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MSK SM > Musculoskeletal infections > Flashcards

Musculoskeletal infections Flashcards

1
Q

What are the 5 main types of oesteoarticular infections

A 
Prosthetic-joint infection
Septic arthritis
Post-traumatic infection
Vertebral osteomyelitis
Diabetic foot infection
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2
Q

What are the 3 most common causative pathogen of osteoarticular infections?

A

Staph aureus
Streptococci
Coliforms

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3
Q

What are the most likely pathogens of a prosthetic joint infection

A

Coagulase negative staphylococci

Proprionobacteria (diptheroids)

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4
Q

What are some less common pathogens

A

Pseudomonas aeruginosa

Kingella (in children

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5
Q

What are 3 risk factors for developing an osteoarticular infection

A

Sickle cell
Immunocompromised
Diabetes

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6
Q

What are the clinical presentation of acute bone and joint infections

A

Temperature / systemic signs
Pain/ swelling/ redness over area
Reduced mobility/ movement of joint/ held in flexed position

Children (not feeding/ playing/ cranky)

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7
Q

What does SIRS stand for

A

Systemic Inflammatory Response Syndrome

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8
Q

SIRS is present when there are 2 or more of what

A

Temperature >38 or 90bpm
RR >20bpm or
PaCO2 12000 cells/mm3 or

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9
Q

What is septic arthritis

A

An infection of the joint space

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10
Q

How are organisms introduced to the joint space

A 
Haematogenous spread
Contiguous spread (infected bone)
Direct inoculation (injection / trauma)
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11
Q

What are the main pathogens of Septic arthritis

A

MSSA

Streptococci

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12
Q

What tests should be performed to diagnose acute septic arthritis

A 
Blood cultures if pyrexial 
CRP, FBC, U&E, lactase, ESR
Joint fluid aspirate/ washout for microscopy and culture 
cruystals white cells and gram stain 
US scan, XR, MRI, CT, bone scan
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13
Q

What is the antibiotic treatment for septic arthritis and by what route should it be given
How long should the treatment be for?

A

Staph aureus –> FLUCLOXACILLIN (high dose to get into the joint)
Usually needs to be IV for joints
2-4 weeks (2 minimum)

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14
Q

Define osteomyelitis

A

Inflammation of bone and medullary cavity, usually long bones or vertabrae

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15
Q

In which population is there an increasing incidence of osteomyelitis

A

Children

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16
Q

Why might osteomyelitis recur

A

If the treatment is suboptimal

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17
Q

In what 4 ways can acute osteomyelitis spread?

A

Haematogenous (most likely - often towards the knee - femur, tibia)
Contiguous
Peripheral vascular disease associated
Prosthesis associated

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18
Q

Why are infants more at risk of septic arthritis

A

Due to vessels crossing metaphysis to epiphysis

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19
Q

Where in the body is there most likely to be haematogenous spread

A

Femur/ tibia

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20
Q

In what 4 joints may acute osteomyelitis spread into joint space and why?

A

Shoulder ankle hip elbow

because the metaphysis is intracapsular

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21
Q

If there is a delay in treating acute infection what can this lead to

A

A high risk of abscess
permanent damage
septicaemia

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22
Q

What are 4 risk factors for infections in prosthetic joints

A

Rheumatoid arthritis
Diabetes
Malnutrition
Obesity

23
Q

What are the 3 types of implant infection

A

Early postoperative
Delayed (low grade)
Late

24
Q

What is an ideal treatment for a prosthetic joint infection

A

Removal of prosthesis and cement

Re implantation of the joint after antibiotic treatment

25
Q

What is necrotising fasciitis

A

Uncommon but acute and severe infection of the subcutaneous soft tissues

26
Q

What areas of the body can be affected by necrotising fasciitis

A

Limbs
Abdominal wall
perineal and groin area
post operative wound

27
Q

Describe the clinical picture of Necrotising fasciitis

A

Highly painful
some signs of inflammation
spread through tissues very raidly
systemic toxicity

28
Q

What is type 1 necrotising fasciitis

A

Anaerobes plus multiple other bacteria (synergistic gangrene)

29
Q

What is type 2 necrotising fasciitis

A

Flesh eating bacteria

Group A streptococcus

30
Q

How can we diagnose necrotising fasciitis

A

Pain disporportionate to superficial appearances
Swabs and tissues biopsy for microbiology gram stain and culture
Blood cultures
CRP, FBC, clotting U&E

31
Q

What are the infection control procedures for a patient with necrotising fasciitis

A 
Standard precautions
Single room
gloves
aprons 
risk assess need for droplet precautions
32
Q

What is gas gangrene

A 
Clostridium perfringens (part of normal bowel flora)
Gram positive strictly anaerobic rods
33
Q

What is the causative organism of tetanus

A

Clostridium tetani

Gram positive strictly anaerobic rods

34
Q

Where is tetanus found

A

Soil
gardens
animal bites

35
Q

What happens in tetanus

A

Neurotoxin causes spastic paralysis

It binds to inhibitory neurones, preventing release of neurotransmitters

36
Q

What is the incubation period of tetanus

A

4 days to several weeks

37
Q

What is the treatment for tetanus

A 
Clinical suspicion
Surgical debridement 
Antitoxin
Supportive measure 
Penicillin/ metronidazole
Booster vaccination.... toxoid
38
Q

When is the tenaus vaccination given

A

2,3,4 months

39
Q

What might be the cause of sepctic arthritis if the patient is sexually active

A

Gonnorhoea

40
Q

What is PVL? And what effect does it have on a patient

A

A toxin - poisonous protein
Toxin can be quite damaging to patients
Aggressive infection
More commonly found in younger people

41
Q

What are coliforms

A

A group of organisms which normally live in the bowel - they can give rise to an osteomyelitis

42
Q

What can be a sign of a PVL infection

A

Recurrent boils

43
Q

How do we measure treatment

A

CRP response - should be decreasing if the treatment is working

44
Q

Why do we look for crystals in the diagnosiss of acute septic arthritis

A

To rule out gout and pseudogout

45
Q

What should be added in for children antibiotic treatment and why?

A

Ceftriaxone (for H influenzae/ Kingella cover)

46
Q

What type of patients are more likely to get salmonella osteomyelitis

A

Those with sickel cell

47
Q

When do we start antibiotics of chronic osteomyelitis

A

When SIRS is absent and when cultures have been taken so we know the exact antibiotic to use

48
Q

Necrotising Fascitis is a medical emergency - true or false

A

True - can be minutes - hours before mortality

49
Q

How does clindomycin work?

A

It stops Strep A producing a toxin as well as fighting the infection

50
Q

What are Clostridium perfringens

A

Part of the normal bowel flora

Gram positive strictly anaerobic rods

51
Q

How does Gas Gangrene cause an infection

A

The spores get into the tissue.

This causes the tissue to die and anaerobic conditions

52
Q

WHat happens if the the spores germinate

A

There is an accumulation of gas bubbles in tissues space gas gangrene (crepitus

53
Q

What is the treatment for Gas gangrene

A

Urgent debridement in theatre
Antibiotic in high doses (penicillin, metronidazole - either or both)
Possibly hyperbaric oxygen

MSK SM (42 decks)

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