1 / 67

chronic specific bone infection

jana
Download Presentation

chronic specific bone infection

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. CHRONIC SPECIFIC BONE INFECTION DR.MARWAN ZAMZAMI,ABOS

    2. CHRONIC SPECIFIC BONE INFECTION TUBERCULOSIS BRUCELLOSIS FUNGAL SYPHILIS

    3. TUBERCULOSIS THE BASIC MICROSCOPIC LESION; THE TUBERCLE FIRST DISCOVERED BY THE FRENCH PHYSICIAN LAENNEC (1781-1826) WHO DIED AT THE AGE OF 45 BY TB

    4. TUBERCULOSIS ESTIMATED 30 MILLION TB PATIENTS WORLD WIDE. 1 -3 % (300 000 1000 000) HAVE SKELETAL INVOLVEMENT

    5. TUBERCULOSIS OF BONES AND JOINTS TB Bacilli lived in symbiosis with mankind since time immemorial. Recorded in ancient Egyptian mummies Still common in developing countries

    6. REDUCED INCIDENCE OF TB DUE TO: IMPROVED LIVING STANDARDS; SANITATION, HYGIENE, NUTRITION B.C.G. VACCINE (80% PROTECTION)

    7. TUBERCULOSIS BACILLI

    8. TUBERCULOSIS

    10. BLOOD SUPPLY AND STAGNATION LOCAL TRAUMA; HAEMATOMA? LOCAL STEROIDS ?

    11. TB PATHOLOGY Secondary to other primary TB lesions (Pulm., GL, Renal, LN) Route of spread: HAEMATOGENOUS **** DIRECT (much less) * bone to joint * soft tissue to bone THE PRIMARY LESION QUIESCENT ACTIVE: (Apparent, Latent)

    12. TB PATHOLOGY INFLAMMATION HYPEREMIA - OSTEOPENIA TB FOLLICLES (TUBERCLE): LYPHOCYTE MONOCYTES ENDOTHELIAL CELLS LANGHANS GIANT CELLS COALESCE CASEATION LATER GRANULATION TISSUE BONE DISTRUCTION SINUSES

    13. TB Follicle

    14. TB PATHOLOGY (JOINTS) SYNOVIAL SWELLING GRANULATION TISSUE PERIPHERAL ARTICULAR DESTRUCTION NO PROTEOLYTIC ENZYMES CENTRAL ARTICULAR WEIGHT-BEARING AREA PRESERVED RICE BODIES FIBRIN & ARTICULAR CARTILAGE INCREASED BLOOD SUPPLY OSTEOPENIA

    16. CLINICAL PICTURE AGE INSIDIOUS ONSET MONO ARTICULAR OTHER LESIONS FAMILY HISTORY CONTACT GROUPS AT RISK

    17. SYMPTOMS & SIGNS CONSTITUTIONAL LOW GRADE FEVER ANOREXIA WEIGHT LOSS NIGHT SWEATING TACHYCARDIA ANEMIA

    18. SYMPTOMS & SIGNSLOCAL Symptoms : PAIN NIGHT CRIES SWELLING STIFFNESS ULTERED FUNCTION Signs : WASTING SYNOVIAL SWELLING TENDERNESS WARM STIFFNESS LIMPING

    19. INVESTIGATIONS LEUCOPENIA LYMPHOCYTOSIS ANEMIA RAISED ESR MANTOUX POSITIVE NOT IN: MILIARY TB / RECENTLY VACCINATED/ ON STEROIDS / REDUCED IMMUNITY / FEVER

    20. RADIOLOGY CHEST X-RAY : ALL PATIENTS JOINTS: PHEMISTERS TRIAD: 1. PERIARTIC. OSTEOPENIA 2. REDUCED JOINT SPACE 3. PERIPH. OSSEOUS EROSIONS BONES: 1. DESTRUCTION 2. SEQUESTRATION 3. ABSCESS FORMATION

    21. RADIOLOGY BONE SCAN: MONO ARTICULAR CF: RHEUMATOID ARTHRITIS CALLIUM SCAN INFECTION CT SCAN MORPHOLOGY MRI MORPHOLOGY

    34. DIAGNOSTIC ASPIRATION: AFB POSITIVE HISTOLOGICAL CULTURE

    36. TB SPINE (POTTS DISEASE)PERCIVAL POTT 1779 SECONDARY TO OTHER PRIMARY HEMATOLOGICAL 20% OTHER VISCERA 12% OTHER BONES/JOINTS TWO ADJACENT VERTEBRAE SOMETIMES MORE THAN ONE SKIP LESIONS IN 7%

    37. TB SPINESURGICAL PATHOLOGY FIRST THREE DECADES THORACO-LUMBAR CENTRAL SPINE SPARKS POSTERIOR ELEMENTS SPREADEDS UP/DOWN ANT./POST. LONG. LIGS. LESIONS COALESCE COLLAPSE KYPHUS FORMATION

    38. TB SPINESURGICAL PATHOLOGY PARA VERTEBRAL ABSCESS CERVICAL : RETROPHARALYGEAL THORACIC : P.V. & ALONG RIBS LUMBAR : PSOAS ABSCESS POSTERIOR:LUMBAR TRIANGLE ANTERIOR: ILIAC FOSSA BELOW ING. LIG. NEUROLOGICAL COMPLICATION MORE IN THORACIC (NARROWEST CANAL)

    40. TB SPINECLINICAL FEATURES GENERAL: INSIDIOUS ONSET CONSTITUTIONAL LOCAL: PAIN FIRST INDICATION LOCAL REFERRED STIFFNESS SPASM WEAKNESS NEUROLOGICAL

    41. SIGNS OF TB SPINE MUSCLE SPASM KHPHUS GIBBOUS TENDERNESS STIFFNESS PARA VERTEBRAL ABSCESS NEUROLOGICAL WEAKNESS PARAPLEGIA

    43. TB SPINERADIOLOGICAL FEATURES DISC NOT INVOLVED PRIMARILY NARROWING OF DISC SPACE BONE DESTRUCTION USUALLY TWO ADJACENT VERTEBRAE MAY SHOW SKIP LESIONS PARA VERTEBRAL ABSCESS KHYPUS CT/MYELOGRAM/MRI IN PARAPLEGIA

    57. PARAPLEGIA IN TB SPINE IN 10-30% OF TB SPINE MORE IN THORACIC REGION PRESSURE ON CORD ANTERO LATERAL MOTOR EARLIER THAN SENSORY SIGNS: UPPER MOTOR NEURON MAY START BY CORD SHOCK REMARKABLE ABILITY TO RECOVER

    58. PARAPLEGIA IN TB SPINECAUSED BY EXTRADURAL PRESSURE GRANULATION TISSUE PRESSURE OF ABSCESS & CASEATON SEQUESTRUM PATHOLOGICAL FRACTURE/DISLOC. SEVERE KYPHUS INFLAMMATION: TOXIC EDEMA VASCULAR

    59. MANAGEMENT OF TB SPINE USUALLY CONSERVATIVE GENERAL SPECIFIC REST IMMOBILISE CHEMOTHERAPY SURGICAL DIAGNOSE ASPIRATION DRAIN ABSCESS DEBRIDE DECOMPRESS ANTERIOR ANTERO-LATERAL STABILISE FUSION

    60. MOST CASES OF TB SPINE RESPOND VERY WELL TO CONSERVATIVE TREATMENT INCLUDING THOSE WITH PARAPLEGIA THE NEED FOR SURGICAL DECOMPRESSION OF THE CORD IS LIMITED

    61. BRUCELLOSIS MILK AND MILK PRODUCTS BACK PAIN AND STIFFNESS MUSCLE SPASM FEVER MILD SACRO-ILIAC JOINT LESS DESTRUCTIVE OF TB BRUCELLA TITRE ANTIBIOTICS e.g. SEPTRIN - OXYTETRACYCLINE

    62. SYPHILIS SPIROCHETE TREPONEMA PALLIDUM CONGENITAL SYPHILIS COMMONEST CHRONIC OSTEOCHONDRITIS PERIOSTEITIS OSTEITIS TIBIA LESABRE TIBIA

    63. FUNGAL INFECTION CHRONIC VERY LOW GRADE FEET FARMERS THORNS Madura Foot SLOW DESTRUCTION SINUSES GRANULES SECONDARY BACTERIAL INFECTION RESISTANT TO CHEMOTHERAPY NEEDS SURGICAL DEBRIDEMENT IF ADVANCED MAY NEED AMPUTATION

More Related