Infection of Bones & Joints, A Review - Everything You Need To Know - Dr. Nabil Ebraheim скачать в хорошем качестве

Infection of Bones & Joints, A Review - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes infection of bone and joints - review. Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Infection of Bone & Joints This lecture is about musculoskeletal infections. A specific infection could have a specific infecting agent, a specific presentation, or a specific treatment. I am going to try to present the most common types of infections that probably has a specific thing about it. The majority of orthopedic surgical site infections (SSI) are caused by Staph Aureus. Chronic Paronychia. This is a fungal infection (Candida albicans). It involves an infection of the nail fold. It is common in diabetics. It does not respond to antibiotics. It occurs in people who work with water such as bartenders or dishwashers. There is really no abscess, but the area around the nail is red, tender, and swollen. It can affect multiple fingers. It should be treated with topical antifungals such as miconazole. In severe resistant cases, marsupialization should be done. Herpetic Whitlow occurs from the herpes simplex virus. It is a self-limited disease. It is seen in dentists, respiratory therapists, or anesthesiologists, and it can also affect toddlers. It affects some vesicles on the finger, and it will have inflammation or redness at the base of the vesicle. There is clear fluid in the vesicle, and the gram stain will be negative. You should use the Tzanck test, and the treatment is Aciclovir. Surgery is not needed. Sickle Cell Disease can be associated with Salmonella Osteomyelitis. Pseudomonas Aeruginosa is commonly associated with foot punctures in children and IV drug abusers. Pseudomonas Aeruginosa infection is responsible for the majority of the osteomyelitis following nail puncture through shoes. Pseudomonas is the most characteristic cause of this infection. Treatment is incision and drainage (I&D). You must remove the foreign bodies inside and give the patient antibiotics. With chronic osteomyelitis and draining sinus for years, rule out squamous cell carcinoma. With a diabetic patient with draining sinus for several months, you don’t know if it is a Charcot joint or if it is an osteomyelitis (the look alike on x-ray), the MRI will not be helpful. These patients have plantar ulcer of the forefoot. You need to probe the ulcer, and if the probe goes down to the bone, it is probably osteomyelitis, and this will require debridement. Fungal infections occur in sick, malnourished old people with chronic illness. They can also occur in people who are on IV antibiotics for a long time and may be getting parenteral nutrition (PN). Erysipelas is caused by Group A Beta Hemolytic Streptococcus. It affects the superficial layers of the skin. It has geographic demarcation or distribution over the extremity or over the face. Treatment is antibiotics. Necrotizing Fasciitis is polymicrobial, but there is a Group A Streptococcus involved. It is a rapidly progressive infection which affects the fascia early, and then the toxins liquefy the tissues underneath. The edema and pain is more than what appears at the surface of the skin. It looks like cellulitis, but it is really not cellulitis. Underneath the fascia can be a really terrible infection which can involve all the tissues, including the muscles, without even having a smoking gun mark on the skin surface. The blisters and the bullae are late. If you are in doubt about the presence of cellulitis or necrotizing fasciitis, do a biopsy by doing an incision down to the fascia and see if the fascia is involved (if the fascia is involved, then you have a problem). If the fascia and the muscles are involved, then you have necrotizing fasciitis. Hepatitis C is an associated risk factor for necrotizing fasciitis, and the prognosis of these patients are worse. Treatment for necrotizing fasciitis is emergency aggressive debridement. The mortality rate is high, up to 25%, and it depends on early diagnosis (mortality improves by early diagnosis and treatment). Necrotizing fasciitis is then treated with antibiotics. Gas Gangrene occurs due to Clostridium perfringens (C. perfringens). It is an anaerobic gram-positive bacilli. It is almost like every bad infection is due to gram-positive bacteria Gas gangrene is treated by wide debridement and leaving the wound open. It is then treated with antibiotics. Penicillin G and clindamycin are usually given. There is a difference between Clostridium perfringens (C. perfringens) and Clostridium difficile. Clostrodium difficile causes C. Diff (clostridium difficile colitis). Clostridium Difficile Colitis can be caused by antibiotics, especially clindamycin. It is characterized by unexplained post-operative fever, leukocytosis, or watery diarrhea. C. diff is treated by oral Metronidazole (flagyl). Human bites can cause Eikenella Corrodens. Treatment is Augmentin. If the wound goes to a joint, you have to clean and debride the joint in the operating room.