You are here: Home / Archives for Musculoskeletal Infections

Fungal Osteomyelitis of Caprals and Metacarpal Bones – Anteroposterior Xray

June 17, 2010 By Leave a Comment

Fungal infection of bone is very rare. A 39 year old man, laborer by profession presented to out patient department with complaints of multiple discharging sinus in dorsum and palmar aspect of hand.

The problem had been there for about 4 months and severity had increased in spite of treatment with antibacterial and antitubercular drugs.
An xray was taken which revealed osteomyelitis of metacarpals and carpals.

In the xray all metacarpals except thumb metacarpals were involved and so were distal row of carpal bones. Note that metacarpals are sclerotic and deformed. Compare them with normal metacarpal of the thumb. Carpal bones can be compared to proximal row of carpal bones which are normal.

A culture for fungi cam positive and patient was put on antifungal drugs.

Unfortunately, he neve returned back for follow up.

Popularity: 4% [?]

Filed Under: Musculoskeletal Infections, Musculoskeletal Radiology, Orthopaedic Images Tagged With: , , ,

Severe Oseomyelitis Involving Whole Ulna – Xray

June 14, 2010 By Leave a Comment

Osteomyelitis is infection of the bone and usually involves metaphysis of the bone. In severe forms it may show a greater involvement than the metaphysis.

Following xray is of  a 12 year old female child who presented with a pus discharging sinus. The xray showed destruction of whole of ulna with presence of pathological fracture.

The child was put on above elbow brace and is still under treatment.

Popularity: 3% [?]

Filed Under: Musculoskeletal Infections, Musculoskeletal Radiology, Orthopaedic Images Tagged With: , ,

What Is DOTS Therapy for Tuberculosis

May 25, 2010 By Leave a Comment

DOTS stands for directly observed treatment short course.
DOTS divides the patient into four categories and the treatment is dependent upon which category patient is in.
Category I

  • Freshly diagnosed smear-positive pulmonary tuberculosis
  • Smear-negative pulmonary tuberculosis with extensive parenchymal involvement
  • New cases with severe forms of tuberculosis e.g. miliary tuberculosis, tuberculous meningitis, tuberculous pericarditis, tuberculous peritonitis, intestinal TB, genitourinary TB, bilateral bilateral or extensive tuberculous pleurisy, spinal disease with neurological complications.

[Read more...]

Popularity: 4% [?]

Filed Under: Musculoskeletal Infections Tagged With: , ,

Toxicity of Antitubercular Drugs

May 24, 2010 By Leave a Comment

A number of adverse drug reactions are possible from the use of antitubercular drugs. If  cause is identifiable then it becomes easy to tackle the issue. Then the offending drug is withdrawn.   However,  if a reaction occurs but its nature does not single out a particular drug, the situation is little more difficult.

Then only the offending drug or drugs is cautious rechallenge.

In rechallenge, all the drugs are withdrawn and one by one they are reintroduced starting with the one least likely to be responsible for the symptoms.

Rechallenge is started with one drug in a small challenge dose, which is increased stepwise to full therapeutic dose over a few days. [Read more...]

Popularity: 2% [?]

Filed Under: Musculoskeletal Infections Tagged With: ,

Multi Drug Resistance In Osteoarticular Tuberculosis

May 22, 2010 By Leave a Comment

Multi-drug-resistant TB (MDR-TB) is defined as resistance to both isoniazid and rifampicin, with or without resistance to any other antituberculosis drugs.

Resistance to multiple first-line antitubercular drugs should be should be suspected if disease activity does not show signs of subsiding after 4-6 months of uninterrupted multidrug therapy.

Treatment of multidrug resistance needs many questioned t be answered.Many crucial management issues in MDR-TB treatment remain unanswered and the existing primary literature on the issue is not enough. [Read more...]

Popularity: 2% [?]

Filed Under: Musculoskeletal Infections Tagged With: , ,

Treatment Of Osteoarticular Tuberculosis In Patients With HIV

May 21, 2010 By Leave a Comment

The risk of developing tuberculosis is much higher in people who are infected with human immunodeficiency virus [HIV].

HIV weakens the immune system, people that have both HIV and TB have a 40 percent higher risk of developing  active, infectious TB than people who are not HIV positive.

Together both infections make  each other worse.

TB makes HIV multiply faster and HIV helps TB become active.

It is very important for people that are HIV positive to be tested for TB. If infected you need to complete therapy as soon as possible.

However treatment of tubeculosis patients with HIV is complex. [Read more...]

Popularity: 1% [?]

Filed Under: Musculoskeletal Infections Tagged With: , , ,

Duration of chemotherapy In Osteoarticular Tuberculosis

May 19, 2010 By 4 Comments

Duration of chemotherapy in tuberculosis is a controversial issue.  This is an area where there is no consensus. According to World Health Organization, the spinal tuberculosis is a severe form of extrapulmonary tuberculosis and is  assigned to CategoryI. All other cases are placed in category II.

Therefore, by WHO criteria, all caries spine cases should be treated for a minimum of 6 months and others for 5 months. However, many surgeons in India [where the disease in endemic] prefer to continue treatment till there is adequate radiological evidence of healing, which can take much longer than 6 months. The practiced range of duration is 1-1.5 years. [Read more...]

Popularity: 2% [?]

Filed Under: Musculoskeletal Infections Tagged With: , ,

Second Line Antitubercular Drugs

May 16, 2010 By Leave a Comment

A second line drug for tuberculosis is either less effective than the first line drug or has an associated toxicity that makes second choice for use in tuberculosis patients.
Second class drugs are used when the patient either does not respond to first line or does not tolerate them and substantiating the treatment is necessary.

Following are  second-line drugs used for the treatment of tuberculosis.

  • Thioacetazone (T)
  • P-aminosalicylic acid (PAS or P).
  • Thioamides – Ethionamide, prothionamide
  • Cycloserine
  • Polypeptides- capreomycin, viomycin, enviomycin
  • Aminoglycosides: e.g., amikacin (AMK), kanamycin (KM)
  • Fluoroquinolones-Ciprofloxacin (CIP), levofloxacin, moxifloxacin (MXF), Ofloxacilin

Commonly used drugs are discussed below- [Read more...]

Popularity: 3% [?]

Filed Under: Drugs, Musculoskeletal Infections Tagged With: ,

First Line Drugs For Tuberculosis

August 22, 2009 By Leave a Comment

There are five drugs in first line attack against tuberculosis. The durgs differ in their mechanism of action; whether they are bactericidal i.e. kill bacteria rapidly or bacteriostatic i.e. inhibits the multiplication and growth of bacteria but do not kill them. They also differ in their action against intracellular bacilli (those mycobacteria that are in the cell), extracellular bacilli (those mycobacteria that are outside the cell) and the bacilli in the lesion itself.

No single drug is effective in treating the disease but when used in combination, they can cure the disease. Here are the first line drugs used in treatment of tuberculosis.

All except streptomycin are given orally.

Isoniazid

It is bacteriostatic for resting bacilli but kills those which divide actively.   It is active against intracellular bacilli, extracellular bacilli and bacilli at lesion. It has good penetration in cerebrospinal fluid and possesses good overall activity. Along with rifampicin, it is the main drug in treatment of tuberculosis. [Read more...]

Popularity: 1% [?]

Filed Under: Musculoskeletal Infections Tagged With: , , , ,

First Line Drugs For Tuberculosis Treatment – Recommended Doses

August 19, 2009 By Leave a Comment

Antitubercular drugs are mainstay of treatment of tuberculosis. The major drugs used and effective are called first line drugs. Following are the first line drugs in tuberculosis

  • Isoniazid
  • Rifampin
  • Pyrazinamide
  • Ethambutol
  • Streptomycin

These five drugs are responsible for control and containment of tubercular disease, among other factors.

The drugs are given on basis of patient weight and dosage may vary in different individuals. The dosage also differ depending on the regimen given. There are three regimen that traditionally have been used for treatment [Read more...]

Popularity: 3% [?]

Filed Under: Drugs, Musculoskeletal Infections Tagged With: , , , , , , ,
« Older Posts
Newer Posts »