Osteomyelitis acute

Compare and contrast the classic signs and symptoms of acute and chronic osteomyelitis. 

O Osteomyelitis, an infection of the bone, can be an acute or chronic process. 

Typical signs and symptoms of osteomyelitis include local pain and tenderness over the affected bone, as well as inflammation, erythema, edema, and decreased range of motion. Patients with acute hematogenous osteomyelitis may also present with fever, chills, and malaise. 

The treatment goals for acute and chronic osteomyelitis are to eradicate the infection and prevent recurrence. Higher cure rates are seen with acute compared to chronic osteomyelitis. 

Treatment of osteomyelitis is dependent on the extent of bone necrosis. For acute osteomyelitis with minimal bone destruction, an extended course of antimicrobial therapy should effectively treat the infection however, in chronic osteomyelitis surgical intervention is also typically required. 

O Osteomyelitis is an infection of the bone that is associated with high morbidity and increased health care costs. The inflammatory response associated with acute osteomyelitis can lead to bone necrosis and subsequently chronic infections. Bacterial pathogens, particularly Staphylococcus aureus, are the most common microorganisms implicated in these infections. Diagnosis and treatment are often difficult due to the heterogeneous... 

Historically, osteomyelitis has been classified as acute or chronic based on duration of disease (Fig. 78-2).2,4 However, there are no established definitions for acute and chronic infections.2-4 Acute infection has been defined as first episode or recent onset of symptoms (less than 1 week).2,3 Chronic osteomyelitis is generally defined as relapse of the disease or symptoms persisting beyond 4 weeks.2,3 Others describe chronic osteomyelitis as the presence of necrotic bone.3 ... 

The epidemiology of osteomyelitis has been changing over the past several decades.6 The incidence of acute hematogenous osteomyelitis, which is most often seen in children, has been declining.6,7 In contrast, the frequency of contiguous osteomyelitis has been increasing. This trend may be related to... 

An elevated WBC is mostly seen in patients with acute osteomyelitis. 

Antimicrobial therapy alone is the mainstay of treatment for acute osteomyelitis.7 12 In comparison, treatment for chronic osteomyelitis typically requires a combination of antimicrobial therapy and surgical intervention.3 6 14 15 If the patient is not a candidate for surgical intervention, prolonged antimicrobial therapy is generally necessary.6,10,16... 

The duration of treatment is typically 4 to 6 weeks for acute osteomyelitis,15 Chronic osteomyelitis also requires 4 to 6 weeks of therapy however, the total length of therapy should be counted after the date of the last major surgical intervention.8 15 Longer courses may be necessary for certain populations such as patients with vascular insufficiency.3,6,10,16... 

Steer AC, Carapetis JR. Acute hematogenous osteomyelitis in children recognition and management. Pediatr Drugs 2004 6 333-346. 

Although used as a simulant, it can cause acute bacterial meningitis, pneumonia, intraabdominal infections, enteric infections, urinary tract infections, septic arthritis, endophthalmitis, suppurative thyroiditis, sinusitis, osteomyelitis, endocarditis, and skin and soft tissue infections. There are also strains of E. coli (C17-A015) that produce lethal cytotoxins (C16-A052). ... 

Field First Aid Brucella is typically an acute, non-specific feverish illness with chills, sweats, headache, fatigue, myalgias, artthralgias, and anorexia (loss of appetite). Cough occurs in 15 to 25 percent of cases but a chest X-ray is usually normal. Complications may include arthritis, sacroiliitis, and vertebral osteomyelitis. Untreated disease may persist for month to years, often with relapses and remissions. Disability may be pronounced, and lethality may approach six percent. Brucellosis may be indistinguishable clinically from the typhoidal form of tularemia (see Guide For Emergency Response for Tularemia) or from typhoid fever itself. 

Streptococci and staphylococci Serious respiratory tract infections serious skin and soft tissue infections septicemia (parenteral only) acute staphylococcal hematogenous osteomyelitis (parenteral only). 

Clinical improvement, especially the disappearance of fever or defervescence, is the best parameter to judge the response to therapy. However, clinical improvement can be difficult to monitor objectively in critically ill patients with multi-system disease. Also, clinical improvement can be very slow for certain infections, e.g. tuberculosis. The peripheral blood leukocyte count including the presence of early stages in leucocyte differention and the level of serum C-Reactive Protein (CRP, an acute phase protein) are parameters that can be sequentially determined to monitor improvement. For monitoring the effect of treatment of chronic infections such as endocarditis or osteomyelitis, weekly determination of the erythrocyte sedimentation rate has been proven useful. 

It is indicated in upper and lower respiratory tract infections, skin infections, septicaemia, bone and joint infection including acute haematogenous osteomyelitis. 

Osteomyelitis may be acute or chronic and the causative bacteria arrive in the bloodstream or are implanted directly (through a compound fracture, chronic local infection of local tissue, or surgical operation). Staphylococcus aureus is the commonest isolate in all patient groups but Haemophilus influenzae is frequently seen in children (much reduced now by the Hib vaccine), and Salmonella species in the tropics. Chronic osteomyelitis of the lower limbs (especially when underlying chronic skin infection in the elderly) frequently involves obligate anaerobes (such as Bacteroides species) and coliforms. 

Definitive therapy is guided by the results of culture but commonly used regimens include flucloxacillin with or without fusidic acid (for Staphylococcus aureus), cefotaxime or co-amoxiclav (in children), and ciprofloxacin (for coliforms). Short courses of therapy (3 weeks) may suffice for acute osteomyelitis. 

The available data suggest that the incidence of arthro-toxicity in children taking ciprofloxacin is the same as in adults the use of other fluoroquinolones is too rare to obtain clear information about the risks in children (51). In 12 children with sickle cell disease treated successfully for acute osteomyelitis with oral ciprofloxacin, transient bilateral Achilles tendon tendinitis occurred in one 5-year old (52). Another case was reported in a hemodialysis patient with a ciprofloxacin-associated Achilles tendon rupture (53). 

A 51-year-old man was given piperacillin 2 g bd for osteomyelitis. After close to 4 weeks he developed acute renal insufficiency and superior mesenteric venous thrombosis. His coagulation profile showed disseminated intravascular coagulation. Withdrawal of piperacillin and anticoagulation therapy resulted in clinical improvement and normalization of the laboratory data. 

Acute and chronic osteomyelitis Septic arthritis/bursitis Prosthetic joint infections IV line infection Infective endocarditis... 

There are a number of nonspecific laboratory tests that are useful to support the diagnosis of infection. The inflammatory process initiated by an infection sets up a complex of host responses. Activation of complements, such as C3a and C5a, initiates inflammation and sets off a cascade of changes and the subsequent release of mediators, all of which can be measured and monitored. Serum complement concentrations, particularly C3, usually are consumed as part of the host defense mechanism and subsequently are reduced during the early stages of an acute infectious process. Acute-phase reactants, such as the erythrocyte sedimentation rate (ESR) and the C-reactive protein concentration, are elevated in the presence of an inflammatory process but do not confirm the presence of infection because they are often elevated in noninfectious conditions, such as collagen-vascular diseases and arthritis. Large elevations in ESR are associated with infections such as endocarditis, osteomyelitis, and intraabdominal infections. ... 

Weinstein MP, Stratton CW, Hawley HB, et al. Multicenter collaborative evaluation of a standardized serum bactericidal test as a predictor of therapeutic efScacy in acute and chronic osteomyelitis. Am J Med 1987 83 218-222. 

The most importanttreatment modality of acute osteomyelitis is the administration of appropriate antibiotics in adequate doses for a sufficient length of time. 

Osteomyelitis also may be classified based on the duration of the disease. Acute osteomyelitis describes infections of recent onset, usually several days to 1 week, whereas chronic infections are those of a longer duration. Some authors describe chronic infections as those with symptoms for more than 1 month before therapy, whereas other authors define chronic infections as relapse of an initial infection. Yet a third system sometimes used to classify osteomyelitis is based on the anatomic location of the infection (medullary or superficial)... 

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