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NYCC MSP > Infectious Joint Pathologies > Flashcards

Infectious Joint Pathologies Flashcards

1
Q

What populations are affected by septic arthritis?

A
  • immunocompromised
  • children
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2
Q

How do microorganisms get into joints?

A
  • hematogenous
  • direct
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3
Q

In a patient with pneumonia, how would microorganisms get into a joint causing septic arthritis?

A

hematogenous

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4
Q

In a child with a soft tissue infection, how would microorganisms get into a joint causing septic arthritis?

A

hematogenous

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5
Q

In a patient with osteomyelitis, how would microorganisms get into a joint causing septic arthritis?

A

direct

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6
Q

What is the etiology of septic arthritis?

A

bacterial infection
- S aureus
- H. influenza
- gonococcal infection in sexually active adults
- E. coli

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7
Q

What is the most common infectious organism to cause septic arthritis?

A

S. aureus

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8
Q

What are the clinical manifestations of septic arthritis?

A
  • acutely red, swollen joint
  • mono-arthrotic
  • favours LE
  • joint (intracapsular) effusion (soft tiss. swelling) distorts fat folds
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9
Q

What locations are most commonly affected by septic arthritis?

A

lower extremity (knee & hip)

(hand - often due to human bite)

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10
Q

What are the radiographic characteristics of septic arthritis?

A
  • rapid loss of jt. space
  • loss of subchondral white line
  • aggressive bone destruction
  • osseous ankylosis (late stage)
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11
Q

What is the radiographic latency period for septic arthritis?

A
  • 7-10 days in extremities
  • 21 days in spine
    (this is for any infectious process)
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12
Q

What is the first confirmatory radiographic finding for septic arthritis?

A

loss of subchondral white line

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13
Q

How long would it take to see loss of subchondral white line in the hip joint?

A

7-10 days

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14
Q

Regarding septic arthritis, once a joint becomes infected, what is the guaranteed outcome for this joint?

A

destruction leading to long-term sequela (eg. subluxations)

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15
Q

What are the relevant lab findings for septic arthritis?

A
  • ^ESR/CRP
  • normal alk phos
  • HLA-B27 neg.
  • RF neg.
  • synovial biopsy: normal uric acid (DDx gout); purulent exudate
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16
Q

What are the possible treatments for septic arthritis?

A
  • antibiotic therapy
  • aspiration (decompress jt.)
  • jt. irrigation
  • decrease motion & weight bearing
  • joint replacement (or may end in ankylosis)
17
Q

What are the etiologies of fungal arthritis?

A
  • often complication of neoplasia or immunocompromise (HIV/AIDS, chemotherapy)
  • Candida species (yeast infection)
  • TB
18
Q

What is often the primary site of involvement of fungal arthritis?

A

lung

19
Q

Fungal arthritis in the spine presents similar to ____

A

Pott’s Dz

20
Q

How does fungal arthritis appear radiographically?

A

Same as septic (bacterial) arthritis, highly destructive

21
Q

What are the possible treatments for fungal arthritis?

A
  • very difficult (usually already immunocompromised)
  • anti-fungal drugs are toxic to other tissues, especially liver
22
Q

What is the etiology of Lyme disease?

A

Spirochete infection (borrelia burgdorferi) transmitted by Ixodes tick

23
Q

What age group is affected by Lyme disease?

A

any age

24
Q

When do Ixodes ticks feed?

A

May-July during nymph (feeding) stage

25
Q

When does stage 1 of Lyme disease occur?

A

3-5 days post-bite

26
Q

When does stage 2 of Lyme disease occur?

A

weeks to months following skin lesion

27
Q

When does stage 3 of Lyme disease occur?

A

months to years post-infection

28
Q

What are the clinical manifestations of stage 1 of Lyme disease?

A
  • erythema chronicum migrans (Bullseye rash)
  • fever & malaise
  • fatigue, headache & brain fog
  • arthralgias
  • lymphadenopathy
  • cough
  • meningeal irritation
  • migratory myalgia (diffuse, achy)
  • testicular swelling
29
Q

What is the medical term for a bullseye rash?

A

erythema chronicum migrans

30
Q

What inflammatory cells would be found in a patient with Lyme disease?

A

chronic inflammatory response: lymphocytes & plasma cells

31
Q

What are the clinical manifestations of stage 2 of Lyme disease?

A
  • migratory MSK pain
  • cardiac & neurologic abnormalities
  • transient & migratory jt. pain
32
Q

What are the clinical manifestations of stage 3 of Lyme disease?

A
  • > 50% have arthralgia & severe arthritis
  • swollen jts (especially knee)
  • neuro effects: tingling, paresthesia, encephalomyelitis, dementia
  • skin manifestations
33
Q

Histopathology of joints affected by Lyme disease are similar to what other pathology?

A

RA
(synovial mem. undergoes hypertrophy w/ mononuclear infiltrate)

34
Q

What clinical manifestations, if experienced by a patient with Lyme disease, will be permanent?

A

neurologic effects:
- tingling
- paresthesia
- encephalomyelitis
- dementia

35
Q

How is Lyme disease diagnosed?

A

Antibody titers (IgM & IgG) if Lyme disease is suspected
(not usually done)

36
Q

What is the treatment for Lyme disease?

A

Antibiotics
- early: tetracycline or erythromycin
- Late stage: long-term, high dose antibiotics

37
Q

At what stage of Lyme disease is treatment most effective?

A

Stage 1

38
Q

Loss of the subchondral white line is indicative of ____

A

septic arthritis

NYCC MSP (44 decks)

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