1. Slow growing bac-prolonged constitutional symptoms 2. Malnourished 3. Severe pain late sign - ass W/ bone collapse 4. Neuro symps eg lower limb weak and numb- Potts paraplegia

Infections Flashcards by Carla de Kock

Which part of skeleton does TB most commonly affect?

Spine

Then hip

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What is Pott’s disease

TB spondylitis (spine) - complication
Paraplegia

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What is bac load of spine TB

Low-paucibacillary

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How does tb spine spread? (4)

Along ant long ligament
Post into spinal cord → cord compression and paralysis
Down psoas muscle to groin
Posterior: triangle of petit (inf lumbar triangle)

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4 symptoms spinal TB

Slow growing bac-prolonged constitutional symptoms
Malnourished
Severe pain late sign - ass W/ bone collapse
Neuro symps eg lower limb weak and numb- Potts paraplegia

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2 possible findings on Clin examination of back in spinal TB

Gibbus. (prominent spinous process)

Psoas abscess

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Which part of spine most commonly affected by tb

Thoracic

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Xr features spinal TB early and late (9)

Early:
• local osteoporosis of 2 adjacent vertebrae
• Narrow disc spaces
• fuzziness of end plates

Late
• disc space destruction
• lucency and compression of adjacent vertebral bodies
• severe kyphosis (gibbus)
• paraspinal soft tissue shadows due to oedema, swelling or paravertebral abscess
• paraspinal abscess
. Sclerotic + lytic lesions

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Microscopy stains available to diagnose TB (2)

Ziehl - Nielsen stain: acid fast bacilli

H&E stain: TB granuloma

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Where does TB hip begin (3)

Superior rim acetabulum (early joint invasion)
Epiphysis
Greater trochanter

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3 radiological signs of hip TB

Phemister triad: periarticular osteoporosis, femoral head and neck erosions, decreased joint space
Kissing sequestra: femoral and acetabular sides wedge shaped necrosis
“Wandering acetabulum”

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What is a “fight bite” (3)

Attacker with finger in full flexion punches another penson in mouth with clenched fist.
Presents as pt fingers in extension
Superficial puncture wound
Much deeper into MPJ - “closing off”
Extremely dangerous palymicrobial infection!

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If you see a fist wound, what should you suspect?

fight bite - human bite

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What do kanavel’s 4 cardinal signs indicate?

Septic tenosynovitis

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What are kanavel’s four cardinal signs

(Indic tenosynovitis of hand )

Slight flexion finger
Swelling
Pinpoint tenderness over sheath
Pain on passive extension

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What is osteomyelitis

Bone infection involving medullary cavity with progressive inflammatory destruction, typically bacterial

Etiology osteomyelitis? (2)

Most commonly S aureus. Also group B strep in neonates, kingElla kingae, pseudomonas in direct puncture wounds to foot…
mechanism of spread mostly hematogenous, also direct inoculation and contiguous focus

Name 6 risk factors osteomyelitis

Diabetes mellitus , peripheral neuropathy, poor vascular supply
hemoglobinopathy, especially sickle cell disease
immune compromise, iv drug use, malnutrition
recent trauma / surgery
poor hygiene, male
children at risk !

Clinical features (symptoms and exam) of osteomyelitis? (7)

Symptoms:
. pain with limp or refusal to bear weight
• may have fever

Examination
• erythema (rubor)
• tenderness (dolor)
•Edema (tumor)
• hot (calor)
• may have abscess or draining sinus tract

Which investigations should be done for osteomyelitis? (5)

WBC count elevated, not very sensitive
ESR elevated, very sensitive for diagnosis
CRP increased, most sensitive to monitor treatment response
blood culture: only positive in 50% or less
aspirate culture/bone biopsy if really not sure - do surgical drainage if pus is aspirated

Treatment acute osteomyelitis? (4)

Iv antibiotics 4-6 weeks, started empirically and adjusted after obtaining blood and aspirate cultures
. S aureus: first line flucloxacillin; second line ceftriaxone / clindamycin
. MRSA: first line vancomycin and rifampicin; second line linezolid or daptomycin

Surgery incision and drainage if abscess, significant involvement, chronic infection, failure to respond to antibiotics

Treatment chronic osteomyelitis? (5)

Surgical debridement
Dead space management
Bone stability: may need external fixation
Antibiotics: local and systemic after cultures
Soft tissue cover

Name 5 complications osteomyelitis

DVT, especially older children and adults
meningitis
septic arthritis, especially neonates
growth disturbances and limb length discrepancy from growth plate involvement
pathologic fractures

Septic arthritis etiology? (4)

Adults: S aureus mostly
prior joint replacement: coagulase negative staphylococcus
sexually active adults and newborns: neisseria gonorrhoea

• most common route = haematogenous

Name 7 risk factors septic arthritis

* Young and elderly >80 * any pre-existing joint disease eg ra, oa, Uraemia * immune suppression: diabetes mellitus, alcoholism * hip or knee joint prosthesis * iv drug use * skin infection or ulcer * previous intra-articular corticosteroid injection

Clinical features septic arthritis? (5)

* rubor (redness) * dolor (pain) ! And Inability to weight bear , pseudoparalysis children * tumor (oedema) * Color (warmth) * fever in 60% • paeds hip: leg held in flexion and external rotation, fullness palpable in loin and upper thigh(late sign), If child can flex and extend joint, IT IS NOT SEPTIC ARTHRITIS!

Name the kocher criteria

To differentiate between septic arthritis and transient tenosynovitis in child with painful hip. If present, give 1 point • unable to weight bear • pyrexia >38,5 • wcc >12 x10^9 cells/l • ESR>40 mm/h Score of 3 or more = 93% probability of septic arthritis

Which investigations should be done if suspect septic arthritis? (6)

• Xray to rule out #, tumour, metabolic bone disease • ESR (>40 mm/h) • CRP • WBC (>12 x10^9 cells/L) • blood cultures . Joint aspiration for gram stain, leukocyte count, microscopy and culture - best to do during arthrotomy, not aspiration • listen for heart murmur (infective endocarditis)

Treatment septic arthritis? (2)

* Empirical antibiotics (cloxacillin) ASAP adjusted when culture comes back after /during arthroscopy * arthroscopy = definitive treatment for irrigation and debridement and drainage

Name the 4 joints in order that are most commonly affected by septic arthritis

* Hip * elbow * ankle * sternoclavicular joint

Name 3 complications septic arthritis

* Adults: secondary osteoarthritis, ankylosis (fused joint), contractures * Paediatrics destroy epiphysis: osteonecrosis and osteomyelitis!, (fixed flexion) deformities

What is sequestrum?,

``` a piece of dead bone tissue formed within a diseased or injured bone, typically in chronic osteomyelitis. Appear sclerotic (white) on xr ```

What is involucrum?

a complication of osteomyelitis - a thick sheath of periosteal new bone surrounding a sequestrum. To protect bone from breaking

What is a cloaca?

a gap in the cortex of a bone affected by chronic osteomyelitis that allows the drainage of pus or other material from the bone into the adjacent tissues.