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-MSK Diseases > 5.1. Bone and Soft Tissue Infection - Acute (and Subacute) Osteomyelitis > Flashcards

5.1. Bone and Soft Tissue Infection - Acute (and Subacute) Osteomyelitis Flashcards

1
Q

What are the 4 categories of Osteomyelitis?

A
  1. Acute (Subacute) Osteomyelitis
  2. Chronic Osteomyelitis
  3. Specific Osteomyelitis
  4. Non-Specifc Osteomyelitis
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2
Q

What are the Risk Factors for having Haematologenous spread of infection, causing Acute Osteomyelitis?

A
  1. Children and Elderly
  2. Boys > Girls
  3. History of Trauma
  4. Other Diseases (e.g. Diabetes, Rheumatoid Arthritis, Immune compromise, Long-term Steroid Treatment, Sickle Cell Anaemia)
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3
Q

How does Haematologenous spread, causing Acute Osteomyelitis occur?

A

Local spread from Contiguous Site of infection:

  1. Trauma (open fracture)
  2. Bone Surgery (ORIF)
  3. Joint Replacement
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4
Q

What are the most common sources of infection, causing Acute Osteomyelitis, in infants?

A

Infected umbilical cord

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5
Q

What are the most common sources of infection, causing Acute Osteomyelitis, in children?

A
  1. Boils (Furunculosis)
  2. Tonsilitis
  3. Skin abrasions
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6
Q

What are the most common sources of infection, causing Acute Osteomyelitis, in adults?

A
  1. Urinary Tract Infections

2. Arterial Line

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7
Q

What are the most common infective organisms, causing Acute Osteomyelitis, in Infants (<1 year)?

A
  1. Staph. Aureus
  2. Group B Streptococci
  3. E. Coli
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8
Q

What are the most common infective organisms, causing Acute Osteomyelitis, in Older Children?

A
  1. Staph. Aureus
  2. Strep Pyogenes
  3. Haemophilus Influenzae
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9
Q

What are the most common infective organisms, causing Acute Osteomyelitis, in Adults?

A
  1. Staph. Aureus
  2. Coagulase Negative Staphylococci
  3. Propionibacterium spp
  4. Streptococcus Pyogenes
  5. Mycobacterium Tuberculosis
  6. Pseudomonas Aeroginosa
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10
Q

What type of Organism is likely to cause Acute Osteomyelitis, from a Diabetic Foot patient?

A

Mixed infection including Anaerobes

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11
Q

What type of Organism is likely to cause Acute Osteomyelitis, from a Pressure Sore patient?

A

Mixed infection

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12
Q

What type of Organism is likely to cause Acute Osteomyelitis, from a Vertebral Osteomyelitis patient?

A
  1. Staph. Aureus

2. Tuberculosis

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13
Q

What type of Organism is likely to cause Acute Osteomyelitis, from a Sternal Osteomyelitis patient?

A

Coagulase Negative Staphylococci (post-cardiac surgery)

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14
Q

What type of Organism is likely to cause Acute Osteomyelitis, from a Sickle-Cell Anaemia patient?

A

Salmonella Spp

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15
Q

What type of Organism is likely to cause Acute Osteomyelitis, from a Sexually Transmitted Disease patient?

A

Gonococcus

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16
Q

What is the pathology of Acute Osteomyelitis?

A
  1. Trauma causes acute inflammation and vascular stasis
  2. Pus forms and Bone reformation occurs
  3. If infection gets into the bone during this time - granulation tissue “walls off” the diseased bone tissue (sequestrum)
  4. Bacterial proliferation results in further destruction, and abscess formation in the bone
17
Q

What are the clinical features of Acute Osteomyelitis in an infant?

A
  1. Minimal signs / may be very ill
  2. Failure to thrive
  3. Drowsy / Irritable
  4. Metaphyseal tenderness / swelling
  5. Decreased Range of Movements + positional change
18
Q

What are the clinical features of Acute Osteomyelitis in a Child?

A
  1. Severe pain - reluctance to move / not weight bearing
  2. Fever (swinging Pyrexia)
  3. Tachycardia
  4. Malaise (Fatigue, Nausea, Vomiting)
  5. Toxaemia
19
Q

What are the clinical features of Primary Acute Osteomyelitis in an Adult?

A

This is seen commonly in the Thoracolumbar Spine:

  1. Fever
  2. Backache
  3. History of UTI or Urological procedure
  4. Old
  5. Diabetic / Immunocompromised
20
Q

What are the clinical features of Secondary Acute Osteomyelitis in a Adult?

A

This is more common the Primary Osetomyelitis - often seen after:
1. An open fracture
2. Surgery
Note - this often contains a mixture of organisms

21
Q

What Clinical (Blood) Investigations are done to diagnose Acute Osteomyelitis?

A
  1. Full Blood Count + Diff. WBC
  2. Inflammatory markers - ESR + CRP
  3. 3 x Blood Cultures
  4. Urea & Electrolytes
22
Q

What Radiological Investigations are done to diagnose Acute Osteomyelitis?

A
  1. X-Ray
  2. Ultrasound
  3. Aspiration
  4. Isotope Bone Scan
  5. Labelled White Cell Scan
  6. MRI
23
Q

What is found on an X-Ray of a suspected Acute Osteomyelitis patient?

A
  1. It appears normal in the first 10-14 days
  2. Late Metaphysial Destruction
  3. Late Medullary Changes - Lytic Areas
  4. Late Osteonecrosis - Sequestrum
  5. Late Periosteal New Bone - Involucrum
24
Q

How is a Microbiological diagnosis of Acute Osteomyelitis arrived at?

A
  1. Blood Cultures
  2. Bone Biopsy
  3. Tissue Swabs from up to 5 sites around an implant at debridement in prosthetic infection
25
Q

What is the differential diagnosis for Acute Osteomyelitis?

A
  1. Cellulitis
  2. Eryipelas
  3. Necrotising Fasciitis
  4. Gas Gangrene
  5. Toxic Shock Syndrome
  6. Acute Septic Arthritis
  7. Trauma
  8. Acute Inflammatory Arthritis
  9. Transient Synovitis
26
Q

What is the treatment for Acute Osteomyelitis?

A
  1. Analgesia
  2. Rehydration Therapy
  3. Rest and Splintage
  4. I.V. / Oral Antibiotics for 4-6 weeks (Flucloxacillin + Benzylpenicillin until know more specifics)
  5. Surgery
27
Q

What are the indications for surgery in Acute Osteomyelitis?

A
  1. Abscess drainage

2. Debridement of Dead / Infected / Contaminated Tissue

28
Q

What are the complications of Acute Osteomyelitis?

A
  1. Septicemia, death
  2. Metastatic Infection
  3. Pathological Fracture
  4. Septic Arthritis
  5. Altered Bone Growth
  6. Chronic Osteomyelitis
29
Q

When does Subacute Osteomyelitis occur?

A
  1. Increased Host Resistance
  2. Lowered Bacterial Virulence
  3. Antibiotic Usage
30
Q

What are the Clinical Features of Subacute Osteomyelitis?

A
  1. Long history (weeks-months)
  2. Variable Pain / Limp
  3. Local Swelling / Warmth
  4. Local Tenderness
31
Q

What is the Differential Diagnosis for Subacute Osteomyelitis?

A
  1. Tumour (Ewing;s Sarcoma, Osteoid Osteoma)

2. Tuberculosis

32
Q

What is the name of the Abscess which forms during Subacute Osteomyelitis?

A

Brodie’s Abscess - A well defined cavity in Cancellous Bone

33
Q

What are the Clinical Features of Subacute Osteomyelitis?

A
  1. Painful Limp
  2. No systemic Features
  3. Most commonly seen in older children
34
Q

What is seen on Radiographical Imaging, when Subacute Osteomyelitis is present?

A

Luency in a Long Bone Metaphysis

35
Q

What is the treatment of Subacute Osteomyelitis?

A
  1. Prolonged course of Antibiotics

2. Surgery - Curettage

-MSK Diseases (43 decks)

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