Lecture 4 Infection in Bone and Joints Flashcards
What group of people are more prone to osteomyelitis
Boys
Children
What are the risk factors for osteomyelitis
DM Rheumatoid arthritis Immune compromise Long term steroid use Sickle cell
What are the sources of infection for osteomyelitis in children and elderly
Haematogenous- children and elderly
What are the sources of infection for osteomyelitis in trauma
• Local spread from contiguous site of infection o Trauma (open fracture) o Bone surgery o Joint replacement • Secondary to vascular insufficiency
What are the sources of infection for osteomyelitis in infants
Infected umbilical cord
What are the sources of infection for osteomyelitis in children
Boils
Tonsilitis
Skin abrasions
What are the sources of infection for osteomyelitis in adults
UTI
Arterial line
Name 3 common organisms that affect infants <1 who have osteomyelitis
o Staph aureus
o Group B streptococci
o E. coli
Name 3 common organisms that affect older children who have osteomyelitis
o Staph aureus
o Strep pyogenes
o Haemophilus influenza- immunisation significantly reduced
Name 3 common organisms that affect adults who have osteomyelitis
o Staph aureus o Pseudomonas aeruginosa - Immunocompromised - Trainer’s foot- penetrating foot injuries - IVD o Coagulase negative staphylococci - Prostheses o Propionibacterium spp. - Shoulder replacements - Prostheses
What organism causes osteomyelitis in diabetic foot and pressure sores
Mixed infection including anaerobes
What organism causes osteomyelitis in vertebral osteomyelitis
Staph aureus
TB
What organism causes osteomyelitis is Sickle Cell Disease
Salmonella spp.
Candida causes osteomyelitis in what groups of people
HIV/AIDs
Long term antibiotic treatment
Extensive GI surgery
Malignancy
What part of the bone does osteomyelitis start
Metaphysis
What are the clinical features of osteomyelitis in an infant
- Failure to thrive
- Drowsy or irritable
- Metaphyseal tenderness and swelling
- Decrease ROM
- Positional change- may be flexed
- Commonest around the knee
- Often multiple sites
What are the clinical features of osteomyelitis in children
- Severe pain
- Reluctant to move
- Fever (swinging pyrexia) + tachycardia
- Malaise (fatigue, nausea, vomiting, fretful)
- Toxaemia
What are the clinical features of osteomyelitis in adults
Backache
History of UTI or urological procedure
Often after open fracture
How is osteomyelitis diagnosed
History and clinical examination FBC and WBC (neutrophil leucocytosis) Blood culture U&Es X-Ray US Aspiration Isotope bone scan Labelled white cell scan MRI
What are the differential diagnosis of osteomyelitis
- Acute septic arthritis
- Trauma (fracture, dislocation)
- Acute inflammatory arthritis
- Transient synovitis (irritable hip)
What is the treatment of osteomyelitis
Supportive
Rest and splintage
Antibiotics
Surgery (debridement, drainage, infected joint replacements)
Name complications of osteomyelitis
- Metastatic infection
- Pathological fracture
- Septic arthritis
- Septicaemia, death
- Altered bone growth
- Chronic osteomyelitis
Name the causes of Chronic Osteomyelitis
Follow acute osteomyelitis De novo o Following operation o Following open fractures o Immunosuppressed, diabetics, elderly, drug abusers
Name common organisms that cause osteomyelitis
Often mixed Staph aureus E.coli Strep pyogenes Proteus