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Osteomyelitis - Infection of the bone

Skin Conditions, Age related illnesses, Inflammation, Bones | July 15, 2020 | Author: Naturopath

Skin conditions, Inflammation, age related

Osteomyelitis - Infection of the bone

Osteomyelitis describes inflammation and destruction of bone due to infection. This can occur from infection traveling in the blood stream or from infected tissue located nearby or can occur in the bone itself after an injury which has exposed bone to germs. Infection can be due to bacteria, mycobacteria or fungi.

Pathophysiology

Osteomyelitis tends to block blood vessels which causes necrosis (cell death) and increases the spread of infection locally. Infection may expand through the bone cortex and form subcutaneous abscesses which drain through skin.

Signs and Symptoms and Diagnosis of Osteomyelitis

  • Acute Osteomyelitis. Pain and tenderness, warmth, swelling and erythema to area of infection, fever and weight-loss.
  • Chronic Osteomyelitis. Chronic pain and tenderness that is intermittent. Sinuses may drain.

Osteomyelitis is confirmed by medical imagery, cultures taken from the site and serum ESR or C-reactive protein.

Causes of infection

Hematogenous osteomyelitis. This is when infection is from the blood stream. Risk factors include debilitation, aging, injection drug users, those with liver disease, sickle cell anaemia or the immunocompromised.

Open Wounds. This can be from injury or surgery. Trauma to the bone, ischaemia (lack of oxygen) and foreign objects can predispose to osteomyelitis. In some cases, ulcers from pressure sores may be the cause.

Contiguous Spread. Infection can come from prosthetic joints or wounds in the feet (complications from diabetes or peripheral neuropathy for example).

Other risks may include: sinus, tooth or gum infection which spreads to the skull; penetrating wound or trauma of bone during surgery; site damage from radiation therapy; and ulcers in vulnerable areas such as hip or sacrum.

  • Prosthetic joints are often used as a replacement to natural joints due to damage or deterioration from arthritis. Infection can occur during replacement operation or postoperative bacteraemia resulting from skin infection, pneumonia, dental procedures, urinary infection, invasive instruments or sometimes from trauma from a fall.
     
  • Diabetes and peripheral vascular disease can result in wounds of the extremities due to reduced circulation and poor nerve function (neuropathy causes loss of sensation and can result in trauma to the extremity). Diabetics (mellitus) with poor sugar control are at further risk of bacterial or fungal infection due to the adverse effects of sugar (hyperglycaemia) on immune function. Hyperglycaemia is a well-established risk factor for surgical site infection.

Contiguous spread is the most common cause of osteomyelitis occurring from infected tissue or an open wound nearby. Infection can be poly-microbial – meaning many different microbes, could be contributing to the infection, but Staphylococcus aureus is the culprit in 50% of cases. Other common bacteria include streptococci, gram-negative enteric organisms and anaerobic bacteria. Complications can develop when Staphylococcal form a biofilm (a natural mechanism), making it harder to eliminate, and is suggested as the main cause of chronic osteomyelitis.

Treatment of Osteomyelitis

Treatment of OsteomyelitisAntibiotics are the usual course of treatment. Different local delivery strategies are currently available which simultaneously deliver antibiotics to the site of infection as well as supporting bone regeneration.

In some cases, surgery may be necessary. If infection control is not completely resolved, a chronic osteomyelitis develops. 



Resistance to antibiotic treatmen may occur due to formation of a microbial biofilm. Biofims can provide pathogens with protection from antibiotic therapy as well as the host's own immune response, resulting in chronic and resistant infection. Surgery is usually required in these cases. 

Other non-antibiotic therapies include: metals (silver, iron, mercury, tellurium, copper, zinc and lead possess antimicrobial properties and have shown to be potential antimicrobial agents against drug-resistant bacteria, including MRSA and MRSE.

Chitosan is often combined with metal ions, such as the ions discussed above, to increase its antimicrobial activity against bacteria.

 Antimicrobial peptides are short proteins which form part of the human innate immune system and are secreted by leukocytes, the skin and various mucosal membranes. They have shown to inhibit both binding and biofilm -forming abilities of Staphylococcus aureus and Staphylococcus epidermidis.

Can Natural therapies help?

Natural therapies can be used to support the immune system and aid recovery.

Pre-operative care - preventative strategies

Supporting the immune system before any surgery can aid in recovery and help with prevention of infection. Vitamins A, D, C, E, B6, B12, folate and the minerals zinc, iron, copper and selenium play important roles, individually and sometimes together, at every stage of the immune response. Adequate amounts ensure appropriate function of physical barriers and immune cells. Dietary intake of micronutrients may be inadequate and further to this infection, stress and pollution can decrease the body’s stores.

Pre-operative care - preventative strategiesWhen micronutrients are deficient immunity is impaired. Supplementing can help modulate immune function and help reduce the risk of infection.

The most important of these micronutrients identified for their immune-supporting function are Vitamin D (very often deficient in many people), zinc and vitamin C. Zinc and vitamin C are also important for wound repair.

When these nutrients are needed to optimize immune protection and resistant to infection amounts taken are often above the RDA (recommended daily amount) and in treating an established infection, even higher doses are usually required. For example, vitamin C intake falls between 40 -110 mg daily, prophylactic amount suggested is 100 – 200mg daily, whereas infighting infection the amounts rise to around 6 grams daily. As we age our nutrient needs may increase due to issues of malabsorption. 

An adequate micronutrient intake is essential to aid recovery from infection

Probiotics influence the microbiota of the gut. Help strengthen mucosal barrier function and positively influence immune function.

Other ways to support a healthy immune response

  • Nutritious diet - fruit, vegetables and proteins - rich food (meat, poultry, fish, nuts, seeds, grains and legumes).
  • Reduce stress. Stress lowers immunity.
  • Adequate good quality sleep. Lack of sleep increases the ability to cope with stress, and lowers immunity
  • Physical activity help with circulation as well a healthy mind and body.

When the above is not balanced, oxidative stress is increased which increases the need for antioxidant nutrients – vitamin C and E and magnesium.

Chronic health conditions such as obesity and diabetes can also have an adverse effect on the efficient function of the immune system. Diabetics need to maintain healthy blood sugar levels and have regular podiatry checks of feet.

Dental health. Reduce risk of infection by maintaining healthy dental hygiene practices – efficient brushing and flossing and regular dental checks.

In cases of infection

Exposure to pathogens increases immune response and can cause losses of micronutrients, as can lack of appetite during infection and antibiotic use. Vitamin C and zinc can support recovery and aid wound repair, probiotics help to bring back the balance and support immune recovery.

Herbal medicines to conside

Turmeric/curcumin offers anti-microbial, anti-inflammatory and wound-healing abilities.

Echinacea offers immune stimulating, anti-inflammatory and anti-microbial activity.

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References

https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/infections-of-joints-and-bones/osteomyelitis?query=osteomyelitis

https://www.mayoclinic.org/diseases-conditions/osteomyelitis/symptoms-causes/syc-20375913#:~:text=Osteomyelitis%20is%20an%20infection%20in,exposes%20the%20bone%20to%20germs.

https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/infections-of-joints-and-bones/prosthetic-joint-infectious-arthritis

https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/complications-of-diabetes-mellitus#v29299410

Staphylococcal Osteomyelitis: Disease Progression, Treatment Challenges, and Future Directions https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5967688/

Staphylococcus aureus vs. Osteoblast: Relationship and Consequences in Osteomyelitis https://www.frontiersin.org/articles/10.3389/fcimb.2015.00085/full

A Review of Micronutrients and the Immune System–Working in Harmony to Reduce the Risk of Infection https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019735/

Zinc in Wound Healing Modulation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793244/

Diet affects mix of intestinal bacteria, risk of inflammatory bone disease https://www.sciencedaily.com/releases/2014/10/141002123243.htm

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