Osteomyelitis causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

The etiology of osteomyelitis include a wide range of microbes, organized based on prevalence in patients of different age groups.

Causes

Etiolgic agents of osteomyelitis can be classified in several ways.

Etiologies based on age group

Age group	Most common organisms
Newborns (younger than 4 mo)	S. aureus, Enterobacter species, and group A and B Streptococcus species
Children (aged 4 mo to 4 y)	S. aureus, group A Streptococcus species, Haemophilus influenzae, and Enterobacter species
Children, adolescents (aged 4 y to adult)	S. aureus (80%), group A Streptococcus species, H. influenzae, and Enterobacter species
Adult	S. aureus and occasionally Enterobacter or Streptococcus species

Microbiology based on prevalence

Microbiology of osteomyelitis

Common causes
≥ 50% cases

Occasional causes
25%-49% cases

Rare causes
<5% cases

•Staphylococcus aureus
•Coagulase-negative staphylococci

•Streptococci
•Enterococci
•Pseudomonas spp
•Enterobacter spp
•Proteus spp
•Escherichia coli
•Serratia spp
•Anaerobes (Finegoldia spp, Clostridium spp, Bacteroides fragilis group)
•Mycobacterium tuberculosis

•Mycobacterium avium-intracellulare complex
•Rapidly growing mycobacteria
•Dimorphic fungi (blastomycosis, •coccidioidomycosis, •sporotrichosis)
•Candida spp
•Cryptococcus
•Aspergillus spp
•Mycoplasma spp
•Tropheryma whipplei
•Brucella spp
•Salmonella spp
•Actinomyces

Common Causes

Staphylococcus aureus

Streptococcus pyogenes

Haemophilus influenzae

Enterobacter

Escherichia coli

Pseudomonas

Streptococcus pneumoniae

Mycobacterium tuberculosis

Cellulitis

Septic arthritis

Fracture

Causes by Organ System

Cardiovascular	Arterial insufficiency ulcer, Polyarteritis nodosa, Thrombophlebitis, Rheumatic fever
Chemical / poisoning	No underlying causes
Dermatologic	Cellulitis, Marjolin’s ulcer, Fanconi like syndrome
Drug Side Effect	Daptomycin, Flucloxacillin, Pergolide, Pramipexole
Ear Nose Throat	Otitis
Endocrine	Diabetic myonecrosis
Environmental	No underlying causes
Gastroenterologic	Gaucher disease
Genetic	Congenital insensitivity to pain with anhidrosis, Gaucher disease, Infantile cortical hyperostosis, Pycnodysostosis, Thick skull syndrome
Hematologic	Acute lymphoblastic leukemia, Acute myelocytic leukemia, Deep vein thrombosis, Multiple myeloma, Sickle cell disease
Iatrogenic	No underlying causes
Infectious Disease	Bacteria: Arcanobacterium, Bacteremia, Bacteroides, Brucellosis, Campylobacterium sputorum, Cat scratch disease,Congenital syphilis, Enterobacter, Escherichia coli, Group A streptococcal infection, HACEK organism,Haemophilus influenzae, Klebsiella, Melioidosis, Mycobacterium boenickei, Mycobacterium brisbanense,Mycobacterium fortuitum, Mycobacterium goodii, Mycobacterium haemophilum, Mycobacterium houstonense,Mycobacterium lentiflavum, Mycobacterium neworleansense, Mycobacterium ulcerans, Mycobacterium wolinskyi,Neisseria gonorrhoeae, Pasteurella multocida, Pseudomonas, Salmonellosis, Sepsis, Serratia,Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus lugdunensis, Streptococcus pneumoniae,Streptococcus pyogenes, Trench fever, Treponema pallidum, Yaws,Mycobacterium tuberculosis, Actinomycosis,Gas gangrene Fungi: Apophysomyces, Candida albicans, Coccidioidomycosis, Sporotrichosis
Musculoskeletal / Ortho	Albers-Schonberg disease, Avascular necrosis, Brodie abscess, Ewing sarcoma, Fracture Garre’s sclerosing osteomyelitis, Osteosarcoma, Plantar fasciitis, SAPHO syndrome, Septic arthritis, Infantile cortical hyperostosis, Thick skull syndrome, Diabetic myonecrosis, Multiple myeloma
Neurologic	Neuroblastoma, Neuropathic joint disease
Nutritional / Metabolic	Gout, Pseudogout, Scurvy, Gaucher disease
Obstetric/Gynecologic	No underlying causes
Oncologic	Cementoblastoma, Primary neuroectodermal tumors, Marjolin’s ulcer, Acute lymphoblastic leukemia, Acute myelocytic leukemia, Multiple myeloma, Ewing sarcoma, Osteosarcoma, Neuroblastoma, Fanconi like syndrome
Opthalmologic	No underlying causes
Overdose / Toxicity	Radium
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	Fanconi like syndrome, Juvenile rheumatoid arthritis, Rheumatic fever, Serum sickness, Synovial osteochondromatosis, Transient synovitis
Sexual	No underlying causes
Trauma	Cephalhematoma, Nursemaid’s elbow, Physical abuse
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Amyloidosis, Animal bite, Bedsore, Eagle syndrome, Ingrown nail

Causes in Alphabetical Order

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References

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