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MSK - ABDN > Bone and soft tissue infection > Flashcards

Bone and soft tissue infection Flashcards

1
Q

what is osteomyelitis

A

this is infection of the bone

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2
Q

what is the difference between acute and chronic osteomyelitis

A

acute - develops from a recent injury or infection

chronic - the condition regularly returns

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3
Q

what group of people is most affected by acute OM

A

children (boys)

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4
Q

name some predispositions to acute OM

A
  • diabetes
  • immunocompromised
  • long term steroid use
  • rheumatoid arthritis
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5
Q

what is the most common cause of acute OM

A

haematogenous spread of infection to the bones

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6
Q

in new borns, what is the most common cause of acute OM

A

infection of the umbilical cord

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7
Q

if acute OM occurs in adults, what are the likely sources of infection

A

UTI or arterial lines

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8
Q

what are the causative agents of acute OM

A
  • staph aureus
  • E. coli (babies)
  • strep pyogenes
  • mycobacterium tuberculosis
  • salmonella (those with sickle cell)
  • usually a mixed infection in those with diabetes (may need to alter the empirical formula)
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9
Q

where in the bone does acute OM begin

A

at the metaphysics of the bone

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10
Q

what is meant by sequestration

A

necrosis of the bone as a result of OM

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11
Q

what is meant by involucrum

A

this is the formation of a new layer of bone outside existing bone seen in OM

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12
Q

what are the clinical features of acute OM

A
  • failure to thrive
  • metaphysical tenderness and swelling
  • decreased range of movement or reluctancy to move
  • not weight bearing
  • fever and tachycardia
  • toxaemia (blood poisoning)
  • history of source of infection (e.g. UTI)
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13
Q

what is secondary acute OM

A

this is more common in adults and arises as a result of an open fracture or surgery (especially ORIF - open reduction and internal fixation procedures)

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14
Q

name some investigations you should carry out in acute OM

A
  • FBC + WCC
  • ESR and CRP
  • x-ray (usually normal in the first 2 weeks but afterwards you may see metaphysical destruction)
  • U+Es
  • white cell scan
  • isotope bone scan
  • MRI
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15
Q

what is the differential diagnosis of acute OM

A
  • acute septic arthritis
  • trauma
  • acute inflammatory arthritis
  • sickle cell crisis
  • transient synovitis
  • soft tissue infection (cellulitis, necrosing fascitis, toxic shock syndrome, gas gangrene
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16
Q

what is the cause of gas gangrene

A

clostridium perfingens

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17
Q

when are x-rays useful in the diagnosis of acute OM

A

after 2 weeks

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18
Q

name some things that can be done to determine the microbiological cause of acute OM

A
  • blood cultures
  • bone biopsy
  • tissue swabs
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19
Q

what is the treatment of acute OM

A

1) supportive - pain relief and rehydration therapy
2) antibiotics (IV for the first 7-10 days) - should be take for 4-6 weeks (depending on ESR)
3) rest and splitage

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20
Q

what is the empirical antibiotic formula for the treatment of acute OM

A

Fluclox and benzoyl penicillin

21
Q

what are the complications of acute OM

A
  • chronic osteomyelitis
  • septic arthritis
  • septicaemia
  • altered bone growth
  • pathological fracture
22
Q

what is subacute OM

A

this is a milder version of acute OM - there is absence of systemic symptoms, more vague symptoms which causes a delay in the diagnosis

23
Q

in someone with subacute OM, what may you find on clinical examination

A

local tenderness - there may be warmth, redness or swelling over the affected area (there is unlikely to be any systemic symptoms such as nausea, vomiting or fatigue)

24
Q

why would some people get subacute OM rather than acute OM

A

the development of subacute OM rather than acute OM is thought to be the result of a greater host defence, a weaker infective agent or recent antibiotic use

25
Q

what must be ruled out in subacute OM and how is this done

A

you must rule out malignancy and this is done with the use of imaging and bone biopsy

26
Q

name some complications of subacute osteomyelitis

A

chronic osteomyelitis and growth disturbances

27
Q

what is the differential diagnosis of subacute osteomyelitis

A

wings sarcoma, TB and osteoid osteoma

28
Q

what is meant by Brodie’s abscess

A

this is a form of subacute osteomyelitis and it typically presents in children in the metaphysical region of the proximal or distal tibia

29
Q

what is the most common microbiological cause of Brodie’s abscess

A

staph aureus

30
Q

what investigations would be useful in Brodie’s abscess

A

X-ray, bone scan, bone biopsy

31
Q

what is the treatment of Brodie’s abscess

A

prolonged antibiotics and curettage surgery if the epiphyseal is involved, if there is no improvement despite treatment or for recurring cases

32
Q

what is the cause of chronic osteomyelitis

A

chronic OM can arise from acute OM or can arise from surgery or an open#

33
Q

name some predisposing factors of chronic OM

A
  • diabetes
  • immunosuppression
  • drug abuse
34
Q

name the likely causative organisms in chronic OM

A
  • staph aureus
  • E. coli
  • strep pyogenes
35
Q

what is the treatment of chronic OM

A
  • eradication of infected bone via surgery
  • long term antibiotic treatment (local and systemic antibiotics)
  • treatment of soft tissue problems/complications
  • amputation
36
Q

complications of chronic OM

A
  • ongoing infection
  • pathological fracture
  • growth disturbance
  • deformity
  • squamous cell carcinoma
37
Q

what is acute septic arthritis

A

this is the acute inflammation of a joint caused by bacterial infection

38
Q

what is the cause of acute septic arthritis

A

can be caused by direct invasion (e.g. penetrating injuries or open#), haematogenous spread or an infection from another site or the eruption of a bone abscess

39
Q

what organisms cause acute septic arthritis

A

staph aureaus, E. coli, strep pyogenes and H. influenzae

40
Q

describe the pathology of acute septic arthritis

A

the articular cartilage in the joint is destroyed by the bacterial toxins and the enzymes

41
Q

what are the signs and symptoms of acute septic arthritis

A
  • resistant to move - not necessarily weight bearing because any movement will be painful
  • ill and irritable
  • tender joint
  • fever and tachycardia
42
Q

investigations that should be carried out in suspected acute septic arthritis

A
  • FBC and WBC
  • ESR and CRP
  • blood cultures
  • USS
  • aspiration and culture
  • X-ray
43
Q

what is the most common cause of septic arthritis in adults

A

infected joint replacements

44
Q

what is the differential diagnosis of acute septic arthritis

A
  • acute osteomyelitis
  • trauma
  • rheumatic fever
  • gout
  • irritable joint
45
Q

what is the treatment of acute septic arthritis

A
  • general supportive treatments
  • antibiotics for 3-4 weeks
  • surgical drainage
46
Q

what are the clinical features of a TB joint infection

A
  • pain (especially at night)
  • contact with others with TB
  • low grade fever
  • decreased range of movement
  • sweating
  • weight loss
  • joint swelling
  • ankylosis (fusion of bones over a joint causing stiffness)

usually only one joint will be affected and there will be marked muscle wasting

47
Q

what investigations should you do if you suspected a TB joint infection

A
  • FBC + ESR
  • Mantoux test
  • urine culture
  • joint aspiration and biopsy
48
Q

what is the treatment of TB joint infections

A
  • rest and splint age

- chemotherapy - rifampicin, ethambutol and isoniazid for 8 weeks followed by rifampicin and isoniazid for 6-12 months

MSK - ABDN (33 decks)

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