Infections of bone and joints

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Infections of bone and joints

  1. 1. INFECTIONS OF BONE AND JOINTS DR.Chandrashekar rao Asst. professor
  2. 2. ACUTE SEPTIC ARTHRITIS • Definition – Infectious disease of a joint by bacteria of one of the pyogenic groups • Typically its acute infection of rapid development but may be sub acute or chronic.
  3. 3. pathogenesis • 3 Routes of entry by organism – Haematogenous – wound or surgery – adjacent site of osteomyelitis or cellulitis
  4. 4. pathogenesis • Synovium is infected, becomes hyperemic and infiltrated with neutrophils. • Stimulation of T lymphocytes • Enzymes of inflammatory cells, bacteria and synovium • Purulent or serous exudate in joint space. • Erosion and wear of articular cartilage
  5. 5. • Organisms – Staph aureus (M.C) • H.influenzae • Streptococcus • E.coli • At risk groups, conditions – Rheumatoid Arthritis (m.c) – Diabetes – IV Drug Us – Hemodialysis – Immunosuppressed Host,
  6. 6. Clinical features • Infants – Signs of septicaemia – Local signs of warmth , tenderness – Examine umblical card • In children – Acute pain in joint – Pseudoparesis – Severely ill and fever – Local signs of inflammation – Restriction of joint movements
  7. 7. • In adults – Knee, wrist and finger or toe joints are involved – Marked local tenderness – Restricted joint movements – Careful history is important
  8. 8. DIAGNOSIS • Lab investigations – ESR:Elavated in 48 to 72 hrs returns to baseline in 2 to 4 weeks – CRP:Raises within 6 hrs and peaks 30 to 50 hrs.Good marker for early diag – Bacteriological examination of joint aspirate:synovial leukocyte >50,000/mm
  9. 9. • X-ray – First few days: may show soft tissue swelling, joint space widening due to edema – Later on: joint space narrowing due to destruction of cartilage, rarefaction of adjacent bone and possible destruction • USG – can detect even small collection of fluid in joint • MRI – differentiates b/w bone and soft tissue infection, and shoes joint effusion.
  10. 10. DIFFERNTIAL DIAGNOSIS • Acute ostoemylitis:assume that both are present in children • Traumatic synovitis and haemarthrosis:hx of injury • Irritable joint:No signs of infection
  11. 11. DIFFERNTIAL DIAGNOSIS • Haemophilic Bleed:aspiration will resolve the doubt • Rheumatic Fever:No signs of septicemia • Gout and pseudogout:Joint fluid is turbid.Microscopic exam by polarized light will show crystals
  12. 12. TREATMENT • Antibiotics and Supportive Therapy. • Aspiration and Drainage • Correction of deformities • Antibiotics – as per antibiotic sensitivity – Usually administered for 6 weeks – Gram neg and staphylococci respond slowly – Streptococci and Neisseria respond rapidly
  13. 13. SURGERY • Indications – Hip or Joints difficult to aspirate or monitor – Extensive spread of infection to soft tissues – Inadequate clinical response after 5 to 7 days • Aspiration and drainage – Early diagnosis,repeated aspirations and proper antibiotics –good results • Arthroscopic drainage is good alternative
  14. 14. • Deformities – Are corrected with Osteotomies and arthroplasties • Prognosis ,poor – RA, prematurity – prosthetic infections – +ve cultures after aspiration after 7 days of anti.bxs
  15. 15. BRUCELLA OSTEOMYELITIS • Common in mediterranean countries,africa and parts of india • Organisms – Brucella melitensis – Brucella abortus – Brusella suis • Source – Infected milk ingetion (mc) – Contact with inf. Meat – Through injured skin and mucosa • Chance – 50% with chronic brucellosis
  16. 16. • Diff.diagnosis – TB – Reiters disease • Bones affected – Spine(lumbar) – Hip and – Knee
  17. 17. • Pathology – Cronic inflammatory granuloma with round cell infiltration and giant cells – May be central necrosis and caseation- abscess formation
  18. 18. • Clinical features – Fever,headache,weakness – On and off fever(undulant) – Initial illness is acute, – begins insidiously – Then symptoms localize to one joint or spine – Joint become tender and swollen – Movements restricted – Back movements restricted
  19. 19. • Investigations – A positive agglutination test is diagnostic – Synovial biopsy and culture • X-ray – Loss of joint space – Slowly progressive bony erosions – Peri –articular osteoporosis
  20. 20. • Treatment – tetracycline+streptomycin for 4 weeks or – Rifampicin +cephalosporin for 3 weeks – Early diagnosis give good prognosis
  21. 21. TYPHOID OSTEOMYELITIS • Occurs during convalescent phase • Sub acute osteomyelitis • Occurs in sickle cell anaemia • Common sites – Ulna, tibia and spine • Multiple bones may be affected • Some times b/l symmetrical • X-ray – Diaphyseal sclerosis
  22. 22. MYCOTIC INFECTION • Divided in to sup. And deep • Superficial – Infection of skin and mucous membrane – Spread in to bones – Maduromycoses,candida • Deep – Source is bird droppings and food grains – Entry through lungs – Blastomycoses,histoplasma,cryptococcus and aspergillus
  23. 23. maduromycoses • Seen in north america and india • Through skin cuts • In form workers • Spread to subcutaneous tissues and bones • Abscess breaks through multiple sinuses
  24. 24. • Clinical features – Tender sub cut. Nodule in early stages – After some years seen with – Swollen and indurated foot – With discharging sinuses and ulcers • X-ray – Multiple bone cavities • Organism identfied on tissue biopsy
  25. 25. • Treatment – No effective chemotherapy – I.V amphoterecine B is used ,but more toxic – Wide excision – amputation
  26. 26. HYDATID BONE INFECTION • Caused by ECHINOCOCUS • Definitive host dog or other carnivore • Cattle or Man is int. host • Infected meat eaten by man contains cysts • Scolices occasionally settle in bone • Affected bones are – Vertebrae – Pelvis – Femur and scapula
  27. 27. • Clinical features – Pain and swelling – Pathological fracture – Spinal cord compression – Symptoms may not be appear for many years • X-ray – Solitary or multi loculated cysts – Moderate cortical expansion – Paravertebral soft
  28. 28. • Casonis test positive • Benign and malignant bone cysts excluded • Albendazole – 10mg per kg wt – For 3 weeks – In 4 cycles with 1week gap • Recurrence is common • Curettage and bone grafting • Cavity is cleaned with saline and formalin
  29. 29. SYPHILIS OF BONES and JOINTS • Caused by treponema pallidum • Sexually transmitted • Can cross placental barrier (congenital) • Primary lesion chancre appears after 1 month • Bone changes occur in the secondary stage – Periostitis – Osteitis and – Osteochondritis • In tertiary stage – Gummata in bones – Charcot joints develope
  30. 30. • Congenital, early stage – Joint swelling after 7- 10 weeks after birth – Pseudo paralysis – Symmetrical lesions in tubular bones • X-ray – Osteochondritis • Lucent band in metaphyseal region – Periostitis • Diffuse periosteal new bone formation
  31. 31. • Congenital; late – Resemble those of adults – Gummata may develop in adolescents – SABRAE TIBIA dense edosteal and periostael new bone – Hutchinson's teeth – Cluttons joints (painless effusions) – Dactilitis • Others – Tabes dorsalis – General parasis of insane
  32. 32. • Treatment – Early, benzyl penicillin IM – For 3 weeks – Tertiary lesions will not respond at all – 3rd gen. cephalosporin may work

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