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MMB > MMB [025] Bone infections > Flashcards

MMB [025] Bone infections Flashcards

1
Q

What is osteomyelitis?

A

It is inflammation of the medullary and cortical portions of bone, including the periosteum.

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2
Q

Types of osteomyelitis ?

A

-Pyogenic osteomyelitis

-Tuberculous osteomyelitis

-Syphilitic osteomyelitis

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3
Q

main cause of ; Acute Pyogenic Osteomyelitis ?

A

Bacteria ; Most commonly Staphylococcus aureus

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4
Q

Major Causative Organisms of Acute Pyogenic Osteomyelitis ,, in NEONATES ?

A

E coli and group B streptococci

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5
Q

Causative Organisms of Acute Pyogenic Osteomyelitis ,, in BONE TRAUMAS ?

A

Mixed bacterial infection

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6
Q

Routes of infection for : Acute Pyogenic Osteomyelitis ?

A
  • Hematogenous dissemination
  • Direct extension (from adjacent septic arthritis or soft tissue abscesses)
  • Traumatic implantation (following compound fracture, surgical prosthesis, implants)
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7
Q

Predisposing Factors for : Acute Pyogenic Osteomyelitis ?

A

• Debilitating diseases

• Bone or joint prostheses

• Immunodeficiency

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8
Q

Risk factors for development of haematogenous osteomyelitis ?

A

• Infants and young children

• Elderly patients

• IV drug abusers

• Central venous catheters

• Joint disease

• Immuno-suppression

• Trauma

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9
Q

Organisms causing Haematogenous osteomyelitis in NEONATES ?

A

S. aureus, Group B strep, E. coli

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10
Q

Organisms causing Haematogenous osteomyelitis in CHILDREN ?

A

S. aureus, S. pyogenes

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11
Q

Organisms causing Haematogenous osteomyelitis in ADULTS ?

A

S. aureus, streptococci

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12
Q

Organisms causing Haematogenous osteomyelitis in Sickle cell disease, thalassaemia patients ?

A

Salmonella species

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13
Q

Organisms causing Haematogenous osteomyelitis in immuno-compromized patients ?

A

S. aureus, mixed infections including E. coli and Pseudomonas spp.

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14
Q

Organisms causing Implant-associated infections of Haematogenous osteomyelitis ?

A

Coagulase-negative staphylococci, mixed infections

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15
Q

Rare Organisms causing Haematogenous osteomyelitis ?

A

TB, fungi, Brucella sp.

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16
Q

Basic pathologic changes : associated with Osteomyelitis ?

A

-suppuration

-ischemic necrosis

-healing by fibrosis

-and bony repair

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17
Q

“Infection usually starts at the metaphyseal marrow of long bones “

Why is the metaphysis a favorable site?

A
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18
Q

How does bone necrosis arise in OSTEOMYELITIS ?

A
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19
Q

WHY IS A SUBPERIOSTEAL ABSCESS MORE COMMON IN CHILDREN?

A

In children the periosteum is loosely attached

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20
Q

General sequence of events in Osteomyelitis ?

A
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21
Q

How is the sequestrum formed ?

A

Suppuration + impaired blood supply to the cortical bone&raquo_space; erosion, thinning and infarction necrosis of the part = sequestrum

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22
Q

What’s the Involucrum ?

A

A new bone is formed beneath the periosteum , to encase the SEQUESTRUM (dead bone)

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23
Q

What is the Cloaca ?

A

It is the site of rupture of the periosteal abscess in the involucrum ; where there is holes from which the purulent exudate passes out through the sinuses

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24
Q

This is part of the Osteomyelitis sequence of events : Name the hidden

A
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25
Q

This is part of the Osteomyelitis sequence of events : Name the hidden

A
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26
Q

This is part of the Osteomyelitis sequence of events : Name the hidden

A
27
Q
A
28
Q

What are the blood investigations that would drive to a proper diagnosis?

A

• Blood culture ( positive for microorganisms)

29
Q

What are the X-ray investigations that would drive to a proper diagnosis?

A

• X- ray&raquo_space; (early osteolytic metaphyseal lesion) when is it definite? (by the time osteomyelitis becomes chronic)

30
Q

What are the aspiration investigations that would drive to a proper diagnosis?

A

• Aspiration biopsy at the point of maximal tenderness using a large core needle&raquo_space; pus is aspirated and culture of pus is positive for microorganisms

31
Q

Where and how to aspirate in Acute pyogenic osteomyelitis ?

A

at the point of maximal tenderness using a large core needle

32
Q

What are the definitive investigations and findings that would drive to a proper diagnosis?

A

intra-operative biopsy (heavy leukocytic infiltrate with necrotic bony remnants & a sub-periosteal abscess)

33
Q

Management of osteomyelitis ?

A

• Antibiotics targeting causative organism ( proved by culture& sensitivity)

• Surgery is indicated to Eradicate infection by achieving a viable environment Debridement of dead tissue Prevent recurrences

• Control of blood sugar in diabetic patients

• Conservative treatment

• Symptomatic treatment: analgesics and anti-pyretics.

34
Q

Drugs used for MSSA Ostomyolitis
(methicillin-susceptible Staphylococcus aureus) ?

A

Flucloxacillin + fucidic acid, or clindamycin

35
Q

Drugs used for MRSA Ostomyolitis
(methicillin-resistant Staphylococcus aureus) ?

A

Vancomycin or teicoplanin + fucidic acid, or clindamycin

36
Q

Drugs used for Streptococci Ostomyolitis ?

A

Amoxycillin, ceftriaxone, vancomycin

37
Q

Drugs used for E. coli Ostomyolitis ?

A

Ceftriaxone, ciprofloxacin

38
Q

Drugs used for Pseudomonas spp. Ostomyolitis ?

A

Ceftazidime, ciprofloxacin, piperacillin-tazobactam Osteomyelitis antibiotic

39
Q

Duration of antibiotic treatment for Osteomyelitis ?

A

• Acute: 6 weeks

– Chronic: 12 weeks

– Acute in children: 2-4 weeks

40
Q

IV versus oral routes for osteomyolitis treatment ?

A

May be equally effective if antibiotics with high oral bio-availability can be used

41
Q

Initial symptom of vertebral osteomyelitis?

A

non-specific backache.

+/- edema, hotness and redness.

42
Q

Describe the disease progression of vertebral osteomyelitis ?

A

masked onset of signs and symptoms( it takes up to 2 months to establish the diagnosis)

43
Q

Diagnostic findings for ostemomyolitis ?

A

-Positive blood culture

-high ESR and CRP

-Imaging : “ plain, MRI, PET”

  • BONE BIOPSY is the gold standard
44
Q

Steps for Vertebral osteomyelitis progression in the vertebrae ?

A

Infection begins in the vertebral disc and spreads to vertebral bodies

45
Q

Chronic affections of osteomyolitis ?

A

• Pathological fracture

• Amyloidosis

• Malignancy within the sinus tract ( squamous cell carcinoma)

46
Q

Why may acute osteomyolitis progress to chronicity ?

A

• lack of treatment

• inadequate treatment

• incomplete surgical debridement of dead bone

47
Q

How may Chronic Osteomyelitis arise de novo ?

A

• localized bone infection with few organisms or with bacteria of lowgrade pathogenicity

48
Q

Tuberculous osteomyelitis is secondary to …….(route) dissemination

A

hematogenous

49
Q

Sequence of morphologic changes in Tuberculous osteomyelitis ?

A

Tuberculous tissue&raquo_space; Haversian canals and marrow spaces
&raquo_space; decalcification and resorption of the bony framework&raquo_space; Bony structures become replaced by caseous material

Extensive endarteritis (artery inflammation) leads to necrosis

> > Sequestrum Involved bone is eventually infiltrated by tuberculous granulation tissue and becomes porous and friable

50
Q

Describe morphology :

Tuberculosis of long bone ?

A

A circumscribed tuberculous focus develops in the metaphysis, extends along the epiphyseal line and gives rise to subperiosteal cold abscess

51
Q

Describe morphology :

Tuberculosis of short bone ?

A

The whole diaphysis of short bones “like the phalanges” is invaded and converted into a mass of tuberculous granulation tissue and caseous material, while a layer of new bone is laid down under the periosteum.

52
Q

Another name for : short bone- Tuberculosis ?

A

tuberculous dactylitis

53
Q

Describe morphology :

Tuberculosis of flat bone ?

A

The initial lesion in the ribs, sternum, skull and pelvis is sub-periosteal and it ends up by the formation of a superficial cold abscess.

54
Q

Describe morphology :

Tuberculosis of flat bone ?

A

The initial lesion in the ribs, sternum, skull and pelvis is sub-periosteal and it ends up by the formation of a superficial cold abscess

55
Q

Another name for Tuberculosis of vertebrae ?

A

POTT’S DISEASE

56
Q

Common Sites for POTT’S DISEASE ?

A

lower dorsal or upper lumbar vertebrae

57
Q

Three Features for POTT’S DISEASE ?

A

1- Deformity

2- Cold abscess

3-Paraplegia: 10% of the cases (pressure of the cold abscess)

58
Q

How does potts cause Kyphosis ?

A

The bodies of vertebrae become caseous ; When vertebral bodies collapse while the spines remain intact, an acute curvature develops with a convexity pointing backward

59
Q

What’s a Cold abscess ?

A

An abscess with no acute inflammation

60
Q

How is the Cold abscess formed in pott’s disease ?

A

Tuberculous vertebrae collapse under body weight. The caseous material collects anterior under the prevertebral fascia forming the cold abscess

61
Q

Which site in the vertebrae is ussually affected first in pots disease ?

A

• The anterior aspect of the vertebral body adjacent to the subchondral plate

62
Q

In adults, (disk disease/vertebral affection) is secondary to the spread of infection from (disks/vertebrae)

A

Disk disease ,, vertebrae

63
Q

• In children, the ….(disk/vertebrae), can be the primary site contary to adults

A

The disk ; because it’s vasclurized

64
Q

prevalance of bony changes associated with TB ?

A

rare – found in only ~5% of cases

MMB (72 decks)

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