Hematogenous osteomyelitis in adults

Hematogenous osteomyelitis (HOM) in adults is a very rare event in industrialised countries. However, in tropical regions the morbidity of HOM is more important, primarily due to the impact of sickle cell disease, thalassemia, HIV-infection and tuberculosis. HOM is most commonly caused by pyogenic bacteria and mycobacteria, but infections by fungi, viruses and parasites must also be considered. In spite of modern diagnostic procedures such as nuclear and magnetic resonance imaging,the histopathologic and microbiologic examination of bone remains the gold standard for diagnosing OM. Other diagnoses should also be considered. Nonbacterial osteomyelitic lesions (plasmacellular OM, sclerosing OM, SAPHO syndrome) as well as acute leukemia, malignant bone tumors (i.e., Ewing's sarcoma, osteosarcoma) are conditions with similar presentations. Acute HOM is best managed by appropriate antibiotic therapy. In case of failure and in chronic HOM, surgical debridement is mandatory.