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Year 3: Block 1: MSK system > Bone and soft tissue infection > Flashcards

Bone and soft tissue infection Flashcards

(60 cards)

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1
Q

What is a bone infection known as

A

Osteomyelitis

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2
Q

What is a joint infection known as

A

Septic Arthritis

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3
Q

Types of osteomyelitis

A

acute
chronic

specific (e.g. TB)
non-specific (most common)

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4
Q

What organisms mainly affect children <1

A

staph A, Group b strep, E.coli

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5
Q

What organisms mainly affect Older children (3)

A

Staph aureus, Strep pyogenes, Haemophilus influenzae

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6
Q

What organisms mainly affect adults ? (4)

A

Staph A
coagulase negative staphylococci Mycobacterium tuberculosis
Pseudomonas aeroginosa

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7
Q

Acute Osteomyelitis = can also be caused by other causes - what are they? (4)

A

Diabetic foot and Pressure sores - mixed infection including anaerobes

Sickle cell disease – Salmonella spp

Mycobacterium marinum (fishermen, filleters)

Candida (debilitating illness, HIV AIDS)

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8
Q

Acute Osteomyelitis Pathology - what long bones does it affect (3)

A

metaphysis
distal femur
proximal tibia
proximal humerus

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9
Q

Acute Osteomyelitis Pathology - what joints does it affect? (2)

A

with intra-articular metaphysis
hip
elbow (radial head)

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10
Q

Different causes of acute Osteomyelitis (8)

A 
role of trauma?
 vascular stasis 
acute inflammation – increased pressure 
 suppuration
 release of pressure 
	(medulla, sub-periosteal, into joint)
 necrosis of bone (sequestrum)
 new bone formation (involucrum)
 resolution  - or not (chronic osteomyelitis
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11
Q

Acute Osteomyelitis Clinical Features - Infant - where are features most common? (7)

A 
may be minimal signs, or may be very ill
failure to thrive
poss. drowsy or irritable
metaphyseal tenderness + swelling
decrease ROM
positional change
commonest around the knee
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12
Q

Acute Osteomyelitis Clinical Features - Child (5)

A

severe pain
reluctant to move (neighbouring joints held flexed); not weight bearing
may be tender fever (swinging pyrexia) + tachycardia
malaise (fatigue, nausea, vomiting – “nae weel” - fretful
toxaemia

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13
Q

Acute OsteomyelitisClinical Features - Adult - where are features most common?

A

Primary OM seen commonly in thoracolumbar spine
backache
history of UTI or urological procedure
elderly, diabetic, immunocompromised

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14
Q

What type of acute OM is more common in adults? when does this often happen?

A

Secondary
often after open fracture, surgery (esp. ORIF)
mixture of organisms

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15
Q

Acute Osteomyelitis -Diagnosis (5)

A

history and clinical examination (pulse + temp.)
FBC + diff WBC (neutrophil leucocytosis)
ESR, CRP
blood cultures x3 (at peak of temperature – 60% +ve)
U&Es – ill, dehydrated

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16
Q

Acute Osteomyelitis - Differential Diagnosis

GIVE EXAMPLES (5)

A

soft tissue infection

cellulitis - (deep) infection of subcutaneous tissues (Gp A Strep)
erysipelas - superficial infection with red, raised plaque (Gp A Strep)
necrotising fasciitis - aggressive fascial infection (Gp A Strep, Clostridia)
gas gangrene - grossly contaminated trauma (Clostridium perfringens)
toxic shock syndrome - secondary wound colonisation (Staph aureus)

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17
Q

Acute Osteomyelitis Diagnosis- TESTS (6)

A 
X-ray (normal in the first 10-14 days) 
ultrasound 
aspiration
Isotope Bone Scan (Tc-99, Gallium-67)
labelled white cell scan (Indium-111)
MRI
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18
Q

When will periosteal changes show on radiograph

A

10-20 days

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19
Q

Medullary changes (radiograph) are?

A
  • lytic areas
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20
Q

late osteonecrosis on radiograph is

A

sequestrum

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21
Q

late periosteal new bone on radiograph is

A

involucrum

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22
Q

Technetium scan is used in the

A

early and late phases

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23
Q

Acute Osteomyelitis - Microbiological diagnosis

A

blood cultures in haematogenous osteomyelitis and septic arthritis
bone biopsy
tissue or swabs from up to 5 sites around implant at debridement in prosthetic infections
sinus tract and superficial swab results may be misleading (skin contaminants

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24
Q

Acute Osteomyelitis - Treatment

A

supportive treatment for pain and dehydration – general care, analgesia
rest & splintage

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25
Acute Osteomyelitis - Treatment - antibiotics
antibiotics route (IV/oral switch – 7-10 days?) duration (4-6 wks – depends on response, ESR) choice - empirical (Fluclox + BenzylPen) while waiting
26
3 features antibiotics have
spectrum of activity penetration to bone safety for long term administration
27
Why may there be antibiotics failure in treatment ?
``` drug resistance – e.g.  lactamases bacterial persistence - ‘dormant’ bacteria in dead bone poor host defences - IDDM, alcoholism… poor drug absorption drug inactivation by host flora poor tissue penetration MRSA ```
28
Acute Osteomyelitis -Treatment - Surgery | indications
aspiration of pus for diagnosis & culture abscess drainage (multiple drill-holes, primary closure to avoid sinus) debridement of dead/infected /contaminated tissue refractory to non-operative Rx >24..48 hrs
29
Acute Osteomyelitis -Treatment - (3)
timing, drainage, lavage | infected joint replacements - one stage revision/ two stage revision/ antibiotics only
30
Acute Osteomyelitis - Complications (6)
``` septicemia, death metastatic infection pathological fracture septic arthritis altered bone growth chronic osteomyelitis ```
31
Chronic Osteomyelitis may follow
AOM
32
Chronic Osteomyelitis - when may it start? (4)
de novo following operation following open # (poss. many years earlier) immunosuppressed, diabetics, elderly, drug abusers, etc. repeated breakdown of “healed” wounds
33
Chronic Osteomyelitis - Organisms causing?
often mixed infection usually same organism(s) each flare-up mostly Staph. Aureus, E. Coli, Strep. pyogenes, Proteus
34
Chronic Osteomyelitis - Pathology (4)
cavities, poss. sinus(es) dead bone (retained sequestra) involucrum histological picture is one of chronic inflammation
35
Chronic Osteomyelitis - Complications (5)
chronically discharging sinus + flare-ups ongoing (metastatic) infection (abscesses) pathological fracture growth disturbance + deformities squamous cell carcinoma (0.07%)
36
How do you treat Chronic osteomyelitis - antibiotics
long-term antibiotics? local (gentamicin cement/beads, collatamp) systemic (orally/ IV/ home AB)
37
How do you treat Chronic osteomyelitis - (5)
eradicate bone infection- surgically (multiple operations) treat soft tissue problems deformity correction? massive reconstruction? amputation? (how many operations/years later?
38
Acute Septic Arthritis- What is theRoutes of infection (3)
``` haematogenous eruption of bone abscess direct invasion penetrating wound (iatrogenic? – joint injection) intra-articular injury arthroscopy ```
39
Acute Septic Arthritis - the route of infection has a
metaphyseal septic focus → either septic arthritis → or osteomyelitis
40
Organisms causing Acute Septic Arthritis (4)
Staphylococus aureus Haemophilus influenzae Streptococcus pyogenes E. coli
41
Acute Septic Arthritis Pathology (3)
acute synovitis with purulent joint effusion articular cartilage attacked by bacterial toxin and cellular enzyme complete destruction of the articular cartilage
42
Acute Septic Arthritis Sequelae (3) - what happens?
``` complete recovery or partial loss of the articular cartilage and subsequent OA or fibrous or bony ankylosis ```
43
Acute Septic Arthritis - Neonate - what do we always picture?
septicaemia irritability resistant to movement ill
44
Acute Septic Arthritis Child/Adult - main features | physical features?
Acute pain in single large joint reluctant to move the joint (any movement – c.f. bursitis where RoM OK) increase temp. and pulse increase tenderness
45
Acute Septic Arthritis in anAdult often involves what joint?
``` superficial joint (knee, ankle, wrist) - rare in adults and may be delayed diagnosis ```
46
Acute Septic Arthritis - Adult - investigations (5)
FBC, WBC, ESR, CRP, blood cultures X ray ultrasound aspiration
47
Acute Septic Arthritis Adult – Infected Joint Replacement is the
most common cause of septic arthritis in adult
48
Acute Septic Arthritis Adult – Infected Joint Replacement- most common organism ?
Staph | rare but a disaster - can cause death
49
Acute Septic Arthritis- Differential Diagnosis (7)
``` acute osteomyelitis trauma irritable joint haemophilia rheumatic fever gout Gaucher’s disease ```
50
Acute Septic Arthritis - Treatment (surgical/antibiotics)
general supportive measures antibiotics (3-4 weeks) surgical drainage & lavage - emergency (“never let the sun set on pus” ); open or arthroscopic lavage; infected joint replacements - one stage revision, two stage revision, antibiotics only?
51
Tuberculosis- Bone and Joint - what are the 3 different classifications?
extra-articular (epiphyseal / bones with haemodynamic marrow) intra-articular (large joints) vertebral body multiple lesions
52
Tuberculosis - Clinical Features (8)
``` insidious onset & general ill health contact with TB pain (esp. at night), swelling, loss of weight low grade pyrexia joint swelling decrease ROM ankylosis deformity ```
53
TB - pathology
primary complex (in the lung or the gut) secondary spread tuberculous granuloma Aids/HIV?
54
How does Tb spinal present?
little pain | present with abscess or kyphosis
55
Tuberculosis -Diagnosis (5)
``` long history involvement of single joint marked thickening of the synovium marked muscle wasting periarticular osteoporosis ```
56
Tuberculosis- Investigation, biopsy numbers?
FBC , ESR Mantoux test Sputum/ urine culture Joint aspiration and biopsy AAFB identified in 10-20% culture +ve in 50% of cases
57
Tuberculosis- Investigation - radiography features you look for?
XRAY soft tissue swelling periarticular osteopaenia articular space narrowing
58
Tuberculosis -Differential Diagnosis (5)
``` transient synovitis monoarticular RA haemorrhagic arthritis pyogenic arthritis Tumour ```
59
TuberculosisTreatment - INITIAL
chemotherapy initial - rifampicin isoniazid - 8 weeks ethambutol
60
TuberculosisTreatment - After initial
rifampicin and isoniazid 6-12 month rest and splintage operative drainage rarely necessary

Year 3: Block 1: MSK system (22 decks)

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