Osteomyelitis Overview
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Questions and Answers

What distinguishes early onset from late onset infections?

  • Symptoms appear after 30 days for late onset. (correct)
  • Symptoms start within 7 days for early onset.
  • Late onset is commonly characterized by high-virulence organisms.
  • Early onset is associated with fever as a common finding. (correct)

Which pathogen is most commonly associated with early onset infections?

  • Staphylococcus aureus (correct)
  • Corynebacterium species
  • Cutibacterium acnes
  • Coagulase-negative staphylococci

What is rare in late onset infections?

  • Fever (correct)
  • Increased C-reactive protein levels
  • Low-virulence organisms
  • Wound healing impairment

What does an increased erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) level help to exclude?

<p>Vertebral osteomyelitis (B)</p> Signup and view all the answers

Which of the following is a characteristic of late onset infections?

<p>Involves low-virulence organisms (D)</p> Signup and view all the answers

What is the primary pathogenic source of osteomyelitis in adults?

<p>Exogenous infection (D)</p> Signup and view all the answers

Which circumstance is least frequently associated with adult long-bone osteomyelitis?

<p>Hematogenous infection during childhood (C)</p> Signup and view all the answers

In children, osteomyelitis typically arises due to which of the following?

<p>Hematogenous seeding (D)</p> Signup and view all the answers

What imaging technique is mentioned in relation to examining a 53-year-old man with osteomyelitis?

<p>MRI (A)</p> Signup and view all the answers

Which statement accurately describes the occurrence of osteomyelitis in adults?

<p>The main source is exogenous infection related to devices. (D)</p> Signup and view all the answers

What is the leading initial symptom of osteomyelitis?

<p>Back pain (D)</p> Signup and view all the answers

What percentage of thoracic spine cases are affected by osteomyelitis?

<p>30% (B)</p> Signup and view all the answers

Which organism is commonly associated with osteomyelitis?

<p>Staphylococcus aureus (B)</p> Signup and view all the answers

Which mechanism is NOT a way osteomyelitis can develop?

<p>Direct contact with infected wound (B)</p> Signup and view all the answers

Which type of osteomyelitis is characterized by symptoms lasting less than 2 weeks?

<p>Acute vertebral osteomyelitis (C)</p> Signup and view all the answers

What percentage of osteomyelitis cases primarily affects the lumbar spine?

<p>60% (C)</p> Signup and view all the answers

What condition is a common cause of neurologic signs and symptoms in osteomyelitis?

<p>Spinal epidural abscess (C)</p> Signup and view all the answers

In children, which bones are most commonly involved in osteomyelitis?

<p>Long bones (B)</p> Signup and view all the answers

What is the most commonly isolated organism in cases of osteomyelitis according to the information provided?

<p>Staphylococcus aureus (B)</p> Signup and view all the answers

What is the standard treatment duration for osteomyelitis mentioned?

<p>4-6 weeks of antibiotic therapy (D)</p> Signup and view all the answers

Which diagnostic method is identified as the current gold standard for osteomyelitis?

<p>MRI (A)</p> Signup and view all the answers

In cases of secondary sternal osteomyelitis, what is always required?

<p>Surgical debridement (B)</p> Signup and view all the answers

What are the leading symptoms of osteomyelitis?

<p>Fever and localized swelling (A)</p> Signup and view all the answers

What is the most common manifestation of hematogenous bone infection in adults?

<p>Vertebral osteomyelitis (D)</p> Signup and view all the answers

In patients with negative blood cultures, what procedure is necessary for diagnosis?

<p>Open biopsy (B)</p> Signup and view all the answers

Which imaging procedure is considered the gold standard for diagnosing osteomyelitis?

<p>MRI (D)</p> Signup and view all the answers

Which route is NOT mentioned as a way microorganisms can invade the disk?

<p>Lymphatic drainage (D)</p> Signup and view all the answers

What should be done if a patient has sepsis syndrome in relation to antibiotic treatment?

<p>Start broad-spectrum antibiotics immediately (A)</p> Signup and view all the answers

What is a potential treatment option for Pseudomonas aeruginosa infections?

<p>Ciprofloxacin (D)</p> Signup and view all the answers

Which of the following is NOT a characteristic of vertebral osteomyelitis?

<p>Always results in positive blood cultures (B)</p> Signup and view all the answers

How should bone samples be cultured for vertebral osteomyelitis?

<p>For aerobic, anaerobic, and fungal agents (D)</p> Signup and view all the answers

Why is plain radiography useful in evaluating patients without neurologic symptoms?

<p>To reveal alternative diagnoses (C)</p> Signup and view all the answers

What is an important indication for performing MRI promptly?

<p>To rule out a herniated disk (C)</p> Signup and view all the answers

What is a common risk factor associated with diabetic foot infections?

<p>Peripheral arterial insufficiency (C)</p> Signup and view all the answers

What is a crucial step in diagnosing a clinically infected foot ulcer?

<p>‘Probe-to-bone’ test (A)</p> Signup and view all the answers

Which bacteria is commonly isolated in cases of diabetic foot infections?

<p>Coagulase negative staphylococcus (C)</p> Signup and view all the answers

What is the recommended empirical antimicrobial therapy for foot infections?

<p>Vancomycin (B)</p> Signup and view all the answers

Which of the following is NOT a risk factor for diabetic foot infections?

<p>Improved blood flow (B)</p> Signup and view all the answers

What is the likelihood of isolating anaerobes in diabetic foot infections?

<p>20-35% (D)</p> Signup and view all the answers

What should be the focus of antibiotic treatment if a foot ulcer is clinically infected?

<p>Focus on bone culture identification (C)</p> Signup and view all the answers

Why is it important to have an active agent against methicillin-resistant S.aureus?

<p>The risk of methicillin-resistant S.aureus is high in diabetic patients (D)</p> Signup and view all the answers

Flashcards

Early Onset Osteomyelitis

Infection of the bone that develops within 30 days of an injury or surgery. It is characterized by wound healing impairment, fever, and S.aureus as the most common pathogen.

Late Onset Osteomyelitis

Infection of the bone that develops more than 30 days after an injury or surgery. It is less likely to cause fever and involves low-virulence organisms like coagulase-negative staphylococci or C.acnes.

ESR and CRP

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are blood tests that can be used to help exclude osteomyelitis.

S. aureus

Staphylococcus aureus is a common bacterium that can cause osteomyelitis, especially in early onset cases.

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Coagulase-negative Staphylococci and C.acnes

These bacteria are often involved in late onset osteomyelitis cases, and are considered less aggressive than S.aureus.

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Osteomyelitis

An infection of the bone that can occur through hematogenous spread, spread from a contiguous site, or secondary infection.

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Hematogenous Osteomyelitis

Osteomyelitis that occurs when bacteria travels through the bloodstream and infects the bone.

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Contiguous Osteomyelitis

Osteomyelitis that spreads from a nearby infection, often following surgery or injury.

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Vertebral Osteomyelitis

Osteomyelitis specifically affecting the vertebrae of the spine.

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Acute Vertebral Osteomyelitis

Vertebral osteomyelitis lasting less than 2 weeks.

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Subacute Vertebral Osteomyelitis

Vertebral osteomyelitis lasting between 2 and 6 weeks.

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IV Drug Users & Osteomyelitis

Injecting drugs directly into the bloodstream increases the risk of osteomyelitis, particularly fungal infections.

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Osteomyelitis: Common Microorganisms

Staphylococcus aureus, Streptococci, Escherichia coli, and Pseudomonas aeruginosa are commonly associated with osteomyelitis.

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Osteomyelitis in long bones

Infection of the bone marrow and bone tissue in long bones.

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Hematogenous seeding

Infection spreads through the bloodstream to the bone.

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Exogenous contamination

Infection introduced from outside the body, often during trauma or surgery.

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Perioperative contamination

Infection introduced during a surgical procedure.

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Internal fixation devices

Metal implants used to stabilize broken bones.

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Sternal Osteomyelitis

Infection of the sternum (breastbone) caused by bacteria, typically Staphylococcus aureus.

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Hematogenous Sternal Osteomyelitis

Sternal osteomyelitis caused by bacteria traveling through the bloodstream to the sternum.

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Exogenous Sternal Osteomyelitis

Sternal osteomyelitis caused by bacteria entering the body directly through a wound or injury.

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Contiguous Sternal Osteomyelitis

Sternal osteomyelitis spreading from a nearby infected area, such as the ribs.

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Sternal Osteomyelitis Treatment

Treatment involves a combination of antibiotics (for 4-6 weeks) and possibly surgery to remove infected tissue (debridement).

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Disk Avascularity

The disks in the spine lack blood vessels, making them susceptible to infection

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Infection Spread in Vertebral Osteomyelitis

Infection enters through the segmental arteries in the endplates and spreads into the disk. It can also spread through the prevertebral venous plexus or during spinal surgery.

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Diagnosis of Vertebral Osteomyelitis

Plain radiography can be used initially, but MRI is the gold standard, especially for patients with neurological symptoms, and helps rule out other conditions like herniated discs.

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Blood Culture

A test to identify bacteria in the bloodstream. It's important for diagnosing vertebral osteomyelitis.

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Biopsy for Vertebral Osteomyelitis

If blood cultures are negative, a biopsy is needed to confirm the diagnosis and identify the causative organism.

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Antibiotic Treatment for Vertebral Osteomyelitis

Antibiotics are essential for treating vertebral osteomyelitis, but should only be started after blood cultures and biopsy results are available, unless the patient has sepsis syndrome.

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Treatment Duration for Vertebral Osteomyelitis

Antibiotics are typically prescribed for 2-4 weeks with several different options depending on the identified bacteria.

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Imaging for Vertebral Osteomyelitis

Imaging tests like CT and MRI are crucial not only for diagnosing vertebral osteomyelitis but also for ruling out other conditions like bone metastases or fractures.

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Pseudomonas Aeruginosa Treatment

Pseudomonas aeruginosa is a common bacteria in vertebral osteomyelitis and requires specific antibiotics like cefepime or ceftazidime with an aminoglycoside.

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What are the risk factors for Diabetic foot infection?

Diabetic foot infections are commonly associated with diabetes, peripheral arterial insufficiency, peripheral neuropathy, and prior foot surgery.

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What are the common organisms found in Diabetic foot infections?

Common organisms include anaerobes (20-35%), gram-negative bacilli (20-30%), and coagulase-negative staphylococcus (0-20%).

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How is diabetic foot infection diagnosed?

Clinically with examination, 'probe-to-bone' test, and imaging like MRI.

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What is the treatment for diabetic foot infection?

Prompt empirical antimicrobial therapy including an agent against methicillin-resistant S. aureus (like Vancomycin).

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Charcot Foot

A neuro-osteoarthropathic deformity caused by nerve damage and compromised blood flow, leading to bone and joint destruction.

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What is the relevance of bone culture in Diabetic foot infection?

Bone culture helps identify the specific organism causing the infection, guiding antibiotic treatment.

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Why is empirical therapy important for diabetic foot infections?

Prompt treatment is crucial to prevent progression to osteomyelitis, a serious bone infection.

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What's the significance of 'probe-to-bone' test?

This test helps determine if the infection has reached the bone, indicating a higher risk of osteomyelitis.

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Study Notes

Infections of the Musculoskeletal System

  • Infections can affect bones, joints, and muscles.
  • Osteomyelitis is a bone infection, often caused by bacteria like Staphylococcus aureus.
  • Vertebral osteomyelitis is a common type, often affecting the spine.
  • Acute vertebral osteomyelitis lasts less than two weeks.
  • Subacute vertebral osteomyelitis lasts two weeks to six weeks.
  • Hematogenous spread, contiguous spread, and secondary infection from vascular insufficiency are the three mechanisms for osteomyelitis.
  • Long bones are commonly affected in children.
  • In adults, the vertebral column is frequently affected.
  • Infections of the long bones are often acquired from trauma or operation.
  • Post-traumatic or post-surgical osteomyelitis in adults is most often caused by exogenous infections.
  • Periprosthetic joint infections (PJI) are infections around artificial joints.
  • These often happen in the first few postoperative years.
  • Staphylococci (S. aureus and coagulase-negative staphylococci) are common causes in PJIs.
  • Poststernotomy infections result from infections in the sternum after open-heart surgery.
  • Staphylococcus aureus is the common cause of these infections.
  • Foot osteomyelitis often affects individuals with diabetes or peripheral nerve damage.

Osteomyelitis

  • Occurs via hematogenous spread, contiguous spread, or secondary site infections.
  • Bacteria and potentially other microorganisms cause the problem.
  • Manifestations include fever and back pain, with the location correlating to the infection site.
  • Neurologic deficits like radiculopathy are possible complications.

Infectious Arthritis

  • Acute bacterial arthritis, sometimes caused by Staphylococcus aureus or Streptococcus.
  • Gonococcal arthritis usually occurs in sexually active individuals.
  • Joint pain, swelling, and redness are common symptoms.
  • Blood tests, synovial fluid analysis, and imaging are diagnostic tools.
  • Treatment involves antibiotics and joint drainage in severe cases.

Skeletal Tuberculosis

  • Tuberculosis can affect bone and joints.
  • It typically involves weight-bearing joints like hips, knees, and ankles.
  • An effective treatment plan for tuberculous arthritis is necessary.
  • This treatment is similar to that of pulmonary tuberculosis, requiring multiple drugs for 6 to 12 months.

Pyomyositis

  • Staphylococcal infections of the muscle tissue.
  • Thigh muscles are frequently affected.
  • Diagnosis uses imaging (CT or MRI) for edema or abscess evaluation.

Gas Gangrene

  • Clostridial (like C. perfringens) infection in subcutaneous tissues, often involving muscle.
  • Often from wound contamination, it causes rapid tissue swelling and discoloration.
  • Diagnosis is primarily clinical, with crepitus and foul odor being common features.

Necrotizing Fasciitis

  • Rapidly spreading infection of subcutaneous tissue and muscles.
  • Streptococcus pyogenes is a common cause, referred to as flesh-eating disease.
  • Prompt diagnosis and aggressive surgical debridement are crucial.

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MP-L10.S1.2B-Infections of the Musculoskeletal System (Lec) PDF

Description

Test your knowledge on the differences between early and late onset infections, specifically focusing on osteomyelitis. This quiz covers causative pathogens, diagnostic indicators, and imaging techniques relevant to osteomyelitis in both adults and children.

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