Download Osteomyelitis

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