Monoarticular joint pain - Microbiology Flashcards
How can joints become infected?
- The haematogenous route
- Directly following trauma or surgery
a) In all age goup, which joint does bacterial arthritis usually affect?
b) What type of organism is it usually caused by?
a) Hip, knee
b) Gram positive cocci
a) Describe what reactive arthtitis is
b) What type of infection does reactive arthritis and arthralgia occur after?
c) Is more than one joint usually affected (polyarthritis) in reactive arthitis?
a) An infection where the pathogen responsible is at a distant site in the body which cause a ‘reactive arthritis’
b) Certain enteric bacerial infection and the athralgia also in rubella and hepatitis B infections (is of similar origin)
c) Yes
For 1. infecion, 2. reacitve arthritis, and 3. inflammatory arthritis.
Say if there is a) an infection b) live organism present c) microbial structure present and d) provide examples for each
a) What is septic arthritis?
b) Which commonest organisms cause septic arthritis?
a) When circulating bacteria localise in joints especially following trauma which causes a suppurative (septic) arthritis
b) Staphylococcus aeurus, streptococci (Group A and B), Myobacterium tuberculosis
a) Describe the role of Staphlococcus aureus in the skin
b) Bacteraemia may cause seeding in distant sides. Provide examples of these.
c) What is the recommended number of days of treatment of bacteraemia to prevent sequelae (after effect of disease) including osteomyeltis
a) Normal skin flora in up to 40%, cause skin/soft tissue infection
b) Osteomyeleitis, septic arthritis, infective endocarditis
c) 14 days of treatment
Describe the clinical features of septic arthritis
- Acutely inflamed tender, swollen joint
- Reduced range of movement
- Systemically unwell e.g., fever
What are the risk factors of septic arthritis
- Joint disease e.g., RhA
- Chronic kidney disease/failure
- Immunospuression (malignancy or treatment)
- Prosthetic joints
- Age > 80 years and children
- Skin infection
- IV drug abuse
Describe the management of septic arthritis
- IV antibiotics
- Considering joint washout under general anaesthetic
- Physiotherapy after acute infection resolves
Superificial bursae are commonly infected (septic bursitis)
a) Which bursas are most commonly infected
b) Are underlying joint infections common?
c) How do bursas occur?
d) What organism is it commonly caused by?
e) How can it be treated?
a) pre-patellar and olecranon bursae
b) No
c) Caused by acute or repetitive trauma
d) Staph aureus
e) By drainage and antibiotics
a) What is osteomyelitis
c) Which group of people does osteomyelelitis affect the most?
d) Describe the presentation
a) Infection of the bone by adjacent infection or hameatogenously
b) Children and adolscents
c) Painful tendor lesion and general febrile illness (fever, high temp, chills etc)
a) In a patient with osteomyelitis what may be visible radiologically?
b) In what cases can osteomyelitis especially become chronic?
a) Periosteal reaction and bone loss
b) When there’s a necrotic bone fragment to act as continued source of infection
a) Describe the diagnosis of osteomyelitis
b) Describe the treatment
a) Blood cultures taken before start of antimicorbial therapy or bone biopsy if an open lesion
b)
- Surgical intervention of debridment and drainage may be necessary
- Prolonged course of antibiotics may be necessary
a) What is the procedure to treat prosthetic joint infection?
b) Can it be treated without removing the material?
a) DAIR
- Debridement (removal of necrotic or infected skin tissue)
- Antibiotics
- Irrigation ((The steady flow of a solution across an open wound surface to achieve wound hydration, to remove deeper debris, and to assist with the visual examination)
- Retention (Used in high tension wound closures to support primary wound closure)
b) Not usually
a) What is arthrocentesis?
b) What are the next steps after arthrocentesis
a) Procedure to remove synovial fluid accumulated around the joints
b)
- mmediate send off to lab for Microscopy, cultures and sensitivites (M,C&S)
- Start antibiotics
