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MHD > Bone and Joint Infection > Flashcards

Bone and Joint Infection Flashcards

1
Q

Septic Arthritis

1. 3 main causes

A
  1. Bacterial (10% of pts presenting w/ acute pain)
  2. Viral- acute, often multi-joint
  3. Fungal- chronic, usually monoarticular
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2
Q

Septic Arthritis

  1. Mortality if untreated?
  2. Morbidity?
A
  1. 10-30%

2. up to 50% w/ permanent loss of function

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3
Q
  1. Who can get septic arthritis?

2. Risk Factors (8)

A
  1. anyone
  2. Age>80, prosthetic joint, recent joint surgery, IV drug use, endocarditis, immunosuppression/chronic disease, joint disease: RA, OA, Gout, skin infection/ulcer
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4
Q

3 ways Septic Arthritis can occur

A
  1. Hematogenous spread
  2. Direct inoculation (via trauma or surgery)
  3. Spread of infection from contiguous source (bone)
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5
Q

Pathogenesis of Septic Arthritis

A
  1. Synovial tissue that lines the joint space is normally leaky
  2. Acute inflammatory response/ infiltrate
  3. This causes synovial effusion and cartilage degradation
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6
Q

Septic Arthritis: Presentation

  1. Onset
  2. Number of joints
  3. Symptoms
  4. Exam
A
  1. hours-days
  2. mono-articular
  3. pain, swelling, warmth, loss of function, fevers (not if you’re immunosuppressed)
  4. Tenderness, limited ROM/painful, effusion, redness
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7
Q

Differential Diagnosis of Septic Arthritis (7)

A
  1. Crystal induced disease
  2. Rheumatoid Arthritis
  3. Osteoarthritis
  4. Systemic Lupus Erythematous (SLE)
  5. Reiter’s and other reactive arthritides
  6. Rheumatic Fever
  7. Other Rheumatological disease
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8
Q

Septic Arthritis: Bacterial Causes

  1. What is it most often?
  2. What could it also be?
  3. When does 2 become more common?
A
  1. Gram +: Staph (30-65%, esp aureus); Strep (20-25%)
  2. Gram Negatives: E. Coli, H. flu, Neisseria, Pseudomonas
  3. IV drug use, immunocompromised, elderly
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9
Q

Septric Arthritis Diagnosis

  1. What is the most important test?
  2. What is seen early on X-ray?
  3. Late?
A
  1. Diagnostic Tap
  2. Early: soft tissue swelling
  3. Late: loss of joint space, erosive and destructive changes
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10
Q

Synovial Fluid Analysis in Septic Arthritis

  1. What increases the likelihood of septic arthritis?
  2. What specifically increases the likelihood of septic arthritis?
  3. If a patient has low PMNs? can you rule out septic arthritis?
A
  1. higher synovial WBCs
  2. PMN >90%
  3. NO;
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11
Q

Diagnosis of Septic Arthritis

  1. How useful is the Gram Stain?
  2. Culture?
  3. Blood culture?
A
  1. diagnostic in only 50%, but good bc rare false positives
  2. 80-90% diagnostic; non-gonococcal arthritis
  3. positive about 50% of the time
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12
Q

Treatment of Septic Arthritis (2)

A
  1. Drainage (daily aspirations, surgical drainage, more important with larger/prosthetic joints)
  2. Empiric, then driven by clinical background
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13
Q

3 Other common causes of infectious arthritis

A

Gonococcal arthritis
Lyme arthritis
Viral arthritis

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14
Q

Gonococcal Arthritis

  1. Who commonly gets it?
  2. What is it a form of?
A
  1. most common in sexually active individuals; usually under 30 y/o
  2. disseminated gonococcal infection (DGI)
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15
Q

DGI

  1. how common is it?
  2. which gender is more likely to get it?
  3. What is it associated with?
  4. Other risk factors?
A
  1. 0.5-3% of gonococcal infections
  2. women
  3. menstruation/pregnancy
  4. same as other STDs: more partners, IV drug use, lower SES
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16
Q

DGI

  1. what causes it?
  2. Classic Triad
  3. Other common symptoms
A
  1. result of occult bacteremia
  2. Dermatitis (numerous painless, non-pruritic macules, papules, pustular lesions)
  3. Tenosynovitis (most common in hands, wrists, fingers, 2/3s of pts)
  4. Migratory polyarthalgia or arthritis
  5. Fevers, malaises
17
Q

DGI- Septic Joint

  1. How common is it?
  2. How many joints?
  3. Which joints?
A
  1. less common, can occur w/ or w/o DGI
  2. usually monoarticular
  3. knees, wrist, ankles
18
Q

Gonococcal arthritis- Diagnosis

  1. What must be done?
  2. Gram stain
  3. Culture
  4. What is the best method?
A
  1. diagnostic tap
  2. only 25% positive for G neg diplococci
  3. only 50% positive
  4. PCR, either of synovial fluid or from mucosal sites of original infection
19
Q

Osteomyelitis

  1. Define
  2. Is it acute or chronic?
  3. Ways of getting it
A
  1. inflammation of bone and marrow (infection)
  2. Acute vs Chronic (considered chronic when sequelae are present)
  3. Hematogenous vs Contiguous
20
Q

Osteomyelitis: Hematogenous spread

  1. Who gets hematogenous spread?
  2. Where?
  3. What bacteria are found there?
A
  1. children, growing bones
  2. Vertebral bodies
  3. monomicrobial
21
Q

Osteomyelitis: Contiguous Spread

  1. What are some risk factors?
  2. What bacteria are there?
A
  1. DM, ischemic ulcers, decubitus ulcers, trauma/ surgery

2. Polymicrobial

22
Q

Osteomyelitis Presentation

  1. Acute
  2. Chronic
  3. What 2 sites present as just pain in acute?
A
  1. Gradual onset of symptoms over days-weeks; pain, erythema, swelling, tender, fevers/rigors,
  2. pain, erythema, swelling, sinus tracts, large ulcers
  3. hip, vertebrae
23
Q

Typical Osteomyelitis Pathogens

A

Staph
Strep
Enterococcus
Gram negative rods (pseudo, e coli, enterobacter)

24
Q

Diagnosis of Osteomyelitis

  1. 3 imaging modalities?
  2. Which is the best? why?
  3. When is it not the best?
  4. What are the 3 nuclear studies?
A
  1. X-ray, MRI, CT
  2. MRI- good sens and spec; good negative predictive value;
  3. when hardware is present?
  4. Triple phase bone scan, Gallium scan, WBC scan
25
Q

Osteomyelitis Diagnosis

  1. What is a common easy test?
  2. If it is positive in a DM foot ulcer, what futher testing is needed?
A
  1. steel probe to bone test

2. none

26
Q

Osteomyelitis Culture

  1. How good is wound swab and deep wound cultures?
  2. How good is percutaneous needle biopsy?
  3. How good is a bone biopsy?
A
  1. poor correlation w/ diagnosed organism
  2. poor correlation w/ diagnosed organism
  3. best method for specimen collection; yields positive cx 87% of the time

MHD (17 decks)

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