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Bone and Soft tissue infection Flashcards

(53 cards)

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1
Q

What is a bone infection called?

A

Osteomyelitis

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2
Q

What is a joint infection called?

A

Septic arthritis

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3
Q

Classes of osteomyelitis

A

Acute
Chronic
Specific (E.g. TB)
Non-specific (most common)

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4
Q

Most common type of osteomyelitis

A

Non-specific

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5
Q

Who does acute osteomyelitis mostly affect?

A

Children (different ages)

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6
Q

Do boys or girls get acute osteomyelitis more?

A

Boys > girls

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7
Q

Associations/things likely in the history with acute osteomyelitis

A 
History of minor trauma 
Diabetes
Rheumatoid arthritis 
Immunocompromised
Long term steroid treatment 
Sickle cell
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8
Q

Source of infection in acute osteomyelitis

A 
Haematogenous spread (elderly and children)
Local spread from contiguous site of infection e.g. 
- trauma
- bone surgery (ORIF)
- joint replacement 
Secondary to vascular insufficiency 
Infected umbilical cord in infants
In children
- boils
- tonsillitis 
- skin abrasions
Adults
- UTI
- Urinary catheter
- arterial line
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9
Q

Most common source of infection in acute osteomyelitis

A

Haematogenous spread

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10
Q

Causative organisms of acute osteomyelitis

A 
Infants < 1 year 
- E coli ( most common )
- Staph aureus 
- group B streptococci 
Older children
- Staph aureus ( most common )
- Strep pyogenes
- haemophilus influenzae
Adults
- staph aureus ( most common )
- protheses; coagulase -ve streptococci 
- mycobacterium TB
- pseudomonas aeruginosa (esp. 2ndry to penetrating foot injuries, IVDAs)
Diabetic foot and pressure sores
- mixed infection including anaerobes 
Sickle cell disease
- salmonella
Fishermans and filleters 
- mycobacterium marinum 
Candida 
- debilitating illness
- HIV AIDs
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11
Q

Pathology of acute osteomyelitis

A
  1. starts of metaphysis (possible role of trauma - bruising/damage)
  2. Vascular stasis (venous congestion + arterial thrombosis)
  3. Acute inflammation - increased pressure
  4. Suppuration - a lot of pus
  5. Release of pressure - put breaks out (medulla, sub-periosteal, into joint)
  6. Necrosis of bone (sequestrum)
  7. New bone formation (involucrum)
  8. Resolution (or not - chronic osteomyelitis)
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12
Q

Causes of chronic osteomyelitis

A

Following acute osteomyelitis
Following operation
Following open fracture (possibly many years earlier)

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13
Q

Risk factors for chronic osteomyelitis

A 
Acute osteomyelitis 
Surgery 
Open fracture
Immunosuppressed
Diabetes
Elderly
Drug abusers
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14
Q

Organisms that cause chronic osteomyelitis

A 
Often mixed infection with the same organisms causing each flare up (usually)
Staph aureus
E. coli 
Strep pyogenes
Proteus
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15
Q

Pathology of chronic osteomyelitis

A

Cavities, possible sinus(es)
Dead bone (retained sequestra)
Involucrum
Histological picture of chronic inflammation

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16
Q

Route of infection of septic arthritis

A 
Haematogenous 
Eruption of bone abscess
Direct invasion  
- penetrating wound
- intra-articular injury 
- arthroscopy
- infected joint replacement 
Metaphyseal septic focus
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17
Q

Most common cause of septic arthritis in adults

A

Infected joint replacement

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18
Q

Causative organisms of septic arthritis

A

Staph aureus
Haemophilus influenzae
Strep pyogenes
E. coli

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19
Q

Pathology of septic arthritis

A

Acute synovitis with purulent joint effusion
Articular cartilage attacked by bacterial toxin and cellular enzyme
Completed destruction of articular cartilage (result of acute septic arthritis)

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20
Q

What happens after septic arthritis?

A

Complete recovery
OR
Partial loss of articular cartilage and subsequent OA OR
Fibrous or bony ankylosis

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21
Q

Classification of bone and joint TB

A

Extra-articular (epiphyeal/bones with haemodynamic marrow)
Intra-articular (large joints)
Vertebral body

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22
Q

How many bone and joint TB infections have multiple lesions?

23
Q

Pathology of bone and joint TB

Study These Flashcards
A

Primary complex (in lung or gut)
Secondary spread
TB granuloma
Note role of nutrition/other disease e.g. AIDs

24
Q

Presentation of acute osteomyelitis in infants

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A 
Minimal signs or very ill 
Failure to thrive
Drowsy/irritable
Metaphyseal tenderness and swelling 
decreased ROM - tough to know if small baby 
Positional change
Commonest around knees
25
Meaning of ROM
Range of movement
26
Commonest site of acute osteomyelitis in infants
Around the knee
27
Presentation of acute osteomyelitis in a child
``` Severe pain Reluctant to move Neighbouring joints held flexed Not weight bearing Tender fever (swinging pyrexia) Tachycardia Malaise Fatigue Nausea, vomiting Toxaemia ```
28
Where in adults is primary osteomyelitis most commonly seen?
Thoracolumbar spine
29
When does secondary osteomyelitis occur in adults?
Iatrogenic (especially ORIF) | Open fracture
30
Presentation of acute osteomyelitis in adults
Backache Temperature History of UTI/urological procedure
31
Acute primary osteomyelitis in adults Is commonly seen in who?
Elderly Diabetic Immunocompromised
32
Presentation of acute septic arthritis in the neonate
Picture of septicaemia - irritability - resistant to movement - ill
33
Presentation of child/adult acute septic arthritis
Acute pain in a single large joint Reluctant to move joint - ANY movement Increased temp and pulse Increased tenderness
34
What joints are usually affected in adult septic arthritis?
Superficial joints (knee, ankle, wrist)
35
How common is septic arthritis in a healthy adult?
Rare
36
Presentation of bone and joint TB
``` Insidious onset with general ill health Contact with TB Presentation (especially at night) Swelling Loss of weight Low grade pyrexia Decreased ROM Ankylosis Spinal (little pain, present with abscess or kyphosis) ```
37
Definition of ankylosis
Abnormal stiffening and immobility of a joint due to fusion of bones
38
Investigations of acute osteomyelitis
``` FBC and different WCC (neutrophil leucocytes) Raised ESR and CRP Blood cultures (x3) if haematogenous osteomyelitis and septic arthritis U and Es Imaging - Xray - USS - Aspiration - isotope bone scan - labelled white cell scan - MRI Bone biopsy Tissue or swabs from up to 5 sites around the implant at debridement in prostetic infections ```
39
Differential diagnosis of acute osteomyelitis
Acute septic arthritis Acute inflammatory arthritis Trauma (fracture, dislocation) Transient synovitis in children ("irritable hip") Soft tissue infection - cellulitis, erysipelas, necrotising fasciitis, gas gangrene, TSS Rare - haemophilia, sickle cell crisis, rheumatic fever
40
What is gas gangrene?
Grossly contaminated trauma
41
What Is gas gangrene caused by?
Clostridium perfringes
42
Investigations of acute septic arthritis
FBC, WBC, ESR, CRP, blood cultures X ray USS aspiration
43
Differential diagnosis for acute septic arthritis
``` Acute osteomyelitis Trauma Irritable joint Haemophilia Rheumatic fever Gout Gaucher's disease ```
44
Bone and joint TB investigations
``` Long history Involvement of a single joint Marked muscle wasting FBC, ESR Mantoux test Sputum/urine culture Xray Joint aspiration and biopsy ```
45
Bones and joint TB differential diagnosis
``` Transient synovitis Monoarticular RA Haemorrhagic arthritis Pyogenic arthritis Tumour ```
46
Treatment of acute osteomyelitis
Supportive treatment for pain and dehydration (general care and analgesia) Rest and splintage Antibiotics (very high dose) for 4-6 weeks depending on response - flucloxacillin and benzylpenicillin Surgery
47
Why do antibiotics fail?
``` Drug resistance e.g. B lactamases Bacterial persistence - 'dormant' bacteria in dead bone Poor host defences - IDDM, alcoholism Poor drug absorption Drug inactivation by host flora Poor tissue penetration ```
48
Treatment of chronic osteomyelitis
``` Long term antibiotics Eradicate bone infection surgically Treat soft tissue problems Deformity correction Amputation ```
49
Treatment of acute septic arthritis
General supportive measures Antibiotics 3-4 weeks Surgical drainage and lavage
50
What responds better to antibiotics, joints or bones?
Joints
51
Treatment of bone and joint TB
``` Initial for 8 weeks - rifampicin - isoniazid - ethambutol Then for 6-12 months - rifampicin and isoniazid Rest and splintage Operative drainage - rarely needed ```
52
Complications of acute osteomyelitis
Septicaemia leading to death Metastatic infection Pathological fracture (due to weakened bones) Septic arthritis Chronic osteomyelitis Altered bone growth (especially in children)
53
Complications of chronic osteomyelitis
``` Chronically discharging sinus plus flare ups ongoing metastatic infection (abscesses) pathological fracture Growth disturbance and deformities Squamous cell carcinoma (0.07%) ```

MSK (25 decks)

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