Inflammatory Disease of Skeletal System
Reviewer
Chapter 2 part 2
Osteomyelitis
• is an infection of the bone and bone marrow caused by a pathogenic microorganism
spread via the bloodstream (hematogenous), from an infection within a contiguous
site, or through direct introduction of the microorganism
• Signs and symptoms may include dull pain, heat in the affected area, and an
intermittent low-grade fever. Generally, hematogenous osteomyelitis develops at
the ends of the long bones
• Acute hematogenous osteomyelitis-commonly affected are infants and children
because of increased vascularity and the rapid growth of their long bones
• Infection may be spread to the marrow space via the nutrient artery from an
infection of the skin, ear, or pharynx
• Staphylococcus aureus and streptococci -the pathogenic microorganisms
primarily responsible for the infections
• Osteomyelitis resulting from contiguous infections is often associated with
burns, sinus disease, periodontal infection, soft tissue infection, or skin ulcers
resulting from peripheral vascular disease
• No specific bone changes may be demonstrated radiographically in the very early
stage of infection.
• But the infection spreads rapidly, with the acute stage of osteomyelitis
characterized by the formation of an abscess, leading to an inflammatory reaction
within the bone that causes a rise in internal bone pressure
• In adults, hematogenous osteomyelitis is commonly secondary to bacteremia
caused by genitourinary tract, soft tissue, or respiratory infections
• Osteomyelitis may be diagnosed with elevated erythrocyte sedimentation rate (ESR)
or cross-reactive protein (CRP) levels; however, normal laboratory values should not
exclude this diagnosis. Because of the constriction of the periosteum, blood vessels
compress and thrombose, leading to bone necrosis within 24 to 48 hours.
, • It is imperative that the condition be recognized clinically and treated with
antibiotics and local drainage.
• Chronic osteomyelitis, however, is characterized by extensive bone destruction with
irregular, sclerotic reaction throughout the bone
• Sequestrum is dead, devascularized bone that appears very dense
• Involucrum is a shell of new supporting bone laid down by the periosteum around
the sequestrum
• Nuclear medicine bone scan studies and MRI are much more sensitive in
detecting osteomyelitis.
Tuberculosis
• Tuberculosis of the bone is a chronic inflammatory disease caused by
Mycobacterium tuberculosis
• It is usually more advanced and often left untreated for a longer period
compared with pulmonary tuberculosis
• It most commonly affects the hip, knee, and spine
• Radiographically, the ends of the long bones display a “worm-eaten”
appearance, with the disease slowly destroying the epiphyses, spreading to the
articular cartilage, and, in some cases, infecting the joint space
• Pott disease- Tuberculosis of the spine
• Described in Egyptian mummies dating back to 3000 BC
• It destroys the spine, causing softening and eventual collapse of the vertebrae,
which results in paravertebral abscess formation and exerts abnormal pressure
on the spinal cord
• For many years, osteoarthritis was believed to be a noninflammatory type of
arthritis; however, current research has indicated that all types of arthritis
involve inflammation of joints
Reviewer
Chapter 2 part 2
Osteomyelitis
• is an infection of the bone and bone marrow caused by a pathogenic microorganism
spread via the bloodstream (hematogenous), from an infection within a contiguous
site, or through direct introduction of the microorganism
• Signs and symptoms may include dull pain, heat in the affected area, and an
intermittent low-grade fever. Generally, hematogenous osteomyelitis develops at
the ends of the long bones
• Acute hematogenous osteomyelitis-commonly affected are infants and children
because of increased vascularity and the rapid growth of their long bones
• Infection may be spread to the marrow space via the nutrient artery from an
infection of the skin, ear, or pharynx
• Staphylococcus aureus and streptococci -the pathogenic microorganisms
primarily responsible for the infections
• Osteomyelitis resulting from contiguous infections is often associated with
burns, sinus disease, periodontal infection, soft tissue infection, or skin ulcers
resulting from peripheral vascular disease
• No specific bone changes may be demonstrated radiographically in the very early
stage of infection.
• But the infection spreads rapidly, with the acute stage of osteomyelitis
characterized by the formation of an abscess, leading to an inflammatory reaction
within the bone that causes a rise in internal bone pressure
• In adults, hematogenous osteomyelitis is commonly secondary to bacteremia
caused by genitourinary tract, soft tissue, or respiratory infections
• Osteomyelitis may be diagnosed with elevated erythrocyte sedimentation rate (ESR)
or cross-reactive protein (CRP) levels; however, normal laboratory values should not
exclude this diagnosis. Because of the constriction of the periosteum, blood vessels
compress and thrombose, leading to bone necrosis within 24 to 48 hours.
, • It is imperative that the condition be recognized clinically and treated with
antibiotics and local drainage.
• Chronic osteomyelitis, however, is characterized by extensive bone destruction with
irregular, sclerotic reaction throughout the bone
• Sequestrum is dead, devascularized bone that appears very dense
• Involucrum is a shell of new supporting bone laid down by the periosteum around
the sequestrum
• Nuclear medicine bone scan studies and MRI are much more sensitive in
detecting osteomyelitis.
Tuberculosis
• Tuberculosis of the bone is a chronic inflammatory disease caused by
Mycobacterium tuberculosis
• It is usually more advanced and often left untreated for a longer period
compared with pulmonary tuberculosis
• It most commonly affects the hip, knee, and spine
• Radiographically, the ends of the long bones display a “worm-eaten”
appearance, with the disease slowly destroying the epiphyses, spreading to the
articular cartilage, and, in some cases, infecting the joint space
• Pott disease- Tuberculosis of the spine
• Described in Egyptian mummies dating back to 3000 BC
• It destroys the spine, causing softening and eventual collapse of the vertebrae,
which results in paravertebral abscess formation and exerts abnormal pressure
on the spinal cord
• For many years, osteoarthritis was believed to be a noninflammatory type of
arthritis; however, current research has indicated that all types of arthritis
involve inflammation of joints
