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Which of the following is NOT a sign of osteomyelitis?

  1. Pain around the infected area

  2. Local swelling and redness

  3. Increased energy levels

  4. Possible drainage of pus through the skin

The correct answer is: Increased energy levels

In the context of osteomyelitis, which is an infection of the bone, various symptoms are commonly observed due to the inflammatory process. Pain around the infected area is a significant sign, as the body's response to infection often results in discomfort in the region affected. Local swelling and redness are also classic indicators of infection, reflecting the accumulation of inflammatory cells and fluids as the body attempts to fight the infection. Possible drainage of pus through the skin indicates an advanced infection where there might be the formation of an abscess, providing further evidence of the inflammatory process at play. Increased energy levels, however, are not a symptom associated with osteomyelitis. In fact, infections generally lead to fatigue and malaise due to the body's immune response and metabolic demands. Therefore, this choice accurately represents a situation that is not characteristic of osteomyelitis, distinguishing it from the other options which are all typical signs of the condition.