Flashcards in Bone and Soft Tissue Infections Deck (54)
What is the pathophysiology of chronic osteomyelitis/
-Cavities, poss. sinus(es)
-Dead bone (retained sequestra)
-Histological picture is one of chronic inflammation
What are the possible complications of chronic osteomyelitis?
-Chronically discharging sinus + flare-ups
-Ongoing (metastatic) infection (abscesses)
-Growth disturbance + deformities
-Squamous cell carcinoma (0.07%)
What are the treatment options for chronic osteomyelitis?
Long-term antibiotics?(either local (gentamicin cement/beads, collatamp) or systemic (orally/ IV/ home AB))
-Eradicate bone infection- surgically (multiple operations)
-Treat soft tissue problems
What are the possible routes of infection in acute septic arthritis?
-eruption of bone abscess
-Direct invasion (penetrating wound, intra-articular injury, arthroscopy)
What are organisms are commonly implicated in acute septic arthritis?
What is the pathophysiology behind acute septic arthritis?
-Acute synovitis with purulent joint effusion
-Articular cartilage attacked by bacterial toxin and cellular enzyme
-Complete destruction of the articular cartilage
What is the sequelae of acute septic arthritis?
Partial loss of the articular cartilage and subsequent OA
Fibrous or bony anklyosis
How do neonates with acute septic arthritis often present?
Picture of septicaemia
-Resistant to movement
How do children and adults often present with acute septic arthritis?
Acute pain in single large joint
-Reluctant to move the joint (any movement – c.f. bursitis where RoM OK)
-Increase temp. and pulse
What is important to note about adults with septic arthritis?
-Often involves superficial joint (knee, ankle, wrist)
-Rare in healthy adult
-May be delayed diagnosis
How is acute septic arthritis investigated?
-FBC, WBC, ESR, CRP, blood cultures
What is the most common cause of septic arthritis in adults?
Infected joint replacements
What is the most common organism implicated in infected joint replacements?
What are the outcomes of an infected joint replacement?
-Removal of arthroplasty
What is the differential diagnosis for acute septic arthritis?
How is acute septic arthritis treated?
-General supportive measures
-Antibiotics (3-4 weeks)
-Surgical drainage & lavage -
How is bone tuberculosis classified?
-Extra-articular (epiphyseal / bones with haemodynamic marrow)
-intra-articular (large joints)
Multiple lesions in 1/3 of patients
What are the clinical features of bone tuberculosis?
-Insidious onset & general ill health
-Contact with TB
-Pain (esp. at night), swelling, loss of weight
-Low grade pyrexia
What is the pathophysiology behind bone tuberculosis?
-Primary complex (in lung or the gut)
-Note the role of nutrition and other disease (HIV/AIDs)
How does spinal tuberculosis present?
-Present with abscess or kyphosis
How is bone tuberculosis diagnosed?
-Involvement of single joint
-Marked thickening of the synovium
-Marked muscle wasting
How is bone tuberculosis investigated?
-X-Ray (soft tissue swelling, periarticular osteopenia, articular space narrowing)
-Joint aspiration and biopsy (AAFB identified in 10-20%, culture + in 50% of cases)
What is the differential diagnosis for bone tuberculosis?