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Osteomyelitis of the tibia of a young child. Numerous abscesses in the bone show as radiolucency.
Spinal tuberculosis. Magnetic resonance imaging of the spine revealing osteomyelitis involving T10 and T11 vertebral bodies and disc space (A; arrow) and an adjacent multiloculated paravertebral abscess (B; arrow).
Psoas abscess: Computed tomographic scan of the abdomen showing a left iliopsoas abscess (arrow) that likely originated from tuberculous osteomyelitis involving the T12, L1, and L2 vertebrae.
Dr. Usman Shams
• Inflammation of bone (osteo) and marrow (myelo),
virtually always secondary to infection.
• Frequently manifests as a solitary focus of disease.
• All types of organisms can produce osteomyelitis, but the
most common are
• Pyogenic bacterial osteomyelitis
• Tuberculous osteomyelitis
• Always caused by bacteria
• Routes of infection
• Hematogenous spread
• Extension from a contiguous site
• Direct implantation
• In children
• Hematogenous in origin
• Develops in the long bones
• Bacteremia stem from trivial mucosal injuries, such as may occur
during defecation or vigorous chewing of hard foods.
• In adults
• Often occurs as a complication of open fractures, surgical
procedures, and diabetic infections of the feet.
• Most common … Staphylococcus aureus in 80% to 90% of
• In patients with genitourinary tract infections and IV drug
abusers … E.coli, Pseudomonas, and Klebsiella
• In neonates … Hemophilus influenza and group B
• In patients with sickle cell disease … Salmonella infection
• During surgery and in open fractures … Mixed infection
• In neonates
• Metaphysis, epiphysis or both
• In children
• In adults
• Epiphysis and subchondral
• Depends upon on the stage and location of lesion
• Bacteria proliferate and induce a neutrophilic
inflammatory reaction and cause cell death.
• Bone undergoes necrosis within first 48 hours
• The inflammation spread and may percolate throughout
the Haversian systems and reach the periosteum
• Subperiosteal abscess
• Lifting of periosteum … segmental bone necrosis …
sequestrum (dead piece of bone)
• Rupture of periosteum leads to a soft tissue abscess in
the surrounding soft tissue and the formation of draining
• In infants
• epiphyseal infection spreads through the articular surface or
along capsular and tendoligamentous insertions into a joint,
producing septic or suppurative arthritis
• In children
• periosteum is loosely attached to the cortex … subperiosteal
abscesses may dissect for long distances along the bone surface.
• After first week, chronic inflammatory cells become more
• Cytokines from leukocytes stimulates
• osteoclastic bone resorption
• ingrowth of fibrous tissue
• deposition of reactive bone in the periphery
• Reactive woven or lamellar bone which forms sleeve of
living tissue surrounding dead bone is called involucrum
(living piece of bone).
• Brodie abscess: It is a small intraosseous abscess that
frequently involves the cortex and is walled off by
• Sclerosing osteomyelitis of Garre: It typically develops in
jaw and is associated with extensive new bone formation
that obscures much of the underlying osseous structure.
•5% to 25% of acute osteomyelitis fails to resolve
•Develop when there is delay in diagnosis, extensive bone
necrosis, inadequate antibiotic therapy or surgical
debridement, or weakened host defenses.
•Course … acute flare-ups
Complications of chronic osteomyelitis
Deformities of bones:
Systemic effects such as chronic fever & fatigue.
Amyloidosis of the AA type (secondary amyloidosis).
This can get further deposited in the kidney, liver & blood
Squamous cell carcinoma of the skin: The skin at the
edges of the draining sinus tracts may undergo malignant
transformation over time.
Rarely sarcoma in the infected bone
LAB DIAGNOSISLAB DIAGNOSIS
• WBC May be elevated, Usually normal
• C-Reactive Protein (CRP)
• Erythrocyte Sedimentation Rate
• Elevated at presentation
• Falls with successful therapy
• Blood culture
• ( Acute osteomyelitis + ve > 50% )
• Bone cultures
Soft tissue swelling
Lytic bone lesion surrounded by a rim of sclerosis
• Dissemination of tuberculosis outside the lungs can lead
to the appearance of skeletalTB:
Tuberculous osteomyelitis involves mainly the
thoracic and lumbar vertebrae (known as Pott
disease) followed by knee and hip.
There is extensive necrosis and bony destruction with
compressed fractures (with kyphosis) and extension
to soft tissues, including psoas "cold" abscess.
• Tuberculous osteomyelitis of the bone is secondary
hematogenous spread from a primary source in the
lung or GI tract.
• Once established, the bacilli provoke a chronic
• Small patches of caseous necrosis occur, and these
coalesce to form larger abscesses.
• The infection may spread across the epiphysis into the
joints or track along soft tissue to appear as a cold
abscess at a distant site (e.g. psoas abscess in case of
• The transplacental spread of spirochetes from
mother to the fetus results in congenital syphilis.
• Long bones, such as the tibia, are mainly affected.
• Congenital syphilis has 2 forms:
• Periosteitis and osteochonditis.
• Regarding acquired syphilis, bone lesions are
manifestations of tertiary syphilis.
• Gummatous lesions appear as discrete punched-out
radiolucent lesions in medulla or destructive lesions
within the cortex.
• The surrounding bone is sclerotic, and no discharge is
• Bones frequently affected are those of nose, palate, skull
and extremities, especially the long tubular bones such as
• Histology : edematous granulation tissue containing
numerous plasma cells and necrotic bone.