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[Hematogenous osteomyelitis in adults]
W Strecker1, M Russ, M Schulte
1II. Chirurgische Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum Bamberg. chirurgie2@klinikum.bamberg.de
Abstract:
Hematogenous osteomyelitis (HOM) in adults is a very rare event in industrialised countries. However, in tropical regions the morbidity of HOM is more important, primarily due to the impact of sickle cell disease, thalassemia, HIV-infection and tuberculosis. HOM is most commonly caused by pyogenic bacteria and mycobacteria, but infections by fungi, viruses and parasites must also be considered. In spite of modern diagnostic procedures such as nuclear and magnetic resonance imaging, the histopathologic and microbiologic examination of bone remains the gold standard for diagnosing OM. Other diagnoses should also be considered. Nonbacterial osteomyelitic lesions (plasmacellular OM, sclerosing OM, SAPHO syndrome) as well as acute leukemia, malignant bone tumors (i.e., Ewing's sarcoma, osteosarcoma) are conditions with similar presentations. Acute HOM is best managed by appropriate antibiotic therapy. In case of failure and in chronic HOM, surgical debridement is mandatory.
Insights
Hematogenous osteomyelitis (HOM) is rare in developed nations but significant in tropical regions due to specific diseases. Diagnosis relies on bone examination, with antibiotics for acute cases and surgery for chronic or failed treatments.
Area of Science:
- Infectious Diseases
- Orthopedics
- Microbiology
Context:
- Hematogenous osteomyelitis (HOM) is uncommon in industrialized countries.
- HOM presents higher morbidity in tropical regions, linked to sickle cell disease, thalassemia, HIV, and tuberculosis.
- Infections involve pyogenic bacteria, mycobacteria, fungi, viruses, and parasites.
Purpose:
- To review the epidemiology, diagnosis, and management of adult hematogenous osteomyelitis.
- To highlight diagnostic challenges and differential diagnoses for osteomyelitis.
- To outline current treatment strategies for acute and chronic HOM.
Summary:
- Histopathologic and microbiologic bone examination remain the gold standard for diagnosing osteomyelitis (OM), despite advanced imaging.
- Differential diagnoses include nonbacterial osteomyelitic lesions and malignant bone tumors.
- Acute HOM management involves antibiotics; chronic or refractory cases require surgical debridement.
Impact:
- Provides a comprehensive overview of HOM for clinicians.
- Emphasizes the importance of accurate diagnosis and appropriate treatment selection.
- Contributes to understanding HOM's global health impact, particularly in endemic regions.
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