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Flashcards in BONE AND JOINT INFECTION Deck (27):
1

What do we call infection of the bone?

Osteomyelitis

2

What is the usual source of infection in osteomyelitis cases?

Haematogenous spread - often secondary to infected wound

3

Where in the bone does osteomyelitis usually start?

In the metaphysis, where there is relative stasis of blood

4

Which bones are most often affected by osteomyelitis?

2/3rds of cases occur in femur or tibia

5

What is the peak age of incidence for osteomyelitis?

Neonatal period

9-11 year children

6

What is the pathogen most commonly responsible for osteomyelitis?

S. aureus

7

Other than s. aureus, what pathogens are known to commonly cause osteomyelitis in children?

Group B streptococcus

E. coli - neonates only

Should also consider M. tuberculosis

8

Which group of patients are more at risk of developing osteomyelitis?

Sickle cell disease

9

Osteomyelitis caused by what other pathogen are children with sickle cell disease particularly prone to?

Salmonella osteomyelitis

10

What are the clinical features of osteomyelitis in a child?

Fever

Pain

Limp

Refusal to move affected limb

Exquisite tenderness over affected bone

Red, warm area

11

What are the investigations that should be done in someone who presents with signs and symptoms consistent with osteomyelitis?

FBC - raised WCC

CRP - raised

ESR - raised

Blood cultures

Bone aspiration for culture and antibiotic sensitivity

Imaging

12

What imaging should be done for a child who presents with osteomyelitis?

MRI, USS and bone scans are more sensitive in the early phase of illness (24-48 hours)

X-rays tend to be normal for the first 10 days

13

How do we manage a child with osteomyelitis?

Urgent IV antibiotics until clinical improvement and normalising of acute phase reactants.

Oral antibiotics for several weeks after coming off IV.

Surgical drainage may be indicated if non-adequate response to antibiotics.

14

What antibiotics should be used in the treatment of osteomyelitis?

Flucloxacillin and sodium fusidate

15

What antibiotics should be used in the treatment of osteomyelitis in a patient who is allergic to penicillin?

Clindamycin

16

What antibiotics should be used in the treatment of osteomyelitis where salmonella is suspected as the causative organism?

Ceftriaxone

17

What are the complications of osteomyelitis?

Chronic osteomyelitis

Septic arthritis

Growth disturbance and limb deformity - especially if infection affects epiphyseal plate)

18

Which is more common in kids: osteomyelitis or septic arthritis?

Septic arthritis

19

In what age group is the incidence of septic arthritis highest?

Younger than 3 years old

20

What is the main source of infection for septic arthritis?

Haematogenous spread

21

What is the most common site of septic arthritis in infants?

Hip

22

What is the most common site of septic arthritis in older children?

Knee

23

What is the pathogen most commonly responsible for septic arthritis?

S. aureus

24

What are the clinical features of septic arthritis in a child?

Fever

Irritability

Refusal to weight bear

Infants will often hold limb rigid (pseudoparalysis)

Tenderness over joint

Red, hot and swollen

25

What investigations should be done for a child who presents with signs and symptoms consistent with septic arthritis?

FBC - raised WCC

CRP - raised

ESR - raised

Aspiration of joint space - white cells and culture

USS - effusions

X-ray - non-specific, widened joint space

26

How do we manage a child with septic arthritis?

Urgent IV antibiotics until clinical improvement and normalising of acute phase reactants.

Oral antibiotics for several weeks after coming off IV.

Surgical drainage may be indicated if non-adequate response to antibiotics.

27

What antibiotics should be used in the treatment of septic arthritis?

Flucloxacillin and sodium fusidate