Presentation of Infection

Abstract

Clinically, three distinct stages of diabetic foot infection may be recognised: localised infection, spreading infection and severe infection. Each of these presentations may be complicated by osteomyelitis. Localised infection refers to infection in the ulcer bed and the immediate surrounding skin. This may present with purulent discharge and limited surrounding erythema, but often classical signs of infection are diminished by the presence of neuropathy and ischaemia. In spreading infection, there is diffuse and extending erythema, oedema with often lymphangitis and lymphadenitis, and in addition, there will be local signs of infection. In severe infection, ulcers are complicated by extensive deep soft tissue infection. This stage may also be associated with bacteraemia with the patient presenting with hypotension and organ failure. Signs of severe infection may include drowsiness shivering, tachycardia, hypotension, reduced body temperature (<35 °C) or high fever (>37 °C). Usually, osteomyelitis will present in association with ulceration and soft tissue infection. Clinically, osteomyelitis may be suspected when a sterile probe inserted into the base of the ulcer penetrates to bone.