Bone and Soft Tissue Infection Flashcards by Pete McEwan

Are adults or children more susceptible to acute osteomyelitis?

Children

How well did you know this?

Not at all

Perfectly

Are boys or girls more likely to get acute osteomyelitis?

Boys

How well did you know this?

Not at all

Perfectly

What history can increase the chances of somone getting acute osteomyelitis?

History of trauma
Diabetes
Rheumatoid arthritis
Immunocompromised
Long term steroid treatment
Sickle cell

How well did you know this?

Not at all

Perfectly

What can cause osteomyelitis?

Haematogenous spread
Local spread from contiguous site of infection - trauma, bone surgery, joint replacement
Secondary to vascular insufficiency

How well did you know this?

Not at all

Perfectly

What can be a source of infection in infants?

Infected umbilical cord

How well did you know this?

Not at all

Perfectly

What are sources of infection in children?

Boils
Tonsilitis
Skin abrasions

How well did you know this?

Not at all

Perfectly

What are sources of infection in adults?

UTI

Arterial line

How well did you know this?

Not at all

Perfectly

What is the most common infecting organism in acute osteomyelitis?

Staph aureus

How well did you know this?

Not at all

Perfectly

What is likely to be an infective organism in acute osteomyelitis in patients with diabetic foot and pressure sores?

Mixed infection with anaerobes

How well did you know this?

Not at all

Perfectly

What is the likely causative organism in acute osteomyelitis in a patient with sickle cell disease?

Salmonella species

How well did you know this?

Not at all

Perfectly

What are common places to be affected by acute osteomyelitis?

Distal femur
Proximal tibia
Proximal humerus
Hip joint
Elbow - radial head

How well did you know this?

Not at all

Perfectly

What is the progression of acute osteomyelitis?

Starts at metaphysis
Vascular stasis
Acute inflammation - increased pressure
Formation of pus
Release of pressure
Necrosis of bone
New bone formation
Resolution or not? May lead to chronic

How well did you know this?

Not at all

Perfectly

What are clinical signs of acute osteomyelitis in infants?

May be very ill
Failure to thrive
Possibly drowsy or irritable
Metaphyseal tenderness and swelling
Decrease range of movement
Positional change

How well did you know this?

Not at all

Perfectly

What are clinical features of acute osteomyelitis in children?

Severe pain
Reluctant to move - not weight bearing
Fever and tachycardia
Malaise
Toxaemia

How well did you know this?

Not at all

Perfectly

What are clinical features of acute osteomyelitis in adults?

Primary infection seen commonly in thoracolumbar spine
Backache
History of UTI
Secondary is much more common

How well did you know this?

Not at all

Perfectly

How is acute osteomyelitis diagnosed?

History and clinical examination
FBC + WBC
ESR,CRP
3xblood cultures
U&amp;Es
X-Ray/ultrasound
Aspiration
Isotope bone scan

How well did you know this?

Not at all

Perfectly

What are differential diagnoses for acute osteomyelitis?

Acute septic arthritis
Acute inflammatory arthritis
Trauma
Transient synovitis
Soft tissue infection

How well did you know this?

Not at all

Perfectly

How is acute osteomyelitis treated?

Supportive treatment for pain and dehydration
Rest and splintage
Antibiotics 4-6 weeks

What can cause antibiotics to fail to treat something?

Drug resistance
Bacterial persistence
Poor host defences
Poor drug absorption
Drug inactivation by host flora
Poor tissue penetration

What are indications for surgery in acute osteomyelitis?

Aspiration of pus for diagnosis
Abscess drainage
Debridement of dead/infected tissue
Refractory to non operative treatment

What are complications of acute osteomyelitis?

Septicaemia/death
Metastatic infection
Pathological fracture
Septic arthritis
Altered bone growth
Chronic osteomyelitis

What can cause chronic osteomyelitis other than following an acute case?

Following an operation
Diabetic
Immunosuppressed
Elderly

What are the most common causative organisms of chronic osteomyelitis?

Staph aureus
E Coli
Strep pyogenes

What are complications of chronic osteomyelitis?

Chronically discharging sinus and flare-ups
Pathological fracture
Growth disturbance and deformities
Squamous cell carcinoma

How is chronic osteomyelitis treated?

``` Long-term antibiotics Eradicate bone infection Treat soft tissue problems Correct deformities Reconstruction Amputation? ```

What are routes of infection in acute septic arthritis?

Haematogenous Eruption of bone abscess Direct invasion

What are common causative organisms of acute septic arthritis?

Staph aureus Haemophilus influenzae Strep pyogenes E coli

What is the progression of acute septic arthritis?

Acute synovitis with purulent effusion Articular cartilage attacked by bacterial toxin and cellular enzyme Complete destruction of the articular cartilage

What are features of acute septic arthritis in neonates?

Irritability Resistant to movement ill

What are features of acute septic arthritis in children and adults?

Acute pain in a single large joint Reluctant to move the joint Increase temp and pulse Increase tenderness

What investigations are done into acute septic arthritis?

FBC, WBC, CRP, etc Blood cultures X-ray/ultrasound Aspiration

How is acute septic arthritis treated?

General supportive measures Antibiotics 3-4weeks Surgical drainage

What is sequestrum?

Necrosis of bone

What is involucrum?

Growth of new bone layer outside of existing bone

What are the classifications of tuberculosis in bone and joint?

Extra-articular (epiphyseal) Intra-articular (large joints) Vertebral body

What are clinical features of Tuberculosis?

``` Insidious onset and general ill health Contact with TB Pain, swelling, weight loss Low grade pyrexia Joint swelling Decrease range of movement Ankylosis Deformity ```

What are features of spinal tuberculosis?

Little pain | Presents with abscess or kyphosis

How is tuberculosis diagnosed?

``` Long history Involvement of a single joint Marked thickening of the synovium Marked muscle wasting Periarticular osteoperosis ```

What investigations can be done into TB?

``` FBC, ESR Mantoux test Sputum/urine culture Xray Joint aspiration and biopsy ```

What would you expect to see in an Xray with TB?

Soft tissue swelling Periarticular osteopaenia Articular space narrowing

What is Mantoux test?

Intradermal injection of tuberculin and immune response is measured 48-72 hours later

What are differential diagnoses for TB?

``` Transient synovitis Monoarticular rheumatoid arthritis Haemorrhagic arthritis Pyogenic arthritis Tumour ```

How is TB treated?

Chemotherapy Rest and splintage Operative drainage rarely necessary

What drugs are used for chemotherapy of TB?

``` For 8 weeks : Rifampicin Isoniazid Etjambutol Then Rifampicin and isoniazid for 6-12 months ```