Review of contemporary knowledge of Osteomyelitis diagnosis

Osteomyelitis is an inflammation of the bone caused by a pyogenic organism that affects about 13 and 90 out of every 10 000 children and adults respectively. Symptoms of osteomyelitis are often nonspecific, including fever, chills, fatigue, lethargy or irritability. The major cause of bone infections is Staphylococcus aureus, however other pathogens may also lead to osteomyelitis. Due to nonspecific clinical picture and pathogenesis of osteomyelitis, the diagnostic process may be difficult, especially in the chronic form of the disease. It is essential to recognize this interdisciplinary malady and carry out a diagnostic process of osteomyelitis. The physical examination is extremely important in recognizing the osteomyelitis. The doctor ought to note scars, wound, erythema or oedema over the involved area and ask for systemic symptoms and bone pain. Subsequently, a physician should commission laboratory tests and microbiological examination, in order to verify the pathogenic organism, which must be treated with antibiotics. To put the right diagnosis, other studies such as plain radiography, magnetic resonance imaging, computed tomography, nuclear modalities must be performed. In differential diagnosis, other diseases such as bone tumours, fractures, Charcot Arthropathy, soft tissue infection, gout, osteonecrosis, and SAPHO syndrome must be considered. When both the diagnosis and the differential diagnosis is done, antimicrobial therapy is a treatment of choice together with an eventual surgical treatment which may be essential in certain cases. The differential diagnosis in patients with bone pain and systemic symptoms may be sometimes misleading and complicated. It is important, both for physician and patient, to recognize, carry out diagnostic and differential process in a way that a proper treatment shall be applied as soon as possible in order to avoid its complications, including even in an amputation of the affected limb.