bráð blóðborin beinsýking barna
DESCRIPTION
Bráð blóðborin beinsýking barna. (BBBB) Acute hematogen Osteomyelitis (AHO). Guðmundur K Jónmundsson Barnaspítali Hringsins. Frekar sjaldgæf sýking. Tíðni ? E.t.v. Um 10 á ári hérlendis Drengir: Stúlkur 2-3 : 1 Oftast á aldrinum 2-5 ára >80% < 16 ára. Pathogenesis. - PowerPoint PPT PresentationTRANSCRIPT
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Bráð blóðborin beinsýking barna
(BBBB)
Acute hematogen
Osteomyelitis
(AHO)
Guðmundur K JónmundssonBarnaspítali Hringsins
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Frekar sjaldgæf sýking
•Tíðni ? E.t.v. Um 10 á ári hérlendis
•Drengir: Stúlkur 2-3 : 1
•Oftast á aldrinum 2-5 ára
•>80% < 16 ára
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Pathogenesis
•Metaphysis langra beina
•Algengasta staðsetningin
•vegna anatomiu og blóðrásar
•Ganglimir í > 70% tilfella
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Osteomyelitis
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Beingerð
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Beingerð
Section parallel to the surface from the body of the femur. X 100. a, Haversian canals; b, lacunæ seen from the side; c, others seen from the surface in lamellæ,
which are cut horizontally.
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Haversian canals
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Staðsetning aho
•Femur 36%
•Tibia 33%
•Humerus 10%
•Fibula 7%
•Radius 3%
•Ulna 2%
•Calcaneus 3%
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Sýklar
•Staphylococcus aureus >70%
•Streptococcus Gr.B
•Strept. Pyogenes
•Strept. Epidermidis
•E.Coli
•Pseudomonas aeruginosa
•Hemophilus influenzae o.fl.
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AHO
Smábörn (< 1 árs) 1 – 16 ára >16 ára
Gr. B streptococca Staph.aureus Staph. aureus
Staph aureus Strept. Pyogenes St. epidermidis
E.coli Hemophilus infl. Pseudom. aerug.Kingela kingae Serratia marcescence E.coli
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Osteomyelitis
•241 barn (Panama 1974-1992)
•92 % acut, 8 % chronic
•Pos. ræktanir 57%
•Staph. aureus 40%
•Pseudomonas aeruginosa 4%
•Salmonella 3%
•Haemophilus influenzae gr. B 3%
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Einkenni við akút hematogen osteomyelitis
Eymsli 88%
Hitahækkun 75%
Bólga 50%
Hreyfihindrun 45%
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BBBBMismunagreining
•Arthritis rheumatoides
•Septiskur arthritis
•Cellulitis
•Ewing´s sarcom
•Hvítblæði
•Æðabólga
•Beininfarkt (sickle cell anemia)
•Toxiskur synovitis (coxitis simplex)
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Rannsóknir
•Blóðstatus
•Sökk
•CRP
•Blóðræktun
•Aspirat í ræktun
•Beinaskann
•Rtg., CT, MRI
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0 – ½ árs:
Cloxacillin+Aminoglysoid
>1/2 árs:
Cloxacillin +/- Cephalosporin
Meðferð
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AHO
Til að breyta frá i.v. lyfjagjöf í oral þarf að tryggja:
1. Að góður árangur hafi verið af lyfjagjöfinni í æð.
2. Meðferðarhlýðni (compliance)
3. Sýkillinn verður að vera til staðar í ræktun og næmi gott fyrir því lyfi, sem ætlunin er að nota.
4. Halda verður drápsþéttni (bactericidal titer)
=eða> 1:2
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Staðsetning sept. arthritis
Hné 38%
Mjöðm 32% 81%
Ökkli 11%
Úlnliður 4%
Olnbogi 8%
Öxl 5%
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Orsakir SEPTISKS ARTHRITIS
STAPH. AUREUS 56%
STREPT GR.A 22%
PNEUMOCOCCI 6%
HEMOPHILUS INFLUENZAE 14%
SALMONELLA 1%
AÐRAR ENTEROBACTERIUR 7%
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MEÐFERÐ
• CLOXACILLININ +/- CEPHALOSPORIN
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ARTHRITIS
• INFEKTIONIR• Staphylococci TBC• Hemophilus infl. LUES• Streptococci LEPRA• Meningococci• Pneumococci• Salmonella• Gonococci
• Hettusótt, Rauðir hundar, Mycoplasma
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SYSTEMSJD.
• JRA
• Febris rheum.
• Vasculitis / Henoch-Schönlein
• Collagen sjd.
• Reiter
• Colitis ulcerosa
• Psoriasis
• Lyme
• TRAUMA