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INFECTIONS OF BONES
AND JOINTS
DANIELLE G. DEVILLERES, PTRP

GENERALITIES
Bone infection = Osteomyelitis
Joint infection = Infectious Arthritis
The structure of bone is such that pathogenic organisms may
remain sealed in its minute channels for long periods,
protected from both cellular and humoral defenses of the
host

GENERALITIES
Common types of joint and bone infection:
Common pathogenic bacteria:

Staphylococcus
Streptococcus
Gonococcus
Salmonella
Brucella

GENERALITIES
Common types of joint and bone infection:
Mycobacterium Tuberculosis
Treponema Pallidum
Pathogenic Fungi

Actinomyces
Blastomyces
Coccidioides
Sporotrichum
Others

GENERALITIES
Sequestrum
Isolated segment of dead bone surrounded by pus

Involucrum
Enveloping immature periosteal bone

Cloacae
Openings in the involucrum where pus may be discharged and
find its way to the skin surface

PYOGENIC
INFECTIONS

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PYOGENIC INFECTIONS
-pathogenic organisms may access to bones/ joints in 3 ways:
1. Bloodstream (haematogenous)
2. External inoculation (exogenous) might occur from open
fracture penetrating wound or surgery
3. Direct extension from an adjacent soft tissue infection

HEMATOGENOUS
OSTEOMYELITIS

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HEMATOGENOUS
OSTEOMYELITIS
Bacteremia
Organisms released into the bloodstream such as a focus
that is not destroyed by macrophages (lung,liver,spleen)
produces new infection called OSTEOMYELITIS
MC : childhood metaphyseal ends of long bones
MC : BOYS > GIRLS

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ETIOLOGY
Infecting organisms : staphylococcus aureus
Infants and younger children may have variety of organisms
encountered
Trauma : Hemorrhage within bone and has hx of a blow
precise area of bone that becomes infected.

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ACUTE HEMATOGENOUS
OSTEOMYELITIS
Malaise, weakness, aching and elevation of body
temperature, intense pain in affected area
Hx of injury : blow or fall
Protective muscle spasm: jt nearest the disease focus being
held in flexion

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ACUTE HEMATOGENOUS
OSTEOMYELITIS: INFANTS
Little or no fever
Chief signs: irritability, loss of function of affected extermity,
tenderness and swelling. Clinical course is rapid
Pts with sickle cell anemia- salmonella
SALMONELLA-infection involve multiple long bones and often
bilateral and symmetric

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CHRONIC HEMATOGENOUS
OSTEOMYELITIS
MC: adults with roentgenographically by bone sclerosis and
periosteal bone formation
Pt. complains : chronic dull, deep, aching pain associated
with low-grade fever
Chronic granulomatous disease
With local pain, increase heat and swelling

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BRODIES
ABSCESS

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BRODIES ABSCESS
Localized form of chronic hematogenous osteomyelitis
with recognized or unrecognized bacteraemia and may
have clinical appearance of abscess
Abcess has a thin wall of fibrous tissue and sclerotic
bone contains pus on culture : STAPHYLOCCOCCI
MC site : lower end of tibia

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BRODIES ABSCESS
Most often occurs : older children and young adults
Onset: gradual
Chief symptoms: local pain worse at night, slightly
increased heat and tenderness over site of lesion

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EXOGENOUS
OSTEOMYELITIS

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EXOGENOUS OSTEOMYELITIS
MC cause : direct contamination through an open
wound(open fx, gunshot or surgical operation)
MC site: extensive soft tissue injury
Large mass of foreign material in wound : susceptible
to infection

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EXOGENOUS OSTEOMYELITIS
CLINICAL PICTURE
Signs and symptoms of infection : 36-48 hrs ff open
fracture, surgical or penetrating wound
body temp & pain, tightness in area of wound,local
swelling and tenderness and gen malaise

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SALMONELLA
OSTEOMYELITIS

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SALMONELLA OSTEOMYELITIS
AND ARTHRITIS
Caused by salmonella typhosa
Infections of bones cause by salmonella group
High in children with sickle cell anemia
Several bones may be involve with local pain & tenderness

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BRUCELLA OSTEOMYELITIS

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BRUCELLA OSTEOMYELITIS &

ARTHRITIS
Human brucellosis
Uncommon disease in US seen chiefly as result of
direct contact with cattle or swine or drinking
unpasteurized milk
ORTHOPEDIC MANIFESTATIONS
1. Fever, excessive fatigue, aches & pains without local
infectious foci
2. Localized osteomyelitis, arthritis and bursitis

BRUCELLA OSTEOMYELITIS &

ARTHRITIS

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BURSAE
Prepatellar is commonly affected and joints (hip and knee)
SPINE INVOLVEMENT
Usually at lumbar level & tends to destroy contiguous vertebral
surfaces & disk tissue ends in bony ankylosis of the bodies

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SEPTIC ARTHRITIS

PYOGENIC ARTHRITIS

INFECTIOUS ARTHRITIS:
PYOGENIC, SUPPORATIVE OR
SEPTIC ARTHRITIS
Results from the activity of pus-forming bacteria in a
synovial jt may rapidly and permanently destroy articular
cartilages
MC: infants & children > adults, M>F , MC sites of
infection : hip and knee
Trauma, use of steroids and other factors influences
localization of infection, S. aureus is common infecting
agent

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INFECTIOUS ARTHRITIS:
PYOGENIC, SUPPORATIVE OR
SEPTIC ARTHRITIS
ROUTES OF INFECTION
Bloodstream in septicemia-distant focus such as infected
abrasion
Direct or lymphatic extension- neighboring infected area
such as osteomyelitis
Direct inoculation of infected material through penetrating
wound

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INFECTIOUS ARTHRITIS:
PYOGENIC, SUPPORATIVE OR
SEPTIC ARTHRITIS
PYOGENIC ARTHRITIS
Usually monarticular
Occasionally multiple joints affected in severe septicemia

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PYOGENIC ARTHRITIS OF HIP:

INFANTS
Warrants individual emphasis because of the difficulty of
diagnosis, prompt treatment
Infection is usually blood borne

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GONOCOCCAL
ARTHRITIS

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GONOCOCCAL ARTHRITIS
Metastatic sequel of inadequately treated acute
gonorrheal urethritis
MC: In women
Jt involvement appears 2-3 wks after onset of urethral or
vaginal discharge

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GONOCOCCAL ARTHRITIS
Arthritis may be polyarticular or monarticular
Fleeting pains in multiple jts and becomes localized in
single jt
Transient skin rash develops in most pts
MC affectation: knee & ankle

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OSTEITIS
PUBIS

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OSTEITIS PUBIS
Painful, nonsuppurative affectation of pubis symphysis
occurs after prostatic operations in older men and pelvic
surgery in older women

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OSTEITIS PUBIS
CLINICAL PICTURE
2-8 wks after pelvic injury: sudden onset of pain over
one side of symphysis with pubic tenderness
Rapid pain is severe and worse on coughing ,
defecation and urination
Pts. Tends to lie in one position : flexed hips (severe
addcutor muscle spasm)

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OSTEITIS PUBIS
ROENTGENOGRAPHIC PICTURE
Symphysis pubis irregular ;pubic bodies & ramiosteoporotic ; ischium and acetabulum-decalcification
extends laterally

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DISKITIS

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DISK INFLAMMATION IN
CHILDREN (DISKITIS)
Inflammation of intervertebral disk in children
Relatively benign for which the cause is often unclear
It occurs in children under 6 yrs with gradual onset
CLINICAL MANIFESTATIONS
Refusal to walk and sit, back pain and irritability, paravertebral
spasm, Limited back motion, localized spinal tenderness, lowgrade fever and WBC is

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DISK INFLAMMATION IN
CHILDREN (DISKITIS)
ROENTGENOGRAPHIC
2 wks after onset-narrowing of disk spaces is evident; 4 wksirregularity of vertebral end plates

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TB OF SPINE & JTS.

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TUBERCULOSIS OF BONE AND

JOINTS
Localized, progressively destructive disease results from
Myobacterium Tuberculosis in bone or articular structure
May occur in any age
Osteoarticular tuberculosis is primary in adults and is rare in
children except for underdeveloped countries
MC sites: spine>hip>knee and shaft of long bones are rarely
involved

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TUBERCULOSIS OF BONE AND

JOINTS
ROUTES OF INFECTION
Bloodstream- mycobacteria travels from lung to bone or joint
Lymphatic channels or direct extension
Initial focus bronchial lymph node reaching after being
ingested
Infected cattle & unpasteurized milk- source of Tuberculosis

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TUBERCULOSIS OF BONE AND JOINTS

CLINICAL PICTURE
Hx of active tuberculosis & chronic cough hemoptysis
Spontaneous pain & in motion of affected joint,
restriction of mobility by spasm followed by muscle
atrophy

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TUBERCULOSIS OF BONE AND JOINTS

CLINICAL PICTURE
Tuberculous abscesses are called cold abscesses
because of the absence of an acute inflammatory
reaction

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TUBERCULOSIS OF BONE AND JOINTS

CLINICAL PICTURE
Painless limp
Superficial jts boggy swelling (no redness, little & slight
tenderness)
Severe deformity from contractures & bone destructions

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TUBERCULOSIS OF BONE AND JOINTS

Roentgenographic picture
Affected bones show faint joint outlines, irregular
notching of joint surfaces
Loss of disk space & erosion, collapse of vertebral
bodies

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TUBERCULOSIS OF SPINE
MC site: spine in any level may be affected
Greatest in lower thoracic region

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TUBERCULOSIS OF SPINE
ABSCESSES
Fusiform or flask-shaped shadow encircling the spine &
below the level involved vertebrae
Posteriorly, laterally, in groin or upper & inner thigh as a
psoas abscess
Untreated, such abscesses rupture through skin ,produces
sinuses and becomes infected

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TUBERCULOSIS OF SPINE
PARAPLEGIA
Paralysis of LE most frequently seen in TB of upper or
middle thoracic vertebrae (spinal canal is narrowed
&slightly kyphotic)
Spinal cord may be compressed by an abscess
TB granulation extends through meninges to Spinal cord

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SYPHILLIS OF
BONES AND
JOINTS

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SYPHILIS OF BONES &JTS

Common infection & serious health in problem
Occurs congenital & acquired form of syphilis
Affects different age group : EARLY INFANCY, CHILDHOOD,
ADULTS

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SYPHILIS OF BONES &JTS:

EARLY INFANCY
Osteochondritis is manifestation of congenital syphilis
Lesions are symmetric involving ends of large bones
Metaphyseal tissues are replaced by syphilitic granulation
Process of enchondral ossification is disturbed

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SYPHILIS OF BONES &JTS:

EARLY INFANCY
Radiograph : irregular calcification appears along the
epiphyseal line
If untreated: suppuration & development of frank syphilitic
osteomyelitis
Often the infant appears to be partially paralyzed =
Pseudoparalysis

SYPHILIS OF BONES &JTS:

CHILDHOOD
Periostitis- enlargement of convex side of shaft of long bone

Saber shin (tibial involvement)

Clutons joints painless bilateral, serous synovitis of knee

& develop gradually without causing disability and subside
about the 20th year without residuals

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SYPHILIS OF BONES &JTS:

ADULTS
Periostitis, osteomyelitis & arthritis are seen in
association with gumma, or necrotizing ischeming
proliferative lesion characteristic of late syphilis

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SYPHILIS OF BONES &JTS:

ADULTS
Little or no pain, acute inflammatory signs are absent
Diffuse thickening of bony cortex with formation of small
hyperostosis leads to suppuration
Pathologic fracture sometimes occur
Joint involvement may produce a severe destructive
arthritis

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FUNGUS INFECTION

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FUNGUS INFECTIONS OF
BONES & JOINTS
This disease is systemic & organisms reach a bone or joint
focus through bloodstream
Involvement takes place by direct extension from infected
overlying tissue

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FUNGUS INFECTIONS OF
BONES & JOINTS
SUBTYPE DISEASES
ACTINOMYCOSIS, PLEURAL OR ABDOMINAL
ACTINOMYCOSIS, BLASTOMYCOSIS,
COCCIDIOIDOMYCOSIS, CRYPTOCOCCOSIS &
SPOROTRICHOSIS

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ACTINOMYCOSIS

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FUNGUS INFECTIONS OF BONES

& JOINTS: ACTINOMYCOSIS
Occurs about the jaw frequently following dental extractions
involves soft tissue and spreads to mandible
Indurated areas & deep abscess
Sulfur granules = a purulent exudate containing mycotic
colonies is often extruded through multiple sinus tracts

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BLASTOMYCOSIS

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FUNGUS INFECTIONS OF BONES

& JOINTS: BLASTOMYCOSIS
Primary disease disseminated widely from lungs through
bloodstream
Causes Chronic destructive Osteomyelitis of vertebrae,
ribs, skull & other bones
Spine (Blastomycotic lesions stimulate TB)

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COCCIDIOIDOMYCOSIS

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FUNGUS INFECTIONS OF BONES AND

JOINTS: COCCIDIOIDOMYCOSIS
Endemic in southwestern part of US
Primary pulmonary infection
Systemic phase characterized by multiple bones, joints
and visceral lesions

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CRYPTOCOCCOSIS

CRYPTOCOCCOSIS

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FUNGUS INFECTIONS OF BONES

& JOINTS: CRYPTOCOCCOSIS

Primarily pulmonary disease disseminated form involving the

Central Nervous System usually as a diffuse mengitis

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SPOROTRICHOSIS

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FUNGUS INFECTIONS OF BONES

& JOINTS: SPOROTRICHOSIS
Disease of gardeners & farmers
Common type of infection begins with wound (thorn prick)
leads to granulomatous lesion of skin & subcutaneous tissue
Disseminates through bloodstream & produced chronic
arthritis