Symptoms of acute osteomyelitis are pain in the diseased bone with fever severe wasting and fatigue may also occur localized redness, swelling and heat Spinal osteomyelitis usually has limited back pain with paravertebral muscle spasm rest heat therapy and analgesics do not relieve it activity makes it worse noble patients usually do not have fever. Acute osteomyelitis that is not treated with hospitalization may develop into chronic transplant osteomyelitis usually causing intermittent (months to years) bone pain pressure and sinus drainage chronic natural osteomyelitis is usually an infection with multiple microorganisms.