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OSTEOMYELITIS & MYCETOMA OSTEOMYELITIS & MYCETOMA

OSTEOMYELITIS & MYCETOMA - PowerPoint Presentation

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OSTEOMYELITIS & MYCETOMA - PPT Presentation

Dr Shashidhar M R Osteomyelitis Pyogenic Tubercular Mycetoma OSTEOMYELITIS Osteomyelitis Nelaton 1834 coined osteomyelitis The root words osteon bone and myelo ID: 780454

osteomyelitis bone metaphysis chronic bone osteomyelitis chronic metaphysis infection amp surrounded tissue involucrum blood response necrosis dead sequestrum abscess

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Slide1

OSTEOMYELITIS & MYCETOMA

Dr

Shashidhar

M R

Slide2

Slide3

Osteomyelitis

-

Pyogenic

, Tubercular

Mycetoma

Slide4

OSTEOMYELITIS

Slide5

Osteomyelitis

Nelaton

(1834) : coined

osteomyelitis

The root words

osteon

(bone)

and myelo (marrow) are combined with itis (inflammation) to define the clinical state in which bone is infected with microorganisms.

Slide6

TYPES

Pyogenic

Tubercular

Chronic Non Specific

Slide7

PYOGENIC OSTEOMYELITIS

Causative agents-

Staphylococcus

aureus

- MC

Neonates :H

influenzae

Streptococci in childrenSickle cell anemia: salmonellaE.Coli :GU infections

Slide8

Why

staphylococcus

most common?

S.aureus

-----

normal skin flora

S.aureus

-----increased affinity for host proteins (traumatised bone)Enzymes (coagulase, surface factor A) ----- hosts immune response .

Biofilm

(polysaccharide “slime” layer) ---- increases bacterial adherence to any substrate .

Large variety of adhesive proteins and

glycoproteins

----- mediate binding with bone components.

Slide9

Pathogenesis:

Direct inoculation

of microorganisms into

bone

penetrating injuries and surgical contamination are most common

causes

Hematogenous

spread

usually involves

the

metaphysis

of long bones in children or the vertebral bodies in

adults

Osteomyelitis

Microorganisms in bone

Contiguous

focus of

infection seen

in patients with severe vascular disease

.

Slide10

Morphology

Three stages-

Acute

Subacute

Chronic

Acute- acute inflammation and necrosis of the bone. Dead bone -

Sequestrum

Slide11

Metaphysis

– infection spreads to

subperiosteum

- segmental bone necrosis-

subperiosteal

abscesses- sinus tracts- discharge dead bone.

If crosses the epiphysis, may involve the joint.

Chronic-

Healing – osteoclasts resorb the bone, chronic inflammatory infiltrate, fibroblasts proliferate in the periphery. New bone formation from the periphery Central dead bone with surrounding new bone- involucrum

Slide12

Sites of infection

Metaphysis

and epiphysis in infants and adults

Metaphysis

in children

Slide13

Pathogenesis

Whatever may be the inciting cause the bacteria reaches the

metaphysis

of rapidly growing bone & provokes an

inflammatory

response

.

why metaphysis is involved

Infected embolus is trapped in U-shaped small end arteries located predominantly in

metaphyseal

region

Relative lack of

phagocytosis

activity in

metaphyseal

region

Highly vascularised region ---minor trauma—hemorrhage ----locus minoris

resistantae---excellent culture medium

Slide14

sharp hairpin turns

– flow becomes considerably slower and more turbulent

Slide15

PATHOLOGENESIS

These are end-artery branches of the nutrient artery

Obstruction

Avascular

necrosis of bone

tissue necrosis, breakdown of bone

acute inflammatory response due to infection

Squestra formation

Chronic

osteomyelitis

Slide16

Pathology:

Pathologic features of chronic

osteomyelitis

are :

The presence of

sclerotic, necrotic

piece of bone usually cortical

surrounded by radiolucent inflammatory

exudate and granulation tissue known as sequestrum.

Features:

Dead piece of bone

Pale

Inner smooth ,outer rough

Surrounded by infected granulation tissue trying

to eat it

Slide17

sequestrum

Involucrum

Slide18

Pathology:

The

involucrum

is the sheath of

reactive, new, immature

,

subperiosteal

bone that forms around the

sequestrum, effectively sealing it off the blood stream just like a wall of abscess. The involucrum is irregular and is often perforated by openings.

The

involucrum

may gradually increase in density and

thickness.

There is exudation of

polymorphonuclear

leukocytes joined by large numbers of lymphocytes,

histiocytes

, and occasionally plasma cells.

Slide19

local signs

calor

,

rubor

, dolor, tumor

Heat, red, pain or tenderness, swelling

Initially, the lesion is within the

medually cavity, there is no swelling, soft tissue is also normal.

The merely sign is

deep tenderness

.

Slide20

Clinic picture

It is important to remember that the

metaphysis

lies within the joint capsule of the hip, shoulder, ankle. Therefore these joints can develop

septic arthritis

by extension of

osteomyelitis

.

If the infection and septicemia proceeded unabated, the patient may have toxic shock syndrome. Sinuses

Slide21

Approach to diagnosis

The white blood cell count will show a marked

leucocytosis

as high as 20,000 or more

The blood culture demonstrates the presence of

bacteremia

, the blood must be taken when the patient has a chill, especially when there is a spiking temperature.

Radiology:

Lytic

focus of bone destruction surrounded by zone of sclerotic bone.

Slide22

Varients

Slide23

Brodie’s abcess

Bone abscess

containing

pus or jelly like granulation tissue surrounded by a zone of sclerosis

Age 11-20

yrs,

metaphyseal

area,

usually upper tibia or lower femurDeep boring pain, worse at night, relieved by restCircular or oval luscency surrounded by zone of sclerosis

Treatment:

Conservative

if no

doubt - rest + antibiotic

for 6 wks

.

if

no response

– surgical evacuation & curettage, if large cavity - packed with cancellous bone graft

Slide24

Garre

’ s

osteomyelitis

Sclerosing

,

nonsuppurative

Jaw (mandible)

No

abcess, cortical thickeningAcute local pain, pyrexia subside-fusiform swellingAcute stage-rest, antibioticsSx: Gutter holing, excision+curettage

Slide25

Complications of chronic

osteomyelitis

Pathologic fracture

Secondary

amyloidosis

Endocarditis

Sepsis

Squampous

cell carcinoma of the tractSarcoma

Slide26

TUBERCULOUS OSTEOMYELITIS

Blood borne

Extension from adjacent sites-ribs

Adolescents

Common sites-

Spine- thoracic and lumbar

Knees

Hips

Pott spine- erosion of the intervertrebral discs and involvement of multiple vertebrae, cold abscess-psoas abscess

Slide27

Microscopy :

tuberculous

granuloma

Clinical features :

Complications :

Spine :

scoliosis, kyphosis, cold & psoas abcsess Tuberculous arthritis Sinus tract formation Amyloidosis

Slide28

Slide29

MYCETOMA

Chronic

suppurative

infection

Actinomycosis

– bacterial form

Eumycetoma – fungal form

Slide30

Actinomycosis

Actinomycetes

israelii

Filamentous & anaerobic

Forms

Cervicofacial

- lumpy jaw, sinuses Thoracic Abdominal Pelvic

Slide31

Slide32

Microscopy

Slide33

Eumycetoma – Madura foot

Madurella

mycetomatis

or

Madurella

griesa

Gross- swelling, black granules from discharging sinuses

Slide34

Slide35

Thank you