Chapter 19 : Osteomyelitis

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Different types of osteomyelitis can be classified according to the source of the infection (i.e., hematogenous or contiguous focus) and the vascular capability of the host (i.e., with or without generalized vascular insufficiency). Due to the abundant vascular supply, the most common sites of hematogenous osteomyelitis are the metaphyses of tubular bones. The major types of hematogenous osteomyelitis seen clinically include long-bone and vertebral osteomyelitis. Chronic vertebral osteomyelitis arises most often in those patients that have predisposing factors, such as the use of nonsterile injection techniques by intravenous drug abusers, previous spinal surgery, or implanted hardware. All three mechanisms may cause skin ulceration with subsequent skin infection, which may lead to contiguous-focus osteomyelitis. Staphylococcal products that have a role in osteomyelitis may be classified as virulence factors responsible for adherence, direct host damage, or immune avoidance. Clinical strains of spp. are able to persist through a number glycocalyx properties. First, this layer has been shown to protect the embedded pathogens from the action of antimicrobial agents and the host immune system by forming a mechanical barrier. Second, local immune deficiency often occurs through frustrated phagocytosis, since the normal phagocytic processes are devoted to the removal of the glycocalyx and the implant, if present. Different types of chronic osteomyelitis can be classified according to the source of the infection (i.e., hematogenous or contiguous focus) and the vascular capability of the host (i.e., with or without generalized vascular insufficiency).

Citation: Shirtliff M, Mader J. 2000. Osteomyelitis, p 375-396. In Nataro J, Blaser M, Cunningham-Rundles S (ed), Persistent Bacterial Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818104.ch19

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Systemic and local factors that affect immune surveillance, metabolism, and local vascularity

Citation: Shirtliff M, Mader J. 2000. Osteomyelitis, p 375-396. In Nataro J, Blaser M, Cunningham-Rundles S (ed), Persistent Bacterial Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818104.ch19

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