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Osteomyelitis is an acute or chronic bone infection.

Bone infection can be caused by bacteria or fungi.

• Infection may also spread to a bone from infected skin, muscles, or tendons next to the bone, as in osteomyelitis that occurs under a chronic skin ulcer (sore).
• The infection that causes osteomyelitis can also start in another part of the body and spread to the bone through the blood.
• A current or past injury may have made the affected bone more likely to develop the infection. A bone infection can also start after bone surgery, especially if the surgery is done after an injury or if metal rods or plates are placed in the bone.

In children, the long bones are usually affected. In adults, the feet, spine bones (vertebrae), and the hips (pelvis) are most commonly affected.

Risk factors are recent trauma, diabetes, hemodialysis, poor blood supply, and IV drug abuse. People who have had their spleen removed are also at higher risk for osteomyelitis.

• Bone pain
• Fever
• General discomfort, uneasiness, or ill-feeling (malaise)
• Local swelling, redness, and warmth
• Nausea

Additional symptoms that may be associated with this disease:

• Chills
• Excessive sweating
• Low back pain
• Swelling of the ankles, feet, and legs

A physical examination shows bone tenderness and possibly swelling and redness.

Tests may include:

• Blood cultures
• Bone biopsy (which is then cultured)
• Bone scan
• Bone x-ray
• C-reactive protein (CRP)
• Erythrocyte sedimentation rate (ESR)
• MRI
• Needle aspiration of the area around affected bones

When treatment is received, the outcome for acute osteomyelitis is usually good.

The outlook is worse for those with long-term (chronic) osteomyelitis, even with surgery. Amputation may be needed, especially in those with diabetes or poor blood circulation.

The outlook is guarded in those who have an infection of a prosthesis.

When the bone is infected, pus is produced within the bone, which may result in an abscess. The abscess steals the bone's blood supply. The lost blood supply can result in a complication called chronic osteomyelitis. This chronic infection can cause symptoms that come and go for years.

Other complications include:

• Need for amputation
• Reduced limb or joint function
• Spread of infection

Call your health care provider if you develop symptoms of osteomyelitis, or if you have osteomyelitis and the symptoms continue despite treatment.

Prompt and complete treatment of infections is helpful. High-risk people should see a health care provider promptly if they have signs of an infection anywhere in the body.

Espinoza LR. Infections of Bursae, Joints, and Bones. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 293.

Gutierrez KM. Osteomyelitis. In: Long SS, Pickering LK, Prober CG. Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Philadelphia, Pa : Churchill Livingstone Elsevier; 2008: chap: 80.