Podcast
Questions and Answers
What is a common source of haematogenous osteomyelitis in elderly individuals?
What is a common source of haematogenous osteomyelitis in elderly individuals?
- Dental extraction
- Chewing candy
- Urinary tract infections (correct)
- Tooth brushing
What is the primary characteristic differentiating acute osteomyelitis from chronic osteomyelitis?
What is the primary characteristic differentiating acute osteomyelitis from chronic osteomyelitis?
- The type of bacteria involved
- The duration of antibiotic treatment required
- The patient's age
- The presence of a biofilm (correct)
According to the Cierny-Mader staging system, which stage of osteomyelitis involves infection throughout the entire bone?
According to the Cierny-Mader staging system, which stage of osteomyelitis involves infection throughout the entire bone?
- Stage 1: Medullary
- Stage 4: Diffuse (correct)
- Stage 3: Localized
- Stage 2: Superficial
In the context of osteomyelitis, what is the primary limitation of sequestra?
In the context of osteomyelitis, what is the primary limitation of sequestra?
In children, which bones are most commonly affected by haematogenous osteomyelitis?
In children, which bones are most commonly affected by haematogenous osteomyelitis?
What is the most common causative organism in both osteomyelitis and septic arthritis?
What is the most common causative organism in both osteomyelitis and septic arthritis?
What is the primary goal of surgical debridement in the treatment of chronic osteomyelitis?
What is the primary goal of surgical debridement in the treatment of chronic osteomyelitis?
What is the most common presentation of septic arthritis?
What is the most common presentation of septic arthritis?
What is the typical duration of antibiotic therapy for adults with osteomyelitis?
What is the typical duration of antibiotic therapy for adults with osteomyelitis?
Which radiological finding is indicative of osteomyelitis on a plain X-ray?
Which radiological finding is indicative of osteomyelitis on a plain X-ray?
Which factor is considered a systemic factor (Bs) affecting immune surveillance in the Cierny-Mader classification?
Which factor is considered a systemic factor (Bs) affecting immune surveillance in the Cierny-Mader classification?
Which of the following is the most appropriate initial antibiotic choice for empiric therapy in osteomyelitis?
Which of the following is the most appropriate initial antibiotic choice for empiric therapy in osteomyelitis?
What is the primary reason for performing a bone biopsy in the diagnosis of osteomyelitis?
What is the primary reason for performing a bone biopsy in the diagnosis of osteomyelitis?
What is the rationale behind using antibiotic-loaded cement in the treatment of osteomyelitis?
What is the rationale behind using antibiotic-loaded cement in the treatment of osteomyelitis?
Which of these factors increases the risk of septic arthritis following a joint procedure?
Which of these factors increases the risk of septic arthritis following a joint procedure?
What is the most important consideration when treating septic arthritis to prevent permanent damage?
What is the most important consideration when treating septic arthritis to prevent permanent damage?
What is the recommended treatment approach for prosthetic joint infections (PJI) involving a biofilm?
What is the recommended treatment approach for prosthetic joint infections (PJI) involving a biofilm?
Which of the following best describes the role of leukocyte enzymes in the pathogenesis of osteomyelitis?
Which of the following best describes the role of leukocyte enzymes in the pathogenesis of osteomyelitis?
In the setting of suspected septic arthritis, what is the significance of joint aspiration and culture?
In the setting of suspected septic arthritis, what is the significance of joint aspiration and culture?
What is the primary advantage of targeted antibiotic therapy over empiric therapy in managing osteomyelitis?
What is the primary advantage of targeted antibiotic therapy over empiric therapy in managing osteomyelitis?
Why is empiric antibiotic therapy crucial in the initial management of suspected osteomyelitis?
Why is empiric antibiotic therapy crucial in the initial management of suspected osteomyelitis?
A non-weight bearing child presents with fever, pain, erythema, and swelling. What condition should you be most concerned about?
A non-weight bearing child presents with fever, pain, erythema, and swelling. What condition should you be most concerned about?
What is the most likely etiology of septic arthritis in intravenous drug users?
What is the most likely etiology of septic arthritis in intravenous drug users?
What is the primary reason for the increased prevalence of prosthetic joint infections (PJI)?
What is the primary reason for the increased prevalence of prosthetic joint infections (PJI)?
According to the information presented, what percentage increase is projected in knee arthroplasties complicated by infections by the year 2030?
According to the information presented, what percentage increase is projected in knee arthroplasties complicated by infections by the year 2030?
A patient presents with a draining sinus tract near a surgical site. What does this finding suggest?
A patient presents with a draining sinus tract near a surgical site. What does this finding suggest?
A patient with suspected Kingella Kingae infection should be treated with what?
A patient with suspected Kingella Kingae infection should be treated with what?
The Orr treatment of Pyogenic Osteomyelitis, as described by Jacob Kulowski in 1936, included which of the following?
The Orr treatment of Pyogenic Osteomyelitis, as described by Jacob Kulowski in 1936, included which of the following?
What is the primary reason why the JAVA man fossil of 1.61 million years old is important to the study of osteomyelitis?
What is the primary reason why the JAVA man fossil of 1.61 million years old is important to the study of osteomyelitis?
What is the most common cause of septic arthritis in adults?
What is the most common cause of septic arthritis in adults?
Which of the following diagnostic methods is MOST sensitive for detecting early osteomyelitis?
Which of the following diagnostic methods is MOST sensitive for detecting early osteomyelitis?
A 25-year-old male presents with migratory polyarthralgia, tenosynovitis, and a pustular skin rash. Which of the following organisms is the MOST likely cause of his symptoms?
A 25-year-old male presents with migratory polyarthralgia, tenosynovitis, and a pustular skin rash. Which of the following organisms is the MOST likely cause of his symptoms?
A patient is diagnosed with chronic osteomyelitis of the tibia and undergoes surgical debridement. Postoperatively, which adjunctive treatment is MOST important to ensure antibiotic penetration into the affected bone?
A patient is diagnosed with chronic osteomyelitis of the tibia and undergoes surgical debridement. Postoperatively, which adjunctive treatment is MOST important to ensure antibiotic penetration into the affected bone?
A 60-year-old male with a history of diabetes mellitus and peripheral vascular disease develops osteomyelitis of the foot following a puncture wound. Which of the following pathophysiological mechanisms MOST directly contributes to the development of osteomyelitis in this patient?
A 60-year-old male with a history of diabetes mellitus and peripheral vascular disease develops osteomyelitis of the foot following a puncture wound. Which of the following pathophysiological mechanisms MOST directly contributes to the development of osteomyelitis in this patient?
A patient presents with a Brodie abscess. Which is typically true regarding the presentation of a Brodie abscess?
A patient presents with a Brodie abscess. Which is typically true regarding the presentation of a Brodie abscess?
What is the standard initial route of administration for antibiotics in the treatment of osteomyelitis?
What is the standard initial route of administration for antibiotics in the treatment of osteomyelitis?
In the context of septic arthritis, what does the term 'haematogenous' refer to?
In the context of septic arthritis, what does the term 'haematogenous' refer to?
What is a key early symptom of osteomyelitis that should raise clinical suspicion, especially in children?
What is a key early symptom of osteomyelitis that should raise clinical suspicion, especially in children?
What role does biofilm formation play in chronic osteomyelitis?
What role does biofilm formation play in chronic osteomyelitis?
What is the most common causative organism of septic arthritis in individuals with prosthetic joints (PJI’s)?
What is the most common causative organism of septic arthritis in individuals with prosthetic joints (PJI’s)?
Which of the following historical figures or specimens provided evidence of early osteomyelitis?
Which of the following historical figures or specimens provided evidence of early osteomyelitis?
According to the principles of therapy for osteomyelitis, what is the typical INITIAL route of antibiotic administration?
According to the principles of therapy for osteomyelitis, what is the typical INITIAL route of antibiotic administration?
In the context of osteomyelitis, what is the primary significance of the involucrum?
In the context of osteomyelitis, what is the primary significance of the involucrum?
What is the primary rationale for surgical debridement in the management of chronic osteomyelitis?
What is the primary rationale for surgical debridement in the management of chronic osteomyelitis?
What is a key diagnostic finding that would suggest septic arthritis upon joint aspiration?
What is a key diagnostic finding that would suggest septic arthritis upon joint aspiration?
In a child presenting with a suspected bone or joint infection, what physical exam finding should raise the HIGHEST level of concern?
In a child presenting with a suspected bone or joint infection, what physical exam finding should raise the HIGHEST level of concern?
In cases of suspected septic arthritis, why is it critical to perform joint drainage?
In cases of suspected septic arthritis, why is it critical to perform joint drainage?
A patient is diagnosed with septic arthritis. Empiric antibiotic therapy should target which of the following organisms?
A patient is diagnosed with septic arthritis. Empiric antibiotic therapy should target which of the following organisms?
What is the primary role of leukocytes in the pathogenesis of osteomyelitis?
What is the primary role of leukocytes in the pathogenesis of osteomyelitis?
An elderly patient develops osteomyelitis following a urinary tract infection. What is the MOST likely route of infection in this scenario?
An elderly patient develops osteomyelitis following a urinary tract infection. What is the MOST likely route of infection in this scenario?
Which of the following is MOST indicative of a chronic osteomyelitis infection?
Which of the following is MOST indicative of a chronic osteomyelitis infection?
Which factor is MOST likely to be associated with haematogenous spread of infection in adults?
Which factor is MOST likely to be associated with haematogenous spread of infection in adults?
Why is targeted antibiotic therapy preferred over empiric therapy in osteomyelitis management?
Why is targeted antibiotic therapy preferred over empiric therapy in osteomyelitis management?
A patient with a prosthetic joint infection is undergoing a revision surgery. What is an important consideration during this procedure?
A patient with a prosthetic joint infection is undergoing a revision surgery. What is an important consideration during this procedure?
According to the information presented, what percentage of septic arthritis cases are caused by haematogenous spread?
According to the information presented, what percentage of septic arthritis cases are caused by haematogenous spread?
Which of the following statements best describes the 'Orr treatment' for pyogenic osteomyelitis?
Which of the following statements best describes the 'Orr treatment' for pyogenic osteomyelitis?
A patient presents with pain, fever, erythema and swelling. What additional symptom would MOST lead you to suspect septic arthritis?
A patient presents with pain, fever, erythema and swelling. What additional symptom would MOST lead you to suspect septic arthritis?
What is the most common location of septic arthritis?
What is the most common location of septic arthritis?
For septic arthritis caused by N. gonorrhoeae, what is true regarding symptoms, presentation, and therapy?
For septic arthritis caused by N. gonorrhoeae, what is true regarding symptoms, presentation, and therapy?
Which of the following is the MOST accurate description of a Brodie abscess?
Which of the following is the MOST accurate description of a Brodie abscess?
A patient with a history of intravenous drug use presents with lower back pain and fever. What type of infection should be suspected?
A patient with a history of intravenous drug use presents with lower back pain and fever. What type of infection should be suspected?
Following a dental extraction, a patient develops osteomyelitis. What is the likely route of infection?
Following a dental extraction, a patient develops osteomyelitis. What is the likely route of infection?
If empiric therapy is needed for osteomyelitis, which microbe do antibiotics need to cover?
If empiric therapy is needed for osteomyelitis, which microbe do antibiotics need to cover?
Which of the following imaging techniques is LEAST likely to show changes in early osteomyelitis (e.g., within the first 2 weeks of infection)?
Which of the following imaging techniques is LEAST likely to show changes in early osteomyelitis (e.g., within the first 2 weeks of infection)?
What is the primary concern regarding a biofilm in prosthetic joint infections?
What is the primary concern regarding a biofilm in prosthetic joint infections?
A 70-year-old patient develops osteomyelitis following a recent cystoscopy. Which organism is MOST likely responsible?
A 70-year-old patient develops osteomyelitis following a recent cystoscopy. Which organism is MOST likely responsible?
What is the estimated increase by 2030 if hip arthroplasty infection continues at the current rate?
What is the estimated increase by 2030 if hip arthroplasty infection continues at the current rate?
Why is it important to remove prosthetic or foreign material when treating osteomyelitis?
Why is it important to remove prosthetic or foreign material when treating osteomyelitis?
A 9 year old is diagnosed with osteomyelitis. What duration of therapy is typically recommended?
A 9 year old is diagnosed with osteomyelitis. What duration of therapy is typically recommended?
The Cierny-Mader classification system includes systemic factors that affect immune surveillance. Which of the following is an example of such a systemic factor?
The Cierny-Mader classification system includes systemic factors that affect immune surveillance. Which of the following is an example of such a systemic factor?
What is the MOST likely location for osteomyelitis to occur in children?
What is the MOST likely location for osteomyelitis to occur in children?
What is the treatment regimen for prosthetic joint infection?
What is the treatment regimen for prosthetic joint infection?
According to the Cierny-Mader staging system for osteomyelitis, a patient with Stage III has:
According to the Cierny-Mader staging system for osteomyelitis, a patient with Stage III has:
Compared to acute osteomyelitis, chronic osteomyelitis is characterized by which of the following findings?
Compared to acute osteomyelitis, chronic osteomyelitis is characterized by which of the following findings?
What describes how osteomyelitis is obtained through hematogenous spread?
What describes how osteomyelitis is obtained through hematogenous spread?
You're reviewing post-operative procedures and their rates of positive blood cultures. Based on the information, which common activity has a notable range of positive blood cultures?
You're reviewing post-operative procedures and their rates of positive blood cultures. Based on the information, which common activity has a notable range of positive blood cultures?
Based on the projections provided, which of the following statements accurately describes the future burden of total joint arthroplasties?
Based on the projections provided, which of the following statements accurately describes the future burden of total joint arthroplasties?
Which of the following is the MOST common arthropod vector involved in the transmission of arboviruses?
Which of the following is the MOST common arthropod vector involved in the transmission of arboviruses?
Arthralgia is a term that refers to:
Arthralgia is a term that refers to:
Which of the following viruses is known to cause 'fifth disease'?
Which of the following viruses is known to cause 'fifth disease'?
Which of the following is the MOST typical characteristic of viral arthropathies?
Which of the following is the MOST typical characteristic of viral arthropathies?
Which of the following is the MOST appropriate treatment approach for viral arthropathies?
Which of the following is the MOST appropriate treatment approach for viral arthropathies?
Which of these viruses is classified as a flavivirus?
Which of these viruses is classified as a flavivirus?
What percentage of adult women with rubella report arthralgia?
What percentage of adult women with rubella report arthralgia?
Which of the following viruses is transmitted by Aedes aegypti?
Which of the following viruses is transmitted by Aedes aegypti?
Following an epidemic in South and Central America, which virus has raised concerns due to person-to-person transmission in addition to mosquito vectors?
Following an epidemic in South and Central America, which virus has raised concerns due to person-to-person transmission in addition to mosquito vectors?
A patient presents with fever, rash, and severe joint pain that has persisted for several months after returning from a tropical region. Which of the following viral infections is MOST likely?
A patient presents with fever, rash, and severe joint pain that has persisted for several months after returning from a tropical region. Which of the following viral infections is MOST likely?
A child presents with a 'slapped cheek' rash. Which of the following corresponds with this presentation?
A child presents with a 'slapped cheek' rash. Which of the following corresponds with this presentation?
How is Rubella typically transmitted?
How is Rubella typically transmitted?
Which of the following viruses is MOST commonly linked to epidemics of viral polyarthritis in Australia?
Which of the following viruses is MOST commonly linked to epidemics of viral polyarthritis in Australia?
Which diagnostic method has very high sensitivity and specificity to diagnose Dengue?
Which diagnostic method has very high sensitivity and specificity to diagnose Dengue?
In which of the following populations does parvovirus commonly cause arthralgia?
In which of the following populations does parvovirus commonly cause arthralgia?
After a recent trip to Southeast Asia, a patient presents with fever, headache, rash, and joint pain. Laboratory tests reveal abnormal liver function. Which viral infection is MOST likely?
After a recent trip to Southeast Asia, a patient presents with fever, headache, rash, and joint pain. Laboratory tests reveal abnormal liver function. Which viral infection is MOST likely?
A pregnant woman in her first trimester is diagnosed with rubella. Which of the following is the greatest risk to the fetus?
A pregnant woman in her first trimester is diagnosed with rubella. Which of the following is the greatest risk to the fetus?
Which of the viruses are known to cause fetal loss when the mother is infected during pregnancy?
Which of the viruses are known to cause fetal loss when the mother is infected during pregnancy?
Which of these viruses is LEAST likely to cause an viral arthropathy?
Which of these viruses is LEAST likely to cause an viral arthropathy?
For Dengue fever, which of the following clinical manifestations are common?
For Dengue fever, which of the following clinical manifestations are common?
In Australia, which mosquito types are known vectors for Ross River Virus?
In Australia, which mosquito types are known vectors for Ross River Virus?
The pathogenesis of viral arthropathy is thought to be partially immune-mediated. Which of the following supports this?
The pathogenesis of viral arthropathy is thought to be partially immune-mediated. Which of the following supports this?
Upon reviewing a patient's laboratory results you note the patient has an Aplastic crisis. Which of the following viruses may be the cause?
Upon reviewing a patient's laboratory results you note the patient has an Aplastic crisis. Which of the following viruses may be the cause?
A 29 year old non-pregnant female complains of joint pain 2-3 days after a fever. The patient also has a rash. Which of the following would MOST suggest Chikungunya?
A 29 year old non-pregnant female complains of joint pain 2-3 days after a fever. The patient also has a rash. Which of the following would MOST suggest Chikungunya?
What is true regarding patients who have Dengue and are infected with a different serotype?
What is true regarding patients who have Dengue and are infected with a different serotype?
You are examining a patient that recently traveled. The patient indicates they have joint pain, fever, and a rash. What should your next question be?
You are examining a patient that recently traveled. The patient indicates they have joint pain, fever, and a rash. What should your next question be?
A researcher is studying the immune response to arboviruses in joint tissues. Which of the following findings would MOST strongly support the hypothesis that immune complex deposition contributes to joint symptoms and rash in viral arthropathy?
A researcher is studying the immune response to arboviruses in joint tissues. Which of the following findings would MOST strongly support the hypothesis that immune complex deposition contributes to joint symptoms and rash in viral arthropathy?
Which of the following viral infections, if contracted during pregnancy, is LEAST likely to be effectively prevented through post-exposure prophylaxis?
Which of the following viral infections, if contracted during pregnancy, is LEAST likely to be effectively prevented through post-exposure prophylaxis?
A 30-year-old male is diagnosed with Zika virus. How long can Zika stay in semen?
A 30-year-old male is diagnosed with Zika virus. How long can Zika stay in semen?
A researcher aims to develop a novel diagnostic assay to differentiate between arthralgia caused by Ross River virus and Barmah Forest virus. What approach would MOST effectively target the unique characteristics of each virus?
A researcher aims to develop a novel diagnostic assay to differentiate between arthralgia caused by Ross River virus and Barmah Forest virus. What approach would MOST effectively target the unique characteristics of each virus?
A previously healthy 27-year-old woman, 8 weeks pregnant, presents with a fever, maculopapular rash, arthralgia, and conjunctivitis. She recently returned from a Caribbean island. Serological tests are positive for Zika virus. Which of the following fetal complications is MOST strongly associated with Zika virus infection during the first trimester?
A previously healthy 27-year-old woman, 8 weeks pregnant, presents with a fever, maculopapular rash, arthralgia, and conjunctivitis. She recently returned from a Caribbean island. Serological tests are positive for Zika virus. Which of the following fetal complications is MOST strongly associated with Zika virus infection during the first trimester?
What is the incubation period in days for Rubella?
What is the incubation period in days for Rubella?
What is the incubation period in days for Chikungunya?
What is the incubation period in days for Chikungunya?
After returning from a trip a patient complains of fever, and mild joint pain. Testing indicated the patient is infected with Zika. The patient asks if they have a high chance of serious complications. What can you tell them?
After returning from a trip a patient complains of fever, and mild joint pain. Testing indicated the patient is infected with Zika. The patient asks if they have a high chance of serious complications. What can you tell them?
You are speaking with a woman that is planning on becoming pregnant. After hearing that she travels a lot, what advice can you give regarding arthrogenic viruses seen mainly in travelers?
You are speaking with a woman that is planning on becoming pregnant. After hearing that she travels a lot, what advice can you give regarding arthrogenic viruses seen mainly in travelers?
What is true regarding the vector for Zika-virus?
What is true regarding the vector for Zika-virus?
Which Alphavirus is considered Arthritogenic?
Which Alphavirus is considered Arthritogenic?
You are treating a patient with Dengue. Which of the following is a CRITICAL treatment consideration?
You are treating a patient with Dengue. Which of the following is a CRITICAL treatment consideration?
What is the BEST definition of arthralgia?
What is the BEST definition of arthralgia?
Which of the following viruses is MOST likely to cause widespread epidemics of viral polyarthritis in Australia?
Which of the following viruses is MOST likely to cause widespread epidemics of viral polyarthritis in Australia?
For viral arthropathies, what is a typical characteristic?
For viral arthropathies, what is a typical characteristic?
Which of the following is TRUE regarding the vectors of Dengue?
Which of the following is TRUE regarding the vectors of Dengue?
What laboratory findings would MOST suggest Dengue?
What laboratory findings would MOST suggest Dengue?
A patient has a fever, a rash, joint pain, and is diagnosed with Dengue. After a few days they start to develop plasma leakage and haemorrhage. What is the MOST appropriate next step?
A patient has a fever, a rash, joint pain, and is diagnosed with Dengue. After a few days they start to develop plasma leakage and haemorrhage. What is the MOST appropriate next step?
Which of the following statements regarding Zika virus is MOST accurate?
Which of the following statements regarding Zika virus is MOST accurate?
What timeframe is viral RNA detectable in semen following a Zika virus infection?
What timeframe is viral RNA detectable in semen following a Zika virus infection?
Which of the following neurological complications is MOST strongly associated with Zika virus infection during pregnancy?
Which of the following neurological complications is MOST strongly associated with Zika virus infection during pregnancy?
What advice should you give a woman who is planning on becoming pregnant, and travels a lot, regarding arthrogenic viruses?
What advice should you give a woman who is planning on becoming pregnant, and travels a lot, regarding arthrogenic viruses?
You are examining a patient that recently traveled. The patient indicates they have joint pain, fever, and a rash. What is the MOST important next question?
You are examining a patient that recently traveled. The patient indicates they have joint pain, fever, and a rash. What is the MOST important next question?
What are the primary mosquito vectors for Chikungunya virus?
What are the primary mosquito vectors for Chikungunya virus?
Which of the following clinical manifestations is MOST characteristic of Chikungunya virus infection?
Which of the following clinical manifestations is MOST characteristic of Chikungunya virus infection?
What is the typical duration of arthralgia associated with Chikungunya virus?
What is the typical duration of arthralgia associated with Chikungunya virus?
What is TRUE regarding transmission of Rubella?
What is TRUE regarding transmission of Rubella?
Which of the following is a classic sign of Rubella infection in children?
Which of the following is a classic sign of Rubella infection in children?
A pregnant woman is diagnosed with rubella in her first trimester. Why is this a concern?
A pregnant woman is diagnosed with rubella in her first trimester. Why is this a concern?
Which of the following is TRUE of Rubella in adults?
Which of the following is TRUE of Rubella in adults?
How many days is the typical incubation period for rubella?
How many days is the typical incubation period for rubella?
What percentage of individuals infected with parvovirus are asymptomatic?
What percentage of individuals infected with parvovirus are asymptomatic?
What is a common sign of Parvovirus in youths?
What is a common sign of Parvovirus in youths?
Which population is arthralgia MOST likely to appear after contracting Parvovirus?
Which population is arthralgia MOST likely to appear after contracting Parvovirus?
What is true regarding treatment for Parvovirus?
What is true regarding treatment for Parvovirus?
A woman who is 10 weeks pregnant is diagnosed with parvovirus. How can this be managed?
A woman who is 10 weeks pregnant is diagnosed with parvovirus. How can this be managed?
What is believed to be TRUE regarding the cause of viral arthropathy?
What is believed to be TRUE regarding the cause of viral arthropathy?
Which diagnostic finding would BEST suggest viral arthropathy over bacterial arthritis?
Which diagnostic finding would BEST suggest viral arthropathy over bacterial arthritis?
Which of the following is MOST accurate regarding the range of potential vectors for viruses, often with a limited geographical distribution?
Which of the following is MOST accurate regarding the range of potential vectors for viruses, often with a limited geographical distribution?
What is the typical treatment for both Ross River Virus and Barmah Forest Virus?
What is the typical treatment for both Ross River Virus and Barmah Forest Virus?
Following a mosquito bite in Australia a patient is MOST likely to develop arthralgia from which virus?
Following a mosquito bite in Australia a patient is MOST likely to develop arthralgia from which virus?
What percentage of patients with Ross River Virus experience arthralgia?
What percentage of patients with Ross River Virus experience arthralgia?
Which of the following is true in relation to transmission of arboviruses?
Which of the following is true in relation to transmission of arboviruses?
Which of the following is true for the incubation period for Chikungunya?
Which of the following is true for the incubation period for Chikungunya?
What is typically true regarding vector transmission of Zika virus?
What is typically true regarding vector transmission of Zika virus?
What is the incubation period for Dengue?
What is the incubation period for Dengue?
What is the most common flavivirus infection worldwide?
What is the most common flavivirus infection worldwide?
A researcher aims to study joint tissues, for immune responses, when infected with arboviruses. Which suggests that immune complex deposition contributes to joint symptoms?
A researcher aims to study joint tissues, for immune responses, when infected with arboviruses. Which suggests that immune complex deposition contributes to joint symptoms?
The symptoms of which of these viruses lasts the longest?
The symptoms of which of these viruses lasts the longest?
Why is it important to ask "Are you pregnant?" to a patient complaining of a fever, with joint pain, and rash?
Why is it important to ask "Are you pregnant?" to a patient complaining of a fever, with joint pain, and rash?
What is more common with a SECONDARY infection of Dengue, rather than a PRIMARY?
What is more common with a SECONDARY infection of Dengue, rather than a PRIMARY?
What is the MOST accurate in relation to the pathogenesis of viral arthropathies, in humans?
What is the MOST accurate in relation to the pathogenesis of viral arthropathies, in humans?
A researcher is interested in differentiating arthralgia caused by Ross River virus and Barmah Forest virus. What would work BEST?
A researcher is interested in differentiating arthralgia caused by Ross River virus and Barmah Forest virus. What would work BEST?
Which term BEST describes joint pain?
Which term BEST describes joint pain?
Which of the following is typically associated with symmetrical joint involvement?
Which of the following is typically associated with symmetrical joint involvement?
An infection that is transmitted via an arthropod vector is called what?
An infection that is transmitted via an arthropod vector is called what?
Which of the following viruses is known to cause 'German measles'?
Which of the following viruses is known to cause 'German measles'?
Which virus is MOST associated with causing fetal loss or congenital syndrome when contracted during pregnancy?
Which virus is MOST associated with causing fetal loss or congenital syndrome when contracted during pregnancy?
What is the typical duration of arthralgia caused by Ross River virus and Barmah Forest virus?
What is the typical duration of arthralgia caused by Ross River virus and Barmah Forest virus?
What is a typical incubation period for dengue fever?
What is a typical incubation period for dengue fever?
What percentage of cases of Dengue were diagnosed in Australia in 2016 were contracted in Indonesia?
What percentage of cases of Dengue were diagnosed in Australia in 2016 were contracted in Indonesia?
What is one of the main viruses that cause arthropathy?
What is one of the main viruses that cause arthropathy?
Zika virus is primarily transmitted via:
Zika virus is primarily transmitted via:
What is the typical incubation period (in days) for Chikungunya virus?
What is the typical incubation period (in days) for Chikungunya virus?
In adults, arthralgia is reported in what percentage of women with Rubella?
In adults, arthralgia is reported in what percentage of women with Rubella?
What is the MOST common cause of viral polyarthritis in Australia?
What is the MOST common cause of viral polyarthritis in Australia?
Which of the following is a common symptom of Dengue fever?
Which of the following is a common symptom of Dengue fever?
For confirmed cases of Rubella in pregnancy, what is the recommended course of action?
For confirmed cases of Rubella in pregnancy, what is the recommended course of action?
Which of the following viruses includes strains that are viscerotropic and neurotropic?
Which of the following viruses includes strains that are viscerotropic and neurotropic?
What percentage of people infected with Parvovirus B19 are asymptomatic?
What percentage of people infected with Parvovirus B19 are asymptomatic?
Which arbovirus is known to be transmitted by Aedes aegypti?
Which arbovirus is known to be transmitted by Aedes aegypti?
What is the incubation period for Rubella?
What is the incubation period for Rubella?
What is one of the main modes of transmission for Parvovirus?
What is one of the main modes of transmission for Parvovirus?
What is the MOST important consideration for treating Dengue fever?
What is the MOST important consideration for treating Dengue fever?
Which manifestation is MOST characteristic of Chikungunya virus infection?
Which manifestation is MOST characteristic of Chikungunya virus infection?
In what percentage of cases does Parvovirus present with erythema infectiosum or arthralgia in youth?
In what percentage of cases does Parvovirus present with erythema infectiosum or arthralgia in youth?
Which mosquito type is MOST associated with Dengue transmission?
Which mosquito type is MOST associated with Dengue transmission?
What percentage of pregnancies are affected by transplacental infection of Parvovirus?
What percentage of pregnancies are affected by transplacental infection of Parvovirus?
Prior to the introduction of the vaccine, was Rubella described as common?
Prior to the introduction of the vaccine, was Rubella described as common?
A patient presents with a fever, rash, and joint pain after returning from a trip abroad. Which question should you ask next?
A patient presents with a fever, rash, and joint pain after returning from a trip abroad. Which question should you ask next?
What is the MOST likely recommendation that a doctor can make to a pregnant woman who is consistently traveling, in relation to arthrogenic viruses?
What is the MOST likely recommendation that a doctor can make to a pregnant woman who is consistently traveling, in relation to arthrogenic viruses?
What is TRUE regarding the typical course of Dengue fever?
What is TRUE regarding the typical course of Dengue fever?
What action during treatment is MOST crucial when treating a person with Dengue?
What action during treatment is MOST crucial when treating a person with Dengue?
A woman who is 10 weeks pregnant is diagnosed with parvovirus. Which of the following interventions may be considered to manage potential complications?
A woman who is 10 weeks pregnant is diagnosed with parvovirus. Which of the following interventions may be considered to manage potential complications?
Viral arthropathies are believed to be partially immune-mediated. Which of the following findings supports this hypothesis?
Viral arthropathies are believed to be partially immune-mediated. Which of the following findings supports this hypothesis?
Which statement is MOST accurate regarding laboratory diagnosis of Zika virus?
Which statement is MOST accurate regarding laboratory diagnosis of Zika virus?
Viral RNA can be detected in semen following a Zika virus infection for approximately:
Viral RNA can be detected in semen following a Zika virus infection for approximately:
What is the MOST accurate description of the geographical distribution of viruses that can cause arthralgia?
What is the MOST accurate description of the geographical distribution of viruses that can cause arthralgia?
What is TRUE regarding congenital rubella syndrome?
What is TRUE regarding congenital rubella syndrome?
You are developing a diagnostic test for Ross River and Barmah Forest viruses. Which approach would work best?
You are developing a diagnostic test for Ross River and Barmah Forest viruses. Which approach would work best?
Which alphavirus is considered arthritogenic in old world locations, like Australia?
Which alphavirus is considered arthritogenic in old world locations, like Australia?
Which of the following arboviruses is most likely to cause arthralgia after a mosquito bite in Australia?
Which of the following arboviruses is most likely to cause arthralgia after a mosquito bite in Australia?
Which infection has sexual transmission?
Which infection has sexual transmission?
Flashcards
What is osteomyelitis?
What is osteomyelitis?
Infection of the bone.
What is septic arthritis?
What is septic arthritis?
Infection of a joint.
What causes osteomyelitis?
What causes osteomyelitis?
Post-trauma, MVA, or sporting accident.
What is haematogenous spread?
What is haematogenous spread?
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Osteomyelitis pathogenesis?
Osteomyelitis pathogenesis?
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How does osteomyelitis affect blood supply?
How does osteomyelitis affect blood supply?
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What is sequestrum?
What is sequestrum?
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Acute osteomyelitis treatment?
Acute osteomyelitis treatment?
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Chronic osteomyelitis treatment?
Chronic osteomyelitis treatment?
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What is surgical debridement?
What is surgical debridement?
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What is a sinus?
What is a sinus?
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Cierny-Mader anatomic types?
Cierny-Mader anatomic types?
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What is Staphylococcus aureus?
What is Staphylococcus aureus?
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How does haematogenous osteomyelitis spread?
How does haematogenous osteomyelitis spread?
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Common osteomyelitis bacteria in infants?
Common osteomyelitis bacteria in infants?
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What is a contiguous infection source?
What is a contiguous infection source?
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Causes of osteomyelitis?
Causes of osteomyelitis?
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Symptoms of osteomyelitis?
Symptoms of osteomyelitis?
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What is Brodie abscess?
What is Brodie abscess?
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Diagnosis of septic arthritis via?
Diagnosis of septic arthritis via?
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Osteomyelitis signs on X-ray?
Osteomyelitis signs on X-ray?
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Initial osteomyelitis treatment?
Initial osteomyelitis treatment?
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When does osteomyelitis require surgery?
When does osteomyelitis require surgery?
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Surgery for osteomyelitis?
Surgery for osteomyelitis?
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Septic arthritis is usually caused by what?
Septic arthritis is usually caused by what?
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The key to septic arthritis?
The key to septic arthritis?
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Septic arthritis pathogenesis?
Septic arthritis pathogenesis?
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Septic arthritis common in one joint?
Septic arthritis common in one joint?
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Septic arthritis caused by..?
Septic arthritis caused by..?
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Septic arthritis - treatment
Septic arthritis - treatment
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Prosthetic joint infections -
Prosthetic joint infections -
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Knees -
Knees -
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Study Notes
Viral arthropathies
- Viral infections frequently present with joint pain
- A 29-year-old woman presents with joint pains in hands, wrists, knees and ankles, accompanied by a generalized rash, following 3 days of fever
Terminology
- Arthralgia is defined as joint pain
- Arthritis is defined as joint inflammation
- Arthropathy is defined as joint disease
- Arthritogenic is defined as causing joint disease
- Monoarthritis affects one joint, oligoarthritis affects 2-4 joints and polyarthritis affects 5 or more joints simultaneously.
- Migratory arthritis is fleeting joint pain
Differential Diagnosis of Joint Pain
- Differential diagnosis of joint pain includes both infective and non-infective causes
- Infective causes can be bacterial, viral, or post-infectious
- Non-infective causes may include crystal arthropathy, rheumatological diseases, osteoarthritis, trauma
Viral causes of arthropathy
- Viruses that commonly cause arthropathy include Arboviruses, Rubella virus, and Parvovirus
- Viruses that rarely cause arthropathy include Hepatitis viruses, HIV, Herpesviruses, Enteroviruses, and Adenoviruses
Arboviruses
- These are arthropod-borne viruses, usually transmitted by mosquitoes
- Viruses have a small range of potential vectors with limited geographical distribution
- Two main genera of Arboviruses are Flavivirus (RNA) and Alphavirus (RNA)
Flaviviruses
- Flaviviruses include Yellow fever virus (viscerotropic), Dengue and Zika
- Neurotropic (encephalitic) Flaviviruses, found in Australia, are Murray Valley encephalitis virus and Kunjin virus (a clade of West Nile virus)
- Neurotropic (encephalitic) Flaviviruses include Japanese encephalitis virus, West Nile virus, and St Louis encephalitis virus; the Japanese encephalitis virus was newly found in Australia
- Dengue is the most common flavivirus infection worldwide and Zika caused an epidemic in South and Central America 2015-2016
Alphaviruses
- Old World (arthritogenic) Alphaviruses include Ross River virus, Barmah Forest virus, Chikungunya and O’nyong-nyong, Sindbis, Ockelbo, Igbo-ora, Semliki Forest
- New World (neurotropic) Alphaviruses include Western equine encephalitis virus, Eastern equine encephalitis virus, Venezuelan equine encephalitis virus, and Mayaro (arthritogenic)
Dengue virus
- Approximately 100 million symptomatic cases of dengue occur worldwide every year
- Around 2000 cases diagnosed in Australia in 2016, with ~50% returned from Indonesia
- Dengue virus is transmitted by Aedes aegypti and also Ae. albopictus
- The virus is maintained in human populations, but can infect non-human primates
- There are 4 serotypes which may co-circulate
Dengue fever
- The incubation period is 3-14 days
- Clinical manifestations include fever (>95%), usually lasting 3-7 days, headache, eye pain, myalgia, arthralgia (60-70%), rash (50%), usually 2-5 days after symptom onset, gastrointestinal symptoms (<50%)
- Severe dengue was formerly known as dengue hemorrhagic fever and dengue shock syndrome.
- Secondary dengue infections are more common than primary infections and are serotype dependent
- Plasma leakage, hemorrhage, and shock are clinical signs
- The critical period for severe dengue is 3-7 days after symptom onset
- Dengue fever is treated with supportive care
- Focus is on careful fluid management in severe dengue
- Vaccine development is hampered by antibody-dependent enhancement so has been difficult
Zika virus
- It is mainly transmitted by Ae. aegypti, also Ae. albopictus
- Incubation period is 2-14 days
- Clinical manifestations are similar to dengue but milder
- 50-75% of infections are asymptomatic
- Conjunctivitis is common in symptomatic infection
- Laboratory diagnosis is via serology (IgM and IgG antibodies), although definitive diagnosis can be difficult due to cross-reactivity with other flaviviruses and Nucleic acid testing
- Treatment is supportive care only
- Person-to-person transmission can occur through sexual contact and vertically from mother to baby
- Viral RNA detected in semen for ~3-6 months
- Neurotropism can lead to microcephaly and other neurological abnormalities from intrauterine infection and Guillain-Barré syndrome (2.4 cases per 10,000 infections)
Ross River and Barmah Forest viruses
- These are the most common causes of viral polyarthritis in Australia
- There are 5000-7000 cases every year (~75% RRV) with regular epidemics and a geographical focus
- Distributed throughout Australia and also found in Melanesia (e.g. PNG)
- Multiple mosquito vectors including Ae. camptorhynchus, Ae. notoscriptus, Ae. vigilax, Culex annulirostris
- Infection is enzootic in native macropods (40% seroprevalence) and can also infect horses, livestock, and other wild animals
- Incubation period is 3-21 days Clinical manifestations include arthralgia (>95%; arthritis 40-50%), fatigue (90%), rash (40-60%), fever and myalgia (50-60%)
- Arthralgia is usually symmetrical; affects wrists, knees, ankles, MCP/IP joints of hands
- Arthralgia and fatigue may persist for 3-6 months
- Laboratory diagnosis is via serology (IgM and IgG antibodies), and nucleic acid testing (rarely)
- Treatment is supportive care only
Chikungunya virus
- Primary vectors are Ae. aegypti and Ae. albopictus
- Incubation period 1-14 days
- Clinical manifestations include fever (>95%), usually lasts 3-5 days, arthralgia (>95%), usually 2-3 days after fever onset, similar distribution to other alphaviruses, rash (40-75%), last 3-7 days, headache, myalgia, GI symptoms
- Arthralgia can be debilitating and gradually improves over 3-18 months
- Laboratory diagnosis is via serology (IgM and IgG antibodies), and nucleic acid testing (PCR)
- Treatment is supportive care only
Rubella
- Caused by rubella virus (RNA), in the family Togaviridae
- One of the classic childhood exanthems, a.k.a. German measles
- Prior to the introduction of the vaccine, childhood infection was common, with occasional epidemics Rubella vaccination in Australia was introduced in 1971, now included in MMR(v)
- Rubella infection in Australia is now very uncommon, but the virus still circulates in countries without good vaccination programs/uptake
- Average 30 cases/year in Australia 2010-2019 years, almost all imported
- Incubation period 14-18 days (12-23)
- Transmitted person-to-person via large respiratory droplets
- Clinical manifestations in children are often mild or asymptomatic, distinctive rash spreads from face to trunk and extremities within 24 hours, lasts 3-8 days and low-grade fever and lymphadenopathy may precede the rash
- Clinical manifestations in adults are rarely asymptomatic, prodrome with fever and lymphadenopathy more pronounced, followed by rash and arthralgia reported in 70% of adult women, concurrent with rash
- Arthralgia may persist for 1-2 months with knees, wrists, fingers most frequently involved
- Laboratory diagnosis is via serology (IgM and IgG antibodies) and nucleic acid testing (PCR)
- Treatment is supportive care only
- Transplacental infection may occur and has the greatest risk in the first trimester
- Intrauterine infection may lead to fetal loss, or congenital rubella syndrome
- Congenital rubella syndrome presents with hearing loss, intellectual impairment, cardiac abnormalities, and cataracts
- Testing for rubella immunity routinely recommended in pregnancy and post-pregnancy booster if IgG low
- Post-exposure prophylaxis in pregnancy has not been shown to be beneficial, and confirmed cases managed by maternal-fetal medicine
Parvovirus
- Parvovirus B19 is a small DNA virus with global distribution, first isolated in Australia
- It causes another childhood exanthem, 'fifth disease' with 50% infected by age 15
- Transmitted person-to-person by large respiratory droplets
- Incubation period 1-2 weeks
- Clinical manifestations include 25% asymptomatic, 50% have mild, non-specific illness (fever, myalgia, coryza, headache) and 25% present with erythema infectiosum or arthralgia
- Arthralgia is usually seen in adult women affecting hands, wrists, knees, feet symmetrically lasting 3 weeks with Generalised rash in 75% cases
- Other manifestations include aplastic crisis in hematological disorders and chronic hemolysis in immunocompromised patients
- Laboratory diagnosis is via serology (IgM and IgG antibodies) and nucleic acid testing (PCR)
- Treatment is supportive care only
- There is no vaccine or post-exposure prophylaxis that exists
Parvovirus in pregnancy
- Transplacental infection may occur, with 30% of maternal infections
- Intrauterine infection may lead to fetal loss or fetal hydrops, as parvovirus is cytotoxic to fetal red blood cell precursors
- Like rubella, greatest risk prior to 20 weeks' gestation
- Confirmed infection in pregnancy is managed by maternal-fetal medicine and fetal blood transfusion has been used to treat hydrops
Pathogenesis of viral arthropathy
- It's not well understood, and not simply viral replication in the joints and at least partially immune-mediated
- Virus (e.g. rubella, alphaviruses) has occasionally been cultured from joint aspirates
- Viral antigens and nucleic acid detected more commonly and viral inclusions have been seen in joint macrophages
- Immune complex deposition thought to contribute to joint symptoms and rash
Case revisited
- A 29-year-old woman with no significant medical history presents with joint pains in her hands, wrists, knees, and ankles accompanied by a generalised rash, following 3 days of fever
- Assessment involves whether patient is pregnant or planning pregnancy and if they have travelled
Summary
- Viral arthropathies are usually symmetrical, affecting wrists, knees, hands, feet, and are often accompanied by rash and/or fever
- The main viruses that cause arthropathy are: Arboviruses, Rubella virus, Parvovirus
- Several arthritogenic viruses are seen mainly in travelers: Dengue virus, Zika virus, chikungunya virus, Rubella virus
- Several arthritogenic viruses are important in pregnancy: Rubella virus, Parvovirus, Zika virus
- Ross River virus and Barmah Forest virus are the most common causes of viral arthropathy in Australia
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