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Osteomyelitis (Pathogens that cause osteomyelitis (MOST COMMON: Coagulase…
Osteomyelitis
Epidemiology
Affects children and the older patients. Most young patients develop the condition due to haematogenous osteomyelitis or contiguous osteomyelitis. Older patients develop it due to Diabetes, Peripheral Vasucular disease or arthroplasties.
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Increased incidence of osteomyelitis due to chronic causes such as diabetes and peripheral vascular disease
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Risk Factors
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Vascular supply: arterial disease, diabetes mellitus and sickle cell disease
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Clinical Features
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Signs: fever, night sweats, malaise.
Histopathology:
Acute changes: inflammatory cells, oedema and vascular congestion
Chronic changes necrotic bone, new bone formation and lymphocytes and histiocytes. This is along site inflammatory exudate, this leads to an increased intramedullary pressure and an extension of exudate into the bone marrow ruptures through the periosteum and means that the periosteal blood supply is interrupted leading to necrosis
Acute signs: tenderness and warmth, erythema and swelling
Chronic signs: tenderness,warmth, erythema and swelling and also non healing ulcers and fractures
If it happens in the hip, vertebrae or pelvis you are likely to get pain. Vertebral OM: lumbar, thoracic and cervical. Leads to extension and possibly cause ulcer formation. If the infection breaks through the cortex there can be discharge of pus and ultimately septic arthritis can occur.
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Pathophysiology
Pathogen gets into the bone through direct inoculation of infection of the bone. For example, when you have a breach in the surface of the bone (open fracture
Contigious spread of infection of adjacent soft tissue and joints to the bone. Common causes of this are DM, chronic ulcers and vascular disease
Haematogenous seeding: bacteria products spread in the blood. This is a good example of how metastatic and septic emboli spread. Normally affects the long bones are vertebrae
Metaphysis of a bone has a low blood supply so is less likely to be infected. In this case TB is the likely cause
Haematogenous OM
Very common in IVDU, people with central lines, dialysis and sickle cell disease
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