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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
This is part of the Osteomyelitis sequence of events : Name the hidden
26
This is part of the Osteomyelitis sequence of events : Name the hidden
27
28
What are the blood investigations that would drive to a proper diagnosis?
• Blood culture ( positive for microorganisms)
29
What are the X-ray investigations that would drive to a proper diagnosis?
• X- ray >> (early osteolytic metaphyseal lesion) when is it definite? (by the time osteomyelitis becomes chronic)
30
What are the aspiration investigations that would drive to a proper diagnosis?
• Aspiration biopsy at the point of maximal tenderness using a large core needle >> pus is aspirated and culture of pus is positive for microorganisms
31
Where and how to aspirate in Acute pyogenic osteomyelitis ?
at the point of maximal tenderness using a large core needle
32
What are the definitive investigations and findings that would drive to a proper diagnosis?
intra-operative biopsy (heavy leukocytic infiltrate with necrotic bony remnants & a sub-periosteal abscess)
33
Management of osteomyelitis ?
• 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
Drugs used for MSSA Ostomyolitis (methicillin-susceptible Staphylococcus aureus) ?
Flucloxacillin + fucidic acid, or clindamycin
35
Drugs used for MRSA Ostomyolitis (methicillin-resistant Staphylococcus aureus) ?
Vancomycin or teicoplanin + fucidic acid, or clindamycin
36
Drugs used for Streptococci Ostomyolitis ?
Amoxycillin, ceftriaxone, vancomycin
37
Drugs used for E. coli Ostomyolitis ?
Ceftriaxone, ciprofloxacin
38
Drugs used for Pseudomonas spp. Ostomyolitis ?
Ceftazidime, ciprofloxacin, piperacillin-tazobactam Osteomyelitis antibiotic
39
Duration of antibiotic treatment for Osteomyelitis ?
• Acute: 6 weeks – Chronic: 12 weeks – Acute in children: 2-4 weeks
40
IV versus oral routes for osteomyolitis treatment ?
May be equally effective if antibiotics with high oral bio-availability can be used
41
Initial symptom of vertebral osteomyelitis?
non-specific backache. +/- edema, hotness and redness.
42
Describe the disease progression of vertebral osteomyelitis ?
masked onset of signs and symptoms( it takes up to 2 months to establish the diagnosis)
43
Diagnostic findings for ostemomyolitis ?
-Positive blood culture -high ESR and CRP -Imaging : “ plain, MRI, PET” - BONE BIOPSY is the gold standard
44
Steps for Vertebral osteomyelitis progression in the vertebrae ?
Infection begins in the vertebral disc and spreads to vertebral bodies
45
Chronic affections of osteomyolitis ?
• Pathological fracture • Amyloidosis • Malignancy within the sinus tract ( squamous cell carcinoma)
46
Why may acute osteomyolitis progress to chronicity ?
• lack of treatment • inadequate treatment • incomplete surgical debridement of dead bone
47
How may Chronic Osteomyelitis arise de novo ?
• localized bone infection with few organisms or with bacteria of lowgrade pathogenicity
48
Tuberculous osteomyelitis is secondary to …….(route) dissemination
hematogenous
49
Sequence of morphologic changes in Tuberculous osteomyelitis ?
Tuberculous tissue >> Haversian canals and marrow spaces >> decalcification and resorption of the bony framework >> 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
Describe morphology : Tuberculosis of long bone ?
A circumscribed tuberculous focus develops in the metaphysis, extends along the epiphyseal line and gives rise to subperiosteal cold abscess
51
Describe morphology : Tuberculosis of short bone ?
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
Another name for : short bone- Tuberculosis ?
tuberculous dactylitis
53
Describe morphology : Tuberculosis of flat bone ?
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
Describe morphology : Tuberculosis of flat bone ?
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
Another name for Tuberculosis of vertebrae ?
POTT’S DISEASE
56
Common Sites for POTT’S DISEASE ?
lower dorsal or upper lumbar vertebrae
57
Three Features for POTT’S DISEASE ?
1- Deformity 2- Cold abscess 3-Paraplegia: 10% of the cases (pressure of the cold abscess)
58
How does potts cause Kyphosis ?
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
What’s a Cold abscess ?
An abscess with no acute inflammation
60
How is the Cold abscess formed in pott’s disease ?
Tuberculous vertebrae collapse under body weight. The caseous material collects anterior under the prevertebral fascia forming the cold abscess
61
Which site in the vertebrae is ussually affected first in pots disease ?
• The anterior aspect of the vertebral body adjacent to the subchondral plate
62
In adults, (disk disease/vertebral affection) is secondary to the spread of infection from (disks/vertebrae)
Disk disease ,, vertebrae
63
• In children, the ….(disk/vertebrae), can be the primary site contary to adults
The disk ; because it’s vasclurized
64
prevalance of bony changes associated with TB ?
rare – found in only ~5% of cases

MMB (72 decks)

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