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
How is septic arthritis managed?
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
Give complications of septic arthritis
Infection recurrence Spread to other organs Joint destruction with arthritis Avascular necrosis Death
27
Give features of whipples disease
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
How is whipples disease managed?
Co-trimoxazole