Osteomielite: che cos’è, sintomi e terapia
Table of Contents
Che cos’è l’osteomielite?
L’osteomieliteè un processo infiammatorio acuto o cronico a carico dell’osso che riconosce un’eziologia infettiva; può interessare qualsiasi osso e manifestarsi sia nei bambini sia negli adulti.
Eziologia
L’identificazione dell’ agente eziologico è spesso difficile e riesce solo nel 35-40% dei casi. Il microrganismo più frequentemente in causa è lostaphylococcus aureusper la sua vasta diffusione epidemiologica e per il suo tropismo per il tessuto osseo; raramente lo streptococco, lo pneumococco o associazioni batteriche. La porta di entrata dell’ infezione può essere evidente (foruncolo, antrace, ascesso, impetigo) o inapparente. Un trauma osseo o un intervento chirurgico possono provocare un’infezione locale.
Manifestazioni cliniche dell’ osteomielite
Nel bambino, in cui la patogenesi dell’infezione ossa è per lo più ematogena, il quadro clinico può esordire con i sintomi e i segni della flogosi acuta quali:dolore, limitazione motoria e infiammazione locale, nonché sintomi e segni sistemici:febbre elevata,anoressia, malessere generale. Nel neonato e nel lattante la diagnosi può essere difficile per la mancata localizzazione del dolore. Più frequentemente, specialmente nell’adulto, il quadro clinico è subdolo, i sintomi sistemici sono moderati o assenti e il dolore i segni locali più sfumati. In una discreta percentuale di casi l’ infezione ossea è accompagnata da un tragitto fistoloso che drena verso l’esterno il materiale purulento. La localizzazione più frequente nell’adulto è quella vertebrale con interessamento del corpo vertebrale del disco intersomatico; l’aria più frequentemente coinvolta è il tratto lombare, spesso come complicanza di un intervento neurochirurgico. Il sintomo d’esordio è sempre il dolore locale accompagnato frequentemente da dolore radicolare e talora da febbre che difficilmente raggiunge valori elevati.
Recidive: a volte dopo anni.
Postumi: fragilità ossea e fratture patologiche, disturbi dell’osteogenesi che provocano l’accorciamento e la deformazioni dell’arto.
Esami di laboratorio
- Formula sanguigna: iperleucocitosi con prevalenza di polinucleati.
- Emocolturaa volte positiva all’inizio.
- Colturadella biopsia ossea spesso positiva.
Terapia
- Antibiotici: la somministrazione deve essere il più precoce possibile, appena la diagnosi è stata posta sulla base degli elementi clinici e della formula sanguigna, senza aspettare il risultato dell’ emocolture e le alterazioni radiologiche che sono tardive. Se la terapia è ritardata, gli antibiotici perdono la loro efficacia poiché non riescono a combattere l’infezione nell’osso già necrotizzato. Siccome la maggior parte dei casi di osteomielite acuta sono dovuti allostaphylococcus aureus, le penicilline penicillinasi resistenti sono gli antibiotici di scelta all’inizio della terapia; poi l’antibiotico sarà scelto sulla base dell’antibiogramma. La terapia poi deve essere proseguita 4-6 settimane dopo la guarigione clinica.
- Chirurgiain caso di ascesso sotto-periosteo ribelle o di sequestro osseo.
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