g addicts (Carson De-Witt, 2001). Chickenpox and smallpox virus can also cause osteomyelitis. There have been reports of mycotic osteomyelitis caused by Scedosporium apiospermum in immunocompromised patients who contracted the infection at a penetrating injury site (Sydnor, Kaushik, Knight, Bridges and McCarty, 2003, 656-660). This form is difficult to detect because of its insidious onset, and negative joint fluid cultures, and synovial or bone biopsies are required for accurate diagnosis.
Bone infection can occur at any age, and can be due to the presence of a foreign body (e.g. a bullet or screws put in to hold broken bones together), intravenous drug use, diabetes, kidney dialysis, surgical procedures to bony areas, and untreated infections in tissue adjacent to bone, e.g. untreated sinus infections can lead to osteomyelitis of the skull (Carson-DeWitt, 2001).
Bacteria reach the bone in two main ways: via the bloodstream or from adjacent soft tissue (Carson-DeWitt, 2001). Most bone infections from the bloodstream are caused by S. Aureus, and the most likely site of bone infection is in the long bones, particularly the femur, the tibia, or the humerus in children because these bones have extensive circulatory systems during childhood, allowing access for the bacteria. The circulatory patterns are different in adults and so these bones are less likely to become infected. In adults, the vertebrae are the most likely targets, and in drug addicts the most likely targets are the pubic bones and the clavicle. Tissue infection after injury or surgery is by S. aureus in about 50 percent of cases. Bacteria spread to nearby bone and patients with diabetes are particularly susceptible to this type of infection.
Diagnosis of osteomyelitis is based primarily on clinical findings, such as leukocytosis, an elevated erythrocyte sedimentation rate, and elevated C-reactive protein levels (Carek, Dickerson and Sack, 2001). Bloo...