Osteomyelitis

Osteomyelitis

Osteomyelitis is an acute or chronic bone infection.

Causes

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.


Symptoms

* 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

Treatment

The objective of treatment is to eliminate the infection and prevent it from getting worse.

Antibiotics will be given to destroy the bacteria that are causing the infection. You may be given more than one antibiotic at a time. Often, the antibiotics are given through an IV (intravenously, meaning through a vein) rather than by mouth. Antibiotics are taken for at least 4-6 weeks, sometimes longer.

Surgery may be needed to remove dead bone tissue if you have an infection that does not go away. If there are metal plates near the infection, they may be removed. The open space left by the removed bone tissue may be filled with bone graft or packing material that promotes the growth of new bone tissue.

Infection of an orthopedic prosthesis may require surgical removal of the prosthesis and infected tissue surrounding the area. A new prosthesis may be implanted in the same operation or delayed until the infection has gone away.

If the patient has diabetes, it will need to be well controlled. If there are problems with blood supply, surgery to improve blood flow may be needed.

The oral cavity

Oral bacteria

Oral bacteria include streptococci, lactobacilli, staphylococci, corynebacteria, and various anaerobes in particular bacteroides. The oral cavity of the new-born baby does not contain bacteria but rapidly becomes colonized with bacteria such as Streptococcus salivarius. With the appearance of the teeth during the first year colonization by Streptococcus mutans and Streptococcus sanguis occurs as these organisms colonise the dental surface and gingiva. Other strains of streptococci adhere strongly to the gums and cheeks but not to the teeth. The gingival crevice area (supporting structures of the teeth) provides a habitat for a variety of anaerobic species. Bacteroides and spirochetes colonize the mouth around puberty.

Treponema denticola

The levels of oral spirochetes are elevated in patients with periodontal diseases. Among this group, Treponema denticola is the most studied and is considered as one of the main etiological bacteria of periodontitis. Treponema denticola is a motile and highly proteolytic bacterium.

Fusospirochetes

Spirochetes and fusi-form bacilli live as normal flora in the mouth, but in the case of bleeding in the oral cavity, the bacteria can cause infection and diseases to oral cavity: 1/ Acute necrotizing ulcerative gingivitis (ANUG) 2/ Vincent angina with a membrane covering the throat area

Veillonella

Veillonella are gram-negative anaerobic cocci. It is thought that this species thrives in the acidic environment of caries and is thought to slow the development of dental caries. It converts the acidic products of other species to less acidic products.

Porphyromonas gingivalis

Porphyromonas gingivalis is a Gram-negative oral anaerobe strongly associated with chronic adult periodontitis. The bacterium produces a number of well-characterized virulence factors and can be manipulated genetically. The availability of the genome sequence is aiding our understanding of the biology of P. gingivalis and how it interacts with the environment, other bacteria and the human host.

Aggregatibacter actinomycetemcomitans

Aggregatibacter actinomycetemcomitans is considered an oral pathogen due to its virulence factors, its association with localized aggressive periodontitis in young adolescents, and studies indicating that it can cause bone loss.

Lactobacillus

Some Lactobacillus species have been associated with dental caries although these bacteria are normally symbiotic in humans and are found in the gut flora.

WOMEN WITH PERIODONTAL DISEASE

A new study by NYU dental researchers has uncovered evidence that pregnant women with periodontal (gum) disease face an increased risk of developing gestational diabetes even if they don't smoke or drink, a finding that underscores how important it is for all expectant mothers – even those without other risk factors – to maintain good oral health.

The study, led by Dr. Ananda P. Dasanayake, Professor of Epidemiology & Health Promotion at New York University College of Dentistry in collaboration with the Faculty of Dental Sciences at the University of Peradeniya, Sri Lanka, eliminated smoking and alcohol use among a group of 190 pregnant women in the South Asian island nation of Sri Lanka, where a combination of cultural taboos and poverty deter the majority of women from smoking and drinking.

The findings support an earlier study led by Dr. Dasanayake that found evidence that pregnant women with periodontal disease are more likely to develop gestational diabetes than pregnant women with healthy gums.

That study, which followed 256 women at New York's Bellevue Hospital Center through their first six months of pregnancy, showed that 22 of the women developed gestational diabetes. Those women had significantly higher levels of periodontal bacteria and inflammation than the other women in the study. The findings were published in the April 2008 issue of the Journal of Dental Research.

More than one-third of the women in the new study, which was conducted over the course of one year, reported having bleeding gums when they brushed their teeth. The women were given a dental examination and a glucose challenge test, which is used specifically to screen for gestational diabetes.