Professional Documents
Culture Documents
Winoto, SpOT
General aspect of infection
• Infection
– A condition in which pathogenic organisms
multiply and spread within the body tissue
• Port de entry
– Direct (wound)
– Indirect (blood, urinary tract, etc)
General aspect of infection
• Classic sign
– Redness
– Swelling
– Heat
– Loss of function
General aspect of infection
• Acute pyogenic infection
– Pus
– Abscess
– spread
• Chronic infection
– Granulation tissue
– Lymphadenopathy
– Splenomegali
– Tissue wasting
OSTEOMYELITIS
• Acute/chronic inflammatory
process of the bone and its
structures secondary to
infection with pyogenic
organisms.
OSTEOMYELITIS
Cause :
– Intense pain
– Obstructive to blood flow
– Intravascular thrombosis
Impending ischemia
Suppuration ( second or third day )
• Pus form within the bone
subperiosteal abscess
Septicemia
• Clinical.
• Laboratory.
• Radiological.
Clinical feature
• In children
– Fever, malaise, severe pain
– Pulse rate > 100
– lymphadenopathy
– Look : redness, swelling
– Feel : tenderness, warm
– Rom : restricted because of pain
Clinical feature
• In infant
– Simply fail to thrive, drowsy but irritable
– History of birth dificulty, umbillical catheter,
inflamed iv infusion
– Metaphyse tenderhess, rom restrict
Clinical feature
• In adult
– Commonest site of infection is the thoracolumbar
spine
– History of urology procedure followed by mild
fever, backache
– Background of immunodeficiency illness
Source of Infection
• AHO : slight trauma, mild bacteriaemia
• Source : tonsils, middle ear,lungs,intestine canal,
U.G. Tract, boil,excoriasis, small wound
• Strongly predispose in certain fevers :
– smallpox, malaria, scarlet fever, measles, diphtheria,
influenza(lessen the resistance of bone marrow,favour
the development pyogenic organisms)
• Typhoid fever – followed by chronic osteomyelitis
or acute osteomyelitis if pyogenic infection
superadded
Salmonela osteomyelitis with spread from metaphysis to diaphysis
RADIOGRAPHY
• First is suggested by overlying
soft-tissue edema at 3-5 days
after infection.
• Bony changes are not evident for
14-21 days and initially manifest
as periosteal elevation followed
by cortical or medullary
lucencies.
Diagnostic imaging (X-ray)
• 1st day plain x-ray show no abnormality
• End of 2nd week there may extra-cortical
outline ( periostal new bone formation)
• Periostal thickening
• Combination regional osteoporotic with
segment increase density
Diagnostic imaging (ultrasound)
• Subperiostal collection of fluid in early stage,
but it can’t distinguish between haematoma
and pus
Diagnostic imaging (radioscintigraph)
• with 99mTc-HDP
• Highly sensitive investigation
Diagnostic imaging (MRI)
• Extremely sensitive
• Can differentiate
between soft tissue
infection and
osteomyelitis
Laboratory finding
• The most certain way to confirm the clinical
diagnostis is to aspirate the pus from the
metaphyseal subperiostal abscess or adjacent
join
Laboratory findinng
• Pus : gram stain, bacteriology exam, antibiotic
sensitivity
• White cell count
• Crp, esr
• Blood culture
LABORATORY
• The WBC count may be elevated, but it
frequently is normal.
• The C-reactive protein level usually is
elevated and nonspecific; it may be more
useful than the erythrocyte sedimentation
rate.
• The erythrocyte sedimentation rate usually
is elevated (90%); this finding is clinically
nonspecific.
LABORATORY
• Culture or aspiration findings: normal in 25%
of cases.
• Blood culture results are positive in only 50%
of patients with hematogenous osteomyelitis.
DIFFERENTIAL DIAGNOSIS
• Cellulitis
• Streptococcal Necrotizing Myositis
• Acute suppurative
• Acute Rheumatism
• Sickle-cell crisis
• Gaucher Disease
TREATMENT
4 ASPECTS:
1. Supportive treatment for pain
and dehidration
2. Splintage of the affected part
3. Antibotic therapy
4. Surgical drainage
TREATMENT
• Kultur + Sensitivity Test
• The primary treatment :
Bakterisidal, Parenteral, Dosis tinggi
Distraction of radius
Better Function ADL
Treatment:
• Antibiotic.
• Local treatment.
• Surgery.
• Eradication of infection is difficult.
• Complications associated with infection and
treatment are frequent.
Antibiotic:
• Antibiotic treatment should begin as soon as
blood, synovial fluid, and appropriate culture
materials have been obtained.
• Neonate: empiric therapy: oxacllin in
combination with gentamicyn or cefotaxime.
• In child < 4 years: oxacillin and cefotaxime or
cefuroxime.
• Child > 4 years: Oxacillin.
• Immunocompromised: Oxacillin.
Surgery:
• Once diagnosis is made, the treatment of
Chronis osteomyelitis is often required of
surgery.
• Complete removal of all infected /
devascularized tissue.
• The timing of surgical intervention is
controversial.
Complicatoins:
• Pathologic fracture.
• Septic arthritis with joint destruction.
• Physeal damage.
• Non union or segmental bone loss.
• Leg length discrepancy.
• Malignant transformation (< 1%)
50 yr old woman Chronic Debridement External
osteomyelitis fixation fibular bone graft
Osteomyelitis – Tx conservative Antibiotic
SEPTIC ARTHRITIS (SA)
• Septic Arthritis (SA) requires urgent
treatment.
• The duration of symptoms prior to treatment
is the most important prognostic factor for
outcome.
“Once osteomyelitis, osteomyelitis forever”
THANK YOU!!!