Infectious Diseases Lesson 10 OSTEOMYELITIS, PROSTHETIC JOINT INFECTIONS, DIABETIC FOOT INFECTIONS, AND SEPTIC ARTHRITIS Bernardino Roca Villanueva Servicio de Medicina Interna, Hospital General de Castellón Departamento de Medicina, Universidad Jaume I [email protected] Objectives, learning goal and contents Objective To review all relevant knowledge on infections affecting joints and bone Learning goal To acquire enough knowledge to properly manage a patient who presents with bone or joint infection in any clinical setting Contents • Osteomyelitis • Hematogenous osteomyelitis of long bones and vertebral bodies • Osteomyelitis secondary to a contiguous infection • Diabetic foot infections • Prosthetic joint infections • Septic arthritis • Disseminated gonococcal infection • Key messages • Further reading Osteomyelitis General concepts • Definition: progressive infectious process that can involve one or multiple components of bone: periosteum, medullary cavity, and cortical bone • Characterized by progressive inflammatory destruction of bone, by necrosis, and by new bone formation Classifications, according to… • Temporal profile • Pathogenesis • Affected area • Extent of involvement • Classifications guide prognosis and therapy Classifications: temporal profile • Acute, days to weeks • Chronic, weeks to years; characterized by necrotic bone (sequestra), foreign material, and fistulous tracts Classifications: pathogenesis • Hematogenous, in prepubertal children and elderly • Secondary to contiguous focus, follows trauma, perforation, or orthopedic procedure; diabetic foot infection: ulcer → bone; neuropathy and vascular insufficiency pathogenically relevant