Acute and chronic hematogenous osteomyelitis in children and adults
Acute and chronic hematogenous osteomyelitis: causes and treatments
Hematogenous osteomyelitis is a disease characterized by inflammation of bone marrow and bone destruction.
This condition can occur when the presence in the body of any infectious agents, neoplastic process and conditionally pathogenic microflora in the presence of a reduction reaction of the immune system.
There are risk groups, which include people with an imperfect formation of the immune system.
- children up to 7 years in connection with unformed until the end of bone marrow and bone tissue;
- people with congenital or acquired immunodeficiencies;
- the elderly;
- patients with sepsis;
- people with chronic infection;
- patients with neoplastic diseases.
Most often acute hematogenous osteomyelitis seen in children in Association with increased susceptibility to infections. In children mostly, the disease affects the bones of the facial skeleton and lower jaw.
In children the first year of life entry of infection are the micro-fractures and injuries of the mucous membrane of the mouth and nose.
An important factor in the development of the disease is defeated mucous membranes of the respiratory infections.
Hematogenous osteomyelitis can occur in children and adults of any age in the presence of tuberculosis in the body.
To prevent Mycobacterium tuberculosis from the lungs to the bone marrow, it is necessary to adhere to prescribed treatment regimens, not missing medication.
Bone hematogenous osteomyelitis of the bones of the skull, can often be associated with diseases such as:
- purulent periodontitis.
Forms of the disease
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There are two forms of osteomyelitis:
- The acute form occurs most often in children, adolescents and middle aged people. People with the presence of immunodeficiency States, in most cases, has a chronic form.
- Chronic hematogenous osteomyelitis can also occur in the elderly. This form is also typical for people with chronic diseases, the body.
The stage of development of the disease
The development of hematogenous osteomyelitis begins with an inflammatory process in the bone marrow and can result in breakthrough products of inflammation through the skin.
Depending on injuries of organs and tissues, there are several stages of disease development:
- the development of inflammation of the bone marrow;
- the formation of a bone abscess;
- inflammation periostin tissues and the development of the abscess;
- the formation of intermuscular phlegmon in the cases;
- the development of a breakthrough fistula and purulent content.
During the first stage of pathogens and altered cells of the body fall with blood flow in the bone marrow. That’s where they find their own immune cells and attack them.
At the same time developing an inflammatory process, which captures more bone cells.
In the next stage of the disease the inflammatory process is converted into the fusion of bone cells and bone marrow. In place of the cavity, where bone marrow is formed of a purulent abscess.
Continuing to stretch bone cells, hematogenous osteomyelitis spreads to the periosteum and cartilage, forming inflammation and periosteal abscesses.
After the pus will eventually melt the periosteum, he breaks into soft tissue, pausing in muscle sheaths and forming abscess.
A large number of pus in the bone and soft tissues may lead to the formation of a fistula through which pus and nekrotizirovannye mass of bone come out through the hole in the skin.
Fistula formation and release of pus out often ends acute phase of the disease. In the chronic form of the disease formed a small phlegmon, which do not lead to the development of the fistula, and remain in the soft tissues.
The clinical picture
Manifestations of osteomyelitis may be different, depending on the shape, stage of disease and condition of the human body.
The acute form in the stage of inflammation is a General symptoms of intoxication:
- high temperature;
With further development of the disease, the weakness in some movements (localization depends on the affected bone), fast fatigue, there is a high temperature.
If the affected bone of the lower limb, the person becomes difficult to move. If damaged lower jaw – the violation of chewing function. When a large area of bone destruction can be observed pathologic fractures.
In the acute phase of the disease possible formation of a fistula through which pus comes out. After the release of the necrotic masses and the remnants of the pus, there is a sharp decrease in temperature, disappears the discomfort.
When there is insufficient treatment of the acute phase of the disease, hematogenous osteomyelitis becomes chronic.
Chronic osteomyelitis is characterized by constant slight fever up to subfebrile figures.
Thus, the process of bone destruction is common – until the destruction of the entire bone, joint and switch to another bone.
Also in the chronic form of the disease there is constant fatigue, a slow but noticeable muscle fatigue, discomfort during the movements.
If the chronic form occurs in infants or the elderly, it is quite difficult to diagnose.
A modern approach to diagnosis
An important diagnostic criterion for osteomyelitis is a purulent fever. The man with purulent osteomyelitis the temperature can reach 38,5°C — 40°C.
However, the disease can be nearly asymptomatic – people with immunodeficiencies, the body temperature may either remain at a normal level, or to decrease the depletion of the immune system.
The chronic form also occurs with a slight rise in body temperature.
Feature diagnosis of osteomyelitis is the difficulty in recognizing the process. In the presence of purulent formations on the skin, it is difficult to understand how a given education and how deep it reaches.
Suspected purulent osteomyelitis the following entities:
- breakthrough abscess and prolonged pus.
In addition to the clinical picture are important as laboratory and instrumental diagnostics.
Thus, laboratory tests will help to detect the body’s inflammatory process. A blood test for specific flora will help to identify the causative agent of the disease and prescribe the necessary antibiotics.
Of instrumental methods of diagnostics of the most informative is x-ray and CT scan. X-ray examination allows you to see the pathological process. By measuring bone density, it is possible to know the extent of its destruction.
CT scan will allow doctors to learn the extent of bone lesion and the adjacent tissues. This will determine the amount of required surgical intervention.
Timely diagnosis of the disease depends on the successful treatment of osteomyelitis.
The main objectives of treatment of hematogenous osteomyelitis include:
- elimination of the causative agent;
- stop the inflammatory process;
- removal of necrotic tissues;
- the restoration of the lost functions.
For effective treatment can be applied drug therapy, surgical treatment and combination of these options.
Solely medical therapy prescribed to patients in the initial stages.
As medicines are used:
- specific and nonspecific antibiotics;
- steroid and nonsteroidal anti-inflammatory drugs;
- mineral complexes.
Surgical treatment is aimed at eliminating pus, necrotic masses, and eliminate nonviable tissue.
Also used prosthetics, which allows you to set special pins instead of a damaged bone and to make plastic remote muscles.
In the presence of a fistula, the fistulous course is washed with antibacterial solutions and put the drains, through which the purulent contents comes out.
Individual sensitivity to antibiotics is not always possible to select appropriate antibiotic therapy for a particular patient.
Insufficient audit fistulous bone and adjacent soft tissues may facilitate the growth of pathogenic microflora in the inflammation. All this leads to the fact that the disease continues to develop in the chronic form.
After the surgery is not always possible to restore the function of bones and soft tissues. This creates a susceptibility to frequent fractures, dysfunction of (chewing, support, movement).
Prevention of the disease
Prevention of the disease consists in implementing simple rules of health.
- timely treatment of infectious diseases;
- full treatment of chronic diseases;
- the health check-up every six months.
Hematogenous osteomyelitis is a nonspecific condition that can develop at any age.
To prevent its development, you must carefully monitor your health and regularly visit a physician for checkups.