Term
| classification of osteomyelitis (causes of each) |
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Definition
- medullary
- caused by hematogenous spread
- superficial
- caused by spread from contigous focus of infection w/ or w/o associated vascular insufficiency or atherosclerosis (inadequate tissue perfusion)
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Term
| epidemiology of hematogenous osteomyelitis |
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Definition
| most common in infants and kids with minor trauma |
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Term
| dx of hematogenous osteomyelitis |
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Definition
- cultures usually positive for S. aureus and beta hemolytic strep (group A and B)
- E coli in infants while greater than 1 yr old you may see Haemophilus influenza
- sickle cell patients would have Salmonella
- often associated with overlying soft tissue infection w/ or w/o abscess if extends beyond cortex
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Term
| vertebral osteomyelitis (origin, most common causative agents) |
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Definition
- hematogenous origin
- causative agents
- normal host and IV drug users have S. aureus
- IV drug users could also have P. aeruginosa
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Term
| clinical presentation of vertebral osteomyleitis |
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Definition
- progressive, insidious pain develops (wks to months)
- can be afebrile
- most have tenderness at site
- very few can have motor sensory deficits
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Term
| Vertebral osteomyleitis (fate of extension of infection outside vertebrae: where could they go) |
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Definition
- extension toward posterior
- epidural
- subdural abscesses
- meningitis
- extension toward anterior/lateral
- retropharyngeal
- mediastinal
- subphrenic
- retroperitoneal abscesses
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Term
| Posibilities of types of contiguous focus osteomyelitis |
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Definition
- w/o vascular insufficiency
- w/ vascular insufficiency
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Term
| contiguous focus osteomyelitis (bact. from outside coming in) w/o vascular insufficiency (cause, causative agent) |
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Definition
- cause- direct inoculation by trauma, iatrogenic or spread from adjacent soft tissue infection
- decubitis ulcers (bed sores)
- causative agents: often multiple organism, S aureus
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Term
| contiguous focus osteomyelitis w/ vascular insufficiency (cause, causative agent) |
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Definition
- cause- minor trauma to feet of diabetics, often chronic and/or recurrent
- causative agent-cultures often show mixed organisms (open wound)
- S aureus
- coagulase negative staph
- Streptococcus
- Enterococcus
- gram negative bact. and anaerobes
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Term
| contiguous focus osteomyelitis w/vascular insufficiency (tx goals, complications) |
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Definition
- tx goals
- remove/treat/suppress infection
- revascularize the limb
- maintain functional integrity of limb
- complications (dx difficult, can be chronic)
- neuropathy and blunted tissue response
- skin and deep soft tissue infection
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Term
| infectious causes of arthritis |
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Definition
- bacterial- gonococcal, non gonococcal
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Term
|
Definition
| inflammatory rxn within a joint space |
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Term
| predisposing factors to bacterial arthritis |
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Definition
- preexisting inflam. arthritis (ex: RA, osteoarthritis)
- preexisting joint disease (charcot's joint)
- intra-articular injections
- underlying DM, steroids, malignancy
- extra-articular infections (ex: STD, skin, UTI)
- IV drug use or IV catheters
- surgery or penetrating trauma
- prosthetic joint
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Term
| pathological microscope features of synovial tissue that makes it susceptible to infectious arthritis |
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Definition
- synovial tissue is highly vascular and lacks basement membrane
- makes it susceptible to hematogenous seeding of bacteria
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Term
| infectious arthritis: dx, causative agents |
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Definition
- causative agents- can be many microorganisms
- dx
- all inflammed joints should be evaluated for infection
- aspiration
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Term
| etiologic agents of bacterial arthritis in infants, adolescents/young adults, adults |
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Definition
- infants: Group B strep, gram negative bacilli, S. aureus
- adolescents/young adults: N. gonorrheae (aka GC) (if they are sexually active, think about this)
- adults: S aureus
- minor causes:gram negative bacilli, S pneumoniae, group B, C, G strep
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Term
| clinical presentation of acute bacterial arthritis |
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Definition
- monoarticular 90% of the time (ex: knee)
- fever most of the time
- palpable joint effusion
- joint motion limited, painful
- increased in pain with joint extension is common
- warth, swelling, tenderness over joint
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Term
| acute bacterial arthritis: synovial fluid examination findings |
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Definition
- often purulent appearance
- leukocyte count high
- WBC grreater than 75% neutrophils
- elevated protein
- low glucose level
- gram stain: 1/3 positive for organisms
- culture
- non GC positive 90% of time
- GC less than 50% of time
- read by taking tube and putting paper with X's in back, and if you cant read the X's, there must be a lot of neutrophils
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Term
| gonococcal arthritis (clinical syndromes, who gets it) |
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Definition
- high risk groups
- young adults and adolescents
- women during menses/pregnancy
- clinical syndromes
- gonococcal septic arthritis
- disseminated gonococcal infection
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Term
| gonococcal septic arthritis (dx) |
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Definition
- monoarticular
- usually positive synovial cultures
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Term
| Agar used to culture N. gonorrhea |
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Definition
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Term
| disseminated gonococcal infection (symptoms, dx) |
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Definition
- dx- blood cultures often positive while synovial cultures negative
- symptoms
- polyarticular
- fever, chills, skin rash with erythematous papules/pustules (few, scattered)
- joint pains may be associated with tenosynovitis (extend wrist and pain on lateral side of wrist indicates positive test)
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Term
| septic bursitis (dx, most common locations, causative agent) |
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Definition
- most common locations to become infected are olecranon and prepatellar bursa
- dx- distinguished from septic arthritis by clinical examination
- aspirate bursa fluid
- gram stain and cultures
- causative agent- most are Staph species
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Term
| septic bursitis (predisposing factors) |
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Definition
- trauma or accidental percutaneous puncture
- overlying cutaneous injury often present on examination
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Term
| clinical presentation of septic bursitis and physical exam |
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Definition
- clinical presentation
- painful swelling, redness noted by patient
- often assoc. with systemic symptoms
- physical examination
- focal warmth, erythema, visible swelling
- overlying cutaneous injury
- joint range of motion may be reduced due to pain or edema
- bursa pain worse with flexion
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Term
|
Definition
- antibiotics tapered to cultures or emperically cover Staph/Strep
- daily aspiration combined with antibiotics for best clinical results often required
- some patients require surgical drainage or bursectomy
- 2-3 wks of therapy may be needed
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