Term
| Most common isolates of open fracture Osteomyelitis |
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Definition
Organisms from soil (ex. Staphylococcus aureus*)
Nosocomial pathogens (ex. Pseudomonas aeruginosa)
Normal skin flora ( ex. Propionibacterium acnes and Staphylococcus) |
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Term
| Pseudomonas aeruginosa morphology, culture |
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Definition
Gram negative rods in pairs and singles
Does Not ferment carbohydrates; Obligate anaerobe
Blood Agar (BAP)- brown colonies, semi clearing
MacConkey Agar- colorless colonies lactose-non fermenting
Nutrient Agar- blue-green colonies |
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Term
| Hematogenous seeding (osteomyelitis) in Children |
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Definition
Most common isolates:
Staphylococcus aureus, Strep. pneumoniae, Haemophilus influenzae type B
Population:
predominantly encountered in the pediatric population w/ 85% in children under 17.
Body Region:
In children this is found at the end of the long bones’ metaphysis.
Signs and Symptoms:
Chills, high fever, malaise, local pain, swelling
Bone cultures are positive only 50% of the time |
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Term
| Hematogenous Osteomyelitis of the Adult |
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Definition
Body Region:
In adults this most often affects the spine.
Most common isolates:
S. aureus and coagulase negative Staphylococci
Signs and Symptoms:
Insidious pain and tenderness in the spine (90%); Fever(50%); Motor and sensory deficits (15%) |
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Term
| Osteomyelitis Due to Contiguous Spread |
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Definition
Causes:
Infective arthritis
Post-trauma infections
Soft tissue infections
Puncture wounds |
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Term
| Contiguous-focus Osteomyelitis without Generalized Vascular Insufficiency |
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Definition
Most common isolate :
S. aureus
can be poly microbial including gram-negative bacilli and anaerobic organisms.
Common Causes:
Surgical reduction, internal fixation of factures, prosthetic devices, soft tissue infections
Timing:
1 month after trauma, surgery or soft-tissue infection.
Symptoms:
Low-grade fever, drainage and pain. Loss of bone stability, necrosis and soft tissue damage |
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Term
| Acute Ischemic Neuropathic Osteomyelitis and/or Vascular Insufficiency |
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Definition
Bacterial Isolates
Mostly polymicrobial including aerobic and anaerobic organisms
Most common causes:
Foot ulcer due to : neuropathy, vascular insufficiency and hyperglycemia
Signs, Symptoms and Diagnosis
A chronic ulcer with a surface area of more than 2 cm2 or a positive “probe to bone” test. Increased erythrocyte sedimentation rate, C-reactive protein. |
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Term
| Intravenous Drug Users and Osteomyelitis |
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Definition
Most common isolates:
S. aureus, Pseudomonas, Candida, Eikenella corrodens. Mycobacterial osteomyelitis is more common in these patients.
Unusual locations
Sternoclavicular, sternochondral joint, sacroiliac joint and symphysis pubis |
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Term
| osteomyelitis with Hemodialysis patients |
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Definition
Location:
Vertebral osteomyelitis
Frequent Isolates:
S. aureus and S. epidermidis
Oxacillin resistant S. aureus is common
Timing:
12 to 72 months after initiation of hemodialysis |
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Term
| osteomyelitis with indwelling catheters |
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Definition
Location:
Frequently sacroiliac joint infections although it occurs rarely
Frequent Isolate:
S. aureus |
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Term
| Sickle cell Disease and Osteomyelitis |
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Definition
Common isolates:
Salmonella, S. aureus, other gram negatives
Location:
Long bone and septic arthritis
Genetic component of susceptibility:
HLA class II DRB 15 is protective while
HLA class II DQB1 03 is susceptible
Probable mechanism
Patchy ischemic infarction in the bowel due to sickling
Symptoms:
bone pain and fever, followed in 1 to 2 weeks by spiking fever, chills, and leukocytosis |
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Term
| Salmonella morph and culture |
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Definition
Structure and Morphology:
Gram-negative facultative, rod-shaped, with peritrichous flagella.
Growth:
Can be isolated on MacConkey agar
Usually Non-lactose fermenters
Acid and gas from glucose fermentation
Produce H2S
Disease:
Usually cause two diseases:
Salmonellosis; enteric fever (typhoid)
Acute gastroenteritis, resulting from food borne infection/intoxication. |
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Term
| Mycobacterium tuberculosis’ in Spinal Osteomyelitis morph, culture |
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Definition
Structure and morphology
Acid Fast, rods , intracellular
Resistant to chemicals and drying due to thick cell wall with mycolic acids.
Growth:
Strictly aerobic and slow growing
Transmission:
Primarily respiratory route but disseminated disease can seed many tissues of the body (20%0.
Osteomyelitis:
1-5% of all tuberculosis cases musculoskeletal
Vertebral osteomyelitis due to M. tuberculosis =Pott’s disease
People at risk:
HIV patients, IV drug users and other immunocompromised patients are at risk of Mycobacterium infection |
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Term
| Staph aureus morph, culture |
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Definition
Gram + cocci, non-motile
Catalase +
Facultative anaerobe
β-hemolytic
Salt and Temp tolerant
Golden pigmented colonies
Anti-phagocytic polysaccharide capsule
Coagulase producer |
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Term
| Pathogenesis of S. aureus in osteomyelitis |
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Definition
Invasion:
Hyaluronidase, Staphylokinase, Lipase, Dnase
Adherence: The MSCRAMMS adhesion proteins are important to adhesion to host intracellular matrix proteins including that of bone:
Collagen binding protein – cna
Fibronectin binding proteins – fnbA, fnbB, clf A, clfB
Sialoglycoprotein adhesin
Tissue destruction:
Cytolytic toxins: α, β, δ, γ and the P-V leukocidin |
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Term
| Penicillin resistant S. aureus |
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Definition
Penicillinase encoded by bla
Clips the beta-lactam ring.
Plasmid encoded and easily transferable |
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Term
| MRSA: Methicillin Resistant S. aureus |
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Definition
Defined as having oxacillin MIC of greater than 4μg/ml
All have the mecA gene.
mecA codes for a very low-affinity PBP2A
PBPs link peptidoglycan NAG /NAM (pentapeptide) precursors into polymers that are then linked by peptide bonds
Resistant to all beta-lactams but remain sensitive to vancomycin, the drug of choice |
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Term
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Definition
drug that prevents cell wall assembly by binding to the pentapeptide side chains.
D ala-D ala |
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Term
| VISA and VRSA: Vancomycin intermediate and resistant S. aureus |
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Definition
Transposon: TN1546 (vanA) is on a multi-resistance conjugative plasmid.
Van A gene products modify the Nam-peptide terminus from D-ala-D-ala to D-ala –D-lactate
The modified precursors don’t bind *** and therefore can be used for cell wall assembly.
Alternative Treatment : Daptomycin |
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Term
| Mechanisms of Acquiring Antibiotic Resistance |
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Definition
Possibility 1: Conjugation between E. faecalis and S. aureus followed by transposition into the S. aureus multiple drug resistance plasmid..
The multi-drug resistant plasmid carries resistance to beta lactams, vancomycin, trimethoprim and gentamycin/kanamycin/trobramycin
75% of Enterococcus faecalis isolates are vancomycin resistant (VRE)
Possibility 2: Transduction followed by transposition
The TN1545 transposon is self-transferable. |
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Term
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Definition
| small, quick myelinated fibers for pain and temp (acute pain) |
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Term
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Definition
| larger, slower, unmyelinated fibers for pain and temp (aching pain) |
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Term
| Resting membrane potential |
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Definition
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Term
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Definition
| one neuron uses different neurotransmitters to connect to several neurons |
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Term
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Definition
| Anterograde transport of a vesicle along a microtubule is mediated by ***. Travels from the minus end of a microtubule to the plus end. Fresh components made in soma and moved into axon. Rapid and slow |
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Term
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Definition
| Retrograde transport of a recycled synaptic vesicle along a microtubule is mediated by cytoplasmic ***. Travels from the plus end of a microtubule to the minus end. Worn out materials are returned to the soma for degradation in lysosomes. Rapid. |
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Term
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Definition
| wrap myelin sheaths around axons in the CNS |
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Term
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Definition
| wrap myelin sheaths around axons in the PNS |
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Term
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Definition
| Line the ventricular system of the brain. Cilia on their free surface help the propulsion of cerebrospinal fluid through the ventricles. |
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Term
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Definition
| Collection of structurally and functionally related neurons |
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Term
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Definition
| : Dense network of dendrites, axons, and glial cell processes between neurons |
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Term
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Definition
| layer of neurons within the CNS |
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Term
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Definition
| A collection of nerve fibers in the CNS |
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Term
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Definition
| A bundle of neuronal axons/fibers enclosed by perineurium |
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Term
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Definition
| Bundle of sensory fibers in the brain stem |
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Term
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Definition
| : aggregation of nerve cell bodies |
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Term
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Definition
| Peripheral nerve; fascicles of axons enclosed by a perineurium |
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Term
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Definition
| Dorsal/ventral branches of the spinal nerves |
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Term
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Definition
| Initial segments of a nerve leaving the CNS |
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Term
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Definition
| key excitatory neurotransmitter mediating the perception of pain |
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Term
| EPSP (Excitatory postsynaptic potentials) |
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Definition
| Postsynaptic potential that hyperpolarizes due to K+ channel opening |
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Term
| IPSP(Inhibitory postsynaptic potentials) |
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Definition
| Postsynaptic potential that depolarizes due to Na+ channels opening |
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Term
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Definition
| binding of NT to surface receptor, but not to a channel directly. |
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Term
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Definition
| excitatory (generally) or inhibitory |
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Term
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Definition
| generally excitatory, may be inhibitory at some sites |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| biogenic amines that influence sleep, mood, attention and learning |
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Term
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Definition
| plays role in a-delta pain nerve fiber endings |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| Hepatocellular carcinoma and some germ cell tumor markers |
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Term
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Definition
| Pancreatic and gastric carcinoma marker |
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Term
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Definition
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Term
| The most common etiologies of acute septic arthritis of a native joint |
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Definition
S. aureus (46%)
Streptococci (S. pyogenes
and other β-hemolytic spp)
Gram negative bacilli ( ex. E. coli and Pseudomonas)
Neisseria gonorrhoeae |
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Term
| Gonococcal Arthritis (Neisseria gonorrhoeae) |
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Definition
Virulence factors:
Pili, PorB, Opa, and LOS
Phase variation
Drug resistance
Classical triad presentation:
Dermatitis
Tenosynovitis
Polyarthritis
Laboratory tests: Gram stain (-)
50,000 to 100,000 leukocytes/mm3 in synovial fl |
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Term
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Definition
| is involved in preventing phagolysosome fusion, thus helping it avoid killing by complement, and facilitates invasion. |
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Term
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Definition
| required for adherence to mucous membrane |
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Term
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Definition
| is an opacity protein. It typically mediates firm adhesion to epithelial cells. |
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Term
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Definition
| stands for lipooligosaccharides, which promote adhesion and invasion of host cells |
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Term
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Definition
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Term
| viral agents common to the United States that have been associated with arthritis or arthropathy |
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Definition
Human parvovirus B19
Rubella virus
HIV and HTLV-1- known for AIDS/leukemia
Hepatitis B or C |
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Term
| four bacterial agents known to cause chronic infectious arthritis |
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Definition
| Mycobacteria tuberculosis, Borrelia burgdorferi (Lyme), Treponema pallidum (Syphilis), Tropheryma whippelii |
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Term
| capable of causing infectious arthritis in the course of disseminated infections, based on endemicity |
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Definition
| Blastomyces dermatitidis, Coccidioides immitis, Paracoccidioides brasiliensis,and Sporothrix schenckii |
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Term
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Definition
• primarily pulmonary
• disseminates to joints bone and skin
• broad based buds
• endemic to SE, NE, and Central US |
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Term
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Definition
• Spread through inhalation of arthroconidia, which grow into spherules and produce endospores
• Those more at risk are older, male, w/chronic disease, African American, or Filipino.
• Found in Southwest US. Often referred to as Valley fever or San Joaquin fever |
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Term
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Definition
• Almost always lymphocutaneous
• Cutaneous inoculation not pulmonary ( Rose Gardeners disease- puncture with soil involved)
• Arthritis is usually chronic, affecting weight bearing joints.
• Cigar shaped yeast form and “daisy petal” formation on conidiophores
• Found in Japan, North and South America |
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Term
| Paracoccidioides brasiliensis |
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Definition
• Primary dimorphic endemic fungal infection in Latin American countries.
• Diagnosis is by observation of distinctive yeast form.
• The presence of multiple buds distinguished it from Cryptococcus neoformans
and Blastomyces dermatitis |
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Term
| fungal agents that are most commonly associated with chronic infectious arthritis occurring in immunocompromised patients |
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Definition
| Candida, Cryptococcus and Aspergillus |
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