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Arthritis related to infection Flashcards

1
Q

Common bacterial cause of septic arthritis in neonate

A

Group B strep
Staph
Gram negative

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2
Q

Common cause of septic arthritis in infant

A

Staph
Strep pneumo
H FLu (less common with vacine)

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3
Q

Common cause of septic arthritis in Child

A

Staph
Strep pneumo
Group A strep
Kingella Kingae (may account for culture negative cases)

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4
Q

Common cause of septic arthritis in an adolescent

A

Staph
Strep Pneumo
Group A strep
Gonorrhea

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5
Q

What can predispose to multijoint septic arthritis ?

A

HIV

Chronic granulomatous disease

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6
Q

Synovial fluid abnormalities in septic arthritis

A
  • May be normal, turbin, or grayish-green
  • WBC markedly elevated, with 90% PMN (>100k)
  • Protein concentration high (>2.5g)
  • Glucose low (but could be normal)
  • Gram stain may be positive
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7
Q

Treatment for septic arthritis depending on age

A

<3–> cefotaxime and naf/ox
>3 CA MRSA less than ten percent–> Cefazolin or naf/ox
>3 CA MRSA greater than ten percent –> Clinda or vanc

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8
Q

Tuberculous arthritis

A
  • Indolent chronic monoarthritis knee or wrists on background of pulmonary TB
    Leads to destruction of joint and surrounding bones
  • Complications include chronic draining fistulae, Pott disease of the spine, tuberculous dactylitis
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9
Q

Brucellosis

A
  • Results from unpasterized milk and farm animals
  • Mild systemic illness with undulant fever, GI complaints, LAD, HSM, dermatitis
  • Peripheral arthritis of hip or knee most common in one series, spondylitis and sacroilitis
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10
Q

Most common cause of severe chronic erosive arthritis in patient with congenital immunodeficiency, also seen in HIV

A

Mycoplasma

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11
Q

Infectious arthritis seen in patients with agammaglobulinemia

A

Ureaplasma, urealyticum

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12
Q

Common bacterial cause of septic arthritis in HIV

A

increased incidence of strep pneumo

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13
Q

Signs of Diskitis

A
  • Subtle
  • Vague back pain and stiffness
  • Low grade fever
  • May refuse to walk, stand or bend over
  • May complain of abdominal pain
  • May have localized tenderness (L4-L5 most affected, C spine might also be involved)
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14
Q

Common causes of osteo

A

staph, Group A strep

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15
Q

Other cause of osteo in kids

A

Kingella

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16
Q

Cause of osteo if there is history of puncture through sneaker

A

pseudomonas

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17
Q

Causes of osteo in sickle cell

A

Salmonella, strep pneumo

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18
Q

Causes of osteo in spine

A

Brucella

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19
Q

Strep pneumo causes osteo in…

A

sickle, aspenia, hypogamma

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20
Q

Primary site of osteo

A

metaphysis

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21
Q

Complicated osteo

A

Cellulitis, radiographic findings, high fever, high WBC, elevated ESR, CRO

22
Q

Presence of bone pain and point tenderness should alert the physician of this

A

osteomyelitis accompaning septic arthritis

23
Q

Viruses that cause small joint disease

A

Rubella, hep B, chikungunya

24
Q

Viruses that cause large joint

A

Mumps, varicella and other viruses.

25
Q

Most common life cycle of Borrelia to infect humans

26
Q

How ticks evade the host immune response

A

sequential variation of their outer surface proteins

27
Q

Most common signs of lyme disease

A

Cutaneous, MSK, CNS

28
Q

Borrelia Lymphocytoma

A

Rare in children in US
Purple swelling most commonly at earlobe, scrotum or nipple
Early manifestation of Lyme

29
Q

Most common reversible AV block

A

Lyme carditis

30
Q

Early manifestations of lyme

A
  • Skin (EM)
  • CNS (lymphocytic menigitis, cranial nerve palsy)
  • MSK (arthralgias)
  • Carditis (AV heart block)
31
Q

Late manifestations of Lyme

A
  • Skin (acrodermatitis chronica atrophicans)
  • CNS (chronic encephalomyelitis)
  • MSK (arthritis, mono most common)
32
Q

Western blot testing for Lyme

A

IgM 2/3 positive(takes 3-4 weeks)

IgG 5/10 positive (takes 4-8)

33
Q

Treatment for Lyme arthritis

A

4 weeks duration
Doxy >9
Amox <9, if pcn allergy–> macrolides

34
Q

Treatment failure lyme

A
  • Repeat abx or try another

- Intraarticular steroids, sulfasalazine, MTX, arthoscopic synovectomy

35
Q

Congenital syphilis

A

Juxta-epipheseal osteochondritis in infancy
Periarthritis in infancy
Syphlitic dactylisis in early childhood

36
Q

Clutton joint

A

Occurs later in syphilis infection

Painless, recurring, non progressive, symmetrical synovitis in knee

37
Q

Clinical syphilis infection

A

Primary- Chancre
Secondary- Rash, Fever, malaise, sore throat, myalgias, weight loss, alopecia, hepatitis, GI abnormalities, MSK:synovitis, osteitis, periostitis, neuro abnl, Renal: membraneous GN
Tertiary- GUmmas, Dilated aorta, aortic valve regurge, Neurosyphilis

38
Q

Jones criteria for ARF

A 
Two major or one major and two minor with evidence of a preceding Group A Strep (elevated or rising strep titer, positive throat cx or rapid strep)
Major 
1. Carditis 
2. Polyarthritis 
3. Sydenham chorea
4. Erythema Marginatum
5. Subcutaneous nodules

Minor

  1. Fever
  2. Arthralgia
  3. Elevated ESR or CRP
  4. Prolonged PR
39
Q

Major susceptibility factor for ARF

A

B cell alloantigen B8/17

40
Q

When do ARF symptoms usually appear?

A

4 weeks after infection (2-6 weeks)

41
Q

ARF arthritis

A

Occurs in 70 percent
Large joints
Migratory and additive
Symptoms may resolve spontaneously in one joint and appear in another joint

42
Q

ARF carditis

A

More than 50%
Can be mild or acute/life threatening
Endocardial and valvular
Most common target is mitral valve followed by aortic

43
Q

Chorea ARF

A

Inflammation of basal ganglia and caudate nucleus
occurs 2-4 months after infection (as late as 12 months)
Persistent involuntary and purposeless movements of extremities and face, usually symmetric and with incoordination
Symptoms usually resolved spontaneously in 2-3 weeks but may persist for several months or even years
Mild manifestations only need bedrest and stress relief; anticonvulsant drugs may help control severe symptoms (anti inflammatories not needed)

44
Q

Rash ARF

A

Erythema marginatum is classic
Non pruritic and macular with serpiginous erythematous border
Usually on trunk and proximal extremities
Accentuated by warmth

45
Q

Nodules ARF

A

Rare
On extensor surfaces of joints
Resemble RA nodules

46
Q

Treatment for carditis

A

Mild–> aspirin

Severe/CHF–> PO pred (better than IV), one week before termination start aspirin

47
Q

Options for ARF ppx

A
  • IM pencillin preferred given monthly
  • Oral ppx for patients without cardiac involvement
  • Sulfonamides work well for ppx

Should receive until 21 if no cardiac involvement and life is cardiac involvement

48
Q

Post strep arthritis

A
  • Appears 7-10 days after infection
  • Additive and persistent (can involve small joints, axial skeleton in addition to large joints)
  • Non-migratory in 70-80 percent
  • Response to aspirin/NSAIDs is much more modest or poor
  • Start with NSAIDs then short low course dose of steroids
  • Treat primary infection
  • Abx ppx for 1 year if echo is normal, if develop valvulitis, reclassify as ARF and pxx
49
Q

Possible sequelae of transient synovitis

A

Legg calve perthes, coxa magma and osteoarthritis

50
Q

Why is open surgery required for shoulder or hip septic arthritis?

A

Risk of avasular necrosis due to inadequate blood supply

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