SSTI, Bone and Joint Flashcards
Complication of furuncle/carbuncle involving nares or medial third of face
cavernous sinus thrombosis
SSTI a/w freshwater, estuarine (brackish) water, floodwater
medicinal leeches
aeromonas
→ cellulitis, traumatic wound infection, myonecrosis, necrotizing SSTI
Tx: 3rd gen ceph, FQ, bactrim
*for pts receiving leech therapy - give ppx cipro
tx for vibrio
doxy + CRO/cefotax
SSTI + handling raw seafood
- vibrio - shellfish, liver/iron disease
- erysipelothrix - shrimp, crab, fish
SSTI + foot baths, nail salon
M fortuitum
Dx criteria for burn wound sepsis
- presence of clinical features of infection and systemic signs
- wound bx = bacterial count >105/gm of tissue w/ evidence of invasion into unburned tissue on histopath
SSTI that develop rapidly w/in 48hrs of surgery
think GAS and Clostridium
animal hide/wool
pruritic papule → vesicles/bullae → ulcerate → painless black eschar w/ surrounding induration
cutaneous anthrax
tx w/ cipro or doxy x60 days
Organisms whose growth is stimulated by excess iron
“VELARY” = the sails of a ship
- Vibrio
- E coli
- Listeria
- Aeromonas
- Rhizopus spp (Mucor)
- Yersinia enterocolitica
SSTI a/w oysters
rapid onset - red, painful, hemorrhagic bullae
- diagnosis and RF
- Tx
vibrio vulnificus
- liver disease (EtOH, hemachromatosis, etc)
- Tx: doxy + CRO (alt = FQ)
on a certain medication
fluctuant tender furuncle
F, generalized erythroderma (bullous lesions develop)
skin bx: intra-epithelial split in skin
Staph aureus SSS
Strep vs Staph TSS
- predisposition
- focal pain - y/n
- tissue necrosis/inflammation
- N/V, renal failure, DIC - y/n
- erythroderma
- bacteremia
- mortality
- staph: tampon, surgery, colonization; strep: cuts, burns, erysipelas, varicella
- staph: no; strep: yes
- staph: rare; strep: common
- staph and strep: yes
- staph: very common; strep: less common
- staph: very rare; strep: 60%
- staph: <3%; strep: 30-70%
after cut/abrasion exposure to swine or fish
severe throbbing pain
erysipelothrix (GPR)
- Dx: culture (aspirate/bx)
- Tx: PCN, cephs, clinda, FQ
Bullous impetigo
Staph
***good theme for boards:
- honey-crusted: strep
- bullae = staph
Strep impetigo
Strep: groups A, B, C, G
etiologies for folliculitis
- SA
- PSAR (hot tub)
- Candida (obese pt)
- Malassezia furfur = lipophilic yeast
- AIDS = idiopathic eosinophilic pustular folliculitis
anaerobic small GNR
human bite injury
dx and tx
eikenella
Susc: PCN, FQ, TMP/SMX, doxy
R: clinda, keflex, metronidazole
**amox/clav = TOC for human bites
homeless w/ animal bites
contaminated water/food
fever, extremity rash
symmetrical polyarthralgias
rat bite fever (Strep moniliformis)
tx: PCN, doxy
tx for capnocytophaga
amox/clav
can use zosyn, PCN, clinda (add clinda if needing to use other abx for tx of animal bite, such as bactrim or doxy)
R to: bactrim, ?vanc
pathogens in dog bites
- pasteurella
- capnocytophaga (splenectomy, liver disease)
- human skin: SA, strep pyogenes
6 pathogens that can cause infection after cat bites
- pastuerella
- anaerobes
- bartonella henselae
- rabies
- S aureus
- Strep spp
imaging abn at pubic symphysis (bone marrow edema w/ some symmetric bone erosions)
negative cultures and bxs
unresponsive to abx courses
pt with waddling gait
consider osteitis of the pubic symphysis
noninfectious - a/w radiation, vaginal delivery
spinal osteo as sacroiliitis or spondylodiscitis
think of brucellosis (w/ risk factors)
Bone/joint infection
+
Cat/dog bite
pasteurella spp
Symmetric polyarthritis (usually of small joints) - often a/w fever/rash – think viral
Immune-complex arthritis a/w cryoglobulinemia
think HCV
Bone/joint infection
+
human bite wounds
recent dental procedures
HACEK
(eikenella w/ human bite)
Bone/joint infection
+
NE/upper MW
tick exposure
subacute monoarthritis (knee MC) w/ large effusion
lyme
Bone/joint infection
+
children < 4yo
Grows poorly in cx (dx via PCR)
kingella kingae
young adults with asymmetric oligoarthritis + urethritis, uveitis, or conjunctivitis
dx and what IDs are a/w?
Reactive arthitis (sterile inflammation 2/2 dysregulated immune response from antecedent infection)
- C. trachomatis (can be seen via NAAT in urine)
- Shigella
- Salmonella
- Campy
- Yersinia
lab testing for suspected disseminated gonococcal infection
include indirect testing (via mucosal NAAT)
With septic arthritis: NAAT may be helpful, but not FDA-approved. Blood cultures are low-yield
culturing requires chocolate agar or Thayer-Martin medium
Bone/joint infection
+
Madura foot (barefoot walking)
environmental contamination
IC hosts (neutropenic)
molds
- Symmetric polyarthritis (usually of small joints) - often a/w fever/rash – think viral
- serum-sickness like reaction, resolves with development of jaundice
- often also polyarteritis nodosa
think HBV
Late Non-union:
- Micro:
- Surgical Strategy:
- Abx management:
- Indolent (CoNS, cutibacterium)
- HW removal, revision fixation
- Path-directed tx
septic arthritis
negative cx (or delayed cx)
think: gonococcus, HACEK, lyme, mycoplasma
bone/joint infection
+
splenic dysfunction
Strep pneumo
Bone/joint infection
+
humoral deficiency
postpartum women
tough to grow on cx
Fried egg on culture
mycoplasma spp
2 locations of septic arthritis that should raise suspicion of IVDU
- sternoclavicular joint
- SI joint
Bone/joint infection
+
IC host, indwelling line, IUD
PSAR
Symmetric polyarthritis (usually of small joints) - often a/w fever/rash – think viral
women, history of exposure to young children (teacher, parent)
hands often involved
parvo B19
- Tenosynovitis (esp extensor surface)
- Migratory arthralgias
- purulent arthritis (often w/ lower PMN count)
gonococcal arthritis
Highest yield dx: mucosal site sampling (cervical, urethral). Blood (<30%) and synovial fluid (<50%) lower yield
+ compatible syndrome
bone/joint infection
+
fight bite, oral flora, contamination of IVDU
think of Eikenella and peptostreptococcus
Early/delayed infections prior to fx union
- Micro:
- Surgical Strategy:
- Abx management:
- SA = MC
- Debride and retain (assuming implants fixed well)
- Path-directed; rifampin + if staph
vertebral osteo (thoracic>lumbar)
anterior involvement –> kyphosis deformation
sparing disc space (until later)
think Pott’s disease
indolent presentation
Bone/joint infection
+
unpasteurized dairy
travel to endemic regions (Latin Am, Mediterranean, Middle East)
sacroiliitis, spondylodiscitis
Brucella spp
cutibacterium acnes in seeing of PJI
often a/w shoulder PJI
Symmetric polyarthritis (usually of small joints) - often a/w fever/rash – think viral
+ travel
always consider alphaviruses (esp Chik)
Bone/joint infection
+
tenosynovitis
Dermatitis
arthritis
N gonorrhea
Bone/joint infection
+
IC hosts, IDU
candida spp
bone/joint infection
+
brackish water, water exposure/contamination
Think aeromonas (esp “brackish” water)
also consider pseudomonas
bone/joint infection
+
malignancy
think of GBS
Symmetric polyarthritis (usually of small joints) - often a/w fever/rash – think viral
non-immune (not born in US), cervical LAD
rubella
rash, high fevers, arthritis (>10joints)
Asia, Africa, Europe, Caribbean
relapsing-remitting or unremitting
Dx and testing
think of Chik
RT-PCR if within 1wk of sx
serology if sx >1wk (IgM can be detected up to 3mos)
Bone/joint infection
+
SCD
DM
IC
reptile exposure
travel to developing world
unsafe food hygiene
+/- GI illness
salmonella
PJI Management Table
HCV arthritis
- typically RA-like pattern (symm wrists, MCP, PIPs)
- also can be oligoarthritis w/ large joints (a/w mixed essential cryoglobulinemia)
- d/t immune complex formation
walled off intra-osseous abscess of metaphyseal bone (surrounded by rim of sclerotic bone)
in children/young adults
brodie’s abscess (subacute hematogenous osteo)
- MC d/t SA
- “penumbra sign” = granulation tissue lining abscess cavity – looks like double line
