4. infeksi muskuloskeletal arthritis senin 26 maret 2012-blok13
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Infeksi PadaMuskuloskeletal
Enny Suswati
Lab. Mikrobiologi
Fakultas kedokteran Universitas Jember
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Tahap Klinis Inflamasi
Celsus Rubor, Tumor Calor, Dolor
Galen Fungsio laesa
1. Rubor (Kemerahan) Respon vaskuler (Dilatasi)
2. Tumor (Bengkak) exudate , krn permeabilitaskapiler.
3. Calor (Panas,) aliran darah energi dan
panas4. Dolor (nyeri, pain) Tertekannya saraf
5. Functio laesa (Ggn fungsi) krn perusakan jaringan
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Kelompok Inflamasi
1. Inflamasi Spesifik Penyebab diketahui
Inf . Pyogenik (pus) Arthritis & Osteomyelitis,
Inf. Granulomatous (granuloma) tbc
2. Inf . Non spesifik (idiopatik) (Rematik disease) Rhematic fever, Rh/ Artritis , Transient sinovitis dll
3. Inf . karena iritasi chemis Mis Gout (Metabolik
Arthritis)
4. Inf karena trauma yang berulang
Bursitis & Tenovaginitis stenosans 3/11/2014 4Musculosceletal infection Blok 13
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Pyogenic Arthritis
Pyogenic Suppurativa Pus
Arthritis Articulatio + Itis
Infeksi bakteri pada sendi yang bersifat purulent /
supurativa (Menghasilkan Pus), menyerang jaringan
sinovium dan dapat menghancurkan sendi
1. Akut Septic arthritis / Non Septic artritis
2. Khronis Exacerbasi akut3/11/2014 5Musculosceletal infection Blok 13
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Insiden
No 2 sesudah osteomyelitis
Dapat mengenai semua umur, banyak pada anak
Sering pada pelvis dan siku
Umumnya hematogenous
Hanya menyerang satu sendi (Monoarticular 90%)
Pada dewasa jarang
Akibat pemakaian corticosteroid yang lama
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Kuman Penyebab
1. Stapfilococus aureus Artritis Sup Akut
2. Hemofilis Influenza Bayi
3. Streptococcus4. E coli Dewasa, anak
5. Proteus
6. Gonococcus Dewasa
7. M. tuberculose
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1. Stapfilococus aureus
Artritis Sup Akut • BENTUK : COCCUS / BULAT
• UKURAN : DIAMETER ± 1µm
• SUSUNAN : BERGEROMBOL
SEPERTI
ANGGUR,
KADANG SINGLE ATAU
BERPASANGAN
• PEWARNAAN : GRAM +
(TAMPAK UNGU)
• SPORA (-) , CAPSUL (-), NON
MOTIL
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2. Hemofilis Influenza Bayi
• Fig. 1.Purpura fulminans of patient 1
early in the course of H
influenzae type a infection. Tissue
necrosis led to the amputation of 2
toes, extensive debridement, and skin
grafting
H influenzae type b cellulitis of the
arm proved by positive blood culture.
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3. Streptococcus
MORFOLOGI• BENTUK BULAT
• SUSUNAN SEPERTIRANTAI
• UKURAN DIAMETER0,5 - 1µm
• PEWARNAAN GRAMTAMPAK UNGU(GRAM +)
• SPORA (-), NONMOTIL
• KAPSUL (+) PADASTRAIN GOL. A, B, C
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4. E coli Dewasa, anak
• Morfologi mikrskopisKultur pada media EMB
tampak Methalic Sheen
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6. Gonococcus Dewasa
• Bakteri neisseria
• Bentuk coccus, bulat
• Diameter 0,6-1μm• Susunan berpasangan /
diplococcus ( seperti biji
kopi)
• Gram (-) tampak merah• Non motil
• Mempunyai fimbrae
didinding sel
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Morfologi
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7. M. tuberculose
Bentuk : Bacilus/batang,lurus/bengkok.
- Ukuran : ± 0,4 x 3 μm
- Susunan : terpisah sejajar
- Pewarnaan : Tahan terhadapasam. dengan cat Ziehl
Nelson (ZN) tampak
berwarna merah ( BTA + )
- Tidak berspora, tidakbercapsul
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Tuberculous Osteomyelitis
• 1-3% of pts. with pulmonary
or extrapulmonary T.B. have
osseous infection
• Typically, pts. present with
pain on motion, localized
tenderness, low-grade fevers,
chills and weight loss
• Severe destruction of
vertebrae (Pott’s disease) may
cause skeletal deformities andneurologic deficits
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Patogenesa / Stadium
1. Kuman Masuk
Inflamsi kapsul sendi
3. Std Destruksi sendi
4. Std Deformitas Ankylosis
Inflamasi rawan sendi
Inflamasi synovium
Inflamsi tulang sendi
2. Std Inflamasi / peradangan sendi
3.Septic Arthritis
1.Sembuh sempurna
2.Abses Sendi
4. Sbhg sendi hancur
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Gejala Klinis
Berbeda antara Neonatus, Anak & Dewasa
Gejala umum demam, gelisah dll
Neonatus Menonjol irritability, grk sendi
tertahan, sering sepsis
Anak anak Sendi: nyeri, panas demam dll
Dewasa jarang sepsis3/11/2014 19Musculosceletal infection Blok 13
P k
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Pemeriksaan Sendi :
Bengkak,
Erythema,
Panas
Posisi sendi agak flexi
Palpasi
Nyeri hebat, Terbatas ROM,
Fluktuasi (+) / (-)
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P k
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PemeriksaanLaboratorium Darah
Darah Rutin
Anemia
Leukositosis
Shift to the left
LED dan CRP Meninggi Kulltur darah
Aspirasi sendi3/11/2014 21Musculosceletal infection Blok 13
P ik
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Pemeriksaan
Radiologi
USG ada cairan
Rontgen foto
Destruksi
Penyempitan rongga sendi
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P b t
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Pengobatan
1. Umum
2. Lokal
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P b t
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Pengobatan
Umum
Perbaiki KU, Infus cairan resusitasi
Obat-obatan
Anti piratik
Analgesik
Antibiotik sesuai kultur
Uncomplicated cases (3 minggu)
Complicated cases (3-6 weeks)
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Antimicrobial Agents in
Orthopedics • Penicillin (Pen. G).
• Penicillinase Resitant Synthetic
Penicillins (PRSP).- Naficillin.
- Oxacillin.
- Cloxacillin.
- Flucloxacillin.
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P b t
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Pengobatan
Lokal
Istirahatkan sendi Skin traksi
Jika kasus berlanjut
Drainage mengeluarkan pus Explorasi (artrotomy) evakuasi pus dan irigasi
rongga sendi
Debridemant sendi (pembersihan pus dan jaringan
nekrotik)
Kasus lanjut Arthrodese (Pengakuaan sendi)3/11/2014 26Musculosceletal infection Blok 13
K lik i
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Komplikasi
Segera
Septic Arthritis Kematian
Penghancuran sendi
Dislokasi patologis
Nekrosis epipisis
Lambat
Penyakit sendi degenerativ
Dislokasi patologis
Kaku sendi .3/11/2014 27Musculosceletal infection Blok 13
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Osteomyelitis
• Osteomyelitis denotes inflammation of bone
and marrow and the common use of the
term virtually always implies infection• All type of organisms including viruses,
parasites, bacteria, and fungi can produce
osteomyelitis but infections caused bycertain pyogenic bacteria and mycobacteria
are the most common
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Pyogenic Osteomyelitis
• Pyogenic osteomyelitis is almost always
caused by bacteria
• Organism may reach bone by: 1)hematogenous spread (most common
route); 2) extension from a contiguous site;
or 3) direct implantation• Long bones and vertebral bodies most
commonly involved
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Pyogenic Osteomyelitis
• S. aureus is responsible for 80-90% of cases
• E. coli, Pseudomonas and Klebsiella are
more commonly isolated from pts. with UGtract infections or are drug users
• Mixed infections seen in cases of surgery or
open fractures
• Neonatal period: H. influenzae and group B
strept.; Salmonella in pts. with sickle cell
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Pyogenic Osteomyelitis
• Location of lesions within specific bones is
influenced by vascular circulation and
varies with age• Clinically hematogenous osteomyelitis may
manifest as an acute systemic illness with
malaise, fever, chills, leukocytosis andthrobbing pain over affect site
• X-rays, biopsy & cultures help with dx
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Pyogenic Osteomyelitis
• The combination of antibiotics and surgical
drainage is usually curative
• In 5-25% of cases, acute osteomyelitis failsto resolve and persists as chronic infection
• Complications may include: pathologic
fracture, endocarditis, sepsis, etc.
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Tuberculous Osteomyelitis
• 1-3% of pts. with pulmonary or
extrapulmonary T.B. have osseous infection
• Typically, pts. present with pain on motion,localized tenderness, low-grade fevers,
chills and weight loss
• Severe destruction of vertebrae (Pott’sdisease) may cause skeletal deformities and
neurologic deficits
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