This is part of our House MD Project series.
Click here to read the connection to the episode (spoiler alert!)
Danger level: High
What is it?
Osteomyelitis (OM) is an infection of the bone.
Who gets it?
Osteomyelitis isn’t very common: it happens to about 2 out of every 10,000 people.
It occurs mostly in young children and older adults, but it can affect anyone.
Osteomyelitis is an infection of bone. Photo by an untrained eye.
It’s more likely to occur in these people:
1. People with diabetes, sickle cell disease, HIV or AIDS, Rheumatoid arhritis
2. People who abuse alcohol or IV drugs
3. People who use steroids for a long time
4. People who are after a severe bone fracture or bone surgery
What causes it?
When a bone becomes infected, its inner part (the bone marrow) becomes swollen and presses against the rigid outer wall of the bone. That also presses the blood vessels in the bone, cutting the blood supply to the bone. Without it, bone simply dies.
The dead bone (called sequestra) is difficult for the body to cure, since its protective cells usually use the blood to reach places of infection.
How does it feel?
Acute osteomyelitis (acute because it can also become a long term condition, called chronic osteomyelitis) develops rapidly over a period of 7-10 days. Symptoms include:
- Fever, fatigue, irritability
- Nausea
- Tenderness, swelling, warmth and redness around the area of infection
- Lost range of motion of the involved extremity
If it happens in the vertebrae it can cause back pain.
How is it discovered?
On X-ray changes typical for osteomyelitis may show, but it may take them a few weeks to show up. CT and MRI can also be used, but they can’t make the diagnosis since what you see there may be seen in other types of bone problems.
An image showing osteomyellitis in the vertebral column. Photo by Nuclear Fire
Bone scans (images of bone taken after injecting a radioactive substance into the body) will almost always show a problem.
The doctor may take a sample of blood, pus, joint fluid, or the bone itself to diagnose infection to the bone and the germs causing it.
How is it treated?
Antibiotics are usually used to treat OM. Depending on the severity of the infection, they may be given directly to the vein at first but can be given by mouth later. Usually treatment takes weeks (between 4-8).
Sometimes surgery is needed to clear the infected area.
What happens after treatment?
With early and proper treatment, the condition usually goes away. There can be complications, though, such as an abscess (like the one on the House episode, causing the foul breath in the patient).
In some cases, the disease can spread to a nearby joint, causing an infection in the joint. If OM happens in children, it may impair their growth afterwards. The condition may also lead to skin cancer in the area of the infection.
The bottom line – How do I avoid it?
People with artificial joints or metal components attached to a bone should take preventive antibiotics before surgery since they may be at increased risk of infection from bacteria normally present in the mouth and other parts of the body (In the House episode the patient had an artificial jaw that got infected).
What next?
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Related posts:
- Osteoporosis – How Your Bones Can Get Thinner With Age And What You Can Do To Avoid It
- Treacher-Collins Syndrome – Being Born Without Cheek Bones (As Seen on Grey’s Anatomy)
- Necrotizing Fasciitis Revisited, Osteosarcoma, and Aneurysms – (As Seen on House MD)
- Echoviruses (As Seen on House MD)
- Gas Gangrene – An Infection That Can Rapidly Kill Your Muscles (As Seen on House MD)
