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