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Semester 2 skeletal system > Bone and Joint infections > Flashcards

Bone and Joint infections Flashcards

1
Q

How do organisms get into the bone?

A
  • Haemotogenous spread
  • Local spread (septic arthritis)
  • Compound fracture
  • Foreign bodies
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2
Q

What do people with sickle cell disease have a predisposition to?

A

Salmonella

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3
Q

What do people who have travelled or were foreign born have a predisposition to?

A

Brucella

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4
Q

What fo people who have a prothesis have a predisposition to?

A

S. epidermis

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5
Q

What do children under 5 have a predisposition to?

A

H.influenzae

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6
Q

What do people who have a UTI have a predisposition to?

A

E. coli and others

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7
Q

What is osteomyelitis?

A

An infection of the bone

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8
Q

Which bones are affected by osteomyelitis?

A
  • Humerus (8-10%)
  • Femur (30-35%)
  • Tibia (25-30%)
  • Fibula (5%)
  • Calcaneum (10-12%)
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9
Q

Describe haematogenous spread to the bones

A
  • Usually asymptomatic
  • Skin sepsis may be present but it is usually absent
  • Organisms tend to settle in the growing metaphysis
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10
Q

How do foreign bodies enter the bone?

A
  • Trauma
  • Shrapnel/Gun shot wounds
  • Orthopaedic implants
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11
Q

Which are the 3 main organisms responsible for osteomyelitis?

A
  • S. aureus (>80%)
  • S. pyogenes (~5%)
  • M. tuberculosis
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12
Q

What are the symptoms and signs of osteomyelitis?

A
  • Painful swollen site
  • Fever
  • Reduced movement (may be the only sign in the very young)
  • Paraplegia
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13
Q

What may chronic myelitis lead to?

A

Bone destruction

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14
Q

What investigations are taken for a suspected osteomyelitis?

A
  • Blood culture - not often positive - 3 need to be taken at different times (may be negative early on)
  • X ray - may not be sensitive enough
  • MRI/CT/Bone scan
  • Pus - may not be acquired
  • Operative sample (may not be obtained)
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15
Q

What is the standard empirical therapeutic regimen to treat osteomyelitis?

A

Flucloxicillin with Fucidin (Flucloxicillin doesn’t get in to the bone well)

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16
Q

What is used to treat osteomyelitis if the patient is B lactate allergic?

A

Fucidin and erythromycin or rifampicin

17
Q

What is used to treat osteomyelitis if salmonella is responsible?

A

Ciprofloxacin

18
Q

What is used to treat osteomyelitis if tuberculosis is responsible?

A

Isoniazid, Rifampicin, Pyrazinamide, Ethambutol

19
Q

Aside from the use of drugs, how can osteomyelitis be treated?

A

Drainage/removal of involucrum

20
Q

Which sites are most affected by septic arthritis?

A
  • Knee
  • Hip
  • Lumbosacral spine (facets)
21
Q

What are the predisposing conditions of septic arthritis?

A
  • Rheumatoid arthritis- inflammation, more likely for th bugs to settle
  • Injection of joint (taking bugs from outside to inside with it)
  • Prosthetic joint (1- operative procedure, failure of sterile environment, 2- it is a foreign body which allows the organisms to settle)
22
Q

What are the causative organisms of septic arthritis

A
  • S. aureus
  • S. pyogenes
  • S. epidermis
  • M. tuberculosis
  • Salmonella
  • Brucella
23
Q

How is septic arthritis diagnosed?

A
  • Blood culture x3
  • Joint aspirate (removal of fluid around a joint with a needle and syringe)
  • Joint X ray (more to plan treatment than to diagnose)
24
Q

Post- infectious arthritides

A

I don’t understand this haha

25
Q

What are the primary risk factors for prosthetic joint infection?

A
  • Rheumatoid arthritis
  • Diabetes mellitus
  • Poor nutritional status
  • Obesity
  • Concurrent UTI
  • Steroid therapy
  • Malignancy
  • Post-operative surgical site infection
  • NNIS>0
26
Q

What are the risk factors for a prosthetic joint (revision)

A
  • Prior joint surgery
  • Prelonged operative room time
  • Preoperative infection
27
Q

What are the causative organisms for an infection in a hip prosthetic? (main to least)

A
  • Staphylococcus aureus
  • Coagulase-negative staphylococci
  • Streptococci
  • Gram negative bacilli
  • Anaerobic organisms
  • Enterococcus
  • Culture negative
  • Polymicrobial
28
Q

What are the causative organisms for an infection in a knee prosthetic? (main to least)

A
  • Staphylococcus aureus
  • Coagulase negative staphylococci
  • Streptococci
  • Gram negative bacilli
  • Anaerobic organisms
  • Enterococcus
  • Culture negative
  • Polymicrobial
29
Q

What is Reiter’s Syndrome?

A
  • Synovitis (inflammation of synovial membrane)
  • Conjunctivitis
  • Sacroiliitis (inflammation is sacroiliac joint(s))
  • Aortitis (inflammation of the aortic wall)
  • Circinate balinitis (skin lesions on penis)
  • Keratoderma blennorrhagica (lesions)
  • HLA B27
  • Associated with chlamydial infection

Semester 2 skeletal system (3 decks)

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