What is osteomyelitis?
Osteomyelitis an inflammatory disease of the bone and bone marrow most frequently caused by bacteria, fungal infections and viral osteomyelitis are less common.
The most common bacteria involved in osteomyelitis are Staphylococcus sp, Streptococcus sp, and Escherichia coli after trauma and/or surgery, and Proteus sp, Klebsiella sp, Pasteurella sp as well as anaerobes (bacteria that can live without oxygen) Actinomyces sp, Clostridium sp, and Bacteroides sp are common isolates from bite wounds.
Bone infection is more common in cats than dogs due to bites that occur when cats fight. Entire male cats are at increased risk of developing puncture wounds from cat fights, and cats with compromised immune systems (such as FIV or FeLV) are more vulnerable; however, osteomyelitis can occur in cats of any age, sex, and health status.
Osteomyelitis is often classified as either haematogenous or post-traumatic in origin.
Bones may become infected directly after surgery or trauma (where bacteria enters the site via a bite or a scratch), or as a result of a systemic or local bacterial or fungal infection travelling to the bone through the bloodstream (hematogenous).
- Surgery such as treatment to repair fractured bones after a car accident that introduces bacteria to the site.
- Prosthetic joint implants can cause osteomyelitis either by introducing bacteria during surgery (rare), or an inflammatory reaction to the implants (known as non-infectious osteomyelitis)
- Gunshot wounds
- A systemic bacterial or fungal infection which spreads to the bone via the bloodstream
- Soft tissue infection which spreads to bones nearby
- Dental infection that can spread to the jawbone
- Puncture wounds, usually caused by another cat during a fight as the oral cavity has a high number of bacteria when a puncture wound occurs; bacteria are injected into the skin and deeper layers
Osteomyelitis can be acute (sudden onset) or chronic (waxing and waning over an extended period). The most common location is in the long bones. Additional symptoms may be noted in cats with a systemic infection.
- Swelling around the affected area
- Draining tracts
- Pus may ooze from soft tissues surrounding the area
- Muscle atrophy (wasting)
- Swollen and painful joints close to the affected area
- Stiffness and reluctance to move
- Reluctance to put any weight on the affected leg
- Loss of appetite
If your cat has a systemic bacterial or fungal infection, additional symptoms may also be present.
The veterinarian will perform a physical examination of the cat and obtain a medical history from you including recent surgery, trauma or known infections as well as how long symptoms have been present.
- Biochemical profile, complete blood count, and urinalysis: May reveal increased white blood cell count, which is indicative of an infection. Serum and urinalysis are usually unremarkable unless systemic infection or blood infection is present.
- Bone x-rays: Can identify osteomyelitis but it may take some time for changes to appear in the bone
- MRI scans: An advanced imaging technique to produce clear three dimensional images that can differentiate soft tissue from a bone infection.
- Aerobic and anaerobic bacterial culture and sensitivity: Blood, purulent material or bone samples are taken to identify the organism involved. This enables your veterinarian to prescribe the most suitable antibiotic for that particular bacteria.
- Blood tests (fungal): To identify antibodies to certain fungal infections as well as additional x-rays and samples of any secretions or discharges (if present) which will be sent to a specialist laboratory for evaluation.
- Broad-spectrum antibiotic therapy: Bone infections are difficult to treat, and the cat will require a long course of antibiotics. Initial treatment with Clavamox will be initiated until culture results have returned antibiotics can be targeted for that specific organism.
- Surgical debridement: This procedure involves the surgical removal of diseased bone and tissue and then flushes the area with sterile saline.
- Surgery: If there is a fracture of the bone, the veterinarian will stabilise the break to ensure proper healing. In some cases, an implant may be used, which will be removed once the bone has healed. Severe fractures may require amputation of the affected limb.
- Supportive care: Nutritional support, fluids and analgesics may be necessary if the cat is not eating or drinking and is in pain.
The veterinarian will schedule regular follow up appointments to monitor your cat’s progress.
Cage rest will be necessary during recovery to prevent accidental injury as it heals.
- Thoroughly clean and apply a safe antiseptic to any bites, scratches or wounds
- Keep cats either indoors or in a cat enclosure to limit exposure to cars and other cats
- Prompt veterinary attention if your cat develops an abscess. Signs of an abscess include an area of swelling, pain, and heat. Abscesses in a location where there is an underlying bone close to the site are particularly at risk
- Maintain good oral hygiene to limit his chances of developing a dental infection. Regularly check your cat’s mouth for signs of inflammation or infection
- Always follow your veterinarian’s instructions when giving antibiotics to your cat and ensure you give the entire course.