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IM- Infections of Bones and Joints

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tonystep1's version from 2017-08-08 06:15

INFECTIONS OF THE BONES AND JOINTS CLINICAL FEATURES

Question Answer
OsteomyelitisPain over the involved area of bone is the most common finding.// Localized erythema, warmth, or swelling may be present.// Systemic symptoms (e.g., fever, headache, fatigue) may be present, but are inconsistent findings // A draining sinus tract through the skin may form in chronic disease
Acute Infectious ArthritisThe joint is swollen, warm, and painful. // The range of motion (active or passive) is very limited // An effusion can be palpated // Constitutional symptoms such as fever, chills, and malaise are common
Gonococcal ArthritisThis presents with acute monoarthritis or o l igoarthritis, and often progresses within days in a migratory or additive pattern. // Knees, wrists. hands, and ankles are the most commonly involved. // Tenosynovitis is often present in the hands and feet // Fever. chil ls. and rash l macules. papules. and/or pustules) are signs of disseminated gonococcal infection
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DIAGNOSIS OF INFECTIONS OF BONES AND JOINTS

Question Answer
OsteomyelitisNeedle aspiration of infected bone or bone biopsy (obtained in operating room)most direct and accurate means of diagnosis // MRI is generally the most effective imaging study for diagnosing osteomyelitis and assessing the extent of disease process
Acute Infectious ArthritisPerform a joint aspiration ("tap") and analysis of synovial fluid in all patients suspected of having a septic joint // WBC count with differential-usually >50,000 WBCs/mm3 with >80% PMNs-the most helpful test
Gonococcal ArthritisPCR of synovial fluid because Gram stain and cultures are usually negative
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COMMON BUGS IN OSTEOMYELITIS

Question Answer
Catheter septicemias.aureus
Prosthetic jointcoagulase-negative staphylococci
Diabetic foot ulcerPolymicrobial organisms
Nosocomial infectionsPseudomonas spp.
IV drug abuse, neutropeniafungal species, Pseudomonas spp
Sickle cell diseaseSalmonella spp.
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TREATMENT OF INFECTIONS OF BONE AND JOINTS

Question Answer
OsteomyelitisGive IV antibiotics for extended periods (4 to 6 weeks) once organism is identified // Empiric therapy requires penicillinase-resistant penicillin (e.g., oxacillin) or a first-generation cephalosporin (e.g., cefazolin) //Add an aminoglycoside and possibly a ,8-lactam antibiotic if there is a possibility of infection with a gram-negative organism.
Acute Infectious ArthritisPrompt antibiotic treatment // Certain joints are amenable to arthroscopic drainage (shoulder, knee) whereas others are not (hip, wrist, elbow, ankle) and should be opened.
Gonococcal ArthritisAfter the joint is initially aspirated, repeated aspiration is unnecessary !unlike in other causes of septic arthritis). and antibiotics alone usually lead to improvement and antibiotics alone usually lead to improvement. Treat presumptively for chlamydia infection (eg., with doxycycline).
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