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MBBS - Year 1 > Microbiology - Monoarticular joint pain > Flashcards

Microbiology - Monoarticular joint pain Flashcards

1
Q

How can joints become infected

A

By the haematogenous route
Directly following trauma or surgery
Usually immunologically mediated instead of microbial invasion

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2
Q

What does bacterial arthritis usually affect

A

The hip or knee in all age groups

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3
Q

What kind of bacteria usually causes bacterial arthritis

A

Gram +ve cocci

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4
Q

ReA

A

Pathogen responsible is at distant site and causes a ‘reactive arthritis’
Infection present
No live organisms present
Microbial structures present

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5
Q

What does ReA and arthralgia occur after

A

Certain enteric bacterial infections e.g Campylobacter, Yersinia, salmonellae

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6
Q

Bacteria causing septic arthritis

A

Staph. aureus, Streptococci (Group A and B), Mycobacterium tuberculous

Circulating bacteria sometimes localises in joints

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7
Q

What can Staph aureus cause

A

Skin/ soft tissue infection

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8
Q

What may bacteraemia cause

A

Seeding in distant sites

Osteomyelitis
Septic arthritis
Infective endocarditis

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9
Q

What will 14 days treatment of bacteraemia prevent

A

Sequelae incl OM

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10
Q

Risk factors of septic arthritis

A 
Age > 80 yrs. and children 
Comorbid conditions (esp. diabetes)
Joint damage from arthritis 
Prosthetic joint 
Skin infection 
Immune suppression (malignancy or treatment)
Cirrhosis 
Chronic renal failure and haemodialysis 
IV drug abuse
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11
Q

Pathogenesis of septic arthritis

A 
Haematogenous 
Dissemination from OM 
Spread from adjacent soft tissue 
Puncture or injection (esp. corticosteroids)
Penetrating trauma
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12
Q

Presentation of septic arthritis

A 
Fever 
Joint pain 
Limitation of movement 
Swelling 
Joint effusion
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13
Q

Acute OM

A

Bone can be infected by adjacent infection or haematogenous
Involves the growing end of a long bone, where localization of circulating bacteria is promoted by sprouting capillary loops adjacent to epiphyseal growth plates

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14
Q

What is the result of OM

A

A painful, tender bone lesion and a general febrile illness

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15
Q

Acute OM tends to be a disease of …

A

A disease of children and adolescents, may follow non-penetrating injury to bone

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16
Q

Diagnosis of OM

A

Blood cultures taken before start of antimicrobial therapy or bone biopsy if an open lesion
Periosteal reaction and bone loss may be visible radiologically

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17
Q

When does OM become chronic

A

When there’s a necrotic bone fragment to act as continued source of infection

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18
Q

What may be necessary with serious OM

A

Surgical intervention of debridement
Drainage
Prolonged courses of Abx

19
Q

Paediatric septic arthritis

A

Neonates and young children often have coexisting septic arthritis and OM
Bony cortex is thin, and periosteum is loose
Blood vessels connecting metaphysis and epiphysis serve as conduit by which bony infection may easily reach the joint space

20
Q

Septic bursitis

A

Superficial bursae are commonly infected (pre-patellar and olecranon bursae)
Underlying joint infection is not common
Acute or receptive trauma

21
Q

What is septic bursitis caused by

A

Staph aureus

22
Q

Treatment of septic bursitis

A

Drainage

Abx

23
Q

Prosthetic joint infection

A

Early or late onset
Bacterial adhesion to biomaterial
Cannot be treated w/ out usually removing material

24
Q

DAIR procedure in treating prosthetic joint infections

A

Debridement
Abx (12 weeks)
Irrigation
Retention

involves a two-stage revision

25
Q

Results of prosthetic infection

A 
Periosteal reaction 
Scattered patches of osteolysis 
Generalised bone resorption w/out implant wear 
Transcortical sinus tracts 
Implant loosening 
Scalloping
26
Q

Athrocentesis

A

Procedure done to remove the synovial fluid accumulated around the joints
Immediate send off to lab for M, C & S

27
Q

Amount of fluid in healthy knee

A

< 3ml

28
Q

Amount of fluid in knee w/ infl

A

> 25ml

29
Q

M, C & S

A

Microscopy
Culture
Sensitivities

30
Q

Cause of acute onset of prosthetic joint infection

A

Staph. aureus

Gram +ve

31
Q

Causes of delayed onset of prosthetic joint infection

A

Low virulence organisms

32
Q

Classification of joint effusions

A

Normal
Non - infl
Infl
Septic

33
Q

Features of normal joint effusions

A

Clear, colourless, viscous
<200 WBCs/mm^3
<25% PMNs

34
Q

Features of non-infl joint effusions

A

Clear, yellow, viscous
200-2,000 WBC/mm3
<25% PMNs

35
Q

Features of infl joint effusions

A

Cloudy, yellow, watery
Glucose may be low
2,000 - 100,000 WBC/mm3
>50% PMNs

36
Q

Features of septic joint effusions

A

Purulent
Glucose very low
80,000 WBC/mm3
>90% PMNs

37
Q

Synovial fluid analysis

A

Cell count and differential
Crystals
Culture and sensitivity
Cytology (if malignancy suspected)

38
Q

What does management of bacterial joint diseases depend on

A

Extent of disease
Host factors
Organism

39
Q

Choosing the right Abx

A

Is the bug susceptible
Does the antibiotic get into the bone?
Oral bioavailability? Relatively long-term treatment – side effects?
Can I give it to my patient – children, concurrent therapy

40
Q

Gram +ve cocci

A

Streptococci

Staphylococci

41
Q

Gram +ve rods

A

Listeria

42
Q

Gram -ve cocci

A

Neisseria

43
Q

Gram -ve rods

A

E. coli
Pseudomonas aeruginosa
Haemophilus influenza

44
Q

What drug can be given for MRSA

A

Vancomycin

Trough levels should be 15 -20

MBBS - Year 1 (93 decks)

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