VIRAL CAUSES OF ARTHRITIS

•Rubella
INFECTOUS ARTHRITIS - Women, with rash
CLINICAL FEATURES Acute: - Self limited, usually hands
•90% monoarticular - vaccine induces arthritis in 40% post pubertal women
•60-80% fever-usually mild •Hepatitis B
•Knee most common site, then hip - up to 20%, symmetric
•sternoclavicular-consider IVDA - early-resolves with onset jaundice
•Mumps
(IV drug addict) - onset with parotitis
•10% polyarticular-underlying RA •Parvovirus B19
- women, Erythema infectiosum
CLINICAL PRESENTATION - Late winter, spring
•JOINT EFFUSION - Arthropod borne
•JOINT CONTRACTURE - Lymphocytic choriomeningitis virus
FLEXION - severe flu-like ilness with headache
•PAINFUL MOTION •HTLV-I
•TEMP 39-40 Celcius •HIV
PATHOGENESIS • Usualy hematogenous
GONOCOCCAL ARTHRITIS • Predisposing factors
2 forms : -pre-existing arthritis
• Disseminated -trauma-interruption of capillary integrity
- fever,chills -systemic diseases-malignancy, DM, immunosuppressive therapy
- skin lesions-papules/ petechiae/ pustules LAB FINDINGS/ • elevated ESR
- polyarticular with bacteremia. DIAGNOSTIC TESTS • synovial fluid - turbid
- Organism in skin scrapings. (normal: clear)
- Negative synovial culture • ->50K WBC, 75%PMN's,
- low glucose-bacterial, also RA,
• Monoarticular crystaline disease (diff diagnosis)
- More like routine bacterial, suppurative infection
- positive synovial culture, may have preceding history like disseminated form •Bacteriology
-joint fluid gram stain + 1/3
ETIOLOGY BACTERIA -joint fluid culture + >90%
-blood culture + 10-60% (septicemia)
Most common Staphylococcus aureus -synovial tissue culture fungi mycobacteria (TB : ankle,bone,spine joint)
Adult <30 Gonococcal (Neisseria gonorrhea) - antibiotic testing
children H. influenzae TREATMENT Antibiotics
Salmonella
Neonate Streptococcus MSSA oxacillin(+ rifampin)
Elderly, DM Group B/ S. Agalactiae MRSA Vancomycin(+ rifampin)
Elderly, chronic, UTI Gram negative rod Enterococcus ampicillin/vancomycin, plus
IVDA (sternoclavicular joint) Pseudomonas aeruginosa aminoglycoside for significant part of
Human bite (oral) Streptococcus, time
Anaerobes Gram - (including GC & H Flu) ceftriaxone/ cefotaxime/ ciprofloxacin
Cat, dog bite Pasteurella Pseudomonas ceftazidime (or pipercillin) +
Rat bite Streptobacilus moniliformisl aminoglycoside/ quinolone
Intermittent, migratory Lyme (chronic),
polyarthritis, knee Gonococci (faster)
Chronic TB atypical mycobacteria, fungi-
spores, blasto,cocci,histo
P. Aeruginosa : Greenish pigments on nutrient agar, pungent smell
OSTEOMYELITIS RADIOLOGICAL INVESTIGATIONS

OSTEOMYELITIS • Bone scan

DEFINITION Bone infection usually caused by bacteria, including mycobacteria, but is sometimes
caused by fungi.
CLINICAL FEATURES Leg pain, fever
ETIOLOGY Bacteria or fungal spores may infect the bone directly through
- open fractures,
- during bone surgery, or
- from contaminated objects that pierce the bone.

Staphylococcus aureus is the bacteria most commonly responsible.

Mycobacterium tuberculosis (the main cause of tuberculosis) can infect the
• Bone x-ray
vertebrae to cause osteomyelitis.
- show changes characteristic of osteomyelitis, but sometimes not until more
PATHOPHYSIOLOGY • Hematogenous spread
than 3 weeks after the first symptoms occur.
The original site of infection is elsewhere in the body, and spreads to the bone by
• Computed tomography (CT)
the blood.
• MRI – abscess cavity
Children — distal femur, proximal tibia
Adults — axial skeleton

• Contiguous spread
• In association with vascular insufficiency

• History
- Presence of risk factors
- Symptoms of inflammation

• Physical examination
- Signs of inflammation
- Decreased range of motion
- Drainage, sinus tracts, ulceration
TREATMENT Antibiotics

MSSA oxacillin(+ rifampin)

DIAGNOSTIC TESTS LAB INVESTIGATIONS:
MRSA Vancomycin(+ rifampin)
Enterococcus ampicillin/vancomycin, plus
• Blood cultures : elevated levels of white blood cells.
aminoglycoside for significant part of
- these blood tests are not sufficient to diagnose osteomyelitis.
time
• C-reactive protein (CRP) = increased due to inflammation
Gram - (including GC & H Flu) ceftriaxone/ cefotaxime/ ciprofloxacin
- a protein that circulates in the blood
Pseudomonas ceftazidime (or pipercillin) +
• Erythrocyte sedimentation rate (ESR) = elevated
aminoglycoside/ quinolone
- measures the rate at which red blood cells settle to the bottom of a test
tube containing blood
• Bone biopsy (which is then cultured)
• Needle aspiration of the area around affected bones