osteomyelitis

Bone has two basic parts: the outer, solid cortex, and the spongy inner marrow cavity. Bone marrow is the site of blood cell production; blood flows freely but somewhat sluggishly through a maze of bony channels. If bacteria are present in the blood that courses through the marrow, they may be deposited in a nook or cranny somewhere and have the opportunity to multiply away from the "watchful eyes" of the immune system.

Osteomyelitis means infection of the bone marrow space with bacterial germs. It is one of the more serious infections of childhood, and was once a major crippler of children in the days before antibiotics. Children with osteomyelitis once faced months to even years on hospital orthopedic wards, with chronic draining wounds.

The most common germs involved in such bone infections are the same organisms that cause joint infections (septic arthritis)Staphylococcus aureus, Streptococcus pneumoniae, and Group A streptococcus. Other organisms include E. coli, Salmonella, and other so-called "gram negative" organisms.

Unless there is open penetrating injury to the bone (a fracture), bacteria reach the bone marrow through the blood stream from elsewhere in the body - the gut, an infection, or wound ("hematogenous spread").

Early diagnosis of osteomyelitis can be difficult. Pain over the location of the infection is common, but not always present early on. There may be systemic signs of infection such as fever or chills. The child may either limp or simply refuse to bear any weight on the affected extremity.

After physical examination, diagnostic tests would generally include

direct needle aspiration of the bone is often done for cultures of the joint fluid as well as microscopic examination of specially stained fluid specimens for the presence of pus cells and bacteria
blood specimen for culture and drug sensitivities of any bacteria identified
blood count to assess the severity of infection
a sedimentation rate, a measure of inflammation used to monitor the progress of cure
possible ultrasound examination of the joint to detect increased amounts of fluid if the diagnosis is in doubt
bone scan may be done to localize suspected bone infection

Bone infections are typically more difficult to eradicate than other serious bacterial infections, and treatment programs are longer than for most other infecitons, including joint infections (septic arthritis). Osteomyelitis is treated at least initially with intravenous antibiotics. Initial treatment is in the hospital; home intravenous therapy is often possible. If the infecting bacterium can be identified by culture and it is proven sensitive to an oral antibiotic, oral treatment is sometimes used, either in the hospital or at home.

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