Acute osteomyelitis: symptoms and treatment
Acute osteomyelitis is an ailment that is characterized by the development of bacterial inflammation of the bone marrow and all structural parts of the bone. The danger of the disease consists in a variety of currents — from asymptomatic to lightning. The main source of pathology are pathogenic microorganisms that penetrate the bone and lead to the onset of a purulent process. In addition, there are several mechanisms of development and predisposing factors.
The clinical picture will be slightly different depending on the form of the course of the disease and the bone that was affected. The main symptoms are usually considered pain syndrome, swelling and pathological reddening of the problem area.
Because the disease has a rather specific symptomatology, the diagnosis is based on data received by the physician during physical examination and instrumental examinations, among which are x-rays.
Treatment in the vast majority of cases is surgical, but carried out against a background of conservative techniques.
Currently, the pathogenesis of the development of inflammation of all components of the bone remains not fully understood. However, it is customary for clinicians to single out several theories that stage-by-stage describe the development of the disease. Nevertheless, each of them has its own positive and negative sides, which is why it can not be considered the main one.
Thus, there are the following theories:
- embolic — is to reduce the rate of blood flow in the capillaries, which increases the likelihood of blood clots, which can lead to necrosis. Penetration of pathological agents actually leads to the development of acute purulent osteomyelitis
- allergic — during prolonged studies, it has been found that bacteria by themselves lead to the development of an inflammatory process in about 18% of cases, but with an insignificant trauma, aseptic inflammation occurs. As a result, this leads to a complete cessation of blood flow, the progression of swelling of soft tissues and an increase in the affected area
- neural-reflex — this theory is based on the fact that under the influence of some unfavorable factors, in particular stress, the course of any serious illness, reflex spasm of blood vessels develops.
Despite the presence of the above assumptions, all clinicians agree on the fact that often the pathogens of the inflammatory process become such microorganisms:
- Pseudomonas aeruginosa
- vulgar protey
- E. coli
In some cases, the pathology can be caused by the simultaneous influence of several bacteria.
In addition, the development of such a disease can affect both endogenous and exogenous factors.
Endogenous or internal causes are that an infectious agent enters the bloodstream from the primary focus, which can be localized in:
- the shell of the nasopharynx;
- oral cavity;
- Wounds on the skin
- sources of latent infection
- areas of rubbing or diaper rash — this often leads to a similar ailment in young children who are not yet one year old.
Risk factors that contribute to the emergence of acute hematogenous osteomyelitis are:
- all infectious processes of viral genesis
- inflammatory diseases that occur in both acute and chronic forms
- poor nutrition;
- vitamin deficiency;
- a wide range of conditions that are accompanied by a decrease in the resistance of the immune system.
Exogenous, i.e. external sources of inflammation development are represented by those transferred earlier:
- gunshot wounds
- surgical operations
In the above situations, the infectious source penetrates the bone in two cases — directly from the external environment or from infection of surrounding tissues. This means that the inflammation was not preceded by the formation of a primary lesion.
In addition, to provoke the development of bone inflammation in acute osteomyelitis can:
- Extensive burns and frostbite
- the course of diabetes or tuberculosis
- prolonged starvation
- excessive physical fatigue
- disorders of the psychoemotional state
- treatment of malignant tumors with chemotherapy
By the method of penetration into the human body of a pathological agent, the disease is divided into:
- acute hematogenous osteomyelitis — in children it is diagnosed more often than in adults. In this case, the infection enters the bloodstream from other foci. It has several varieties — septic-piecemic, local and toxic form
- acute exogenous osteomyelitis — is of post-traumatic, contact, gunshot and post-operative origin
A particular type is considered to be acute odontogenic osteomyelitis , which consists in infection of the jaw, followed by the formation of a purulent-necrotic process. It is noteworthy that this type of bone inflammation is diagnosed in representatives of men in the age category over thirty five years. The main reason for the formation is incorrect dental procedures or operations, against which the number of pathogenic bacteria increases.
Depending on which jaw is involved in the pathology, distinguish:
- acute mandibular osteomyelitis is the most frequent type of ailment that is diagnosed in 85% of the total number of diagnoses;
- acute maxillary osteomyelitis — observed at 15% and differs in that it is much lighter than the above form.
Another classification divides bone inflammation into a typical and atypical course.
The type of pathogen acute osteomyelitis happens:
- specific — is caused by exposure to a specific type of bacterium, for example, the causative agent of pneumonia, gonorrhea, syphilis, brucellosis or tuberculosis
- unspecific — develops against the backdrop of the negative influence of chopsticks, fungi and cocci
By the prevalence of inflammation, the disease can be:
Clinical signs of acute osteomyelitis fall into two categories — general and specific. The first group is divided into symptoms of local and generalized form.
Thus, the general local manifestations are:
- raising the temperature to 38.5 degrees;
- edema and unhealthy reddening of the skin, located in the area of bone inflammation
- severe pain syndrome;
- sensation of heat and pulsation in the focus of inflammation
- highlighting pus;
- discomfort and soreness while moving;
- A significant limitation of motor function.
In acute generalized osteomyelitis, the symptomatology will be as follows:
- fever and chills
- strong pain sensations in the region of the affected segment that are constantly present
- weakness and weakness
- intense headaches;
- increased sweating
- urination disorder
- loss of consciousness
- pallor of the skin.
Specific symptoms completely depend on the focus of the infectious process, but they will be as similar as possible with common clinical signs.
Septic-piemic type of acute hematogenous osteomyelitis is characterized by:
- a slight increase in temperature;
- signs of body intoxication
- rapid emetic urges
- permanent headaches;
- delusional condition
- development of hemolytic jaundice
- the appearance of soreness with clear localization
The signs of the local variety of hematogenous acute osteomyelitis are no different from the general symptomatology.
The toxic species of the disease has a fulminant course, which is expressed in the following symptoms:
- a sudden increase in temperature;
- lowering of the blood tone;
- convulsive seizures
- periods of loss of consciousness
- manifestations of cardiovascular failure
Acute odontogenic osteomyelitis of the jaws is manifested by such signs:
- the sharp onset of acute soreness on the side of the jaw in which the focus of infection is localized
- the spread of soreness to the temples, forehead and nasal sinuses
- temperature increase;
- abundant release of cold and sticky sweat
- severe chills;
- general malaise.
Due to the fact that the disease has a rather specific symptomatology, there are no problems with diagnosis. However, laboratory-instrumental examinations of the patient render significant assistance in this process.
Nevertheless, the clinician, first of all, must perform several manipulations independently, among which:
- study of medical history and collection of a patient’s life history — to establish the path of infection of the source of infection
- A thorough physical examination aimed at assessing the condition of the skin over the affected bone and palpation of the problem area. In this case, the doctor pays attention to the reaction of a person;
- a detailed patient survey — to establish the degree of symptom severity and to obtain complete information about the course of such a disease
Among the laboratory diagnostic measures are:
- general clinical blood test — pay attention to ESR and the number of leukocytes. Possible detection of hemolytic anemia, which develops in the generalized form of inflammation;
- a general analysis of urine — to find signs of inflammation and renal insufficiency. There is also an increase in protein in the urine and a decrease in its relative density;
- blood biochemistry — the analysis will show the change in its composition.
The basis of diagnosis is the following instrumental examinations:
- Radiography of the inflamed bone in several projections — X-ray signs begin to appear two weeks after the development of the disease in adults, after five days in children. This determines the presence of a thickening of the periosteum, fuzziness of the contours and the presence of compaction zones;
- Ultrasound, CT and MRI of the problem area
- Diagnostic bone puncture — consists in taking a purulent fluid from the inflammation focus, which is necessary to establish the causative agent of the disease.
A similar disease must be differentiated from:
- allergic arthritis;
- closed fracture;
- festering hematoma
- severe injury;
- primary muscle phlegmon;
The most effective therapy for acute osteomyelitis of the jaw or any other localization is to implement a whole set of therapeutic methods that include:
- taking medications;
- the passage of physiotherapy procedures
- adherence to a gentle diet
Medication is aimed at using:
- physiological solutions that are infused internally,
- antibacterial agents for two months;
- local antimicrobial agents, in particular ointments or powders;
- Vitamin Complexes
The most effective physiotherapy procedures are:
- Medicinal electrophoresis with antibiotics
- ultraviolet irradiation
Treatment of acute hematogenous osteomyelitis by diet is the implementation of such rules:
- Enrichment of the diet with proteins, calcium and iron;
- frequent and fractional food consumption
- third of the menu should consist of fresh fruit, dietary meat and fermented milk products
- copious drinking regime
- cooking dishes by cooking and steaming, putting out and baking.
The remaining recommendations are provided by a dietitian.
In addition, conservative therapy is aimed at:
- limb immobilization
- the course of the therapeutic massage.
Acute hematogenous osteomyelitis in children and adults is eliminated by:
- tooth extraction
- sanation of the source of infection
- medical splinting.
However, without the implementation of medical intervention, inoperable techniques will not be effective. Surgical treatment of acute odontogenic osteomyelitis, hematogenous and exogenous its form consists in excision of any purulent focus.
All the consequences of the disease are divided into general and local. The first category is represented by:
- bacterial endocarditis
- renal and hepatic impairment
Among the local complications is:
- pathological fracture or dislocation
- Ankylosis and contracture
- Arrosive hemorrhage
- Deformation of the affected bone or disruption of its growth
- formation of a false joint
Acute odontogenic osteomyelitis can lead to:
- abscess of the brain or lung;
Acute and chronic osteomyelitis are two concepts that are closely related. Ignoring the symptoms of an acute inflammatory process leads to a chronic illness, and treatment in such cases will be much more difficult.
Prevention and Forecast
In order not to increase the number of patients with a similar diagnosis, it is necessary to comply with the following rules of prevention:
- Properly and nutritionally balanced
- Avoid prolonged hypothermia
- timely treatment of dental pathology
- avoid limb injuries whenever possible
- avoid physical and emotional overwork
- undergo a full preventive checkup several times a year.
As for the forecast, for each patient it will be individual, because it depends on the form and nature of the course of the disease, as well as the presence of complications. Chronic osteomyelitis in a child or adult is almost not amenable to treatment, and the consequences often lead to death.