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  OSTEOMYELITIS INFECTIOUS ARTHRITIS D.Goldberg WRAMC
Osteomyelitis Laboratory Tests White blood cell count Erythrocyte sedimentation rate C-reactive protein Bone aspirate Bloo...
Osteomyelitis   Etiologic agents by age Organism  Total  <2  2-5  6-10  >10 S. aureus   198 (50%) 33  56  66  43 Streptoco...
Osteomyelitis Specimen site   No. done   No. Pos Blood   381  138  (36%) Needle aspirate/surg spec   357  134  (38%) Joint...
Osteomyelitis BONE MONOSTEAL POLYSTEAL Femur 92 12 Tibia 89 18 Humerus 50  8 Fibula 16 10 Phalanx 18  5 Calcaneos 18  0 Ra...
Osteomyelitis Neonatal Osteomyelitis Indolent process Nonspecific signs absent Swelling/tenderness Multiple sites in 50% S...
Osteomyelitis Sickle Cell Disease Salmonella 60% GNR’s  6% Staphylococcus  8% Pneumococcus  5%
Radiologic Diagnosis   X-rays: soft tissue swelling periosteal elevation focal osteopenia 2 week lag
Tc scan: accumulation in areas of inc blood flow and bone formation positive in 48 hrs Three-phase scan false-neg due to p...
Radiologic Diagnosis gallium scan: inc uptake in areas of PMN’s, macrophages do not show bone well imaging at 24h and 72h ...
Septic Arthritis Volume +/+++  +/+++  + Color turbid   turbid   sl turbid Viscosity reduced  reduced   normal WBC’s >50-10...
Septic Arthritis Distribution of Infected Joints Knee 30% Hip 30 Ankle 17 Elbow 11 PIP/MCP   7 Shoulder   2 Nelson PED 1972
Septic Arthritis Organism 0-1m 1m-5y >5   (4%)  (70%)  (26%) S. aureus   36%   11% 33% Hib   7%   31%   1% Streptococci   ...
Therapy Initial regimes: Neonates   nafcillin and cefotaxime children < 5   cefuroxime children > 5   nafcillin/cefuroxime...
Therapy: Minimal duration-   (clinical response, dec ESR) Gram negative 4-6 weeks Staph 4-6 weeks H. influenzae 2-4 weeks ...
Contraindications to oral therapy Inability to swallow Etiologic agent not established Inability to perform bacteriocidal ...
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Osteomyelitis

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Osteomyelitis

  1. 1. OSTEOMYELITIS INFECTIOUS ARTHRITIS D.Goldberg WRAMC
  2. 2. Osteomyelitis Laboratory Tests White blood cell count Erythrocyte sedimentation rate C-reactive protein Bone aspirate Blood culture Antigen Assay
  3. 3. Osteomyelitis Etiologic agents by age Organism Total <2 2-5 6-10 >10 S. aureus 198 (50%) 33 56 66 43 Streptococci 37 (9%) 13 13 6 5 HIb 16 (4%) 14 2 0 0 CNS 10 (3%) 7 1 0 2 Ps. aeruginosa 10 (3%) 1 2 5 2 S. pneumoniae 6 (2%) 6 0 0 0 Salmonella 6 (2%) 3 3 0 0 E. coli 2 1 1 0 0
  4. 4. Osteomyelitis Specimen site No. done No. Pos Blood 381 138 (36%) Needle aspirate/surg spec 357 134 (38%) Joint fluid 86 56 (65%) Wound drainage 31 22 (70% ) Nelson IDCNA 1995
  5. 5. Osteomyelitis BONE MONOSTEAL POLYSTEAL Femur 92 12 Tibia 89 18 Humerus 50 8 Fibula 16 10 Phalanx 18 5 Calcaneos 18 0 Radius 13 4 Ischium 15 1 Metatarsal 8 0 Ulna 6 3 Ilium 7 0 Vertebra 7 2
  6. 6. Osteomyelitis Neonatal Osteomyelitis Indolent process Nonspecific signs absent Swelling/tenderness Multiple sites in 50% Secondary joint space involvement S. aureus, group B strep, coliforms
  7. 7. Osteomyelitis Sickle Cell Disease Salmonella 60% GNR’s 6% Staphylococcus 8% Pneumococcus 5%
  8. 8. Radiologic Diagnosis X-rays: soft tissue swelling periosteal elevation focal osteopenia 2 week lag
  9. 9. Tc scan: accumulation in areas of inc blood flow and bone formation positive in 48 hrs Three-phase scan false-neg due to poor blood flow Radiologic Diagnosis
  10. 10. Radiologic Diagnosis gallium scan: inc uptake in areas of PMN’s, macrophages do not show bone well imaging at 24h and 72h high sens/high radiation MRI scan: bone vs soft tissue T2-inc signal in bone not for screening
  11. 11. Septic Arthritis Volume +/+++ +/+++ + Color turbid turbid sl turbid Viscosity reduced reduced normal WBC’s >50-100 5-50 1-5 PMN’s >80% >60-80% <50% Glucose <0.25 >0.50 >0.80 Bacteria 50-75% 0 0 S.A. Inf Arth Non-IA
  12. 12. Septic Arthritis Distribution of Infected Joints Knee 30% Hip 30 Ankle 17 Elbow 11 PIP/MCP 7 Shoulder 2 Nelson PED 1972
  13. 13. Septic Arthritis Organism 0-1m 1m-5y >5 (4%) (70%) (26%) S. aureus 36% 11% 33% Hib 7% 31% 1% Streptococci 21% 11% 18% GNR 14% 2% 3% N. gonnorrhea 7% 2% 7% Unknown 35% 34%
  14. 14. Therapy Initial regimes: Neonates nafcillin and cefotaxime children < 5 cefuroxime children > 5 nafcillin/cefuroxime Sickle cell nafcillin and ceftriaxone
  15. 15. Therapy: Minimal duration- (clinical response, dec ESR) Gram negative 4-6 weeks Staph 4-6 weeks H. influenzae 2-4 weeks N. meningitis 2-4 weeks streptococci 2-4 weeks Dagan JPID 1992
  16. 16. Contraindications to oral therapy Inability to swallow Etiologic agent not established Inability to perform bacteriocidal levels No effective oral therapy Failure of parental abiotics

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