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MSK > Lec 14 Bone Infections > Flashcards

Lec 14 Bone Infections Flashcards

1
Q

What is osteomyelitis?

A

inflammation of bone and marrow due to infection

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2
Q

What are 4 types of osteomyelitis?

A
  • pyogenic osteomyelitis
  • tuberculous osteomyelitis
  • syphilitic osteomyelitis
  • miscellaneous
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3
Q

What are 3 mech by which organisms reach the bone?

A
  1. hematogenous spread
  2. direct extension from contiguous site
  3. direct implantation
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4
Q

What are most common locations of pyogenic osteomyelitis?

A

long bones and vertebral bodies

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5
Q

What is most common organism responsible for pyogenic osteomyelitis?

A

staph aureus

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6
Q

What 2 organisms cause neonatal osteomyelitis?

A
  • H influenzae

- group B strep

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7
Q

What organisms cause pyogenic osteomyelitis in pats with GU infection or IV drug abuse?

A

gram negative organisms –> E coli, pseudomonas, klebsiella

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8
Q

Where in the bone do most infections occur in kids and adolescents?

A

occur at metaphysis –> growth plate blocks vessels from being in contact w/ epiphyseal vessels

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9
Q

What are symptoms of osteomyelitis?

A
  • high fever
  • localized pain and swelling
  • high WBC
  • high ESR
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10
Q

What are most frequent sites of osteomyelitis in kids?

A

metaphyses of distal femur, proximal tibia, proximal humerus, and distal radius

== areas of rapid growth

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11
Q

In adults what is most frequent site of osteomyelitis?

A

subchondral region of long bones, diaphysis, spine, small bones of feet

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12
Q

Who gets hematogenous osteomyelitis?

A

pts with chronic diseases or drug addicts

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13
Q

Who get spinal osteomyelitis?

A

pts with GU infection

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14
Q

Who gets hematogenous osteomyelitis of the small bones of feet?

A

pts with peripheral vascular insufficiency, diabetes

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15
Q

Where do drug addicts usually have focus of infection?

A

spine or pelvis –> carries from skin or from unclean hypodermic needles

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16
Q

What happens once bacteria proliferates in metaphysis?

A

have bone necrosis and spread of infection to periosteum –> subperiosteal abscess formation –> impaired blood supply and get segmented bone necrosis

17
Q

What is the sequestrum?

A

dead piece of bone

18
Q

What is the involucrum?

A

sleeve of reactive bone around dead piece

19
Q

What radiographic changes do you see in osteomyelitis?

A
  • lytic focus of bone destruction w/ peripheral zone of sclerosis and periosteal reaction

hot spots on bone scan

20
Q

What is differential diagnosis for osteomyelitis?

A

think round cell tumor

21
Q

What is a brodie abscess?

A

small interosseous abscess that involves cortex and is surrounded by reactive bone

22
Q

What are rare complications of osteomyelitis?

A

fractures, sepsis, squamous cell carcinoma, osteosarcoma

23
Q

What is chronic recurrent multifocal osteomyelitis?

A

idiopathic inflammatory disorder of bone in kids and young adults

multifocal; non-pyogenic
have pain, tenderness, swelling

mostly effects lower extremities, metaphysis; medial clavicle

symmetric bilateral lesions; sclerosis

24
Q

What are some pathologic conditions associated w/ chronic recurrent multifocal osteomyelitis?

A
  • psoriasis
  • acne fulminans
  • palmoplantar pustulosis
25
Q

What is tuberculous osteomyelitis?

A

commonly in spine; solitary bone infection [except multifocal in AIDS]

usually blood-borne from focus in lung or intestine

26
Q

What is pathology of tuberculous osteomyelitis?

A

have necrotic tissue w/ white cheesy appearance
typical tubercle contains central necrosis surrounded by epithelioid histiocytes, multi-nucleated giant cells, lymphocytes

27
Q

What is skeletal syphilis?

A

in acquired syphilis –> part of tertiary stage

in congenital –> bone lesions appear 4th month of gestation and fully developed at birth; localize in areas of active endochondral ossification

28
Q

What are pathologic findings in skeletal syphilis?

A
  • granulation tissue w/ plasma cells and necrotic bone
  • gummata composed of necrotic material w/ granulomatous response
  • spirochetes seen w/ silver warthin starry stain
29
Q

What is saber shin?

A

anterior curvature of tibia with excessive bone deposition anteriorly = sign of skeletal syphilis

30
Q

What is infectious arthritis?

A

infection of joint space; can cause rapid destruction of joint in days

31
Q

What are signs of septic arthritis?

A

usually single joint –> knee > hip > shoulder > elbow

32
Q

What is tuberculous arthritis?

A

synovium shows caseous granulomas; seen in hip, knee, ankle

33
Q

Who gets fungal infection of bone/joint?

A

young immune compromised

usually blasto, crypto, aspergillus, candida; often from focus in lungs

34
Q

What kind of parasite causes bone infection?

A

echinococcus granulosus = hydatid cyst –> need to resect

MSK (23 decks)

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