10 Key Symptoms of Osteomyelitis

Osteomyelitis is an infectious and inflammatory condition affecting the bone and bone marrow, predominantly caused by the bacterium Staphylococcus aureus. The term derives from 'osteo' meaning bone, 'myelo' indicating bone marrow, and 'itis', signifying inflammation. This condition typically arises following direct exposure of bone to bacteria through injury, such as fractures or surgical procedures. Moreover, infections from other bodily locations can disseminate hematogenously, reaching and infecting the bone. Factors such as diabetes and rheumatoid arthritis may compromise immune defenses, elevating the risk of osteomyelitis. Clinically, osteomyelitis presents in two forms: acute, characterized by a sudden onset, and chronic, which denotes a prolonged or recurrent infection.

1. Fever

A healthy human body typically maintains a temperature around 98.6°F. However, individuals suffering from osteomyitis may experience elevated fevers, reaching a threshold of 100.4°F or higher, indicating the need for medical evaluation. This fever is a result of inflammatory chemicals influencing the hypothalamus' regulation of body temperature, leading to muscle contractions and consequent heat production. Patients may feel hot and experience sweating. While common practices may include the application of a cool cloth to the forehead, this approach often proves ineffective. Over-the-counter medications may offer relief for mild fevers, but more pronounced fever conditions warrant prompt professional medical care.

2. Fatigue

Individuals suffering from osteomyelitis often experience significant fatigue due to the body's response to the infection. The production of toxins by the infectious agent, coupled with the body's own inflammatory processes, taxes energy reserves markedly. Osteomyelitis typically arises subsequent to an injury that provides a vector for infection to the bone, or through the systemic spread from an infection in another part of the body. Patients, therefore, may be dealing with the compounded effects of an initial injury or another infection, exacerbating their discomfort.

3. Redness, and Warmth

To counteract the presence of pathogens within a specific region of the body, an immune response is initiated which includes an increase in local blood flow. This augmented circulation facilitates the delivery of a greater number of leukocytes, commonly known as white blood cells, to the affected area to combat the infection. Additionally, the heightened blood flow aids in diluting toxins concentrated in the vicinity. Chemical signals released at the site of infection induce the dilation of blood vessels – a process known as vasodilation – resulting in a visible reddening and warming of the area.

4. Swelling

Blood is composed of plasma, various proteins, and cellular elements. During inflammation, an increased blood flow to the affected region occurs. Normally, the inner lining of blood vessels, composed of closely arranged epithelial cells, prevents blood constituents from leaking into the surrounding tissue. However, when chemical mediators are released, they promote the enlargement of gaps between these epithelial cells. This process allows plasma and white blood cells to pass through the vessel wall and enter the tissue space. Their role is to dilute harmful substances and combat any infectious agents present. This migration of fluid into the tissues results in visible swelling. Additionally, lymph nodes associated with the area may become enlarged and tender as they too respond to the inflammation.

5. Irritability and Tenderness

During the inflammatory response, the body releases various chemicals, one of which is bradykinin. Bradykinin provokes the dilation of vascular walls and increases the permeability of endothelial junctions, leading to the extravasation of fluid into surrounding tissues. This process not only results in visible swelling but also contributes to the sensation of pain, serving as a biological signal of inflammation. As pain alerts the organism to potential harm, it is a critical component of the body's defense mechanism. In clinical settings, the presence of tenderness, which is pain elicited upon palpation, can be particularly informative. For pediatric assessments, observable signs of discomfort are especially valuable for evaluating non-verbal children.

6. Loss of appetite

Individuals diagnosed with osteomyelitis may exhibit a reduced appetite and consume less food than is typical for them prior to the onset of the infection. Commonly, these patients experience feelings of fatigue, weakness, and an overall sense of malaise, which can extend to discomfort during eating. Additionally, it is not uncommon for patients to suffer from nausea and vomiting. It is important to note that while nausea is a nonspecific symptom and can arise from various causes, it is frequently reported in the context of osteomyitis.

7. Loss of Function

A cardinal symptom of inflammation is functional impairment, which often leads to an individual's hesitancy to utilize the impacted limb or region; this is typically accompanied by redness, warmth, and swelling. Various factors can contribute to a reduced range of motion, and one such factor is the body's natural response to pain. To avoid further discomfort, the body may instinctively minimize movement in the painful area, a phenomenon understood as a protective neurological reflex.

8. Back Pain

Osteomyelitis, a serious bone infection, commonly affects the vertebrae or pelvis in adults, resulting in significant back pain that intensifies at night. In contrast, children with osteomyelitis often exhibit pain localized to the specific bone area involved. In adults, predisposing factors include prior injuries, compromised immune systems, or a history of drug abuse. Conversely, in children, the condition is frequently caused by the spread of infection from other bodily regions.

9. General Symptoms of Chronic Osteomyelitis

Chronic osteomyitis is a persisting condition that may evolve from an inadequately managed episode of acute osteomyitis, or develop as a primary condition without a preceding acute phase. It is frequently associated with joint replacements, compound fractures, or infections such as tuberculosis and syphilis. This disease can result in continuous bone damage, discomfort, and impaired functionality. Symptoms typically mirror those of acute osteomyitis, including chronic pain, fatigue, and swelling, yet fevers are less intense and may be accompanied by intermittent chills and sweating. Skin changes can also occur near the affected area. Treating chronic osteomyitis is challenging due to the bacteria's ability to reside within the bone cells, which hinders the immune system's response and facilitates the spread of infection.

10. Formation of a Sinus

A sinus tract represents a pathway originating from an infection in the bone, culminating at the skin surface, where it discharges necrotic tissue as pus. Such a condition often arises as a consequence of chronic inflammation associated with abscess complications. Effective management of a sinus tract necessitates addressing the root cause of the infection, which may prove challenging due to potential antibiotic resistance. The critical objective in treating a sinus tract is to ensure that the pathway remains open until complete healing has occurred.