What are the musculoskeletal manifestations of P aeruginosa infection?

Updated: Dec 17, 2018
  • Author: Selina SP Chen, MD, MPH; Chief Editor: Russell W Steele, MD  more...
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Febrile neutropenia

Bone and joint infection (eg, osteochondritis, osteomyelitis, pyarthrosis)

  • Infections of the bones and joints typically result from hematogenous spread from another primary site. This may occur in individuals who have used intravenous (IV) drugs and who have associated urinary tract infections (UTIs) or pelvic infections, in those with penetrating trauma, in postsurgical patients, in those with primary soft tissue infection, and in patients with diabetes or rheumatoid disease.

  • Patients (especially children) may present with osteochondritis after a puncture of the foot through a sneaker or tennis shoe.

  • The sternoclavicular and sacroiliac joints, vertebra, and symphysis pubis are typically involved in individuals who have used IV drugs.

  • Postsurgical patients tend to develop infections in the long bones, especially patients who underwent internal fixation for open fractures. Vertebral osteomyelitis is occasionally observed as a complication of UTI and genitourinary (GU) surgery or instrumentation. Because of vascular insufficiency in the lower extremities of patients with diabetes, they may develop osteomyelitis of the foot. Patients with rheumatoid disease may develop infections in large synovial joints.

  • Children who present with osteochondritis typically experience pain and edema 3-4 days following a puncture wound, only to have symptoms recur or worsen later. Symptoms usually persist more than 1 week without any systemic signs or fever.

  • Sternoarticular pyarthrosis, often seen in individuals who abuse IV drugs, is usually associated with endocarditis, although the primary site is often indiscernible. Joint involvement is typically monoarticular. Complaints include fever, pain, and restricted movement of the shoulder, with limited-to-severe anterior chest pain over the affected joint.

  • Patients with vertebral osteomyelitis can present with pain that persists from weeks to months, especially in the neck or back region. Fever and constitutional symptoms are relatively rare.

  • Chronic contiguous osteomyelitis commonly occurs after a compound fracture or as a complication of surgery for closed fracture of the long bones. It occasionally occurs after a foot puncture wound, as an extension of infection of ischemic ulcers in patients with peripheral vascular disease, following cardiac surgery, and as a complication of peripheral neuropathy associated with pressure necrosis of skin and soft tissue.

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