seminario infecciones osteoarticulares 2012

Download SEMINARIO Infecciones osteoarticulares 2012

Post on 26-Jun-2015

247 views

Category:

Documents

3 download

Embed Size (px)

TRANSCRIPT

  • 1. InfeccionesInfecciones osteoarticularesosteoarticulares Sandra Milena Acevedo Rueda MD Residente 2do ao, Medicina Interna UNAB Noviembre de 2012

2. Artritis spticaArtritis sptica 3. 2-10/100.000 Artritis reumatoide: 28-38/100.000 Mortalidad: 1-7% Morbilidad: 50% Artroscopias: 0.14% Factores predisponentes (20% no identificables) MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 4. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 Estudio de cohorte, pacientes con artritis aguda: edad mayor a 80 aos, diabetes mellitus y artritis reumatoide fueron asociados con incremento en la incidencia de artritis sptica (likelihood ratios: 3.5, 2.7, y 2.5, respectivamente) Kaandorp CJ, van Schaardenburg D, Krijnen P, et al. Risk factors for septic arthritis in patients with joint disease. A prospective study. Arthritis Rheum. 1995;38:1819-1825. 5. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 6. Mordeduras Gatos Perros Humanos Ratas MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 7. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 8. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 9. Monoarticular 80-90% Rodilla 50% Poliarticular: AR, DM, inmunosupresin Cuadro tpico: dolor, limitacin (1 a 2 sem) Fiebre: 47% (S: 57%) MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 10. Cultivo (80-90%) Gram (50%) Hemocultivos (50-70%) Rx, Ecografa Gammagrafa, TAC, RMN MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 11. DXCO ASPECTO COGULO DE FIBRINA COGULO DE MUCINA LEUC POR mm3 PMN (%) GLUCOSA (% DEL NIVEL DE LA SANGRE) Normal Transparente Negativo Bueno < 200 < 25 < 100 Osteoartros Ligeramente turbio Pequeo Bueno < 2 000 < 25 < 100 Artritis traumtica Sanguinolento Pequeo Bueno 2 000 < 25 < 100 Artritis reumatoide Artritis reumatoide Turbio Grande Regular a pobre 5 000 a 50 000 > 65 75 Gota aguda Turbio Grande Regular a pobre 5 000 a 50 000 > 75 90 Artritis sptica Purulento Grande Pobre 50 000 a 200 000 > 80 < 50 Artritis tuberculosa Turbio Grande Pobre < 25 000 Variable < 50 12. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 Diagnostic Parameters of Synovial Fluid White BloodDiagnostic Parameters of Synovial Fluid White Blood Cell Count and Percent Polymorphonuclear Cells inCell Count and Percent Polymorphonuclear Cells in Patients with Septic ArthritisPatients with Septic Arthritis 13. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 14. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 Gonococcal infection. Pustular lesion overlying the fifth toe in a patient with disseminated gonococcal infection. 15. Enfermedad gonocccica diseminada Artritis gonocccica Dermatitis, tenosinovitis, poliartralgias Artritis gonocccica: Mujeres, 1970s, disminucin en 75% Gram 25%, cultivos 30% Sx Reiter MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 16. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 17. En artritis gonocccica: 7-10 das Otros: 2 a 4 semanas Anaerobios: Mordeduras Corticoides sistmicos Virus MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 18. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 19. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 Chronic arthritis of the knee due toChronic arthritis of the knee due to MycobacteriumMycobacterium tuberculosis.tuberculosis. 20. OsteomielitisOsteomielitis 21. EPIFISIS PLACA CRECIMIENTO METFISIS CAPSULA ARTICULAR VASO EPIFISIARIO ARTERIA NUTRICIA 22. CAPSULA ARTICULAR ARTERIA METAFISIARIA ARTERIA NUTRICIA PERIOSTIO CORTEZADIFISIS METFISIS LAGOS VENOSOS EPIFISIS PLACA EPIFISIARIA 23. Inflamacin del hueso producida por un agente infeccioso. Puede permanecer localizada o extenderse por el hueso para afectar medula, cortical, periostio o los tejidos blandos circundantes. Campbell, Cirugia ortopdica. Terry Canale, et all. 11 edicin. 2007. Mosby 24. Lew y WaldvogelLew y Waldvogel Duracin - Aguda - Crnica Fuente de infeccin - Hematgena - Contigua - En presencia de insuf. vascular Osteomyelitis in Long Bones, JBJS, J Bone Joint Surg Am. 2004;86:2305-2318. Lazzarini, Mader, Calhoun 25. Vas de infeccin Osteomielitis hematgena Luego de Bacteriemia. Ms frecuente en nios y ancianos Afecta a metfisis de huesos largos y vrtebras. Tambin por uso de catteres y uso de drogas e.v. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 26. Vas de infeccin Osteomielitis por foco contiguo Luego de fractura abierta de ciruga. Asociada a protsis. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 27. Vas de infeccin Osteomielitis por insuficiencia vascular En diabticos e insuficientes Vasculares Afecta principalmente el pie Curso crnico e insidioso. Suele no haber dolor. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 28. Osteomyelitis in Long Bones, JBJS, J Bone Joint Surg Am. 2004;86:2305-2318. Lazzarini, Mader, Calhoun Cyerny y MaderCyerny y Mader 29. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 Cyerny y MaderCyerny y Mader 30. Osteomyelitis in Long Bones, JBJS, J Bone Joint Surg Am. 2004;86:2305-2318. Lazzarini, Mader, Calhoun Cyerny y MaderCyerny y Mader 31. Signos clnicosSignos clnicos Dolor Edema Fistula Febricula o fiebre Exudado 32. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 33. EstudiosEstudios Rx AP, lat y oblicuas (10 a 14 das) Fistulografa Gammagrafa (Galio, Tec99, Indio 111) Tomografa CH, VSG, Protenas, Tiempos, Uroanlisis, cultivo, antibiograma, hemocultivos, cultivo de fragmento seo, estudio histopatolgico Contrary to common belief, swab cultures from draining wounds and sinus tracts can be of diagnostic benefit for two main reasons. First, the identification of certain resistant microorganisms (e.g., methicillin-resistant S. aureus, vancomycin-resistant enterococcus) indicates the need for infection control measures. Second, the isolation of S. aureus from superficial cultures has a high degree of correlation with deep cultures 34. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 T2-weighted axial MR image of the left tibia reveals abnormality of the midportion and proximal portion of the tibia (arrows). During surgery, there was a significant amount of purulence and osteomyelitic bone present. Cultures grew Pseudomona aeruginosa. 35. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 CT reconstruction image of a nonunited femur fracture 6 months after intramedullary nailing. Surgical cultures grew Pseudomonas aeruginosa and Propionibacterium acnes. 36. Principios quirrgicos en Osteomielitis Adecuado drenaje de los tejidos afectados Desbridamiento Remocin material Manejo del espacio muerto Cierre completo de la herida Estabilizacin fractura MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 37. Secuestro: son fragmentos de hueso muerto, y actan como un cuerpo extrao dentro de la lesin. Involucro: Son capas de hueso nuevo en crecimiento, se forman alrededor del hueso existente, y pueden alterar la cicatrizacin. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 38. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 39. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 Angiogram of lower extremity reveals occluded bypass graft in a patient with diabetes mellitus presenting with chronic gangrene and osteomyelitis of the foot. Angiogram of lower extremity reveals occluded bypass graft in a patient with diabetes mellitus presenting with chronic gangrene and osteomyelitis of the foot. 40. Osteomielitis aguda Nios (2 aos) Metafisis Hematgena Infeccin reaccin inflamatoria necrosis isqumica de la mdula necrosis del hueso - absceso Osteomyelitis in Long Bones, JBJS, J Bone Joint Surg Am. 2004;86:2305-2318. Lazzarini, Mader, Calhoun 41. Fuentes Foco primario : - Dentales - Vas urinarias - Respiratorias - Otras Osteomyelitis in Long Bones, JBJS, J Bone Joint Surg Am. 2004;86:2305-2318. Lazzarini, Mader, Calhoun 42. A: INFANCIA B: LACTANTE C: ADULTO 43. A: INFANCIA B: LACTANTE C: ADULTO 44. MANDELL, DOUGLAS, AND BENNETTS PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES. Seventh Edition. Copyright 2010 Antimicrobial Therapy ofAntimicrobial Therapy of Osteomyelitis in Adults forOsteomyelitis in Adults for Selected MicroorganismsSelected Microorganisms 45. Key wrote: continuous drug over a long period of time will lessen the amount of discharge,

Recommended

View more >