BONE AND JOINT INFECTION Flashcards

1
Q

What do we call infection of the bone?

A

Osteomyelitis

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2
Q

What is the usual source of infection in osteomyelitis cases?

A

Haematogenous spread - often secondary to infected wound

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3
Q

Where in the bone does osteomyelitis usually start?

A

In the metaphysis, where there is relative stasis of blood

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4
Q

Which bones are most often affected by osteomyelitis?

A

2/3rds of cases occur in femur or tibia

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5
Q

What is the peak age of incidence for osteomyelitis?

A

Neonatal period

9-11 year children

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6
Q

What is the pathogen most commonly responsible for osteomyelitis?

A

S. aureus

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7
Q

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

A

Group B streptococcus

E. coli - neonates only

Should also consider M. tuberculosis

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8
Q

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

A

Sickle cell disease

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9
Q

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

A

Salmonella osteomyelitis

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10
Q

What are the clinical features of osteomyelitis in a child?

A

Fever

Pain

Limp

Refusal to move affected limb

Exquisite tenderness over affected bone

Red, warm area

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11
Q

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

A

FBC - raised WCC

CRP - raised

ESR - raised

Blood cultures

Bone aspiration for culture and antibiotic sensitivity

Imaging

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12
Q

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

A

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

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13
Q

How do we manage a child with osteomyelitis?

A

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.

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14
Q

What antibiotics should be used in the treatment of osteomyelitis?

A

Flucloxacillin and sodium fusidate

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15
Q

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

A

Clindamycin

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16
Q

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

A

Ceftriaxone

17
Q

What are the complications of osteomyelitis?

A

Chronic osteomyelitis

Septic arthritis

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

18
Q

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

A

Septic arthritis

19
Q

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

A

Younger than 3 years old

20
Q

What is the main source of infection for septic arthritis?

A

Haematogenous spread

21
Q

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

A

Hip

22
Q

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

A

Knee

23
Q

What is the pathogen most commonly responsible for septic arthritis?

A

S. aureus

24
Q

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

A

Fever

Irritability

Refusal to weight bear

Infants will often hold limb rigid (pseudoparalysis)

Tenderness over joint

Red, hot and swollen

25
Q

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

A

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
Q

How do we manage a child with septic arthritis?

A

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
Q

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

A

Flucloxacillin and sodium fusidate