Infections of the musculoskeletal system

Abstract

Infekcije mišićno-koštanog sustava mogu zahvaćati kosti, zglobove i meka tkiva, a u ciljno tkivo dolaze hematogenim putem, širenjem per continuitatem ili direktnim unosom izvana kroz oštećenu kožu. Najčešći uzročnici su bakterije koje nastanjuju kožu. Infekcije se mogu podijeliti prema lokalizaciji, vrsti uzročnika, zahvaćenosti tkiva, mehanizmu nastanka, trajanju ili nekom drugom kriteriju. Infekcije kosti i zgloba često su kompleksne, s visokim troškovima liječenja i potencijalno opasnim komplikacijama. Potreban je interdisciplinaran pristup i pravovremena dijagnostika radi očuvanja kvalitete života pacijenta. Za postavljanje dijagnoze potrebno je uzeti u obzir kliničku sliku, biokemijske i mikrobiološke metode te slikovne metode. Prva slikovna metoda izbora je rendgenogram (RTG), koji prikazuje promjene na kostima u dvije dimenzije i stoga nije adekvatan pri postavljanju dijagnoze rane infekcije. Izbor daljnje slikovne pretrage ovisi o pojedinoj infekciji i postojećoj kliničkoj sumnji. Kompjutorizirana tomografija (CT) pruža detaljan prikaz promjena na kostima, dok magnetska je rezonanca (MR) metoda izbora za detaljan prikaz mekih tkiva i ranih znakova infekcije. Ultrazvuk (UZV) je visokovrijedna metoda za dijagnostiku infekcija kože i površinskih mekih tkiva, a nuklearno-medicinske tehnike za prikaz metaboličke aktivnosti odnosno stupnja upale u tkivu. Izbor antibiotika ovisi o lokalizaciji i uzročniku. Uz konzervativno, pojedine infekcije kao što su osteomijelitis i periprotetska infekcija zgloba (engl. PJI) često zahtijevaju kirurško liječenje.Musculoskeletal infections can affect the bones, joints, as well as soft tissues. Pathogens enter the target tissue by hematogenous spread, direct spread, or via direct entry through the damaged skin. The most common causative agents are bacteria that inhabit the skin. Infections can be classified according to location, pathogen, tissue involvement, mechanism of infection, duration or some other criterion. Bone and joint infections are often complex, represent a major cost to the healthcare system and may have potentially dangerous complications. Therefore, management of such infections requires an interdisciplinary approach and timely diagnosis to preserve the patient’s quality of life. In order to diagnose, it is necessary to take into account the clinical signs and symptoms, biochemical, microbiological and imaging methods. The first imaging method of choice is radiography, which depicts changes in the bones in two dimensions and is therefore not adequate in diagnosing early infection. The choice of further imaging depends on the type of infection and appropriate clinical suspicion. Computed tomography provides a detailed view of changes in the bones, while magnetic resonance imaging is the method of choice for evaluation of soft tissues and early signs of infection. Ultrasound is a valuable tool for diagnosing skin and superficial soft tissue infections, while nuclear medicine imaging techniques depict metabolic activity or the degree of inflammation in the tissue. The choice of antibiotics depends on the location and causative agents. In addition to antibiotics, osteomyelitis and prosthetic joint infection often require surgical treatment