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MSK > Septic Arthritis and Tuberculosis > Flashcards

Septic Arthritis and Tuberculosis Flashcards

1
Q

What are the routes of infection of acute septic arthritis?

A
  • Haematogenous - most common
  • Eruption of bone abscess
  • Direct invasion
  • penetrating wounds - iatrogenic?
  • intra-articular injury
  • arthroscopy - exceptionally uncommon
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2
Q

What are the outcomes of a ruptured metaphyseal abscess?

A
  • Into joint cavity - septic arthritis

* Sub-periosteal - osteomyelitis

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3
Q

What are the causative organisms of acute septic arthritis?

A 
Commonly:
•Staph A
•Haemophilus influenza - less common now due to vaccine
•Strep pyogenes
•E. coli - neonates and elderly
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4
Q

What is the pathological sequence of acute septic arthritis?

A
  • Acute synovitis with purulent joint effusion - becomes increasingly purulent
  • Articular cartilage attacked by bacterial toxin and cellular enzyme
  • Complete destruction of the articular cartilage
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5
Q

What are the 3 outcomes of acute septic arthritis?

A
  • Complete recovery
  • Partial loss of the articular cartilage and subsequent osteoarthritis - may be many years later
  • Fibrous or bony ankylosis (fusion of bones)
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6
Q

How does acute septic arthritis present in a neonate?

A 
Picture of septicaemia:
•Irritability
•Resistant to movement
•Ill
•MULTIFOCAL - multiple infections - full septic screen including lumbar puncture
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7
Q

How does acute septic arthritis present in a child/adult?

A

Acute pain in a single large joint:
•Reluctant to move the joint (any movement)
•Pyrexia and tachycardia
•Increased tenderness
•No erythema until very late and only in superficial joints

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8
Q

How does acute septic arthritis present in an adult?

A
  • Often involved a superficial joint - knee, ankle, wrist (hip in children)
  • Rare in healthy adult
  • May be delayed diagnosis - especially for deeper joints
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9
Q

What investigations can be used to diagnose septic arthritis?

A
  • FBC, WBC, ESR, CRP, blood cultures
  • X ray
  • Ultrasound - useful for deeper joints
  • MRI
  • Aspiration
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10
Q

What is the most common cause of septic arthritis in adults?

A

•Infected joint replacement

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11
Q

How common are infected joint replacements?

A
  • Rare - 1-1.5%
  • Disastrous - death, amputation, removal of arthroplasty
  • Changing picture of organisms but staph still most common
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12
Q

What are some differential diagnoses for acute septic arthritis?

A
  • Acute osteomyelitis - when directly adjacent to a joint
  • Trauma
  • Irritable joint
  • Haemophilia - bleed into joint
  • Rheumatic fever
  • Gout - common (high uric acid, normal temperature, aspiration shows crystals)
  • Gaucher’s disease
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13
Q

How is acute septic arthritis treated?

A
  • General supportive measures
  • Antibiotics - 3-4weeks - start IV and may continue this way
  • Surgical drainage and lavage - emergency, open or arthroscopic lavage
  • Surgery when temperature doesn’t come down within 24hr
  • Infected joint replacements - one stage revision, two stage revision, antibiotics only
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14
Q

What is tuberculosis known as?

A

The great mimic

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15
Q

What are the classifications of bone and joint TB?

A
  • Extra-articular - in the epiphysis or bones with haemodynamic marrow
  • Intra-articular - large joints
  • Vertebral body - most common
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16
Q

What proportion of patients experience multiple lesions?

A

1/3

17
Q

What are the clinical features of TB?

A
  • Insidious onset and general ill health
  • Contact with TB
  • Pain (esp. at night)
  • Swelling
  • Weightloss
  • Low grade pyrexia
  • Joint swelling
  • Decreased ROM
  • Ankylosis
  • Deformity
18
Q

What is the pathological sequence of TB?

A
  • Primary complex (in the lung or the gut)
  • Secondary spread
  • Tuberculous granuloma
  • n.b. role of nutrition/ other disease (e.g. HIV AIDS)
19
Q

How does vertebral TB present?

A
  • Little pain

* Present with abscess or kyphosis

20
Q

What signs are indicative of TB?

A
  • Long history
  • Involvement of single joint
  • Marked thickening of the synovium
  • Marked muscle wasting
  • Periarticular osteoporosis
21
Q

What investigations should be carried out to diagnose TB?

A
  • FBC , ESR
  • Mantoux test
  • Sputum/urine culture
  • Xray
  • Joint aspiration and biopsy
22
Q

What would a TB x-ray show?

A
  • Soft tissue swelling
  • Periarticular osteopenia
  • Articular space narrowing
23
Q

What would a TB joint aspiration and biopsy show?

A
  • AAFB identified in 10-20%

* Culture +ve in 50% of cases

24
Q

What are some differential diagnoses of TB?

A
  • Transient synovitis
  • Monoarticular RA
  • Haemorrhagic arthritis
  • Pyogenic arthritis
  • Tumour
25
Q

How is TB treated?

A
  • Chemotherapy
  • Rest and splintage
  • Operative drainage rarely necessary
26
Q

What specific chemotherapy is used to treat TB?

A 
•Intially:
•rifampicin
•isoniazid
•ethambutol
(8 weeks)
  • Then:
  • rifampicin and isoniazid for 6-12 months

MSK (28 decks)

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