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ELM2 - infection & immunity > lecture 6 - bone & joint infections > Flashcards

lecture 6 - bone & joint infections Flashcards

1
Q

What is osteomyletis?

A

Inflammatory process of bone, secondary to infection

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2
Q

Is osteomyletis a primary or secondary infection?

A

secondary

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3
Q

What are the 3 classification of osteomyelitis, based on duration?

A

acute, sub-acute, chronic

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4
Q

What are the 2 routes of infection in osteomyelitis?

A

haematogenous (from the blood), exogenous (from outside of the bone)

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5
Q

What is haematogenous osteomyelitis?

A

secondary bone infection arising from blood borne bacteria from another source of infection

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6
Q

What are the 2 key host responses to osteomyelitis?

A

pyogenic/purulence (pus production), granulomatus (granuloma formation)

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7
Q

What is the most common route of infection for osteomyelitis in children?

A

Haematogenous

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8
Q

Is haematogenous osteomyelitis generally polymicrobial or monomicrobial?

A

Monomicrobial

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9
Q

Why do children usually develop the haematogenous form of osteomyelitis?

A

They have vascular stasis (slow moving, convoluted vessels) at their growth plates which allows bacteria to more readily enter the bone

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10
Q

What are the 2 causes of exogenous osteomyelitis?

A

direct inoculation of the bone, contiguous (spread from local infection)

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11
Q

How does direct exogenous osteomyelitis usually arise?

A

trauma (compound fracture), surgery

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12
Q

What disease increases the risk of contiguous exogenous osteomyelitis, and why?

A

Diabetes - poor circulation in the feet can lead to infection that spreads to the bone

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13
Q

Is exogenous osteomyelitis generally polymicrobial or monomicrobial?

A

polymicrobial

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14
Q

What is the key bacteria that most commonly causes osteomyelitis across all age groups?

A

Staphylococcus aureus

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15
Q

What are the risk factors for developing osteomyelitis?

A

immunosupression (diabetes, steroids, cancer, asplenia), age (children & elderly), peripheral vascular disease (smoking, diabetes), injecting drug uses, chronic joint disease, recent surgery/trauma

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16
Q

Where does osteomyelitis typically develop in children?

A

metaphysis/growth plates of long bones

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17
Q

What is the clinical presentation of osteomyelitis in children?

A

severe pain, oedema, erythema, pseudoparalysis, fever, nausea, vomiting

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18
Q

What are the potential complications of osteomyelitis?

A

septic arthritis, dvt (deep vein thrombosis), sepsis, metastatic infection, recurrent osteomyelitis, altered bone growth, fracture

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19
Q

What condition can be caused by the spreading of osteomyelitis to the joints?

A

septic arthritis

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20
Q

What are the consequences of inflammation in osteomyelitis?

A

increased pressure diminishes blood supply leading to ischaema & necrosis, osteolysis (bone destruction)

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21
Q

What is the term for breakdown in bone structure?

A

osteolysis

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22
Q

What can occur in osteomyelitis when pus formation causes pressure and eruption to the skin?

A

sinus formation

23
Q

What are the pathological features of chronic osteomyelitis?

A

sinus, sequestrum, involucrum

24
Q

What is a sequestrum in osteomyelitis?

A

Focus of devitalised/dead bone, caused by necrosis

25
Q

What is an involucrum in osteomyelitis?

A

Formation of healthy bone over a sequestrum (area of dead bone)

26
Q

What are the 6 key diagnostic tools for diagnosing osteomyelitis?

A

1.) aspiration of pus for gram stain/culture
2.) bone biopsy
3.) blood culture (for haematognenous osteomyelitis)
4.) blood count for leukocytosis, raised CRP
5.) imaging (CT, X-ray, MRI)
6.) bone scans

27
Q

What class of osteomyelitis can often be detected with blood cultures?

A

haematogenous osteomyelitis

28
Q

What are the features of a blood count with osteomyelitis?

A

Leukocytosis (particularly high neutrophil count), raised CRP

29
Q

What imaging technique is best for early detection of osteomyelitis?

A

Bone scan - scintigraphy (also MRI)

30
Q

What is the initial treatment for osteomyelitis?

A

IV empiric broad-spectrum antibiotics

31
Q

What is the most common antibiotic first prescribed for osteomyelitis?

A

Flucloxacillin - because most infections caused by Staph aureus infections

32
Q

Why must antibiotic treatment change from empiric once the cause is known?

A

Changing to narrow spectrum antibiotics avoids drug resistance

33
Q

What is the surgical treatment for osteomyelitis?

A

debridement - removal of damaged/infected tissue, amputation

34
Q

What is a Brodie’s Abcess?

A

Localised region of osteomyelitis forming an abscess

35
Q

Are Brodie’s abscess acute, sub-acute or chronic?

A

Sub-acute or chronic - may persist for years until symptoms develop

36
Q

What is the treatment for sub-acute osteomyelitis, such as Brodie’s Abscess?

A

long course antimicrobials, surgical debridement

37
Q

Is chronic osteomyelitis typically monomicrobial or polymicrobial?

A

Polymicrobial

38
Q

What is septic arthritis?

A

pathogenic invasion of a joint causing arthritis

39
Q

What is septic arthritis characterised by?

A

colonisation of synovial fluid, inflammation, joint effusion (swelling), synovial membrane erosion

40
Q

What bacteria most commonly causes acute septic arthritis?

A

staph. aureus

41
Q

What bacteria is the most common cause of acute septic arthritis in young sexually active people?

A

Neisseria gonorrrhoeae

42
Q

What pathogens typically cause chronic septic arthritis?

A

HIV, rubella, TB, syphilis, fungi (candida)

43
Q

What bacteria typically causes early onset (<3 months post-op) septic arthritis following joint surgery/replacement?

A

staph. aureus

44
Q

What mechanism of infection occurs in s. epidermidis septic arthritis following joint surgeries?

A

biofilms

45
Q

What are the risk factors for developing septic arthritis?

A

damaged joints, joint replacement surgery, injecting drug use, immunosupression, age

46
Q

What are the clinical symptoms of septic arthritis?

A

inflammation/swelling (joint effusion), arthralgia (joint pain)

47
Q

What are the routes of entry for pathogens causing septic arthritis?

A

direct innoculation (surgery, trauma, injection), infection of adjacent tissues (e.g. osteomyelitis), haemotogenous spread (in blood)

48
Q

What are the complications of septic arthritis?

A

sepsis, osteomyelitis, joint destruction

49
Q

What are the treatments for septic arthritis?

A

IV empirical antibiotics, aspiration/drainage, debridement

50
Q

What is reactive arthritis?

A

Autoimmune disease in joints following an infection such as STI or gastroenteritis

51
Q

What STI typically causes reactive arthritis?

A

Chlamydia

52
Q

What triad of symptoms are typically present in reactive arthritis?

A

urethritis/cervicitis of UGT, uveitis/conjunctivitis of eyes, arthritis of large joints/sacroilieum

53
Q

What is the treatment for reactive arthritis?

A

anti-inflammatory/immunsuppressant drugs if unresolved

ELM2 - infection & immunity (22 decks)

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