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Year 3 MSK pathologies > Bone and soft tissue infections > Flashcards

Bone and soft tissue infections Flashcards

1
Q

What are the most common bone and soft tissue infections?

A

Osteomyeltis
Septic athritis
TB infection

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2
Q

What is osteomyeltis?

Who typically gets it?

A

Infection within the bone itself, can be acute or chronic

Tends to effect children, boys more than girls.There can be a history of trauma and the individual may have co-morbidities such as diabetes, rheumatoid arrthritis, immune compromisation, long term steroid treatment and sickle cell

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3
Q

How does one develop a osteomyeltic infection?

A

Can spread through the bone or bloood. Can spread from a contagous site of infection, open fracture, bone surgery or joint replacement. Can also occur secondary to vascular insufficiency

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4
Q

What are the common sites of infection?

A

Umbilical cord- infants
Boils, tonsillitis, skin abrasions- children
UTI, arterial line- adults

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5
Q

What are the common organisms that cause osteomyeltis?

A

Infants:staph auresu, grou b strep, e.coli
Older children:staph aureus, strep pyogenes, flu
Adults:staph aureus, coag negative staphlococci, pseudomonas aeroginosa

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6
Q

What rare organisms may cause osteomyeltis in certain subpopulations?

A

Diabetic foot and pressure sores: mixed infection including anaerobes
Sickle cell: salmonella spp
Fishermen, fileters: myocobacterium marinum
Immunoinsufficiency, AIDS: Candida

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7
Q

Where is osteomyeltis typically found?

A

Long bones e.g. distal femur, proximal tibia, proximal humerus.

Joints with intra-articular metaphysis: hip, elbow

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8
Q

What are the clinical features of osteomyeltis in infants?

A 
May be minimal signs or may be very ill
Failure to thrive
Possible drowsy or irritable
Metaphyseal tenderness and swelling
Decreased range of movement
Positional change
Most common around the knee
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9
Q

What are the clinical features of osteomyeltis in children

A

Severe pain
Reluctant to move
May be tender, fever, swinging pyrexia and tachycardia
malaise (fatigue, nausea, vomiting)
toxaemia (degraded bacterial enzymes in the blood)

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10
Q

What are the clinical features of osteomyeltis in adults?

A

Primary OM seen in thoracolumbar spine
backache
history of UTI or urological procedure
elderly, diabetic, immunocompromised

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11
Q

What are the clinical features of secondary osteomyeletis in adults

A

Secondary OM much more common

often after open fracture, surgery especiialy ORIF

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12
Q

How do you diagnose osteomyeltis?

A

History and clinical examination (pulse and temp)
FBC and WBC, ESR, CRP
Blood culturesx3 at peak ofswinging pyrexia
U&Es

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13
Q

What are some differential diagnosis for osteomyeltis

A 
acute spetic athritis
acute inflammatoy arthritsi
trauma
transient synovitis
cellulitis
necrotising fascitis
toxic shock syndrome
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14
Q

What imaging procedures would be carried out for soemone suspected to have osteomyeletis

A 
X0ray
Ultrasound
Aspiration
Isotope bone scan
labelled white cell scan
MRI
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15
Q

What is seen in an x-ray of someone with osteomyeltsi?

A

no change first two weeks
10-20 days periosteal change
Late osteonecrosis
late periosteal new bone

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16
Q

How would you diagnose osteomyeltis with micbiology

A

Blood cultures
Bone biopsy
Tissue or swabs from 5 sites around prosthetic joints
Superifical swaps of skin may be misleading

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17
Q

How do you treat osteomyeltis

A

Rest and splintage, empiracal antibioticcs (fluclox and benzylepen) while waiting for blood cultures

18
Q

Why may antibiotics fail in osteomyeltis

A 
Drug resistance, MRSA
Dormant bacteria in dead bone
poor host defence
poor drug absorbtion
poor tissue penetration
19
Q

What are the surgical indications for osteomyeltis

A

Aspirtions of pus for diagnosis and culture.
Abscess drainage
Debridmen of dead/infected/ contaminated tissue
infected joint replacement

20
Q

What are the complications of osteomyeltis

A

Septicemia, death, metastatic infection, septic athrtits, altered bone growth, chronic osteomyelitis

21
Q

What causes osteomyetis pathology

A

Cavities, sinuses
dead bone
involucrum
chronic inflammation

22
Q

What causes chronic ostemyeltis?

A

Often mixed infection
usually same organism each flare up
typically staph aureus, e coli, strep pyogenes

23
Q

What is the treatment of chronic osteomyeltis

A 
Long term antibiotics
Eradicate bone infection
Treat soft tissue problems
Reconstruction
Amputation
24
Q

What is septic athritis?

A

Infection of a joint that causes athritis

25
Q

How does septic athritis occur?

A

carried in the blood
Eruption of a bone abscess
Direct invasion- penetrating wound, iatrogenic, joint infection, intra-articular injury, arthroscopy

26
Q

What organsims cause septic athritis?

A

Staph.aureus
flu
strep. pyogenes
e. coli

27
Q

What happens during septic athritis

A

Acute synovitis with pruelnt joint effusion
Articular cartilage attacked by bacterial toxin and cellular enzyem
complete destruction of the articular cartilage

28
Q

What may occur after septic atrhitis?

A

Complete recovery
Partial loss of articular cartilage and therfore OA
Fibrous or bony ankylosis

29
Q

Describe how septic athritis presents in an neonate

A

Like septicaemia
iiritable
resistant to movement
ill

30
Q

How does septic athritis occur in a child

A 
Acute pain ina  single large joint
reluctant to movethe joint
reduced range of movement
Increased temperature and pulse
increased tenderness
31
Q

How does septic athritis occur in an adult?

A

Often involves superificial joint (knee, ankle, wrist)
Rare in healthy adult
May be a delayed diagnosis

32
Q

What investigations are carried out if septic athritis is suspected

A

FBC, WBCM ESR, CRP, blood cultures
X-ray
Ultrasound
Aspiration

33
Q

What are the differential diagnosis for septic arthritis?

A 
Acute osteomyeltis
Trauma
irratibel joint
haemophilia
rheumantic fever
gout
gauchers disease
34
Q

What is the treatment of septic athritis

A

Generally supportive mesures
antibiotics for 3-4 weeks
surgical drainge and lavage- never let the sun set on pus
Infected joint replacement

35
Q

Describe a TB infection of the bone

A

Can be extra-articular (epiphyseal, bones with haemodynamic marrow)
Intra-articular (large joints)
Vertebral body
Multiple lesions in 1/3 of patients

36
Q

What are the clinical signs of a TB infection of the bone

A 
Insidious onset and general ill health
Pain (at night), swelling, loss of weight
low grade pyreaxia
joint swelling
decreased range of movement
ankylosis
deformitiy
Contact with TB
37
Q

Describe the presentation of TB in the spine

A

Little pain

present with abscess or kyphosis

38
Q

How do you diagnose TB infection from an examination

A 
Long history
Involvemnt of signle joint
Marked thickening of synovium
marked muscle wasting
periarticular osteoperosis
39
Q

TB investigations

A

FBC, ESR, Mantoux test, sputum/urine culture
X ray- soft tissue swelling, preiarticular osteopaenia, articular space narrowing
Joint aspiration and biopsy AAFB indeitified in 10-20%

40
Q

What is the differential of TB

A 
Transient synovitis
Monoarticular RA
Haeorrhagic athritis
Pyogenic arthritis
Tumour
41
Q

What is the treatment of TB

A

Rifampicin
Isoniazid
Ethambutol for 8 weeks

Rifampcina dn isoniazid for 6-12 months
rest and splint
operative drainage rarely necessary

Year 3 MSK pathologies (34 decks)

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