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Basic Orthopaedic Sciences > Infections > Flashcards

Infections Flashcards

1
Q

What are the common organisms involved in Septic arthritis?

A 
S. Aureus
N Gonnorhoea
Salmonella - sickle cell
Bartonella - HIV
Kingella + GBS in children
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2
Q

What organisms are involved in SA in IV drug users?

A

Pseudomonas

GNB

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3
Q

What is the pathophysiology behind the damage done to cartilage in SA?

A

Proteolytic enzymes are released from bacteria and synovium

IL 1

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4
Q

How does one diagnose septic arthritis?

A

WBC > 50 000 on fluid

Bone scan

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5
Q

What factors are involved in Kochers criteria?

A
  1. Weight bearing status
  2. Temp >38.5
  3. WBC count >12
  4. ESR >40
2 = 40%
3 = 93%
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6
Q

Common bony infections in dialysis patients?

A

Spine and Ribs

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7
Q

What are the 5 stages of biofilm formation?

A
  1. Adherence (reversible)
  2. Aggregation
  3. Biofilm formation
  4. Maturation
  5. Dispersion
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8
Q

What are the 2 anti-biofilm agents?

A
  1. Rifampacin - Gram Pos

2. Cipro - Gram Neg

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9
Q

What are the 2 characteristics of a biofilm?

A

Bacteria enter a sessile stage

Biofilm made from a Extracellular Polymeric Substance (EPS) - GLYCOLAX

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10
Q

What is the staging system of osteomyelitis and what 2 broad categories is it based on?

A

Cierny-Mader

Host and Anatomic location

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11
Q

What type of bacteria is TB?

A

Obligate aerobic acid fast bacilli

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12
Q

How is TB cultured?

A

Lowenstein-Jensen Medium

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13
Q

What does histology reveal in TB infection?

A

Granuloma

Casseating central necrosis

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14
Q

TB Treatment duration in bone/joint?

A

12-18 months

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15
Q

What are the 2 main mechanisms of action of anti-TB drugs?

A

Cell wall inhibition

Inhibition of cell protein synthesis

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16
Q

All of the 1st line TB drugs interfere with production of the cell wall except?

A

Rifampacin - inhibit mRNA transcription and translation

17
Q

What 3 factors contribute to osteitis at the metaphysis?

A

Sluggish + turbulent blood flow
Low o2
Low ph

18
Q

Septic arthritis CANNOT develop in which joint following osteitis?

A

Knee

19
Q

What are the 3 most common pathogens for osteitis in kids?

A
  1. S AUREUS!!
  2. GBS in neonates
  3. Kingella
20
Q

What is a Brodie’s abscess?

A

Chronic abscess surrounded by sclerotic bone

21
Q

When is a bone scan indicated in osteomyelitis?

A

Need to localise infection in an infant/toddler with non-focal exam

22
Q

What can increase the sensitivity of a MRI in Osteomyelitis?

A

Gadolinium

23
Q

What are the 2 mechanisms of infection with hardware?

A

Seeding

Biofilm

24
Q

What is the most sensitive test in hardware infections?

A

CRP - should decrease D2 post op

25
Q

How long should DMARDs be stopped prior to replacement?

A

4-6/52

26
Q

What markers should have normalised off antibiotics for revision arthroplasty?

A

ESR

CRP

27
Q

What is the time to onset for acute periprosthetic infections?

A

<90 days from surgery

28
Q

What is the difference between the acute and chronic periprosthetic infections?

A

Acute = no invasion into the prosthetic-bone interface

No biofilm production

29
Q

Key radiographic findings in periprosthetic infections?

A

Generalised bone resorption without implant wear

30
Q

What other 2 scans are used with periprosthetic infections?

A
  1. Bone scan - Tc-99m detects inflammation
    In-111 - detects leukocytes
    If infection suspected but cannot be confirmed via bloods/aspiration
  2. PET
31
Q

What criteria are used to diagnose periprosthetic infections?

A
  1. MSIS criteria

2 Major
2. Minor

32
Q

What are the 2 most sensitive blood markers for prosthetic joint infection?

A

alpha defensin

IL 6

33
Q

What is the treatment for acute (<3 weeks) periprosthetic infections?

A

Poly exchange with component retention and 4-6/52 abx

34
Q

What are the 2 classes of antibiotics available in PMMA?

A

Aminoglycosides (Genta/Tobra)

Vancomycin

Basic Orthopaedic Sciences (25 decks)

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