Inflammation of the bone marrow, usually combined with inflammation of the surrounding bone, caused by bacteria, viruses or fungi, but in 90 per cent of cases by staphylococci. Osteomyelitis occurs predominantly in children. Bacteria from an inflamed tonsil or boil reach the bone marrow via the bloodstream; usually the shin or thigh is affected, often near the knee. The first sign is often pain in the knee, associated with fever and nausea. Bacteria can also reach the bone from outside through injury at any age and in any bone. If bone marrow inflammation is not quickly recognized and treated it will spread, and there is danger that an abscess may form which, by increasing pressure and damaging the blood vessels of the bone, can limit blood supply, causing bone death. The dead bone floats loose (sequestered) in the abscess. As the process of inflammation proceeds, the abscess can break through the bone to lie under the periosteum, then break through this, and possibly form a fistula to the surface of the body. In such a case bacteria in the encapsulated abscess die, stopping the inflammation, but the encapsulation prevents the body from clearing away the abscess. Diagnosis is by symptoms, a blood test which may show the cause of inflammation, and bone examination by X-rays or possibly bone scan, in which radioac- tive material is injected which accumulates in the affected bone. A special photograph makes this visible. It may also be advisable to look for inflammation elsewhere in the body, which could be a source of the bone inflammation. Bone tumours give similar symptoms to bone marrow inflammation, and checks should be made for these too. If osteomyelitis is not treated quickly, chronic inflammation may set in, which could last a lifetime. For this reason the patient should be admitted to hospital as quickly as possible; the affected part must have maximum rest, if necessary by means of splints; and antibiotics should be administered in large quantities. An abscess can be lanced, the pus removed and antibiotics injected directly. In the case of widespread inflammation and dead bone in the abscess the bone can be opened by surgery, and antitibiotics again administered locally. In very severe cases amputation of the affected limb may be necessary.

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