Infective bone lesions, with osteomyelitis being the predominant entity, constitute a major source of morbidity globally, affecting patients across all age groups and often leading to prolonged hospitalization and functional impairment. These infections arise via multiple pathways, including hematogenous dissemination, direct inoculation following trauma or surgical interventions, and contiguous spread from adjacent soft tissue infections or ulcers, particularly in immunocompromised individuals or those with chronic comorbidities. Clinically, affected patients frequently present with localized pain, swelling, tenderness, erythema, and occasionally warmth over the involved site. Systemic manifestations such as fever, malaise, and elevated inflammatory markers may also be observed, reflecting the underlying inflammatory response [1,2]. Radiologically, early osteomyelitic changes are often subtle and may manifest as soft tissue swelling, periosteal elevation, juxtacortical lucencies, or minimal cortical irregularities on plain radiographs, making early diagnosis challenging. Advanced imaging techniques, such as magnetic resonance imaging (MRI) and computed tomography (CT), enhance diagnostic accuracy by detecting osteolytic foci, cortical destruction, medullary edema, and periosteal reactions, and they provide critical information for surgical planning and monitoring therapeutic response [3]. From a microbiological perspective, Staphylococcus aureus remains the predominant causative pathogen across both acute and chronic osteomyelitis cases. The increasing prevalence of multidrug-resistant organisms, notably methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Gram-negative bacteria, has further complicated therapeutic management, necessitating judicious antibiotic selection and often prolonged treatment courses [4,5]. In the Indian context, osteomyelitis continues to represent a significant public health concern, with an increasing incidence attributed to trauma, diabetes, and surgical interventions. A thorough understanding of its clinical, microbiological, and radiological spectrum is essential for timely diagnosis, targeted therapy, and minimizing long-term complications, underscoring the need for region-specific data to guide effective management strategies.

Study Design and Setting: This was a prospective observational study conducted at a tertiary care hospital in India. Informed consent was obtained from all participants or their guardians. Sample Size and Participants: A total of 100 patients with clinically suspected infective bone lesions were included. Sample size was calculated based on prior prevalence data of osteomyelitis and other bone infections in similar tertiary care settings, with an expected prevalence of 15–20% and 95% confidence interval, allowing for 10% attrition. Inclusion Criteria: • Patients of all ages and both sexes presenting with clinical features suggestive of infective bone lesions, including localized pain, swelling, erythema, or draining sinuses. • Patients undergoing radiological investigations (X-ray, CT, or MRI) for the suspected lesion. • Patients who consented to undergo biopsy or surgical sampling for histopathological and microbiological analysis. Exclusion Criteria: • Patients with bone lesions of non-infective etiology (e.g., neoplastic or metabolic bone diseases). • Patients who had received systemic antibiotics for more than 72 hours prior to biopsy or culture. • Patients with incomplete clinical or radiological data. Clinical Assessment: Demographic data, comorbidities (diabetes, immunosuppressive conditions), history of trauma, and presenting symptoms were recorded. Clinical examination focused on local signs of infection, sinus formation, and functional impairment. Radiological Evaluation: All patients underwent plain radiography of the affected bone. Computed tomography (CT) or magnetic resonance imaging (MRI) was performed in selected cases to evaluate the extent of bone and soft tissue involvement, cortical destruction, and periosteal reaction. Radiological findings were classified based on the site, size, and pattern of bone involvement. Histopathological and Microbiological Analysis: • Tissue specimens obtained by biopsy or surgical debridement were sent for: • Histopathological examination using hematoxylin and eosin staining. • Microbiological culture and sensitivity to identify bacterial or fungal pathogens. Statistical Analysis: Data were analyzed using SPSS version 25.0. Continuous variables were expressed as mean ± standard deviation, and categorical variables as frequencies and percentages. Associations between clinical, radiological, and histopathological findings were analyzed using chi-square or Fisher’s exact test, with a p-value <0.05 considered statistically significant.

A total of 100 patients with infective bone lesions were included in the study. The mean age of the cohort was 38.5 ± 16.2 years, with 60% males and 40% females. Most patients (62%) resided in rural areas, and 22% had diabetes mellitus. A history of trauma was reported in 36% of cases, and 41% of patients presented with symptoms lasting more than three months (Table 1). Clinical features are summarized in Table 2. The most common presentation was localized pain, observed in 92% of patients, followed by swelling (78%) and redness/erythema (55%). Sinus formation was present in 27%, while functional limitation and fever were reported in 35% and 21% of patients, respectively (Table 2). Radiological findings revealed that osteolytic lesions were the most frequent abnormality (48%), followed by cortical destruction (42%) and soft tissue involvement (40%). Periosteal reaction was observed in 35% of patients, and multifocal lesions were detected in 12%. Advanced imaging with CT or MRI was performed in 52% of patients to better delineate lesion extent (Table 3). Histopathological and microbiological analysis showed that 85% of patients had histopathology consistent with infection, while culture positivity was observed in 68%. The most commonly isolated pathogen was Staphylococcus aureus (42%), followed by Streptococcus spp. (12%) and Pseudomonas spp. (6%). Fungal isolates were found in 8% of cases, and 32% of patients had negative cultures (Table 4). Table 1. Demographic and Clinical Profile of Patients with Infective Bone Lesions (n = 100) Variable Total (n=100) Male (n=60) Female (n=40) p-value Age (years) 38.5 ± 16.2 37.2 ± 15.8 40.2 ± 16.7 0.35 Rural residence (%) 62 (62%) 38 (63.3%) 24 (60%) 0.71 Diabetes mellitus (%) 22 (22%) 14 (23.3%) 8 (20%) 0.68 Trauma history (%) 36 (36%) 22 (36.7%) 14 (35%) 0.85 Duration of symptoms >3 months (%) 41 (41%) 25 (41.7%) 16 (40%) 0.87 Table 2. Clinical Presentation of Patients (n = 100) Clinical Feature n % Localized pain 92 92% Swelling 78 78% Redness/erythema 55 55% Sinus formation 27 27% Functional limitation 35 35% Fever 21 21% Table 3. Radiological Findings (n = 100) Finding n % Osteolytic lesion 48 48% Cortical destruction 42 42% Periosteal reaction 35 35% Soft tissue involvement 40 40% Multifocal lesions 12 12% CT/MRI performed 52 52% Table 4. Microbiological and Histopathological Correlation (n = 100) Parameter n % Histopathology consistent with infection 85 85% Culture positive 68 68% Most common pathogen: Staphylococcus aureus 42 42% Other bacterial isolates: Streptococcus spp. 12 12% Other bacterial isolates: Pseudomonas spp. 6 6% Fungal isolates 8 8% Negative culture 32 32%

Our study provides a comprehensive analysis of infective bone lesions, emphasizing their clinical, radiological, and microbiological characteristics. The high prevalence of localized pain and swelling aligns with findings from previous studies, which report these symptoms as common presentations in osteomyelitis cases [6-8]. Radiologically, osteolytic lesions and cortical destruction were predominant, consistent with the observations of bone sclerosis and cortical thickening in chronic osteomyelitis. The use of advanced imaging modalities, such as MRI and CT, has been shown to enhance the detection of these features, aiding in the accurate diagnosis of infective bone lesions [9]. Microbiologically, Staphylococcus aureus was the most frequently isolated pathogen, corroborating the results of a systematic review that identified this bacterium as the leading cause of osteomyelitis. The variability in culture positivity rates, with some studies reporting lower yields, underscores the importance of employing a combination of diagnostic methods, including histopathological analysis, to improve diagnostic accuracy [10-12]. The demographic data from our study, including the higher prevalence of infective bone lesions in males and the association with diabetes mellitus, are consistent with existing literature that highlights these factors as risk determinants for osteomyelitis [13,14]. This study has several limitations. First, it was conducted at a single tertiary care center, which may limit the generalizability of the findings to other populations. Second, the sample size, though adequate, was relatively small for subgroup analyses of less common pathogens and radiological patterns. Third, culture negativity in some cases may have underestimated the true microbial spectrum. For future research, multicenter studies with larger sample sizes are recommended to better characterize the epidemiology, microbiology, and radiological features of infective bone lesions. Additionally, the incorporation of advanced molecular diagnostic techniques could improve pathogen detection and guide targeted therapy. Longitudinal studies assessing treatment outcomes and prognostic factors would further enhance clinical management strategies.

Infective bone lesions present with a wide spectrum of clinical, radiological, and microbiological features. Localized pain and swelling were the most common presentations, while osteolytic lesions and cortical destruction predominated radiologically. Staphylococcus aureus was the most frequent pathogen isolated. A multimodal diagnostic approach, integrating clinical assessment, imaging, and histopathological/microbiological analysis, is essential for accurate diagnosis and effective management.

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