Chronic osteomyelitis occurs when acute osteomyelitis is poorly or inadequately treated, but it can also appear without a previous phase of acute infection. Joint replacement, compound fractures, and infection with tuberculosis and syphilis can produce chronic osteomyelitis as an initial symptom without an acute stage. Chronic osteomyelitis may lead to persistent bone damage, pain, and loss of function.
The symptoms of chronic osteomyelitis are similar to that of acute osteomyelitis: chronic pain, fatigue, and swelling. The fever is not as severe, but the patient may still experience chills and sweating. Chronic infection could also cause changes in the skin surrounding the inflamed area. It's usually hard to treat chronic bone infection because the bacteria can become present inside the bone cells themselves. This partially protects the bacteria from the immune system and gives it time and freedom to spread from one cell to another.

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