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Bone, Joint, and Necrotizing Soft Tissue Infections.


In: Baron S1, editor.


Medical Microbiology. 4th edition. Galveston (TX): University of Texas Medical Branch at Galveston; 1996. Chapter 100.

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University of Texas Medical Branch at Galveston, Galveston, Texas


Necrotizing infections of the soft tissues are characterized by extensive tissue necrosis and production of tissue gas. These infections may extend through tissue planes and are not well contained by the usual inflammatory mechanisms. They may develop and progress with dramatic speed, and extensive surgery and systemic antibiotic therapy are required to eradicate them. Arthritis or inflammation of a joint space may be caused by a wide variety of infectious or noninfectious processes. Non-infectious arthritis is the more common type of arthritis and is usually secondary to degenerative, rheumatoid, or posttraumatic changes within the joint. Infectious arthritis, although less common, is often accompanied by a striking polymorphonuclear inflammatory response and can cause severe destruction of the articular cartilage if not properly diagnosed and treated. Bone infections are called osteomyelitis (from osteo [bone], plus myelitis [inflammation of the marrow]). Hematogenous osteomyelitis and contiguous-focus osteomyelitis are the two major types of bone infections. Both types can progress to a chronic bone infection characterized by large areas of dead bone. Bone, joint, and soft tissues, with the exception of the skin, are normally sterile areas. Bacteria may reach these sites by either hematogenous spread or spread from an exogenous or endogenous contiguous focus of infection (Fig. 100-1). Host defenses are important in containing necrotizing soft tissue infections. A systemically or locally compromised host (Table 100-1) is more likely to develop these types of infections and to be unable to contain them.

Copyright © 1996, The University of Texas Medical Branch at Galveston.

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