LO WEEK 5 MSK

1. Types and clinical feature of musculoskeletal infections

Types of Bone Infection
Infection has several stages, from mild to severe.
 Mild infection does not weaken the structural integrity of the bone and allows safe use of the
bone for weight bearing.
 Severe infection eats away at the structural integrity of the bone. When the bone loses its
structural integrity, it cannot support weight and will likely break. This can be extremely painful.

Osteomyelitis, septic arthritis, pyomyositis, and necrotizing fasciitis.

2. Pyogenic and granulomatous osteomyelitis

 Bacterial Osteomyelitis
Acute Hematogenous Osteomyelitis
Posttraumatic Osteomyelitis
 Fungal Osteomyelitis
Coccidiomycosis
Blastomycosis
Histoplasmosis
Pathogenic Actinomycetes

Demographics and clinical presentation

Osteomyelitis can occur at any age. In those without specific risk factors, it is particularly common between the
ages of 2-12 years of age and is more common in males (M:F of 3:1) 6.

Pathology and microbiology

In most instances, osteomyelitis results from haematogenous spread, although direct extension from trauma
and/or ulcers is also relatively common (especially in the feet of diabetic patients).

In the initial stages of infection, bacteria multiply setting up a localised inflammatory reaction and resulting in
localised cell death. With time, the infection becomes demarcated by a rim of granulation tissue and new bone
deposition.

Although no organisms are recovered in up to 50% of cases 1, when one is isolated Staphylococcus aureus is by far
the most common agent. Different organisms are more common in specific clinical scenarios 1,4:

 Staphylococcus aureus: 80-90% of all infections

 Escherichia coli: IVDU (intravenous drug users) and genitourinary tract infection
 Pseudomonas spp: IVDU and genitourinary tract infection
 Klebsiella spp: IVDU and genitourinary tract infection
 Salmonella spp: sickle cell disease
 Haemophilus influenzae: neonates
 group B streptococci: neonates
Location
The location of osteomyelitis within a bone varies with age, on account of changing blood supply 1,4:

 neonates: metaphysis and/or epiphysis

 children: metaphysis
 adults: epiphyses and subchondral regions
Variants
 emphysematous osteomyelitis

Radiographic features
In some instances, radiographic features are specific to a region or a particular type of infection, for example:

 subperiosteal abscess
 Brodie's abscess
 Pott's puffy tumour
 sclerosing osteomyelitis of Garré
Below are general features of osteomyelitis.

Treatment and prognosis

Treatment is typically with intravenous antibiotics, usually for extended periods. If a
collection, sequestrum or involucrum is present then drainage and/or surgical debridement is often necessary.

Complications include 1:

 sinus track formation with occasional superimposed squamous cell carcinoma (Marjolin ulcer)
 secondary sarcoma (e.g. osteosarcoma): rare
 pathological fracture
 secondary amyloidosis

Differential diagnosis
General imaging differential considerations include:

 Charcot joint
 metastases
 primary bone neoplasm
o Ewing sarcoma
o osteosarcoma
o lymphoma
o multiple myeloma
  Langerhans cell histocytosis (LCH)

3. pathogenesis and treatment MSK infections

4. Common causative organism in bone and joint infection

Infections are usually caused by bacteria that are present in our normal living environment. The
most common bacteria causing bone, joint, or muscle infections in children is Staphylococcus
aureus (often referred to as "Staph" infections).

Bacteria can get into the body in a variety of ways. They circulate through the bloodstream until
they reach a bone, joint, or muscle. Bacteria then leave the bloodstream and multiply in the
bone, joint, or muscle tissues.

Causes

The harmful bacteria that cause bacterial joint inflammation can enter your body via the skin,
eyes, ears, mouth, nose, and mucous membranes. Some of the types of bacteria responsible for
causing this infection include:

 Staphylococcus aureus, which causes staph infections

 Streptococcus, which causes strep throat
 Streptococcus pneumonia, which causes pneumonia
 Neisseria gonorrhoeae, which causes gonorrhea
 Mycobacterium tuberculosis, which causes tuberculosis
 Borrelia burgdorferi, which causes Lyme disease

5. Clinical symptoms of MSK infection

Symptoms

Symptoms of bacterial joint inflammation vary depending on the type of bacteria. General
symptoms of bacterial joint inflammation occur rapidly and may include:

 elevated body temperature

 pain in a joint
 swelling and redness
 warm skin over the joint
 lack of appetite
 fatigue
 elevated heart rate
Children most commonly experience bacterial joint inflammation in their hips and shoulders.
Adults tend to notice joint pain in their arms and legs, particularly the knees. The back, head, and
neck can also be affected, but these are less common.

6. Principle of antimicrobial in MSK infection

Treatment

As soon as the bacterium causing the infection is identified, your doctor will prescribe an
antibiotic. Initially, antibiotics might be provided intravenously so that the medication is released
directly into your bloodstream. Your physician may follow up by giving you an oral antibiotic.
Antibiotic treatment might take two to six weeks depending on the type of bacterial infection and
your overall medical condition.

Your physician might drain the fluid around the joint. This helps to reduce pressure and
eliminate harmful bacteria. Arthroscopy is a common procedure for this, It involves using tubes
for fluid draining and suctioning. Arthrocentesis, a procedure in which a needle penetrates the
joint area, is another procedure to eliminate fluid.

Other treatments involve taking over-the-counter or prescribed anti-inflammatory medications to

reduce any swelling and discomfort. Resting the affected area, elevating the joint, and applying
warm or cold compresses might also help ease the pain and inflammation. Follow your
healthcare provider’s instructions for exercising or moving the joint. If movement is
recommended, rotating or moving the joint can prevent stiffness and weakness and help promote
blood flow for healing. Physical therapy or other rehabilitation services may be required to aid in
recovery.