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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
Most common life cycle of Borrelia to infect humans
Nymphs
26
How ticks evade the host immune response
sequential variation of their outer surface proteins
27
Most common signs of lyme disease
Cutaneous, MSK, CNS
28
Borrelia Lymphocytoma
Rare in children in US Purple swelling most commonly at earlobe, scrotum or nipple Early manifestation of Lyme
29
Most common reversible AV block
Lyme carditis
30
Early manifestations of lyme
- Skin (EM) - CNS (lymphocytic menigitis, cranial nerve palsy) - MSK (arthralgias) - Carditis (AV heart block)
31
Late manifestations of Lyme
- Skin (acrodermatitis chronica atrophicans) - CNS (chronic encephalomyelitis) - MSK (arthritis, mono most common)
32
Western blot testing for Lyme
IgM 2/3 positive(takes 3-4 weeks) | IgG 5/10 positive (takes 4-8)
33
Treatment for Lyme arthritis
4 weeks duration Doxy >9 Amox <9, if pcn allergy--> macrolides
34
Treatment failure lyme
- Repeat abx or try another | - Intraarticular steroids, sulfasalazine, MTX, arthoscopic synovectomy
35
Congenital syphilis
Juxta-epipheseal osteochondritis in infancy Periarthritis in infancy Syphlitic dactylisis in early childhood
36
Clutton joint
Occurs later in syphilis infection | Painless, recurring, non progressive, symmetrical synovitis in knee
37
Clinical syphilis infection
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
Jones criteria for ARF
``` 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
Major susceptibility factor for ARF
B cell alloantigen B8/17
40
When do ARF symptoms usually appear?
4 weeks after infection (2-6 weeks)
41
ARF arthritis
Occurs in 70 percent Large joints Migratory and additive Symptoms may resolve spontaneously in one joint and appear in another joint
42
ARF carditis
More than 50% Can be mild or acute/life threatening Endocardial and valvular Most common target is mitral valve followed by aortic
43
Chorea ARF
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
Rash ARF
Erythema marginatum is classic Non pruritic and macular with serpiginous erythematous border Usually on trunk and proximal extremities Accentuated by warmth
45
Nodules ARF
Rare On extensor surfaces of joints Resemble RA nodules
46
Treatment for carditis
Mild--> aspirin | Severe/CHF--> PO pred (better than IV), one week before termination start aspirin
47
Options for ARF ppx
- 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
Post strep arthritis
- 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
Possible sequelae of transient synovitis
Legg calve perthes, coxa magma and osteoarthritis
50
Why is open surgery required for shoulder or hip septic arthritis?
Risk of avasular necrosis due to inadequate blood supply

Rheum Boards Studying (34 decks)

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