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Musculoskeletal + Rheumatology > Bone Infection > Flashcards

Bone Infection Flashcards

1
Q

What sex is more likely to be affected by osteomyelitis?

A

M>F

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2
Q

Give risk factors for acute osteomyelitis?

A

Open bone fracture/trauma history

Orthopaedic surgery

Immunocompromised

HIV

Sickle cell anaemia

Tuberculosis

DM

Secondary infection

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3
Q

What organisms can cause acute osteomyelitis?

A

Staph aureus

Group B streptococci

E coli

Strep pyogenes

Haemophilus influenzae

Salmonella species

Mycobacterium tuberculosis

Pseudomonas aeroginosa

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4
Q

What organism is the most common cause of osteomyelitis?

A

Staph aureus

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5
Q

What organism is associated with acute osteomyelitis in patients with sickle cell disease?

A

Salmonella species

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6
Q

How does acute osteomyelitis present?

A

Refusing to move limb/weight bear

Pain

Swelling

Tenderness

Low grade fever

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7
Q

What is the imaging modality of choice in osteomyelitis?

A

MRI

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8
Q

What investigations are used in acute osteomyelitis diagnosis?

A

FBC

  • Increased WCC

>ESR and CRP

Blood cultures X3, at peak of temperature

Xray or bone scan

Bone marrow aspiration or bone biopsy

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9
Q

What acute osteomyelitis signs are seen on xray?

A

Normal in the first 10-14 days

Sequestrum/late osteonecrosis

Involucrum/late formation of new bone in response to injury

Regional osteopenia

Focal corticol loss

Periosteal changes

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10
Q

Give complications of acute osteomyelitis

A

Septicemia, death

Metastatic infection

Pathological fracture

Septic arthritis

Altered bone growth

Chronic osteomyelitis

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11
Q

Give the complication of sub-acute osteomyelitis

A

Brodie’s abscess, well defined cavity in cancellous bone

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12
Q

How is acute osteomyelitis managed?

A

Supportive

  • Fluids
  • Analgesia
  • Rest and splintage

Antibiotics

  • 4-6 weeks
  • Flucloxacillin plus fusidic acid, clindamycin if penicllin allergic​
  • Start IV and switch to oral when stable

Extensive surgical cleaning

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13
Q

What is the most common location of osteomyelitis in children?

A

Metaphysis

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14
Q

What is the most common location of osteomyelitis in adults?

A

Epiphysis

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15
Q

What causes chronic osteomyelitis?

A

May follow acute osteomyelitis, but is much rarer in children

De novo/new onset

  • Following operation
  • Following open surgery
  • Immunosuppressed, diabetics, elderly, drug abusers etc

Repeated breakdown of healed wounds

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16
Q

What organisms cause chronic osteomyelitis?

A

Often mixed infection

Usually same organism each flare up

Staph Aureus

E Coli

Strep Pyogenes

Proteus

17
Q

How does chronic osteomyelitis present?

A

Chronically discharging sinus and flare-ups

Ongoing/metastatic infection causing abscesses

Pathological fracture

Growth disturbance and deformities

Squamous cell carcinoma

18
Q

How is chronic osteomyelitis managed?

A

Antibiotics

  • At least 12 weeks, usually 3-6 months
  • Treatment is usually delayed until culture and sensitivity results are obtained

Surgical debridement

19
Q

What is septic arthritis?

A

Bacteria causing rapid irreversible cartilage destruction resulting in monoarthritis, presenting as a hot, swollen and tender joint

20
Q

Give risk factors for septic arthritis

A

IVDU

Age >80

Comorbidities

  • DM, RA

Endocarditis due to septic showers

Surgery/dental work

Immunocompromised

21
Q

What organisms cause septic arthritis?

A

Staphylococcus aureus

Haemophilus influenzae, children

Streptococcus pyogenes

Neisseria Gonorrhoea, young sexually active adults

Staph epidermis, prosthesis

E-coli, IVDU

Pseudomonas, IVDU

Salmonella, sickle cell disease

22
Q

What organism is the most common cause of septic arthritis?

A

Staphylococcus aureus

23
Q

How does septic arthritis present?

A

Tender swollen joint

Reduced range of movement

Effusion

Erythema

Systemic features such as fever and lethargy

24
Q

What investigations are used in septic arthritis diagnosis?

A

Joint aspiration prior to antibiotic therapy

  • Sent for gram stain, culture and crystal examination
  • Purulent
  • In ED if native joint or in surgery if replacement joint
25
Q

How is septic arthritis managed?

A

Septic 6

General supportive measures, analgesia

Antibiotics for 3-6 weeks, alteration of

  • Flucloxacillin + rifampicin
  • Vancomycin + rifampicin
  • Clinamycin

Surgical drainage and lavage/washout, in emergency

26
Q

Give complications of septic arthritis

A

Infection recurrence

Spread to other organs

Joint destruction with arthritis

Avascular necrosis

Death

27
Q

Give features of whipples disease

A

Rare systemic condition caused by tropheryma whipplei

Primarily presents with diarrhoea, abdominal pain, joint pain

Cardiac and neurological involvement

Small bowel biopsy shows acid-Schiff (PAS)-positive macrophages

28
Q

How is whipples disease managed?

A

Co-trimoxazole

Musculoskeletal + Rheumatology (16 decks)

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