Osteomyelitis

Osteomyelitis is a bone infection, usually caused by bacteria. It can affect any bone but most commonly affects the long bones of arms and legs, the spine (vertebral osteomyelitis), or bones of the feet in people with diabetes. Early treatment is important — untreated bone infection can destroy bone and spread.

Causes

Bacteria can reach a bone in three main ways:

• Through the bloodstream from infection elsewhere (haematogenous — most common in children)
• Direct spread from a nearby infection, injury, or surgery (including fractures, implants, joint replacements)
• Reduced blood flow to tissues — particularly in diabetic foot ulcers, pressure sores

In India, tuberculosis is an important cause of chronic osteomyelitis and spinal infection (Pott's disease), and often needs to be ruled out.

Symptoms

• Fever, chills
• Pain, swelling, warmth, and redness over the affected bone
• Limited movement of the limb
• Back pain (vertebral osteomyelitis)
• Wounds or ulcers that don't heal
• Sometimes fatigue and feeling generally unwell

Diagnosis

• Blood tests and blood cultures
• Imaging — X-ray, MRI, or bone scan
• Bone biopsy to identify the bacterium and choose the right antibiotic
• Tests for TB where relevant

Treatment

Treatment usually involves several weeks of antibiotics, often starting intravenously. Surgery is sometimes needed to drain pus, remove dead bone, or remove infected implants. Diabetic foot osteomyelitis needs careful wound care and strict glucose control. TB osteomyelitis needs long-course anti-TB treatment. Early, correct treatment gives good outcomes; delay risks chronic infection and bone damage.