Osteomyelitis - is the medical term used to describe infections of the bone tissue. In children, osteomyelitis most often affects the long bones of the legs and arms, and adults - the bones that make up the spine - the vertebrae. Previously considered incurable today osteomyelitis successfully treated.

Symptoms

Symptoms of osteomyelitis include:

• Fever or chills;
• Irritability or lethargy in young children;
• Pain in the area that struck the infection;
• Swelling and redness at the site of infection.

Sometimes osteomyelitis asymptomatic.

Causes

In most cases, osteomyelitis caused by staphylococcus, which lives on the skin, even in healthy people.

Bacteria can enter the bone in several ways:

• Through the bloodstream. Germs cause infection in other parts of the body - such as pneumonia, can get into the blood through the weakened areas of bone. In children, osteomyelitis pathogens often enter the so-called growth plates - a relatively soft portions of the bone at the ends of bones.
• From the infected surrounding tissue. If as a result of serious injury began soft-tissue infection, after a while the infection can spread to the bone.
• Direct contamination can occur as a result of severe bone fracture A bone fracture - the scourge of children and the elderly . Furthermore, some risk of direct infection of bone associated with surgery.

Risk factors

Normally, bones are highly resistant to infection. To happened disease osteomyelitis, requires the presence of factors that make the bones vulnerable:

• Recent trauma or orthopedic surgery.
• Circulatory problems. When blood vessels are damaged or blocked, cells of the immune system The immune system - how it works?   hard to get to the area of ​​the body, which began to develop an infection. As a result, a small cut, which normally heals quickly, can become a deep ulcer, from which, in turn, the infection can spread to the bone. For diseases that disrupt blood flow include diabetes, peripheral artery disease, often associated with smoking, sickle-cell anemia.
• Some medical procedures during which uses catheters, dialysis Dialysis - maintains normal body , and so on. With such procedures associated increased risk of penetration into the body of bacteria, which can lead to osteomyelitis.
• Introduction of intravenous drug users using non-sterile needles also increases the chance of developing osteomyelitis - as well as many other diseases.

Complications

Osteomyelitis can cause the following complications:

• Osteonecrosis - bone necrosis. Infection of bone may prevent blood flow in the bone tissue, causing a gradual extinction. This complication is treated by means of a surgical operation, during which removes the dead tissue. If osteonecrosis struck a significant part of the bone to prevent the spread of infection may require amputation.
• Septic arthritis Arthritis - a variety of forms and complications   It occurs when the infection spreads to the bone surrounding the joints.
• Dysplasia - a complication of osteomyelitis, which is found only in children.
• Skin cancer. If osteomyelitis led to the formation of purulent ulcers, there is a high probability that the surrounding skin will develop cancer cells.

Diagnostics

For the diagnosis of osteomyelitis of the following methods:

• Blood test. Using the blood test reveals increased white blood cell count and other factors, which may be an indicator that the body is fighting infection. If osteomyelitis caused by infection, pathogens are present in the blood analysis will help determine the type of infection.
• X-rays help identify damaged bone. However, the damage may become apparent until several weeks after the onset of osteomyelitis.
• Computed tomography provides a more complete picture of what happens to human bone tissue.
• Magnetic resonance imaging provides a detailed picture of bone and adjacent soft tissues.
• Biopsy of bone makes it possible to identify the causative agent of osteomyelitis, and then choose the most appropriate method of treatment.

During Mycobacterium tuberculosis miliary spread through the bloodstream through the lungs, and often throughout the body, leading to the emergence of many tuberculous lesions, the diameter of which is from 1 to 5 mm. Miliary tuberculosis develops in 1-3% of patients suffering from open tuberculosis. Without treatment, the disease can lead to death.

Miliary tuberculosis, or other individual organs is rare - less than 5% of cases; it usually affects several organs, including the brain. TB brain lesions detected in approximately a quarter of patients with miliary tuberculosis. Miliary tuberculosis is dangerous by the fact that it tries to mimic other diseases, and there are cases when it is diagnosed only after the death of the patient.

Symptoms of miliary tuberculosis

Miliary tuberculosis patients may experience the following symptoms:

• Weakness, lethargy (found in 90% of patients with the disease);
• Weight reduction (80%);
• Headache (10%);
• Increase in body temperature (80%);
• Cough (60%);
• Generalized lymphadenopathy (40%);
• Enlargement of liver (40%);
• Increase of the spleen (15%);
• Pancreatitis (less than 5%);
• Adrenal insufficiency.

Diagnostics

Differential diagnosis plays an important role in the diagnosis of miliary tuberculosis. Its symptoms can be similar to symptoms of the following diseases:

• Respiratory distress syndrome;
• Addison's disease;
• Ascites;
• Blastomycosis;
• Cardiac tamponade;
• Hypersensitivity pneumonitis;
• Pneumocystis pneumonia;
• Bacterial pneumonia;
• Fungal infections;
• Histiocytosis Langerhans cell;
• Pulmonary opportunistic infections associated with HIV;
• Measles.

The procedures that are used in the diagnosis of miliary tuberculosis:

• A complete blood count;
• Analysis on the erythrocyte sedimentation rate - usually in patients with miliary tuberculosis, it increased by about 50%;
• Lumbar puncture;
• Tuberculin skin test;
• Chest x-ray;
• Computed tomography (CT). The diagnostic process may require chest CT, brain or abdomen;
• Ultrasonography (US). Using ultrasound can detect lesions caused by miliary tuberculosis of the liver, spleen, lymph nodes, and so on;
• Echocardiography - the most accurate method of diagnosis of exudative pericarditis Pericarditis - not a disease but a complication Which is sometimes seen in patients with miliary tuberculosis.

Treatment of miliary tuberculosis

It is crucial time to begin treatment of miliary tuberculosis; late only 1-8 days significantly increases the risk of death.

For the treatment of multiple drugs used (usually four), among which - isoniazid, rifampicin, ethambutol, pyrazinamide, amikacin, ethionamide, moxifloxacin, para-aminosalicylic acid, streptomycin. If miliary tuberculosis Tuberculosis - a full recovery is not guaranteed   caused by bacteria that respond well to drugs, treatment can last 6-9 months. When tuberculous meningitis TB meningitis - the consequences of the spread of the pathogen   It can be assigned to a course of therapy lasting twelve months, and if the disease pathogens have become drug-resistant bacteria, medications sometimes have to take up to eighteen months. Moreover, different drugs often must be taken at different times, and it is important not to miss taking medication that therapy was as effective as possible. Many patients, especially those living in the same household with children under five years of age or people with weakened immune systems Immunity - types and characteristics in children in adults It is recommended to be hospitalized for the first 2-4 weeks of treatment. At the hospital, doctors attach great importance not only receive medicines according to the mode of therapy, and nutrition of patients: many of them due to illness there is no appetite, but nutrition plays a key role in the treatment process. Typically, patients are discharged after three consecutive sputum examination will give a negative result - that means that the person is no longer contagious.

Forecast

Before there were anti-TB drugs, the mortality rate of patients with miliary tuberculosis was close to 100%. Timely and correct treatment reduces mortality to 10%. The sooner was diagnosed and started treatment, the prognosis is more favorable. Most of the deaths in this disease occurs in the first two weeks of stay in hospital - probably due to the late start of treatment. Up to 50% of all cases of miliary tuberculosis are detected only during the autopsy.

The probability of relapse is 4%, and it is the smaller, the more carefully the patient performs a doctor's recommendation regarding the medication. Most relapses occur within the first 24 months after treatment.