Osteomyelitt

Osteomyelitt
Område(r)Revmatologi, podiatri
Ekstern informasjon
ICD-10-kodeM86
ICD-9-kode730
DiseasesDB9367
MedlinePlus000437
eMedicineped/1677 
MeSHD010019
MeSHC01.539.160.495

Osteomyelitt er en infeksjonssykdom som setter seg i bensubstans. Infeksjonen kan i prinsippet sette seg hvor som helst, men sitter oftest knenært hos barn, det vil si; distale femur og proksimale tibia. Årsaken er en hematogen spredning av steptokokker eller stafylokokker. Kan også forekomme etter operativ behandling av lukkede brudd.

Hos barn er ofte de lokale symptomene sparsomme, men det er vanlig at barnet ikke vil bruke det infiserte benet. En skal derfor være obs om et barn hinker eller ikke vil gå på foten i fravær av et traume. Pasienten trenger ikke alltid ha feber, og nedsatt almenntilstand. Sterke smerter i det angrepne beinvevet er også til stede.

Diagnosen er lett å stille klinisk, men blir ofte oversett, blant annet fordi tilstanden ikke kan sees på røntgen i tidlige stadier. Både senkningsreaksjonen og C-reaktivt protein (crp) vil være forhøyet. Også antall hvite blodceller vil være forhøyet. Ved mistanke om osteomyelitt skal en prøve til blodkultur taes snarest. En eventuell abscess skal punkteres, slik at en får materiale til bakterie- og resistensbestemmelse. I fravær av bevis med røntgen, vil en CT eller MR uvurderlig informasjon vedrørende diagnostisering og behandling.

Behandlingen starter så tidlig som mulig med antibiotika. Den første tiden vil antibiotikaen gis intravenøst. Behandlingen skal fortsette en stund etter pasienten er blitt symptomfri.

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