Bone Infections

Bone infection (osteomyelitis) is infection of bone — usually bacterial, but in India TB of bone (including spinal TB / Pott's disease) is also an important cause. Early, correct treatment usually cures; late or incomplete treatment leads to chronic infection and disability.

Symptoms

• Deep bone pain — persistent; worse with movement; not settling with rest or painkillers.
• Swelling, warmth, redness over the area.
• Fever (more prominent in acute bacterial).
• Limited movement.
• Discharging sinus in chronic infection — pus draining from a persistent wound.
• Constitutional symptoms — weight loss, night sweats (more with TB).

Who is at higher risk

• Open fracture, penetrating wound, recent bone surgery.
• Diabetes (particularly diabetic foot).
• Poor circulation (peripheral arterial disease).
• Immune suppression (HIV, cancer treatment, long-term steroids).
• Sickle cell disease.
• Intravenous drug use.
• Previous TB, close contact with TB cases, HIV co-infection.

Spinal TB — India-specific importance

• Slow, insidious back pain with evening fever, weight loss, night sweats.
• Can cause vertebral collapse → deformity (gibbus) + spinal cord compression → weakness/paralysis.
• MRI is the key test; tissue diagnosis (biopsy) + TB culture/NAAT.
• Fully treatable with standard anti-TB treatment (6-12 months); some cases need surgical stabilisation.
• Any chronic back pain with constitutional symptoms → always consider TB in India; miss this diagnosis and progressive damage is avoidable.

Evaluation

• Blood tests — CBC, ESR, CRP, blood culture.
• X-ray, MRI, sometimes bone scan.
• Bone biopsy / aspiration — essential to identify the organism and match antibiotic.
• Rule out HIV, diabetes, TB; look for source of infection elsewhere.

Treatment

• Targeted antibiotics — usually 4-6 weeks IV followed by oral; sometimes longer.
• TB treatment — anti-TB drugs for 6-12 months for spinal TB; compliance matters.
• Surgical drainage/debridement — removes dead bone (sequestrum) and pus.
• Address underlying conditions — diabetes, vascular disease, immune status.
• Rehabilitation — physiotherapy is crucial once infection is controlled.
• Care at a hospital with orthopaedic + infectious disease + (for spine TB) neurology input.