Osteomyelitis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nate Michalak, B.A.

Natural History

• Acute osteomyelitis presents with symptom onset after several days to weeks.

• Acute infection is typically defined as symptoms lasting less than 14 days.
• Patients typically develop prodromal symptoms after several days including: fever, malaise, irritability, lethargy, and chills.
• Local symptoms soon follow the prodrome and include: erythema, edema, warmth, and pain.

Complications

When the bone is infected, pus is produced in 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 to surrounding tissues or the bloodstream.

Prognosis

With treatment, 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 for those with an infection of an orthopedic prosthesis depends, in part, on:

• The patient's health
• The type of infection
• Whether the infected prosthesis can be safely removed