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24 Cards in this Set

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  • Back
Osteomyelitis vs Septic arthritis?
osteomyelitis: an abscess in bone; requires bone resection and antimicrobial therapy to stop infection

septic arthritis: a closed space infection in synovial lined joint as opposed to inflamm in joint space

**both can present w/ similar clinical features
Bone architecture?
bones are composed of cortex* of compacted or lamellar* bone and a medulla* of spongy or cancellous* bone
4 groups of bones?
1. tubular
2. cuboidal
3. flat
4. irregular
Heamtogenous spread of osteomyelitis promoted by skeletal tissue w/:
1. rich arterial supply
2. sluggish sinusoidal flow
3. marrow cavity
Pathophysiology of hematogenous osteomyelitis?
bacteremia --> deposition w/in sinusoidal veins initiates inflamm response which cuts off blood suplly --> necrosis, abscess formation and sequestration of infarcted bone
Risk factors for hematogenous osteomyelitis (4):
1. hemoglobinopathies lead to reduction of RES to phagocytize circulating bacteria

2. chronic granulomatous disease of childhood

3. pre-existing infection of GU orrespiratory tract or skin

4. IV access
Another way hematogenous infection may spread:
infected material goes thru cortical canals into subperiosteal space --> joint space or to cutaneous surface as sinus tract
Risk factors for hematogenous osteomyelitis (4):
1. hemogloboninopathies - leads to reduction of RES to phagocytize circulating bacteria
2. chronic granulomatous disease of childhood
3. pre-existing infection of GU or resp tract or skin
4. intravenous access
What is Contigous Focus Osteomyelitis?
=skeletal tissue adjacent to infected soft tissue becomes infected (iatrogenic/otherwise)
Pathophysiology of contiguous focus osteomyelitis (4):
1. adjacent soft tissue
2. devitalized bone
3. presence of foreign bodies
4. bone instability
What is Vascular Insufficiency-Associated Osteomyelitis?
=contiguous infection in the small bones of the feet seen in patients w/ severe peripheral vascular disease
Pathogenesis of vascular insufficiency-assoc osteomyelitis (4):
1. DM or generalized severe atherosclerotic disease
2. neuropathy
3. vasculopathy
4. tissue necrosis w/ subsequent infection
What is the single most common pathogen in osteomyelitis?**
Staphylococcus aureus**
Virulence factors associated with osteomyelitis:
Staph aureus:
-intracellular pathogen survival
-adherence factors
-inflamm response mediators
Table 1: Microorganisms Isolated from Patients w/ Bacterial Osteomyelitis
see Table 9 (???)
Types of infectious arthritis?**
1. Pyogenic (septic arthritis)
2. Reactive "Post-Infectious/Inflamm" Arthritis
Risk factors for infectious arthritis?
-host phagocytic defects
-impaired host defense mechanisms
-direct penetration
-joint damage
Characteristics of pyogenic (septic) arthritis?
-usually hematogenous in origin
-acute synovial inflamm leads to cartilage destruction if untreated
What microbial pathogens are most commonly found in native joints of:

1. elderly?
2. pre-adolescents?
3. adolescents?
elderly and pre-adolescents: Staph aureus, Strep, GNR

adolescents/young adults: Gonococcus (sexually active)
What microbial pathogens are most commonly found in PROSTHETIC joints of:

early onset?

late onset?
early onset: S. aureus, CNS, GNR

late onset: Strep, CNS, GNR
What is "post-infectious/inflammatory" arthritis?
=deposition of bacterial antigens, Ig, complement components, circulating immune complexes, and exotoxins --> inflamm response in synovial space
Reactive "Post-infectious/Inflamm" Arthritis:

systemic diseases associated?
aka: crystal deposition disease

findings: hemarthrosis

causes: foreign body rxns/trauma

systemic diseases: LRA, SLE, IBD, psoriasis, Bechet's, Reiter's syndrome
Therapeutic approach to bone and joint infections:
1. surgical intervention
2. antimicrobial therapy
Long-term management of bone infection:
1. follow-up
2. chronic suppressive therapy
3. management of relapse episodes