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microbiology 3 > bone and joint infections > Flashcards

bone and joint infections Flashcards

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1
Q

osteomyelitis aetiology

A
  • post trauma or surgery eg. orthopaedic device infection, sporting incidents
  • haematogenous
  • contiguous with another infection
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2
Q

osteomyelitis pathogenesis

A

invasive bacteria cause inflammatory reaction
leukocytes release enzymes that lyse the bone
oedema, vascular congestion, and small-vessel thrombosis
impaired flow of both medullary and periosteal blood supply

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3
Q

chronic osteomyelitis

A

produces areas of devitalized infected bone, sequestra
body forms new bone, involucrum
leads to bone sclerosis and deformity

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4
Q

involucrum

A

new bone that the body forms

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5
Q

sequestra

A

areas of devitalized bone

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6
Q

acute osteomyelitis treatment

A

may be curable with antibiotics alone

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7
Q

chornic osteomyelitis treatment

A

frequently requires surgical debridement

remove sequestrum and nectrotic tissue

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8
Q

haematogenous OM in adults microbiology

A

staph aureus

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9
Q

haematogenous OM in infants

A

staph aureus
strep agalactiae
e coli

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10
Q

haematogenous OM in pre school

A

staph aureus
strep pyogenes
H influenzae
kingella kingae

also S pneumoniae and salmonella

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11
Q

symptoms of OM

A

general infection symtoms

fever, pain, erythema, swelling,

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12
Q

brodie abscess

A 
subacute osteomyelitis in children 
host immunity controls infection 
leg > arm bones, usually tibia 
usually S aureus 
also streptococcus, pseudomonas, haemophilus influenzae, and coag negative staphylococcus 
increase prevelance of kingella kingae
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13
Q

diagnosis of OM

A

raised inflammatory markers

  • CRP
  • white cell count
  • others: procalcitonin, IL-6

infections is often very localised, so may not cause a systemic response and these markers may be normal

microbiological

  • blood cultures
  • joint aspiration and culture
  • bone biopsy
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14
Q

imaging - x ray

A

soft tissue swelling

periosteal reaction - lifting

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15
Q

other imaging for OM

A

CT
MRI
nuclear scans - not useful, may indicate need for further scans

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16
Q

principles of therapy in antibiotics

A

high dose antibiotics , usually IV initially
empiric therapy must cover staph aureus eg. flucloxacillin, vancomycin if patient is septic or risks of MRSA, add cephallosporin in kids

at least 6 weeks of therapy in adults
3 weeks sufficient in children
targeted therapy
oral therapy may be effective

17
Q

principles of therapy in surgery

A
  • acute osteomyelitis may require surgery - drainage of sub periosteal and intra osseous collections
  • chronic OM usually requires surgery for debridement, sequestrum, abscess, devitalised tissue
  • prosthetic or foreign material needs removal eg. biofilm
18
Q

septic arthritis pathogenesis

A

bacteria in the synovium
acute inflammation
no basement membrane, therefore bacteria enter synovial fluid

19
Q

septic arthritis description

A

purulent inflammation of joint
synovial hyperplasia
cytokine and proteases release
cartilage destruction and growth inhibition

20
Q

microbioloty of septic arthritis

A

MSSA and MRSA
strep species
grem negatives in elderly, catheterised and IDU
N. gonorrhoea

21
Q

septic arthritis clinically

A

usually one joint - moost commonly the knee
wrists, ankle hip
sacro-iliac and sterno-clavicular joints in IDU
20% are oligoarticular or polyarticular
joint pain, swelling, warmth, and restricted movement
fever common

22
Q

diagnosis of septic arthritis

A

raised inflammatory markers - CRP, white cell count

blood cultures, joint aspiration and culture - culture positive in most, high leucocyte count

23
Q

septic arthritis treatment

A

antibiotics and joint drainage

antbiotics choice as per OM

24
Q

septic arthritis prognosis

A

inflammaton and destruction of joints may continue even in those with sterile joints despite effective antimicrobial therapy
persistance of bacterial antigens within the joint
50% of s aureus infectons have poor outcome at worse, require arthroplasty

25
Q

gonococcal arthritis

A 
younger patient group 
multiple joints may be affected 
cultures may be negative 
may be co-existing pastular rash 
not as joint destructive

microbiology 3 (10 decks)

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