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MSK > Microbiology > Flashcards

Microbiology Flashcards

1
Q

What is osteomyelitis?

A

Inflammation of the bone and medullary cavity, usually located in one of the long bones

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2
Q

How can osetomyelitis be classified?

A

Acute vs chronic
Contiguous vs haematogenous
Host status - presence of vascular insufficiency

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3
Q

What is an example of how the host status can change oestomyelitis?

A

Those with sickle cell are susceptible to salmonella ostemomyelitis

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4
Q

What is the gold standard for diagnosis of oesteomyelitis?

A

Bone biopsy
MRI
If you can see bone or tendon this is DEFINITELY osteomyelitis

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5
Q

When should antibiotics be prescribed for oestomyelitis?

A

AFTER CULTURES

NEVER EMPIRICAL unless septic or there is systemic upset

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6
Q

What are the hallmarks of inflammation?

A 
Color
Dolor
Tumor
Rubor
Function lasea
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7
Q

What risk factors predispose to osteomyelitis?

A 
Open fractures
Diabetes/ vascular insufficiency
Haematogenous osteomyelitis 
Vertebral osteomyelitis 
Prosthetic joint infection
Specific hosts and pathogens
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8
Q

When is osteomyelitis likely to occur?

A

Bone is highly resistant to infection and therefore, will only occur with necrosis +/- high inoculum

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9
Q

How long does an infection bone take to heal?

A

Debrided bone takes 6 weeks to be revascularised with soft tissue

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10
Q

How long should antibiotics be given for in osteomyelitis?

A

6 weeks

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11
Q

What bacterium is likely to affect prosthetic joints?

A

Staphylococcal coagulase negative - staphylococcal epidermidis

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12
Q

How are open fractures managed?

A

Aggressive debridement
Fixation
Soft tissue cover

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13
Q

What bacteria are likely to infect an open fracture?

A

Staphylococcus aureus and aerobic gram negative bacteria (pseudomonas, neisseria, e.coli, salmonella, kelbsiella, proteus, shigella)

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14
Q

What is the treatment for diabetic ulcers?

A

Surgical debridement and antimicrobial’s

Antibiotics CANNOT penetrate abscesses or necrotic tissue - these need surgical removal

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15
Q

What are the three markers you need to evaluate for the presence of osteomyelitis?

A

Chronic, indolent or deep ulcer
Positive probe-to-bone test
Elevated levels of inflammatory markers (CRP, PV)

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16
Q

What radiological investigations are best for osteomyelitis?

A

X-ray

Gold standard is MRI

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17
Q

What are appropriate cultures for osteomyelitis?

A

Per-cutaneous aspirate

Bone biopsy surgically

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18
Q

What is the definition of a mild diabetic foot ulcer?

A

2 or more: pus, erythema, pain, tender, warmth, in-duration
OR
Cellulitis <2cm confined to skin or subcutaneous

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19
Q

What is the treatment for a mild ulcer?

A

Flucloxacillin (oral)

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20
Q

What are the main bacterial causes for mild diabetic feet ulcers?

A

MSSA
MRSA
Streptococci

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21
Q

How long is treatment for feet ulcers?

A

7 days
10 days if severe
14 days IV if S.aureus bacteraemia

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22
Q

What are the main bacterial causes for moderate and severe diabetic feet ulcers?

A 
MSSA
MRSA
Streptococci
Enterobacteriacae
Obligate anaerobes
23
Q

How are moderate diabetic feet ulcers treated?

A

Flucloxacillin and metrondiazole (oral)

24
Q

How are severe diabetic feet ulcers treated?

A

Flucloxacillin
Metrondiazole
Gentamicin or aztreonam (IV)

25
Q

What is the alternative for penicillin allergic patients with a mild diabetic foot ulcer?

A

Doxycycline

Co-trimoxazole

26
Q

What is the alternative for penicillin allergic patients with a moderate diabetic foot ulcer?

A

Doxyxycline and metrondiazole

27
Q

What is the alternative for penicillin allergic patients with a severe diabetic foot ulcer?

A

Vancomycin
Gentamicin/ aztreonam
Metrondiazole

28
Q

Who is susceptible to haematogenous osteomyelitis?

A

Prepubertal children
PWID
Central lines/ dialysis
Elderly

29
Q

What is gaucher’s disease?

A

Lysosomal storage disorder that can mimic a bone crisis

Often affects tibia

30
Q

What can vertebral osteomyelitis be associated with?

A

Epidural abscess

Psoas abscess

31
Q

Who is susceptible to vertebral osteomyelitis?

A 
PWID
IV site infections
GU infections
STI
Post operative
32
Q

What are the clinical symptoms of osteomyelitis?

A 
50% fever
90% insidious pain and tenderness
15% neurological signs
90% raised inflammatory markers 
32% abnormal plain film
NEED to do MRI
33
Q

How is vertebral osteomyelitis treated?

A

Drain lare paravertebral abscesses
Antibiotics for 6 weeks
ONLY repeat MRI if: unexplained increase in inflammatory markers, increasing pain, new anatomical signs

34
Q

What is Potts disease?

A

Skeletal TB

Less than half have pulmonary TB

35
Q

What are risk factors for developing an infection in prosthetic joints?

A

RA
Diabetes
Malnutrition
Obesity

36
Q

What unusual organisms are likely in PWIF haematogenous osteomyelitis?

A 
Candidia = heroin
Eikenella = those who lick needles before injection
37
Q

What additional test should be done in those who present with TB?

A

HIV test

38
Q

What is the mechanism of prosthetic joint infection?

A

Direct inoculation at time of surgery
Manipulation of joint at time of surgery
Seeding of a joint at a later time

39
Q

What can PVL staph auerus cause?

A

Skin infections
Necrotising pneumonia
Bacteraemia
Septic arthritis

40
Q

What will sessile bacteria form?

A

A biofilm

41
Q

What are organisms that indicate a very bad infection?

A

Fungal is BAD

Mycobacteria is even WORSE

42
Q

How is prosthetic joint osteomyelitis diagnosed?

A

Culture perioperative tissue
Blood cultures
CRP
Radiology

43
Q

How is prosthetic joint osteomyelitis treated?

A

Remove prosthesis and cement
Therapy for 6 weeks
Re-implant device after aggressive antibiotic treatment

44
Q

How is staphylococcus epidermidis treated?

A

Vancomycin IV

45
Q

Where can septic arthritis originate from?

A

Direct invasion through a penetrating wound
Haematogenous spread
Spread from infectious focus (cellulitis abscess)
Spread from focus of osteomyelitis in adjacent bone

46
Q

How is septic arthritis diagnosed?

A

Severe pain, red, hot, swollen
Joint fluid - microscopy, C&S
Blood culture if pyrexial
Exclude crystals

47
Q

What viruses can cause viral arthritis?

A

Alphavirus
Hep B
Rubella virus
Parovirus B19

48
Q

What is pyomisitis?

A

Bacterial skeletal muscle infection which results in pus filled abscesses

49
Q

How is clostridium tetani classed?

A

Gram positive, strictly anaerobic spore forming bacillus

50
Q

What is the incubation period of tetanus?

A

4 days to several weeks

51
Q

What can tetanus infection cause?

A 
Spastic paralysis 
Trismus
Risus sardonicus
Dysphagia
Complete tetanic spasm
52
Q

How is tetanus treated?

A

Surgical debridement
Antitoxin
Supportive measures
Booster vaccination - toxoid

53
Q

What can cause myositis (inflammation of muscles)?

A

Viral - HIV, influenza, CMV, rabies, chikungunya
Protozoa
Fungal
Schistomsoma, taenia

MSK (34 decks)

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