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Infection
Is a condition in which pathogenic
organism multiply and spread
within the body tissues
Directly
Indirectly
type of invader
the site of infection
the host response
Acute Pyogenic
Infection
Sub-acute Phase
Chronic
Pus
(defunct leucocytes, dead bacteria
tissue debris)
Granulomatous
Reaction
Granuloma
(lymphocyte, macrophage
giant cell)
Host susceptibility
Local Factor:
Trauma
Poor circulation
Sensiblity
Foreign body (+)
Chronic bone or
joint disease
Systemic factor
Malnutrition
Diabetes
Imunitas
Debility
Common in children
Adults with special condition
diabetes, immunocompromised, malnutrition, drug user
Post-traumatic event
haematomes, fluid collection
Gram +
Gram -
Staphylococcus Aureus
Haemophylus Influenza
Streptococcus Pyogenes
E. Coli
Streptococcus Pneumonia
Pseudomonas Aerogenosa
Proteus Miriabilis
Bacteroides Fragilis
Characteristic Pattern
Inflammation
Suppuration
Necrosis
New Bone Formation
Resolution or
Intractable chronicity
Inflammation
Vascular congestion
exudation of fluid
leucocyte infiltration
intra-osseus pressure
PAIN
Suppuration
Suppuration
Necrosis
intra-osseus pressure
Periosteal Stripping
due to pus
Bone death
sequestra
Stripped periosteum
Involucrum
Enclose the infected bone
& sequestra
Patogenesis (4)
Setelah 1 minggu terjadi nekrosis tulang
Sequester.
Setelah 2 minggu terbentuk tulang baru
dari periosteum yang terangkat
involucrum.
Pus mencari jalan keluar membuat lubang
yang disebut cloaca/fistel
Resolution or
Intractable Chronicity
Healing
Remodelling
Clinical Features
Look
Feel
Swelling
Pain
Hyperaemia
Febris
Pus discharge
Fluctuation
Lymphadenopati
Tachicardia
History of infection
Tenderness
Move
Diagnostic Imaging
Diagnostic
Imaging
X-Rays
No abnormalities
Displacement
Combination
fat plane
Patchy
rarefication
Extra cortical outline
Osteoporotic
Haematoma Periosteal new bone
metaphysis
Inc. dense
swelling
1-2 days
10-14 days
>21 days
Diagnostic
Imaging
Diagnostic
Imaging
USG
Radioscintigraphy
99mTc-HDP
67Ga-citrate or 111 ln
MRI & CT
Sensitive
Differentiate
Soft tissue infection & Osteomyeliti
Diagnostic
Imaging
Diagnostic
Imaging
Laboratory
Differential Diagnose
Cellulitis
Streptococcal Necrotizing Myositis
Acute Suppurative Arthritis
Acute Rheumatism
Treatment
Treatment Principles
Treatment
Supportive Treatment
Splintage
Antibiotic Therapy
Surgical Drainage
Treatment
Supportive Treatment
Analgesic
Dehydration
Treatment
Antibiotic Therapy
the prompt administration
of antibiotics is so vital, that treatment
should not await the result
Treatment
Antibiotic Therapy
I.V
(1-2 weeks)
Adults
Staphylococcal
Oral
Children
(3-6 weeks)
I.V
Cephalosporin
(cefuroxime / cefotaxime)
Oral
Amoxyclav
Haemophylus
Treatment
Surgical Drainage
if the clinical features do not
improve within 36 hours of starting treatment, or
even
before that if there are signs of deep pus (swelling,
oedema, fluctuation), and most certainly if pus is
aspirated,
the abscess should be drained by open operation
generalintramedullary
anaesthesiaabscess
if there under
is an extensive
drainage can be better achieved
by cutting a small window in the cortex
Complication
Metastatic Infection
Suppurative Arthritis
Altered Bone Growth
Chronic Osteomyelitis
Sub-Acute Haematogenous
Osteomyelitis
presumably due to
the organism being less virulent or
the patient more resistant (or both)
Clinical Features
Pain near one of the larger joints
for several weeks or even months
May have a limp and often there is
slight swelling, muscle wasting and local
tenderness.
The temperature is usually normal and there is little
to
suggest an infection.
Imaging
The typical radiographic lesion is a circumscribed,
round or oval cavity 1-2 cm in diameter,
most often it is seen
in the tibial or femoral metaphysis
abscess
The radioisotope scan shows
markedly increased activity
If fluid is encountered,
it should be sent for bacteriological culture
Treatment
Conservative
immobilization and antibiotics
(flucloxacillin and fusidic acid) for 6
weeks usually result in healing
Chronic Osteomyelitis
Chronic Osteomyelitis
dreaded sequel to
unresolved acute haematogenous
osteomyelitis
Chronic Osteomyelitis
Sequestra
Pus
Vascular Tissue
Sclerotic Area
Chronic Osteomyelitis
Clinical Features
The patient presents because
pain, pyrexia, redness and
tenderness have recurred
(a 'flare')
or with a discharging sinus
Chronic Osteomyelitis
Laboratory
During acute flares
the ESR and blood white cell count
may be increased, these non-specific signs are
helpful
in assessing the progress of bone infection
but they are not diagnostic
Antistaphylococcal antibody titres may be
elevated
a valuable sign in the diagnosis of hidden
infections and in tracking progress to recovery
Chronic Osteomyelitis
Treatment
Antibiotics
Chronic Osteomyelitis
Treatment
Local Treatment
Sinus dressing
Colostomy paste
Incission & Drainage for acute abcess
Chronic Osteomyelitis
Treatment
Significant symptoms
Clear evidence of a sequestrum
or dead bone
All infected soft tissue and
all dead or devitalized bone
Operation
Excised
Chronic Osteomyelitis
Treatment
Chronic Osteomyelitis
Treatment
Papineau Technique
Fill completely the dead space left after excision of necrotic
tissue with
living or potentially living material
Cancellous bone graft
(autogenous)
Antobiotic
Muscle-flap transfer
+
Fibrin sealant
Split skin graft
Common in adults
Early
Intermediate
Late
Post Operative
Osteomyelitis
Antobiotics Treatment
Septic arthritis
Septic arthritis; terjadi akibat osteomielitis
pada tulang metaphysis yang terletak intra
capsular
Septic arthritis juga terjadi akibat inokulasi
bakteri langsung ke dalam sendi ,
misalnya trauma tembus ke dalam sendi
atau infeksi menembus jaringan lempeng
epiphysis
Septic arthritis
Septic arthritis
Infeksi bakteri yang menyerang jaringan
synovium dan ruang / kapsul sendi yang
mengakibatkan berkumpulnya reaksi selsel PMN dan ilepaskannya enzym
proteolitik
Infeksi sendi
Septic arthritis
Septic bursitis
Infeksi pada pasien pasca total Hip / knee
replacement
Faktor predisposisi
Riwayat aspirasi
sendi / injeksi
Gangguan /
insufisiensi vascular
Riwayat infeksi sendi
sebelumnya
Sendi predileksi
Lutut 53%
Hip 20%
Bahu 11 %
Siku 17%
Wrist 9 %
Ankle 8 %
Kuman penyebab
Staphylococcus aureus
Strepticoccus sp
Gram negatif
Pnoumococcus
Kuman penyebab
Anak di bawah 2 th :
Haemophylus influensa
Tes diagnostik
Lab :
Leukosit
LED > 20
Kultur darah
(+)35 %
Pemeriksaan radiologi
Soft tissue : bengkak
Effusi cairan sensi
CT scan
Bone scan Tc 99
Prinsip terapi
Menghambat multiplikasi kuman dg
antibiotik
Drainage abses superiosteal ( bila sudah
terbentuk )
Penatalaksanaan
Kultur resistensi
Antibiotik intra vena : 2- 4 minggu
Operasi drainage
Tuberculosis
(Tuberculosis Osteomyelitis)
Bakteri : Micobacterium Tuberculosa
Humanus droplet infection paru-paru
Bovinus susu usus (jarang)
Pathology
Focus primer komplex primer (lesi paru +
KGB sekitar) bakteri bisa dorman di KGB
bertahun-tahun.
Penyebaran Sekunder
Bila daya tahan tubuh rendah TBC milier di
paru2/meningitis.
Gejala Klinis
Pembengkakan dan nyeri sendi
terdapat gangguan gerak.
Berat badan menurun.
Night cry.
Spondilitis TBC
Umumnya daerah
thoracolumbal.
Penyebaran melalui
Batsons Plexus dari vena
paravertebral.
Gejala Klinis
Anamnesa
Pembuluh darah : BSE
meningkat, differential
count, PCR TBC.
X-ray
MRI
Therapy
Anti TBC 2 R7H7E7
10 R2H2
Open operation fusi dengan / tanpa
instrumen.
Komplikasi
Potts paraplegia
Oleh karena :
1. Tekanan extra dural
(pus, squester)
2. Penyebaran langsung
ke spinal cord