Osteoarticularinfection
Spondylodiscitis
Fxx Marion
DCEM2
Toulouse Purpan medical school
01/25/2011
ECN Item 92
http://www.mcs-dentaire.fr/Patients/Posturologie/Douleurs.html
Overview
Epidemiology
Spondylodiscitis
Septic arthritis
Complication
General treatment
Specific treatment
Epidemiology
Diagnosis
=
Emergency
Predisposing factors:� ID/Diabetes/OH...
Contamination� blood/inoculation/contiguity
Acute or chronic
Germs
Spondylodiscitis 30%
Septic arthritis 60%
Osteitis &
Osteomyelitis
10%
Spondylodiscitis
• Men: 50-60 years old
• Pathophysiology:-blood-borne
-direct inoculation: surgery, ponction
• Lumbar rachis +++ http://ajns.paans.org/article.php3?id_article=160
Diagnosis
CLINIC
� Inflammatorypain
�Vertebralstiffness--->bell'sphenomenon
�Fever
BIOLOGIC
�Inflammatorysyndrom
�Germ --> identification
MRI
http://www.laconferencehippocrate.com/conhipp/exrhumat.asp
http://www.google.fr/imgres?q=staphylocoque&um
Septic Arthritis
Pathophysiology� Intra-articular
� Hematogenous way or inoculation
� Germs: S.aureus, BGN, streptococcus, gonococcus, lyme disease
� Prosthetic joint infectionshttp://cofer.univ-lille2.fr/
Diagnosis
Identification
� Puncture
� Blood culture...
http://ifr48.timone.univ-mrs.fr
Clinic
�Painful
�Functional disability
�Local inflammation→ cardinal signs
�Adenopathies
http://ifr48.timone,univ-mrs.fr
Complications
Spondylodiscitis Septic arthritis
Cartilaginoussequelae
Septicemia+
Endocarditis
�Radicular+medullar�compression�Spinal deformity
General Treatment
• Hospitalization
• After puncture+++
Bi-antibiotic therapy
Probabilistic
Germ6 to 12 weeks
Parenteral
Per os
Specific treatment
AntalgicNotification→ BK, brucellosis
ReeducationDraining punctureWashing the joint
Surgery
Spondylodiscitis
EntranceImmobilization
PreventionMonitoring
Septic arthritis
Take home message
EMERGENCY
Similarities:predisposing factors/germs/contamination
Diagnosis:→Clinical
→Microbiological: samples before antibiotics
→RMI: spondylodiscitis
Bibliography
• http://www.rhumatologie-bichat.com/spondylodiscites.html
• http://ajns.paans.org/article.php3?id_article=160
• http://ifr48.timone.univ-mrs.fr/Dictionnaire_semiologie/details_images/arthrite.html
• http://emedicine.medscape.com