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First Aid Step 3 Infectious Disease 2
Osteomyelitis, Septic Arthritis, AND Diverticulitis
19
Medical
Professional
12/25/2013

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Term
A 23 yo woman is diagnosed with osteomyelitis. She is an IV heroin user and has a past medical history that is significant for sickle cell anemia. While you are awaiting culture results, she needs to begin empiric antibiotic treatment. In addition to S aureus, what other organism is this patient at risk for?
Definition
IVDU makes her at risk for Pseudomonas
Sickle Cell increases risk for Salmonella
Term
How does osteomyelitis present?
Definition
pain with overlying erythema, edema, and tenderness. Pts also may have an overlying ulcer or skin interruption. Systemic symptoms include fevers, chills, and fatigue.
Term
How do you diagnose osteomyelitis?
Definition
Blood cultures and radiograph of the area. If imaging (-), but high suspicion, order MRI or bone scan.
Consider ESR and CRP.
Bone biopsy is definitive.
Term
How do you treat osteomyelitis?
Definition
unless patient is septic, delay antimicrobial therapy until micro specimen has been obtained through debridement.
Start with broad coverage antibiotics and treat for 4-6 weeks.
Term
What are the most common organisms in osteomyelitis?
Definition
General: S aureus
Sickle cell: Salmonella
IVDU: Pseudomonas
Term
What complications are there to osteomyelitis?
Definition
amputation, sepsis, and death
Term
What is septic arthritis?
Definition
Infection of a joint.
Term
What are the risk factors for septic arthritis?
Definition
Recent instrumentation of a joint, joint damage, gonococcal infection, and bacteremia.
Term
How does septic arthritis present?
Definition
Erythematous, warm, swollen, and painful joint wiht decreased range of motion. Gonococcal septic arthritis may present with multiple infected joints. Pts can have fever and chills.
Term
What is the DDx for septic arthritis?
Definition
Trauma, hemarthrosis, ostoarthritis, crystalline arthropathy, RA
Term
How do you diagnose septic arthritis?
Definition
Arthrocentesis with gram stain, culture, cell count/diff, and crystal analysis.
Blood culture.
Term
How do you treat septic arthritis?
Definition
Start broad coverage abx after specimen is obtained.
Surgical mgmt wiht washout and 4-6 weeks of directed antimicrobials is needed for mgmt.
Term
What are the complications of septic arthritis?
Definition
Joint destruction, sepsis, and death
Term
What is diverticulitis?
Definition
Inflammation and microperforations of the diverticula.
Term
How does diverticulitis present?
Definition
Fever, chills, nausea, vomiting, and abdominal pain, classically in the LLQ. Occasionally there may be a palpable mass in the LLQ.
Term
How do you diagnose diverticulitis?
Definition
CT scan.
Get CBC and blood cultures.
DO NOT SCOPE patient. HIGH RISK FOR PERF!
Term
What is the ddx for diverticulitis?
Definition
UC, Crohn's, perforating colon cancer.
Term
How do you treat diverticulitis?
Definition
Bowel rest and antimicrobial coverage of G- and anaerobic organisms (cipro and metro). If diverticular abscess is present, manage surgically with a drain or resection.
Term
What are the complications to diverticulitis?
Definition
Abscess, obstruction, sepsis, death.
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