Osteomyelitis
Hematogenous, continuous, vascular disease, chronic
Staph Aureus is the #1 cause
Neonates-Group B Step, Kids-H Flu, Sex-gonorrhea, Elderly-gram neg, sicklers-salmonella
Puncture through shoes-pseudomonas (also prostheses and IVDA), animal bites pasteurella
Pain over bone, +ESR, 90% of Xrays positve after 1 month. (lucent areas of bone or periosteal rxn)
Bone Scan-3 phases. Technetium. Predilection for areas of increased osteoblastic activity. 1. 60 Seconds-angiogram 2. 15 min-areas of blood pooling 3. 2-4 hours-Inflammation Osteo is positive in all three phases
Can increase sensitivity with Indium 111 scan (WBC scan)
Rx: 2 to 4 weeks abx
Systematic Review of labs for osteo, white count useless, combination of ESR and CRP may be helpful. Normal ESR or CRP <5 mg/L seems to indicate negative unless high suspicion
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