Yes, you absolutely can have osteomyelitis (a bone infection) for years and not know it, as it can be insidious, asymptomatic, or present with vague pain, forming chronic abscesses (like Brodie's abscess) that go undetected for months or even decades, especially if the bacteria are less virulent or the immune system is suppressed, leading to delayed diagnosis.
Sometimes, chronic osteomyelitis is undetectable for a long time, causing no symptoms for months or years.
Chronic osteomyelitis – This infection is hard to treat with antibiotics and can go undetected for months or even years, where it causes severe bone pain and continuous development of (pus) drainage after a certain point.
Late onset chronic osteomyelitis is unusual and necessary to be considered as differential diagnosis when dealing with new onset pain in trauma sites. A few cases of late infections up to 19 years after healed fractures have been reported in the literature.
Symptoms of osteomyelitis
Imaging features of extranodal lymphoma can mimic osteomyelitis when affecting the bone marrow of long bones [43]. Similarly, primary bone lymphoma, which is a non-Hodgkin lymphoma, also shares similar imaging characteristics as a long bone infection [44].
For most people, bone-on-bone knee pain is a dull ache that worsens over time. Some people experience sharp pain, but it's less common. Sometimes, the sensation is described as being similar to a toothache but in the knee. The pain may get worse with activity, especially high-impact exercise like running.
Chronic pain, an area of erythema around the affected bone, swelling and bone tenderness, impaired wound healing often associated with tissue necrosis, increased drainage or persistent sinus tracts, chills, low grade fever and general malaise are some of the most commonly reported clinical symptoms (Fig. 1).
Diagnosing Osteomyelitis
Osteomyelitis can develop rapidly and may be accompanied by pain, fever, and stiffness. Symptoms may appear within days. Chronic osteomyelitis progresses slowly and may be the result of a previous bone infection.
Systemic infection: People can live with bone infection for years as long as the bacteria do not enter the bloodstream and cause the rest of the body to become sick. Signs of systemic infection include fever, chills, rapid heartbeat, and low blood pressure.
Pain at the site that becomes worse when pressing on the affected area or standing. Deep bone pain. Swelling, redness, and tenderness at the site. Fever, chills, and sweating.
Historically, osteomyelitis has been categorized as acute, subacute or chronic, with the presentation of each type based on the time of disease onset (i.e., occurrence of infection or injury).
[13] Imaging modalities such as plain radiography, CT, and MRI can help visualize the bony structural changes, soft tissue involvement, and extent of infection in osteomyelitis.
This blood test analyses the minerals, proteins and enzymes in your bones to help you understand the health and development of your bone structure. This can help identify your risk of various bone disorders. As you age, bones naturally weaken, which can have a negative impact on your health.
The hallmark of chronic osteomyelitis is the presence of dead bone (sequestrum). Other common features of chronic osteomyelitis include involucrum (reactive bony encasement of the sequestrum), local bone loss, and, if there is extension through cortical bone, sinus tracts.
MRI has the highest accuracy to detect osteomyelitis with a sensitivity of 90% and specificity of ~80% 21.
Thanks to exceptional experience and skill, orthopaedic surgeons and infectious disease specialists work together to provide unparalleled diagnosis and treatment of osteomyelitis.
Adults usually develop it in their vertebrae (the bones that make up your spine) or hips. If it's not treated in time, osteomyelitis can cause permanent bone loss and necrosis (tissue death).
Osteomyelitis in your foot doesn't always cause symptoms. You may not know you have a bone infection until you get treatment for a wound that won't heal. Some people experience one or more signs of a bone infection: Drainage around a foot or ankle wound (drainage can vary in color, consistency, and odor)
Bone pain usually feels dull and achy — like the pain is coming from deep inside your body. The skin near the affected area will probably feel tender to any touch. It might also hurt when you move or use that part of your body. You'll probably be able to pinpoint exactly where your bone hurts.
Blood cultures should always be obtained when osteomyelitis is suspected, though they are often negative except in cases of hematogenous osteomyelitis. The gold standard for the diagnosis of osteomyelitis is bone biopsy with histopathologic examination and tissue culture.
Bone pain is a “red flag” and is a common feature of leukaemia, metastatic neuroblastoma and primary bone tumours. This may be night pain or constant 'nagging' pain. These malignancies may present with a swollen joint(s) and can mimic arthritis.
What Are The 10 Most Painful Bone Fractures
Treatment strategy