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Rheumatology > E: Septic Arthritis + Osteomyelitis > Flashcards

E: Septic Arthritis + Osteomyelitis Flashcards

1
Q

What is septic arthritis

A

Infection of a joint

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2
Q

How does bacterial contamination of a joint occur

A
  • Haematogenously

- Direct contamination

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3
Q

How can infection from the blood stream occur

A
  • From a distant site (eg. abscess)

- Or, disseminated infection (eg. gonorrhoea)

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4
Q

How does direct contamination occur

A
  • Trauma

- Iatrogenic (eg. arthroscopy)

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5
Q

What is the most common cause of septic arthritis

A

Staphylococcus aureus

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6
Q

What may cause septic arthritis in sexually active patients

A

N. Gonorrhoea

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7
Q

What are 5 risk factors for septic arthritis

A
  • Old age
  • Diabetes
  • Immunocompromised
  • Prosthetic joints
  • IVDU
  • Chronic skin infection
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8
Q

Explain the clinical presentation of septic arthritis

A
  • Fever
  • Reduced range of movement
  • Pain
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9
Q

How will a joint appear in septic arthritis

A

Erythematous, swollen joint

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10
Q

What blood tests may be performed in septic arthritis

A

FBC
ESR
CRP

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11
Q

What is gold-standard investigation of septic arthritis

A

Joint aspiration

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12
Q

What is joint fluid aspirate obtained for

A
  • Culture
  • Cell count
  • Gram stain
  • Glucose
  • Crystal analysis
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13
Q

How will joint aspirate fluid appear in septic arthritis

A

Cloudy (due to being purulent)

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14
Q

What WCC is diagnostic for septic arthritis

A

> 50,000 in native joints.

Often >1,100 in prosthetic joints

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15
Q

How will glucose appear in joint aspirate in septic arthritis

A

<60% of serum glucose

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16
Q

What imaging is recommended for septic arthritis

A

Lateral and AP x-rays

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17
Q

What is the Kocher criteria used for

A

Differentiate septic arthritis as a cause of hip pain in children (often compared to transient synovitis of the hip)

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18
Q

How is septic arthritis managed

A

IV Vancomycin (30mg/kg/day) for 2W, then switch to Vancomycin PO for 4W. And joint aspiration.

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19
Q

If an individual is allergic to vancomycin, what should be used

A

Clindamycin or cephalosporin

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20
Q

What are 4 factors that may indicate gram-negative septic arthritis

A

Old age
Recurrent UTI
Recent abdominal surgery

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21
Q

What is used to manage gram-negative septic arthritis

A

IV Ceftriaxone 2g/24h and joint aspiration

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22
Q

what is osteitis

A

infection of the bone

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23
Q

what is osteomyelitis

A

infection of the bone marrow

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24
Q

in which age group does haematogenous ostemyelitis tend to occur

A

children and adolescents.

50% of cases occur in under 5y

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25
Q

in which age group does vertebral osteomyelitis tend to occur

A

adults

26
Q

what is haematogenous osteomyelitis

A

haematogenous spread of a disseminated pathogen

27
Q

what is the most common cause of haematogenous osteomyelitis

A

s.aureus

28
Q

what are 4 exogenous causes of osteomyelitis

A
  • Trauma
  • Iatrogenic
  • Secondary infection from diabetic foot ulcer
  • Contigous spread from adjacent tissue
29
Q

what are 3 local risk factors for osteomyelitis

A
  • Open fracture
  • Soft tissue damage
  • Poor perfusion
30
Q

what are 3 systemic factors for osteomyelitis

A
  • Immunocompromised
  • Systemic disease
  • IVDU
31
Q

how long does it take for acute osteomyelitis to occur

A

sudden onset over hours-days

32
Q

how long does it take for chronic osteomyelitis to occur

A

onset over months-years

33
Q

how will acute osteomyelitis present

A
  • Pain at infection site
  • Joint is tender, erythematous, warm, swollen
  • May be fever, malaise
34
Q

in infants what is the most common site of osteomyelitis

A

Metaphysis of long bone

35
Q

in children, what is the most common site of osteomyelitis

A

Metaphysis of long bone

36
Q

in adults, what is the most common site of osteomyelitis

A

Vertebrae

37
Q

what is chronic osteomyelitis and how will it present

A

occurs following previous episode of osteomyelitis and may persist for months

38
Q

what pathogen commonly causes osteomyelitis

A

s. aureus

39
Q

what organism tends to cause osteomyelitis in diabetic patients with foot ulcers

A

s. epidermis

40
Q

what organism may cause osteomyelitis in patients with prosthesis

A

s. epidermis. Although due to prevalence s.aureus more commonly causes osteomyelitis in patients with prosthetics

41
Q

what organism may cause osteomyelitis in IVDU

A

pseudomonas auerginosa

42
Q

what organism may cause osteomyelitis in plantar puncture wound (particularly if rubber footwear is worn)

A

pseudomonas auerginosa

43
Q

what organism may cause osteomyelitis in sickle cell patients

A

salmonella

44
Q

what organism may cause osteomyelitis in patients with recurrent UTI

A

enterobacteria

45
Q

what investigations are ordered in osteomyelitis

A 
FBC 
CRP
ESR
Blood culture 
X-ray 
MRI
46
Q

what is the problem with WBC for identifying osteomyelitis

A

only raised in 1/3 of patients

47
Q

What does ESR show

A

if ESR decreases following treatment it is a good prognostic indicator

48
Q

What is the most sensitive test in osteomyelitis

A

CRP (97% raised in osteomyelitis)

49
Q

What may positive blood cultures indicate

A

Disseminated haemotegenous infection. Although is often negative in osteomyelitis

50
Q

What is the problem with x-ray for acute osteomyelitis

A

It takes 2W for evidence of infection to present on x-rays

51
Q

what is the gold standard for identifying osteomyelitis

A

MRI

52
Q

what sign is seen on MRI in osteomyelitis

A

penumbra sign

53
Q

what is the penumbra sign

A

a dark abscess in the centre with hyper intense thin ring of white sclerosis around the outside

54
Q

what is used as a confirmatory test for osteomyelitis

A

bone biopsy

55
Q

why is a bone biopsy performed

A

to look at histology, be able to perform gram stain and culture

56
Q

what is the management of osteomyelitis

A

IV Flucloxacillin for 6W

57
Q

what should patients with osteomyelitis also be considered for and why

A

Surgical debridement. If patients have necrotic tissue or a biofilm it will not heal without debridement

58
Q

what scoring system is used to predict prognosis in osteomyelitis

A

Cierney-Mader Classification

59
Q

what are 4 complications of osteomyelitis

A
  • Sepsis
  • Amputation
  • Marjolin’s Ulcer (malignant transformation)
  • Chronic osteomyelitis
60
Q

what typically causes chronic osteomyelitis and what is a risk factor for this

A
  • Presence of SCC

- RF: presence of a chronic draining sinus

Rheumatology (10 decks)

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