Lecture+2+-+Arthritis+-+2023 copy.pptx

Moving Musculoskeletal Infections Arthritis & Osteomyelitis Tessa LeCuyer [email protected] What will we be Discussing? Bacterial Infections of:  Joints = Septic arthritis  Bone = Osteomyelitis Diskospondylitis How Do Joints Get Infected? How Do Clinical Signs Develop? 1. Direct arthropathy...

Moving Musculoskeletal Infections Arthritis & Osteomyelitis Tessa LeCuyer [email protected] What will we be Discussing? Bacterial Infections of:  Joints = Septic arthritis  Bone = Osteomyelitis Diskospondylitis How Do Joints Get Infected? How Do Clinical Signs Develop? 1. Direct arthropathy  Infectious or septic arthritis  Live microorganisms are in the articular cavity 2. Indirect arthropathy  Arthritis can ALSO be caused by deposition of immune complexes in the synovial membrane  The immune complexes may have an infectious origin, for example Infections of Joints Bacteria Animal Species Staphylococci, Streptococci, All species Pasteurella, Borrelia Enterobacteriaceae (E. coli, Salmonella, Enterobacter, Proteus) Trueperella pyogenes Erysipelothrix rhusiopathiae Pasteurella, Brucella, Yersinia, Nocardia, Mycobacteria, strict anaerobes Ehrlichia, Rickettsia, Chlamydia Blastomyces, Histoplasma, Cryptococcus, Coccioides, Aspergilus, Candida Mycoplasma Disease Polyarthritis (hematogenous) and monoarthritis All species (especially young) Ruminants, pigs Pigs (dogs) Dogs, cattle, sheep, pigs, - Diamond Skin Disease Rarer infections Dogs, - Rickettsial Dogs, cats - Fungal Calves, dogs - Mycoplasma Infections of Joints Bacteria Animal Species Disease Staphylococci, Streptococci, Pasteurella, Borrelia Enterobacteriaceae (E. coli, Salmonella, Enterobacter, Proteus) Trueperella pyogenes Erysipelothrix rhusiopathiae Pasteurella, Brucella, Yersinia, Nocardia, Mycobacteria, strict anaerobes Ehrlichia, Rickettsia, Chlamydia Blastomyces, Histoplasma, Cryptococcus, Coccioides, Aspergillus, Candida All species Polyarthritis (hematogenous) and monoarthritis All species (especially young) Ruminants, pigs Pigs (dogs) Dogs, cattle, sheep, pigs, - Diamond Skin Disease Rarer infections Dogs, - Rickettsial Dogs, cats - Fungal Infections of Joints Bacteria Animal Species Disease Staphylococci, Streptococci, Pasteurella, Borrelia Enterobacteriaceae (E. coli, Salmonella, Enterobacter, Proteus) Trueperella pyogenes Erysipelothrix rhusiopathiae Pasteurella, Brucella, Yersinia, Nocardia, Mycobacteria, strict anaerobes Ehrlichia, Rickettsia, Chlamydia Blastomyces, Histoplasma, Cryptococcus, Coccioides, Aspergillus, All species Polyarthritis (hematogenous) and monoarthritis All species (especially young) Ruminants, pigs Pigs (dogs) - Diamond Skin Disease Dogs, cattle, sheep, pigs, - Rarer infections Dogs, - Rickettsial Dogs, cats - Fungal Clinical Case: Sabre History 2 year old, male, castrated Malamute to your clinic in Blacksburg The owner has had the dog since he was 8 weeks old and has always had problems with the dog, including GIT disease and poor appetite Sabre is now presented to you with a chronic history of lethargy and behavioral changes every 6-8 weeks, exhibiting alternatively depression and aggression This morning the dog was very quiet and appeared lame The owner says that she has noticed that Sabre limps from time to time Clinical Case: Sabre Clinical Signs You examine the dog and determine that it is small for its age with a poor coat The dog is not febrile and has a normal heart rate and respiratory rate The dog is lame on both its right hind and right fore limbs, particularly its right hind limb which is almost nonweight bearing In addition, you think there is joint effusion in the right carpus, which seemed painful but was not hot to touch Clinical Case: Sabre What is your next step? Clinical Case: Sabre Problems Chronic problems Shifting lameness – multiple leg involvement Joint effusions Stunted growth Poor coat Previous history of GIT dz Most important problem? Clinical Case: Sabre Problems Chronic problems Shifting lameness – multiple leg involvement Joint effusions Stunted growth Poor Bodycoat System?  Previous history of GIT dz Musculoskeletal system Differential Diagnosis Multiple Joint Disease  Inflammation Infectious Bacterial (incl Spirochetes) Mycoplasma Rickettsia Fungi Viral Non-Infectious Immune Mediated Disorders So what do you do now? Will a specific diagnosis change treatment, control or prognosis? Clinical Case: Sabre – Dx Tests 1. CBC + MBA Mild inflammatory leukogram 2. Radiography/Ultrasound Soft tissue swelling around joints 3. Synovial Fluid Analysis Culture joint samples in fluid medium Multiple joints sampled Decreased viscosity + turbid fluid Sent away for clin path evaluation and aerobic & anaerobic culture Fluid Culture Bottle Clinical Case: Sabre – Dx Tests 4. Immunological/Serological Tests Negative on SNAP4DxPlus for Borrelia burgdorferi Positive Control Clinical Case: Sabre Normal Joint Synovial Fluid Analysis: Protein – 5.1 g/dL (normal<3g/dL) TNCC – 5500/µL (normal<1000) Diff Quik – What is your INTERPRETATION? Mostly non-degenerate PMNs No bacteria observed (mainly mononuclear cells) Sabre’s Joint Diagnosis = arthritis! Do you need to do anything more? (mainly PMNs)) Clinical Case: Sabre Culture of Joint Fluid Pure growth of Erysipelothrix rhusiopathiae What is the significance of this isolate? Clinical Case: Sabre 4 POINT RULE FOR SIGNIFICANCE OF ISOLATES 1. 2. 3. Did we collect correct sample?  Collected from the appropriate site  Collected in an appropriate fashion  Processed in an appropriate fashion Evidence of inflammation?  Clinical Signs? – YES were consistent with inflammation  Cytology? – YES there were many PMNs + protein Evidence of bacteria  Cytology – no intracellular bacteria - but doesn’t rule it out  Positive culture of a sample – YES we isolated Erysipelothrix rhusiopathiae 4. Does this bacteria have the ability & opportunity to cause this disease? Clinical Case: Sabre You could only make an informed decision about the significance of this isolate IF you knew something about these bacteria! Next: Let’s learn about: Erysipelothrix What Bacteria will we be Discussing? G + cocci G + rods Staphylococci Bacillus Streptococci Clostridium Enterococci Actinomyces NS Anaerobes Nocardia Dermatophilus Rhodococcus Trueperella Corynebacterium Erysipelothrix Listeria Mycobacteria pyogenic pyogranulomato us granulomato us necrotizing What type of Bacteria are Erysipelothrix? Gram positive rods short rods Facultatively anaerobic Non motile Erysipelothrix rhusiopathiae is the major species in the genus ( & the only one that we will discuss) Where do Erysipelothrix come from? Isolated from a wide variety of environmental settings, including: Sewage, decaying vegetation and soil, surface slime of fresh and saltwater fish GIT & mucous membranes of many different mammals and birds Tonsils of apparently healthy pigs, which are thought to be the primary reservoir How are Erysipelothrix transmitted? Ingestion is the primary route of infection: feco-oral urine-oral saliva-oral How does Erysipelothrix cause Disease? Virulence Factors 1. Facultative intracellular 2. Capsule – prevents phagocytosis 3. Adherence – to endothelial cells 4. Neuraminidase – causes hemolysis, vascular damage, coagulopathy & thrombus formation What Specific Diseases does Erysipelothrix Cause?  4 disease syndromes  Mostly in pigs and turkeys  May occur in other species  Sheep, dogs, cats, other birds, marine mammals & humans What Specific Diseases does Erysipelothrix Cause? a) Septicemia  Animals with E. rhusiopathiae have systemic spread of the bacteria via the bloodstream  Mostly in young pigs & turkeys  This is a severe form of the disease and often presents as sudden death What Specific Diseases does Erysipelothrix Cause? b)Diamond Skin Disease  Some animals with acute septicaemia have a less severe form of disease  Classical rhomboid lesions of the skin may be observed in these animals This is a skin manifestation of a systemic dz What Specific Diseases does Erysipelthrix Cause? b)Diamond Skin Disease  In turkeys see swelling of the “snood”  Skin manifestation of a systemic disease What Specific Diseases does Erysipelothrix Cause?  Other 2 syndromes observed mostly in chronic disease  Syndromes seen in other species (like dogs) c)Arthritis  Infection localized in joints.- live bacteria in the joints  Also immune-mediated inflammation  Pathology: synovial membrane hyperplasia with pannus formation What Specific Diseases does Erysipelothrix Cause? Erysipelothrix rhusiopathiae Polyarthritis Pannus formation Pannus = vascularized synovial thickening that infiltrates adjacent spac What Specific Diseases does Erysipelothrix Cause? d)Endocarditis Valvular endocarditis  Valvular endocarditis may be observed with the mitral valve most commonly affected  +/- dissemination of infection and infarcts throughout the body Localisation in other sites and infarct development What Specific Diseases does Erysipelothrix Cause? What about humans? Erysipelothrix How do you Diagnose Erysipelothrix Infections ? History, clinical signs, species Obtain sample from lesions Joint lesions, blood, skin, or post-mortem specimens Gram stain/Diff Quik Gram positive short rods May not be present especially in chronic disease To confirm diagnosis Aerobic culture How do you Treat Erysipelothrix Infections ? Antibiotics Penicillin is the drug of choice for Erysipelothrix  BUT: treatment is often not effective in chronic cases  Because the infections are:  widely disseminated  in locations that are difficult to treat  heart valves, joints, CNS How do you Control Erysipelthorix Infections ? Management Reduce predisposing factors for transmission and disease Crowding and poor hygiene Cull chronically affected animals Vaccines E. rhusiopathiae vaccines available in U.S. for pigs & turkeys Any Questions? Clinical Case: Sabre Clinical Signs You examine the dog and determine that it is small for its age with a poor coat The dog is not febrile and has a normal heart rate and respiratory rate The dog is lame on both its right hind and right fore limbs, particularly its right hind limb which is almost nonweight bearing In addition, you think there is joint effusion in the right carpus, which seemed painful but was not hot to touch Clinical Case: Sabre #2 Let’s talk about this case again, but with some different results….. Clinical Case: Sabre #2 1. CBC + MBA Mild inflammatory leukogram 2. Radiography mild soft tissue swelling 3. Synovial Fluid Analysis decreased viscosity + turbid fluid sent away for Analysis + Culture Fluid Culture Bottle Clinical Case: Sabre #2 4. Immunological/Serological Tests Positive on SNAP4DxPlus for Lyme Do you want to do anything else? If so, why? Clinical Case: Sabre #2 Normal Joint Synovial Fluid Analysis: Protein – 5.1 g/dL (normal<3g/dL) TNCC – 5500/µL (normal<1000) Diff Quik – What is your INTERPRETATION? Mostly non-degenerate PMNs No bacteria observed (mainly mononuclear cells) Sabre #2’s Joint Diagnosis = arthritis! Do you need to do anything more? (mainly PMNs)) Clinical Case: Sabre #2 Culture of Joint Fluid Negative What is your interpretation? What would you do next? Clinical Case: Sabre #2 Suspect Lyme Disease (Borreliosis)! But can Lyme disease cause these clinical signs? Next, we will learn about: Borrelia