Osteomyelitis (bone infection): symptoms, causes and treatment

The NHS says osteomyelitis usually causes severe pain, most often affecting the legs, but it may affect other parts of the body. Other symptoms include swelling of the affected area, a feeling of warmth, redness of the skin (which may be harder to see on black or brown skin), a limp (more common in children) and a high temperature.

NI Direct adds that the area of infected bone will be tender to touch, and that you may feel hot and shivery and generally unwell. The NHS says that young children do not always get a high temperature, so take your child to a GP if they do not want to use an arm or leg and seem irritable.

Osteomyelitis is the medical term for infected bone. Oxford University Hospitals explains that it can occur in any bone, is more commonly associated with an area of bone near a site of previous injury or surgery, and can also occur spontaneously without known injury or disease.

Cambridge University Hospitals says that in most cases bacteria are responsible, although fungi can also cause it, and that bacteria usually travel via the bloodstream and settle in the bone or joint. It can occur together with septic arthritis, an infection of a joint. NI Direct notes that sometimes an infection in the blood affects the bone.

The NHS says anyone can develop osteomyelitis, but you are more at risk if you have had osteomyelitis before, have diabetes (especially with a foot ulcer), have broken a bone, have been injured and have a wound, have had an infection or surgery, or have a weakened immune system, for example because of chemotherapy or HIV. Children may also be more likely to get it after a respiratory infection or chickenpox.

The NHS also notes that if you have poorly controlled diabetes you can lose sensation in your feet and not notice small cuts, which could develop into an infection that spreads to the bone, so it is very important to look after your feet.

The NHS says the GP will examine the area and may do tests. You might need a blood test or to go to hospital for an X-ray, CT scan or MRI scan, and a biopsy, where a small sample of fluid is taken from the bone and sent for testing.

Cambridge University Hospitals explains for children that blood tests cannot confirm osteomyelitis alone but can show a high number of white blood cells, that early on blood tests may identify the type of bacterium to choose the right antibiotics, and that X-rays are not usually useful in early stages whereas MRI can detect bone damage.

The NHS says osteomyelitis is treated with antibiotics, either in hospital or at home. You will usually take antibiotics for 4 to 6 weeks, and if you have a severe infection you may need them for up to 12 weeks. It is important to finish the course even if you feel better. You can take painkillers to ease the pain, and if the infection is in a long bone such as an arm or leg you may be fitted with a splint so you do not move it as often.

NI Direct explains you may have to stay in hospital to get antibiotics directly into a vein, and when you get better you may be able to take tablets at home. For children, Cambridge University Hospitals says osteomyelitis is usually treated with antibiotics for two to six weeks, often given intravenously through a long-term line, with community nurses sometimes giving them at home.

Oxford University Hospitals explains that antibiotics reach the infected area through the blood, but infection can weaken bone or cause bone to die, and dead bone has an impaired blood supply, so treating bone infection with antibiotics alone can be difficult, which may mean removing dead or infected bone.

The NHS says children may be more likely to get osteomyelitis after a respiratory infection or chickenpox, and that young children do not always have a high temperature. Cambridge University Hospitals says to look out at home for a high temperature of 38C or above, intense bone pain, swelling, redness and warmth in the affected area, irritability and reduced appetite, and reluctance to use a limb.

It describes a team that includes paediatricians, paediatric orthopaedic surgeons, anaesthetists, nurse specialists and community nursing teams, and says the orthopaedic surgeon may need to monitor the growth of the bone long term.

The NHS says to ask for an urgent GP appointment or contact NHS 111 if you have pain, swelling, redness and a warm sensation over an area of bone, a very high temperature (or you feel hot, cold or shivery) and feel generally unwell, or have had osteomyelitis before and think the symptoms have come back.

Take your child to a GP if they do not want to use an arm or leg and seem irritable. If it is not treated quickly, the NHS says osteomyelitis can cause serious long-term problems, such as infections and permanent damage to your bones.

Osteomyelitis is assessed urgently by a GP, NHS 111 or hospital, and often treated by a team including infection specialists and orthopaedic surgeons. Specialist limb reconstruction services, such as the one described by Oxford University Hospitals, treat complex chronic bone infection.

Private orthopaedic and infection services also exist. Whatever the route, the crucial points are prompt antibiotics, finishing the full course and attending follow-up so that relapse is picked up early.