ISSN 2398-2969      

Osteomyelitis

Clapis

Synonym(s): Bacterial osteomyelitis, fungal osteomyelitis


Introduction

  • Cause: (most common) bacterial infection secondary to dental disease Dental malocclusion / overgrowth, introduced during orthopedic surgery Limb fracture repair: internal fixation or contamination from wounds or chronic ulcerative pododermatitis Ulcerative pododermatitis (Bumble foot).
  • Diagnosis
    • Radiographic changes: these lag 10-14 days behind surgery or introduction of infection.
    • Clinical signs.
    • Discharging sinuses, swelling at surgery site, limb dysfunction.
  • Treatment:
    • Early antimicrobials; culture and sensitivity Therapeutics: antimicrobials is essential because expensive antimicrobials are required for a protracted time.
    • Stabilization of fractures Limb fracture Spinal injury and excision of necrotic material/teeth/bone sequestrae.
    • Surgery; if chronic osteomyelitis.
    • Euthanasia Euthanasia in severe cases of ulcerative pododermatitis.
  • Prognosis: depends on factors such as site and extent of infection, and sensitivity of pathogen(s) involved.

Presenting signs

  • Acute: pyrexic systemic illness (very young animal following omphalophlebitis) - rare.
  • Chronic: limb dysfunction, muscle wasting, local pain, draining fistulous tracts.
  • Pain and lameness: sterile inflammatory reaction to implants, ulcerative pododermatitis.

Acute presentation

  • Systemically ill, lame (neonates).

Geographic incidence

  • Fungal osteomyelitis in warm climates (tropical and sub-tropical - rare in UK), eg coccidiomycosis, histoplasmosis, nocardiosis, cryptococcosis, aspergillosis, blastomycosis.

Age predisposition

  • Young: (acute osteomyelitis as primary disease following hematogenous spread) - rare.

Cost considerations

  • Long courses of antibiotics necessary.
  • Chronic osteomyelitis: surgery usually necessary to remove associated teeth, sequestrae, implants and graft bone.
  • Amputation may be necessary with severe ulcerative pododermatitis but should only be undertaken if contralateral limb is unaffected.

Special risks

  • Chronic osteomyelitis is rare unless bacterial contamination, tissue damage and continuing fracture instability exist.
  • Sterility is of paramount importance throughout any procedure involving hard tissue since treatment is problematic due to enlodgement, persistence of infection in bone and implants.
  • Infection can lead to → implant loosening → instability → reduction in body's ability to resolve the infection and decreased bone healing.
  • Operate on all bone graft sites with separate instruments and fresh surgical gloves.
  • Harvest graft before touching infected site.
  • Culture and sensitivity are essential; mixed infections are common/anaerobic infections are uncommon.
  • With dental associated abscesses Abscess, perform culture and sensitivity on a sample from the abscess capsule.

Culture surgically recovered tissue or implants. Superficial culture swabs from discharging sinuses are of little diagnostic value.

Pathogenesis

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Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Crawford A H, Hedley J E, Lam R et al (2017) Surgical treatment of a paraspinal abscess with osteomyelitis and spinal cord compression in a rabbit. JAVMA 251 (3), 340-344 PubMed.
  • Capello V (2016) Surgical treatment of facial abscesses and facial surgery in pet rabbits. Vet Clin Exot Anim Pract 19 (3), 799-823 PubMed.
  • Lindsey M J (2000) Metaphyseal osteomyelitis. Vet Rec 146 (1), 28 PubMed.
  • Dernell W S (1999) Treatment of severe orthopedic infections. Vet Clin North Am Small Anim Prac 29 (5), 1261-1274 PubMed.
  • Harcourt-Brown F M (1995) A review of clinical conditions in pet rabbits associated with their teeth. Vet Rec 137 (14), 341-346 PubMed.

Other sources of information

  • Hess L, Tater K (2012) Dermatological Diseases. Bacterial Infections. Ulcerative Pododermatitis. In: Ferrets, Rabbits & Rodents. Clinical Medicine and Surgery. Eds: Quesenberry K E & Carpenter J W. 3rd edn. Elsevier. pp 235. ISBN: 978-1-4160-6621-7.
  • Vella D (2013) Rabbits. Dental Disease. In: Clinical Veterinary Advisor. Birds and Exotic Pets. Eds: Mayer J & Donnelly T M. Elsevier. pp 355-360. ISBN: 978-1-4160-3969-3.
  • Vella D (2013) Rabbits. Pododermatitis. In: Clinical Veterinary Advisor. Birds and Exotic Pets. Eds: Mayer J & Donnelly T M. Elsevier. pp 407-409. ISBN: 978-1-4160-3969-3.
  • Capello V (2006) Small Mammal Orthopedics. In: Proc BSAVA Congress. pp 209-211.

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