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Microbiology > OSTEOMYELITIS & SEPTIC ARTHRITIS > Flashcards

OSTEOMYELITIS & SEPTIC ARTHRITIS Flashcards

1
Q

How the pathogen reach the bone ?

A

1- Hematogenous route 2- Contiguous soft tissue focus ( post operative infection, contaminated open fracture, soft tissue infection , puncture wounds)
3- In association with peripheral vascular disease (diabetes mellitus ,severe atherosclerosis, vasculitis)
• May have a short duration ( few days for hematogenous acquired
infection) or may last several weeks to months ( if secondary
to contiguous focus of infection).

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2
Q 
S. aureus, group B Streptococcus,Gram
negative rods (eg. E. coli,  Klebsiella ).

Common in ?

A

Infants

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3
Q

S. aureus, group A Streptococcus & H.
influenzae

Common in ?

A

Children

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4
Q

S. aureus

Common in ?

A

Adults

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5
Q

Salmonella species

Common in?

A

Sickle cell disease

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6
Q

S. aureus, group A Streptococcus, Gram
negative rods, anaerobes.
Common in >

A

Infection after trauma ,injury or surgery

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7
Q

Pseudomonas aeruginosa, S. aureus

Common in ?

A

Infection after puncture wound of foot.

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8
Q

Mycobacterium tuberculosis or M. avium.

A

AIDS patients

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9
Q

acute osteomyelitis

Clinically?

A

fever, localized pain , heat , swelling, tenderness of affected site ( one or more bones or joints affected in hematogenous spread). May be local tissue infection ( abscess or wound) .

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10
Q

acute osteomyelitis

Blood tests:?

A

leukocytosis, high ESR and C-reactive

protein.

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11
Q

acute osteomyelitis

• X-ray? Ultrasound? CT scan? MRI?

A

• X-ray : normal at early stages. Swelling of soft tissues
followed by elevation of periosteum , demineralization and
calcification of bone later on.

• Ultrasound: fluid collection (abscess) and surface
abnormalities of bone. • CT scan: reveal small areas of osteolysis in cortical bone. • MRI : early detection ,help in unclear situations. Defines
bone involvement in patients with negative bone scan.

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12
Q

Diagnosis of acute osteomyelitis?

A

Blood culture: bacteremia common.
Biopsy of periosteum or bone or needle aspiration of
overlying abscess if blood culture is negative.
Blood test: complete blood and differential counts .
Erythrocyte sedimentation rate ( ESR) .
C-reactive protein
Imaging studies: X-RAY, MRI, CT-SCAN

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13
Q

Complications of acute osteomyelitis include?

A

oSeptic arthritis
oChronic osteomyelitis
oMetastatic infection to other bones or organs
oPathological fractures

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14
Q

Chronic Osteomyelitis

Infection due to?

A

hematological spread is rare.

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15
Q

Chronic Osteomyelitis

Infection are ?

A

secondary to a contiguous focus or

peripheral vascular disease.

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16
Q

Chronic Osteomyelitis

Most common pathogen ?

A

• S. aureus is the most common pathogen.

17
Q

? And ? clinically have
indolent “chronic” course
?

A

Tuberculosis and fungal osteomyelitis

18
Q

Chronic Osteomyelitis
? And ? may be the cause in
immunosuppressed patients.

A

Mycobacteria and fungi

19
Q

common in KSA. ?

Chronic Osteomyelitis

A

TB & Brucella

20
Q

Diagnosis of chronic osteomyelitis

?

A

• Blood culture is not very helpful because bacteremia is
rare.
• WBC usually normal, ESR elevated but not specific.
• Radiological changes are complicated by the presence of
bony abnormalities.
• MRI helpful for diagnosis and evaluation of the extent
of disease.

21
Q

Management & Treatment

Of chronic osteomyelitis

A

• Extensive surgical debridement with antibiotic therapy.
• IV antibiotics for 3-6 weeks followed by long term oral
suppressive therapy.
• Some patients may require life long antibiotic ,others for
acute exacerbations.

22
Q

 Is an acute inflammation of the joint space secondary to

infection. ?

A

Septic (Infectious) Arthritis:

23
Q

Generally affects a single joint and results in suppurative
inflammation.
?

A

Septic Arthritis

24
Q

Haematogenous seeding of joint is most common.

In ?

A

Septic Arthritis

25
Q

Septic Arthritis

Common symptoms?
Diagnosis by ?
Management?

A

Common symptoms: pain, swelling, limitation of movement. Diagnosis by Arthrocentesis to obtain synovial fluid for
analysis; Gram stain, culture & sensitivity.
Drainage & antimicrobial therapy important management.

26
Q

Common causes of septic arthritis
S. aureus, group B Streptococcus, Gram
negative rods ( e.g. E. coli, Klebsiella,
Proteus, Pseudomonas) .

Common in ?

A

Neonates

27
Q 
Common causes of septic arthritis
S. aureus, group A Streptococcus, S.
• Infants /children
pneumoniae, H. influenzae type b
 Common in ?
A

Infants. Children

28
Q

S. aureus, Neisseria gonorrheae
Common organism
septic arthritis
?

A

Adults

29
Q

Salmonella species
septic arthritis
Common in ?

A

Sickle cell disease

30
Q

S. aureus
Common in ?
Septic arthritis

A

Trauma /surgical procedure

31
Q

septic arthritis
Mycobacterium tuberculosis , Fungi

Common in ?

A

Chronic arthritis

32
Q

Other causes of septic arthritis

Reactive arthritis due to: ?

A
  • Campylobacter jejuni
  • Yersinia enterocolitica
  • Some Salmonella species
33
Q

Other causes of septic arthritis

Non-infectious causes of arthritis?

A
  • Rheumatoid arthritis
  • Gout
  • Traumatic arthritis
  • Degenerative arthritis
34
Q

Risk factors
Of septic arthritis
?

A
  1. Gonococcal infection :
    • Most common cause in young, sexually active adults.
    • Caused by Neisseria gonorrheae .
    • Leads to disseminated infection secondary to
    urethritis/cervicitis
    . • Initially present with polyarthralgia, fever, skin lesions.
  2. Non-gonococcal arthritis :
    • Occurs in older adults. • Results from introduction of organisms into joint space as
    a results of bacteremia or fungaemia from infection at
    other body sites.
  3. Lyme disease due to tick bite in endemic areas.
    Uncommon in KSA.
35
Q

Diagnosis of Septic Arthritis

?

A
  1. History/examination to exclude systemic illness. Note
    history of tick exposure in endemic areas
  2. Arthrocentesis should be done as soon as possible;
    1- Synovial fluid is cloudy and purulent.
    2- Leukocyte count generally > 25,000/mm3,with
    predominant neutrophils.
    3- Gram stain and culture are positive in > 90% of cases.
    4- Exclude crystal deposition arthritis or non-infectious
    inflammatory arthritis.
  3. Blood cultures indicated

• If Gonococcal infection suspected, take specimen
from cervix, urethra, rectum for culture or DNA testing
for N. gonorrheae.
• Investigate for other sexually transmitted diseases.
• Culture of joint fluid.

36
Q

Management & treatment

Of septic arthritis?

A
  1. Arthrocentesis with drainage of infected synovial fluid.
    • Repeated therapeutic Arthrocentesis often needed.
    • Occasionally, surgical drainage/debridement
    • Antimicrobial therapy should be directed at the suspected
    organism and susceptibility results

Microbiology (6 decks)

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