4. infeksi muskuloskeletal arthritis senin 26 maret 2012-blok13

8/12/2019 4. Infeksi Muskuloskeletal Arthritis Senin 26 Maret 2012-Blok13

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Infeksi PadaMuskuloskeletal

Enny Suswati

Lab. Mikrobiologi

Fakultas kedokteran Universitas Jember

3/11/2014 1Musculosceletal infection Blok 13



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




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



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



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

Monoarticular 80%3/11/2014 6Musculosceletal infection Blok 13



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




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




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.




3. Streptococcus

MORFOLOGI• BENTUK BULAT

• SUSUNAN SEPERTIRANTAI

• UKURAN DIAMETER0,5 - 1µm

• PEWARNAAN GRAMTAMPAK UNGU(GRAM +)

• SPORA (-), NONMOTIL

• KAPSUL (+) PADASTRAIN GOL. A, B, C




4. E coli Dewasa, anak

• Morfologi mikrskopisKultur pada media EMB

tampak Methalic Sheen




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




Morfologi




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

3/11/2014 Musculosceletal infection Blok 13 15



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




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




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



Pemeriksaan Sendi :

Bengkak,

Erythema,

Panas

Posisi sendi agak flexi

Palpasi

Nyeri hebat, Terbatas ROM,

Fluktuasi (+) / (-)


P k



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

http://uwcme.org/courses/rheumatology/knee/images/Knee2.jpg

http://uwcme.org/courses/rheumatology/knee/images/Knee2.jpg



Pemeriksaan

Radiologi

USG ada cairan

Rontgen foto

Destruksi

Penyempitan rongga sendi


P b t



Pengobatan

1. Umum

2. Lokal


P b t



Pengobatan

Umum

Perbaiki KU, Infus cairan resusitasi

Obat-obatan

Anti piratik

Analgesik

Antibiotik sesuai kultur

Uncomplicated cases (3 minggu)

Complicated cases (3-6 weeks)




Antimicrobial Agents in

Orthopedics • Penicillin (Pen. G).

• Penicillinase Resitant Synthetic

Penicillins (PRSP).- Naficillin.

- Oxacillin.

- Cloxacillin.

- Flucloxacillin.


P b t



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



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



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



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




• 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




• 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




• 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.



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



TB Arthritis of Hip


4. infeksi muskuloskeletal arthritis senin 26 maret 2012-blok13

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