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( Osteomyelitis)
Osteomyelitis is an infection of bone or bone marrow, usually caused by pyogenic bacteria or mycobacteria. It can be usefully subclassified on the basis of the causative organism, the route, duration and anatomic location of the infection. Generally microorganisms may be disseminated to bone hematogenously (i.e., via the blood stream), spread contiguously to bone from local areas of infection, such as cellulitis, or be introduced by penetrating trauma including iatrogenic causes such as joint replacements, internal fixation of fractures or root-canalled teeth. Leukocytes then enter the infected area, and in their attempt to engulf the infectious organisms, release enzymes that lyse bone. Pus spreads into the bone's blood vessels, impairing the flow, and areas of devitalized infected bone, known as sequestra, form the basis of a chronic infection. Often, the body will try to create new bones around the area of necrosis. The resulting new bone is often called an involucrum. On histologic examination, these areas of necrotic bone are the basis for distinguishing between acute osteomyelitis and chronic osteomyelitis. Osteomyelitis is an infective process which encompasses all of the bone (osseous) components, including the bone marrow. When it is chronic it can lead to bone sclerosis and deformity. Because of the particulars of their blood supply, the tibia, the femur, the humerus, the vertebra, the maxilla and the mandibular bodies are especially susceptible to osteomyelitis. [1] However abscesses of any bone may be precipitated by trauma to the affected area and many of the infections are caused by S. aureus, a member of the normal flora. In children, the long bones are usually affected. In adults, the vertebrae and the pelvis are most commonly affected.
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