such patients had an underlying chronic illness or were immunocompromised by drug or alcohol abuse (Capdevila, 2003). Pneumococcal facial cellulitis occurs primarily in young children at risk for pneumococcal bacteremia (Patel, 1994; Givner, 2000).
Patients who are immunocompromised with granulocytopenia, such as renal transplant recipients, may develop cellulitis due to infection with other organisms, including gram-negative bacilli (eg, Pseudomonas, Proteus, Serratia, Enterobacter, Citrobacter), anaerobes, other opportunistic pathogens (eg, Helicobacter cinaedi, Fusarium species), mycobacteria, and fungi (eg, Cryptococcus) (Anderson, 1992; Kiehlbauch, 1994; Horrevorts, 1994; Nucci, 2002; Guay, 2003; Yoo, 2003; Gupta, 2003; Seyahi, 2005). Preseptal cellulitis caused by dermatophytes is rarely observed, mostly in the pediatric age group (Rajalekshmi, 2003). Persistent cellulitis due to Cryptococcus neoformans infection has also been reported in a patient receiving renal dialysis (Suranyi, 2003).
Escherichia coli may be responsible for cellulitis in patients with nephrotic syndrome (Asmar, 1987).
Cellulitis from unusual bacterial species, including Enterococcus faecalis, Enterobacteriaceae, and Bacteroides and Clostridium species, may be observed following subcutaneous injections of illegal drugs (Dancer, 2002). If Clostridium species or other anaerobes cause the infection, crepitant cellulitis is often observed clinically.
Other uncommon causes of cellulitis include Neisseria meningitidis; Pasteurella multocida, following animal bites; Aeromonas hydrophilia, following contact with fresh water; Streptococcus iniae, a fish pathogen causing infections in aquaculture farms; and Vibrio vulnificus, following contact with seawater. Cellulitis from marine vibrios in hepatopathic patients may also follow ingestion of contaminated raw oysters (Porras, 2001; Cartolano, 2003; Winner, 2003; Lau, 2003; Swartz, 2004, Falcon, 2005). Haemophilus influenzae has become a rare cause of buccal cellulitis in children after the introduction of the H influenzae type B vaccine (Branca, 2003; Lin, 2004

Medical Care
Patients with mild cases of cellulitis may be treated in an outpatient setting. Oral agents with activity against staphylococci and streptococci (eg, dicloxacillin or flucloxacillin, cephalexin, cefuroxime axetil, erythromycin, clindamycin, cotrimoxazole, amoxicillin/clavulanate) are usually effective for treatment of cellulitis in immunocompetent hosts (Roberts, 2005).

Manage more severe disease initially with intravenous antibiotics in the hospital. This is also recommended in immunosuppressed individuals and in any patients with a clinically significant concurrent condition, including lymphedema and cardiac, hepatic, or renal failure.

Elevating limbs with cellulitis expedites resolution of the swelling. Cool sterile saline dressings may be used to remove purulent discharge from any open lesion.

Usually, cellulitis is presumed to be due to staphylococci or streptococci infection and is treated with antibiotics (eg, nafcillin, cefazolin). Other options in allergic patients include clindamycin or vancomycin. Ceftriaxone may be useful in the outpatient setting because it can be administered once daily (Seaton, 2005).
Agents with a broader spectrum of activity are recommended in selected patients, such as diabetic patients (Swartz, 2004).
More specific antibiotic therapy may be indicated in patients who develop cellulitis in special settings (eg, after a human or animal bite, exposure to potentially contaminated fresh water or seawater) (Swartz, 2004). Treatment of cellulitis caused by uncommon organisms, such as Vibrio species or gram-negative bacteria, should be individualized to those recovered organisms (Chuang, 1992). In general, these organisms require treatment with drugs other than those discussed above. For instance, cellulitis due to Vibrio infection may be treated with tetracyclines, chloramphenicol, or aminoglycosides.
Cutaneous cellulitis and soft tissue infections due to community-acquired MRSA represent an emerging problem also among patients who lack traditional risk factors (Eady, 2003).

In such cases, management with standard gram-positive antibiotics may be ineffective, also because concomitant multiresistance to other antibiotics widely used in common empiric therapy, including erythromycin, may occur. Bacterial strains are usually susceptible to clindamycin, gentamicin, rifampin, trimethoprim/sulfamethoxazole, and vancomycin.
Moreover, a randomized, open-label, comparator-controlled, multicenter, multinational study has recently demonstrated the efficacy of linezolid therapy and its superiority to vancomycin in the management of skin and soft tissue infections, including cellulitis, due to MRSA (Weigelt, 2005). However, bacterial culture is still considered essential in order to determine the antibiotic susceptibility of the bacterial isolate and to adjust the systemic antimicrobial therapy according to sensitivity data.
If mycologic investigations performed to rule out tinea pedis as a possible cause of recurrent episodes of cellulitis detect the presence of fungal infection in toe webs or feet, treatment with topical antifungals is recommended. With severe chronic changes or if onychomycosis is providing a source for repeated infection, oral antifungals such as itraconazole or terbinafine may be considered.

Surgical Care
Incision and drainage are indicated if suppuration has occurred.


Consult an infectious diseases specialist for recommendations on appropriate antibiotic therapy.
Consult a surgeon for drainage of any abscess and debridement of any devitalized tissue.

Immobilization of the affected part may relieve pain.

Read more here an  (+ info)

Are you ever heard of Osteomyelitis?

My soon to be eight year old son went in for a CT Scan today and they are thinking that it may be Osteomyelitis. His is effecting the right side of his face. He goes in for a biopsy a week from today to make sure that it is this and nothing else. I understand that every case is slightly different but I have NEVER heard of this and was wondering if anyone else has heard of this or dealt with it and what were the procedures in dealing with it.

Yes, I've heard of it. My son was tested for it after his broken femur wouldn't heal. The Dr said the number one reason for a non union in the femur was an infection in the bone caused by bacteria. Antibiotics are prescribed to treat it. If the infection does not heal the diseased part of the bone will need to be removed. (in severe cases)  (+ info)

If you have Osteomyelitis will it show up in bloodwork?

???or is that jsut a x ray of the bone?

A patient can have osteo with normal blood work and few symptoms. Often a superficial infection is recognized and treated. The spread to the bone can easily be missed.

A wound that doesn't heal may indicate osteo of the underlying bone.

An x-ray is a 3rd line test for osteo.

#1) - MRI
#2) 3 phase nuclear bone scan  (+ info)

I am looking for information on patient teaching for osteomyelitis.?

I am a nursing student in need of this information. I have looked quite a few places and books and cannot find any information in this. I would appreciate anyone knowing where I can find it on the internet or has any information on this topic.

Thank You.

My neice had oseomiloitis, are you referring to the same thing?

If you are, I can tell ya that basically what happened with my neice.
A hammer fell on her big toe. She lost that toe nail. About 2 months later my neice started to complain saying ow ouch everytime she walked (she was barely 2). She had a fever and it wouldn't go away.

Well it ended up being oseomiloitis and she had to have surgery.

It turned out that it is a staph infection in her bone marrow. That is what oseomilotis is. I hoped this helps. Also try google and type in the word. You can find images on it and I am sure somewhere out there in lala land is an article. Possibly check your spelling.  (+ info)

osteomyelitis -- why does the antibiotic treatment take so long?

the antibiotic treatment for nontraumatic osteomyelitis takes minimum of 4 weeks..
why this long? is it because the drugs are harder to reach into the bone?

You need to take the antibiotic that long to make sure all the infection is gone since it was in the bone. Was this because of an ingrown toenail by the way? By the time the infection infiltrates the bone you have had that infection for an extended period of time . It happens more commonly with untreated ingrown toenails. Make sure you complete the whole course of antibiotic's it is the only way to rid the infection from your body. Also taking antibiotics for so long you should be eating a yogurt with each dose to protest your stomach and your bowel.  (+ info)

what is osteomyelitis of the jaw?

2 weeks ago, I had to get surgery on my gums and jaw. I went in to see the dr. because my cheek was badly swollen. He decided that surgery was the best option, because he believes that I may have osteomyelitis of the jaw. Apparently, my jaw never healed from when I got my wisdom teeth taken out. He did get a biopsy of the jaw bone, but the results haven't come yet. how serious could this be?

When I was 6years old I had to get stitches in my leg!
One year later I had gotten osteomyelitis in my bone, the bone was infected by the doctor that had dirty hands! They had to take one & a
half inches of bone out. My mom sued the doctor. Now a days they have no reason to have dirty anything; The answer to your question is
it can be serious if not taken care of SOON!  (+ info)

Can anyone help with treatment of Chronic Osteomyelitis of the big toe?

I Live in Thailand and have had Chronic Osteomyilitis in my big toe for the last 3 months. I have been treated with many antibiotics including Amoksiklav 2X(Co-Amoxyclav 1g) 19 days,Dalacin 300mg(Clindamycin) 20 days,Oxacillin 500mg 9 days,Bactrim 400/80mg 9 days,Ceftriaxone 1g 20 days. I am currently on Cefotaxime 1g. None of these antibiotics have improved my condition it has got worse. I have had several cultures which have revealed Proteus spp,Staphylococcus Coagulase - negative and Morganella Morganii bacteria. I have had 2 operations 1 to remove the nail and the second to cut to the bone and remove puss. I would appreciate any suggestions as I have seen 3 Orthopedic doctors and all have said they can cure it without success. please help as all these drugs are wearing me down and I don't know what to do!!


The results of surgical treatment of chronic osteomyelitis of the diabetic foot, as reported in literature, are disappointing. In this retrospective study, 47 patients with chronic osteomyelitis of the toe were treated surgically; all patients had diabetes and neuropathy. A total of 37 of 47 (79%) patients had complete wound healing after primary surgery. Chronic osteomyelitis of the toe in the neuropathic diabetic foot is best treated with early surgical treatment combined with antibiotic therapy; a cure rate of 94% is possible. A multidisciplinary approach may lead to low recurrence rates.


Infection of the foot, usually as a consequence of skin ulceration, remains one of the major final pathways to lower extremity amputations in patients with diabetes (Apelqvist et al, 2000).

Although a multidisciplinary and aggressive approach lowers the amputation rate, limb loss due to infection remains a major problem (Larsson et al, 1995). Usually the extent of the infection is underestimated and a concomitant osteitis can be demonstrated in many cases (Lipsky, 1999).


Chronic osteomyelitis in people with diabetes is considered to have a better outcome than deep infections of the diabetic foot (Eneroth et al, 1997). The treatment of chronic osteomyelitis of the toe is considered to be surgical, i.e. removal of all the infected bone (Norden, 1999). Most reports mention an amputation of the toe or ray amputation in combination with culture-guided antibiotic treatment. In many retrospective studies, however, the results are disappointing with primary and secondary failure rates of up to 70% (Nehler et al, 1999; Murdoch et al, 1997; Wong et al, 1996).

In this retrospective study, we analysed the results of the surgical treatment of chronic osteomyelitis of the toe in 47 patients with diabetes.

Methods and materials

The Twenteborg hospital is a training hospital; there are 200 000 inhabitants in this rural area. The estimated incidence of diabetes mellitus is 2% of the population. The diabetic foot unit in the Twenteborg Hospital is a subdivision of the department of surgery.

Patients with diabetic foot problems are referred by general practitioners or diabetologists. Diabetes care is supported by specially trained nurses who register and visit patients at home. Therefore, a large number of the patients with diabetes in the area are screened for foot problems on a yearly basis. About 10% of our patients are referred to us from other areas of the country.

Between 1999 and 2001, 47 patients with chronic osteomyelitis of the toe were treated; 22 were female and 25 male. The mean age was 67.8 (range 42-91) years.

Thirty-one patients were treated with oral antidiabetics and 16 were on insulin. All patients had neuropathy, which was diagnosed using a tuning-fork (128 Hz) and 10g Semmes Weinstein monofilament. All patients had absent sensation of pressure with the monofilament on four points of the foot, and had negative discrimination of vibration.

Osteomyelitis was considered present in case of signs of infection in combination with bone contact when probing, and/or the x-ray showed signs of cortical destruction (Grayson et al, 1995). If a positive culture of the probed bone was obtained, this led to the diagnosis of osteomyelitis.

None of the patients had ischaemia. Ischaemia was considered absent if pedal pulses were palpable, ankle brachial indices were above 0.8 or if the transcutaneous oxygen pressure (TcP[O.sub.2]) was above 30 mmHg. All patients had one infected toe.

Patients were treated with antibiotics for 6 weeks. If the results of the culture were not known, a combination of clindamycin 1200 mg and ciprofloxacin 1000 mg daily was administered intravenously. Usually this was changed into oral administration after 2 weeks. The antibiotic regimen was adjusted according to the results of the bacterial culture.


The incision was always made on the dorsum of the foot, leaving the plantar surface free of scars and avoiding weight bearing on the scar. In all cases, we avoided damage to the surrounding soft tissue, leaving as much skin as possible to achieve a tension-free closure of the wound. In all cases, the metatarsophalangeal joint was sacrificed. All patients had non-healing defects prior to surgery for more than 6 weeks. During surgery, a deep culture was obtained. In 35 of 47 (74%) patients, the wound was primarily closed without tension. In case of gross oedema or extensive redness, the wound was left open (26%). Strict bed rest was given until the wound showed a healing tendency, which we defined as a reduction in oedema and redness, and the development of healthy granulation tissue.

Open wounds were treated with an offloading cast. After wound closure, all patients received custom-made shoes. The wound was considered completely healed when there was 100% epithelialisation i.e. intact skin. Outclinic patients with incomplete wound healing were followed up on a weekly basis. Patients with complete healing were seen at 4-6 week intervals during the first year  (+ info)

Osteomyelitis on the outside of bone?

is it possible to get osteomyelitis on the outside of a bone with no trauma to the bone itself and no infection through the blood? If so what are the odds in a healthy person?
Hi, thanks for the response. THe only symptoms I have is tenderness around the site of a previous infection that is still red (3 weeks old) from an ingrown toenail. My doctor saw it today and gave me an anti-inflamitory drug. I have no other symptoms.

Hey, A 66, Neat ! 3 deuces ?
With gas the way it is, I'm sticking with my Fiero!
I saw your question and it sounds as though you haven't received the diagnosis, just worried about the possibilities ?

I appears that you should have a pretty good understanding of what ostomyelitis is and your answers here, are pretty informative.

From the treatment that You Doc has recommended, it doesn't appear that He/She is convinced that you have a bony infection or they would have order an X-ray, at a minimum, to see if you had any indication of erosion of the bone or inconsistencies in the "cortex" (outer layer of the bone).

Yes, there are instances other than trauma (crushing injuries), fracture, surgery, etc. Out side of these common causes, it is , some time associated with diminished micro-circulation I.E. dibetes. atherosclerosis: At 17 years of age and Your inference of good over all health, I think that any likelyhood of you contracting "osteo" are slim to none. ( Like Your GTO getting run off by a 63 Falcon ).

I can see where you would have some concern about having an ingrown nail for three weeks. Have you had the nail trimmed back ?
There is a condition that may mimick an acute inflammation: (Paronychia) and this can be chronic or acute: bacterial or yeast: You may want to ask your Doc if he/she can exclude this possibility. It is a superficail infection of the nail plate and doesn't involve deeper structures.

Are you elevating your foot to optimize the circulation? We say, Re: swelling......"If it doesn't get out, it can't get in "....Swelling and inflammation reduces arterial/capilary circulation. Warm, soapy, salt water soaks are excellent to draw out swelling too. White vinegar(Acetic acid), diluted 10:1 with tap water, makes an excellent antibacterial soak.

I would be worried more about a 66 Chevelle SS than osteomyelitis.

Be Happy: Don't Worry !  (+ info)

I think I have Osteomyelitis , and Im only 12?

Im really scared because I went to the doctors because I have a slight bump on the side on my join on my ring finger, and it has redness on it and hurts when I work with it.
The pediatrician told me to take this pill 3x a day for 5 days for anti - annflimmation. But it hasent been working. What is a treatmeant and do u think i have it?? Im REALLY scared

If you want to know what you have, you should ask your doctor. I don't think that you have osteomyelitis. It usually affects the long bones (leg or arm), and is caused by an infection getting into the bone and interfering with the marrow. If you had an infection in your finger, it would hurt all the time, not just when you work with it. You would have a fever, and there would be other symptoms too.

It is more likely that you have a cyst or a slight swelling from an injury. Your doctor can tell the difference.

If you have questions about your health, it is better to talk to your parents or doctor about them than to try to use the internet to diagnose your symptoms. You will just find the worst possible diseases and then convince yourself that you have them. It is a form of hypochondria, and it is not a good way to live a happy life.  (+ info)

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