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| {{Infobox_Disease | | __NOTOC__ |
| | Name = Septic arthritis
| | {| class="infobox" style="float:right;" |
| | Image =
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| | Caption =
| | | [[File:Siren.gif|30px|link=Septic arthritis resident survival guide]]|| <br> || <br> |
| | DiseasesDB =
| | | [[Septic arthritis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| | ICD10 = M00-M03
| | |} |
| | ICD9 = {{ICD9|711.0}}
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| | MedlinePlus =
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| | eMedicineSubj = med
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| | eMedicineTopic = 3394
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| | MeshID =
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| }}
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| {{SI}} | |
| {{CMG}}
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| {{EH}} | | {{Septic arthritis}} |
| | {{CMG}}; {{AE}}{{VSKP}} |
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| '''Septic arthritis''' is the invasion of the joint space by an infectious agent which produces [[arthritis]]. The usual etiology is bacterial, but viral, mycobacterial, and fungal arthritis occur occasionally. Bacteria are either carried by the bloodstream from an infectious focus elsewhere, introduced by a [[skin]] [[lesion]] that penetrates the joint, or by extension from adjacent tissue (e.g. bone or bursae).
| | {{SK}} Bacterial arthritides, bacterial arthritis, infectious arthritides, infectious arthritis, septic arthritides, suppurative arthritides, suppurative arthritis, non-gonococcal bacterial arthritis, gonococcal arthritis |
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| ==Etiology== | | ==[[Septic arthritis overview|Overview]]== |
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| ==Etiology== | | == [[Septic arthritis historical perspective|Historical Perspective]] == |
| Bacteria are carried by the bloodstream from an infectious focus elsewhere, introduced by a [[skin]] [[lesion]] that penetrates the joint, or by extension from adjacent tissue (e.g. bone or bursae).
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| Micro-organisms must reach the [[synovial membrane]] of a joint. This can happen in any of the following ways:
| | == [[Septic arthritis classification|Classification]] == |
| * dissemination of [[pathogen]]s via the blood, from [[abscess]]es or wound infections,
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| * dissemination from an [[osteomyelitis|acute osteomyelitic focus]],
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| * dissemination from adjacent [[soft tissue]] infection,
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| * entry via [[penetrating trauma]]
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| * entry via [[iatrogenic]] means.<ref name=Axford/>
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| Bacteria that are commonly found to cause septic arthritis are:
| | ==[[Septic arthritis pathophysiology|Pathophysiology]]== |
| * [[Staphylococcus aureus]] - the most common cause in adults
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| * ''Streptococci'' - the second most common cause <ref name=Kaandorp>{{cite journal |author=Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA |title=Incidence and sources of native and prosthetic joint infection: a community based prospective survey |journal=Ann Rheum Dis. |volume=56 |issue=8 |pages=470–5 |year=1997 |month=August |pmid=9306869 |pmc=1752430 |doi= |url=}}<br/>{{cite journal |author=Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M |title=Clinical features and outcome of septic arthritis in a single UK Health District 1982-1991 |journal=Ann Rheum Dis. |volume=58 |issue=4 |pages=214–9 |year=1999 |month=April |pmid=10364899 |pmc=1752863 |doi= |url=}}</ref>
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| * [[Haemophilus influenzae]] - was the most common cause in children but is now uncommon in areas where Haemophilus vaccination is practised<ref>{{cite journal |author=Bowerman SG, Green NE, Mencio GA |title=Decline of bone and joint infections attributable to haemophilus influenzae type b |journal=Clin Orthop Relat Res. |volume= |issue=341 |pages=128–33 |year=1997 |month=August |pmid=9269165 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0009-921X&volume=341&spage=128}}<br/>{{cite journal |author=Peltola H, Kallio MJ, Unkila-Kallio L |title=Reduced incidence of septic arthritis in children by Haemophilus influenzae type-b vaccination. Implications for treatment |journal=J Bone Joint Surg Br. |volume=80 |issue=3 |pages=471–3 |year=1998 |month=May |pmid=9619939 |doi= |url=http://www.jbjs.org.uk/cgi/pmidlookup?view=long&pmid=9619939}}
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| </ref>
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| * [[gonorrhea|Neisseria gonorrhoea]] - in young adults (although this is now thought rare in western europe <ref name=Kaandorp/>
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| * [[Escherichia coli]] - in the elderly, IV drug users and the seriously ill
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| * [[M. tuberculosis]], [[Salmonella]] spp. and [[Brucella]] spp. - cause septic spinal arthritis <ref name=Axford>{{cite book |author=O'Callaghan C, Axford JS |title=Medicine |publisher=Blackwell Science |location=Oxford |year=2004 |pages= |isbn=0-632-05162-0 |edition=2nd ed.}}</ref>
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| In bacterial infection, [[Pseudomonas aeruginosa]] has been found to infect joints, especially in children who have sustained a puncture wound. This bacteria also causes [[endocarditis]].<ref>[http://wordnet.com.au/Products/topics_in_infectious_diseases_Aug01.htm Topics in Infectious Diseases Newsletter, August 2001, Pseudomonas aeruginosa.]</ref>
| | ==[[Septic arthritis causes|Causes]]== |
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| == Diagnosis == | | ==[[Septic arthritis differential diagnosis|Differentiating Septic Arthritis from other Diseases]]== |
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| Septic arthritis should be considered whenever one is assessing a patient with joint pain. Usually only one joint is affected ([[monoarthritis]]) however in ''seeding'' arthritis, several joints can be affected simultaneously; this is especially the case when the infection is caused by [[staphylococcus]] or [[gonococcus]] bacteria.
| | ==[[Septic arthritis epidemiology and demographics|Epidemiology and Demographics]]== |
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| The diagnosis of septic arthritic can be difficult as no test is able to completely rule out the possibility.
| | ==[[Septic arthritis risk factors|Risk Factors]]== |
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| A number of factors should increase ones suspicion of the presence of an infection. In children these are: [[fever]] > 38.5 C, non weight bearing, serum WCBs > 12 x 10^9, [[ESR]] > 40 mm/hr, [[CRP]] > 20 mg/dL, a previous visit for the same.<ref>{{cite web |url=http://www.bestbets.org/bets/bet.php?id=1072 |title=BestBets: Distinguishing between septic arthritis of the hip and transient synovitis in children |format= |work= |accessdate=}}</ref>
| | ==[[Septic arthritis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| Diagnosis is by aspiration (giving a turbid, non-viscous fluid), [[Gram stain]] and [[microbiological culture|culture]] of fluid from the joint, as well as tell-tale signs in laboratory testing (such as a highly elevated [[neutrophils]] (approx. 90%), [[Erythrocyte sedimentation rate|ESR]] or [[CRP]]). A proportion of patients with septic arthritis have little in the way of fever or raised ESR, although the CRP is usually raised <ref>{{cite journal |author=Geirsson AJ, Statkevicius S, Víkingsson A |title=Septic arthritis in Iceland 1990-2002: increasing incidence due to iatrogenic infections |journal=Ann Rheum Dis. |volume=67 |issue=5 |pages=638–43 |year=2008 |month=May |pmid=17901088 |doi=10.1136/ard.2007.077131 |url=}}</ref> | | ==Diagnosis== |
| | | [[Septic arthritis history and symptoms|History and Symptoms]] | [[Septic arthritis physical examination|Physical Examination]] | [[Septic arthritis laboratory findings|Laboratory Findings]] | [[Septic arthritis x ray|X Ray]] | [[Septic arthritis CT|CT]] | [[Septic arthritis MRI|MRI]] | [[Septic arthritis other diagnostic studies|Other Diagnostic Studies]] |
| The Gram stain can rule in the diagnosis of septic arthritis however cannot exclude it.<ref>{{cite web |url=http://www.bestbets.org/bets/bet.php?id=1636 |title=BestBets: Is a negative gram stain in suspected septic arthritis sufficient to rule out septic arthritis |format= |work= |accessdate=}}</ref>
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| ==Treatment== | | ==Treatment== |
| | [[Septic arthritis medical therapy|Medical Therapy]] | [[Septic arthritis surgical management|Surgical Therapy]] | [[Septic arthritis primary prevention|Primary Prevention]] | [[Septic arthritis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Septic arthritis future or investigational therapies|Future or Investigational Therapies]] |
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| Therapy is usually with [[intravenous]] [[antibiotic]]s, [[analgesia]] and washout/aspiration of the joint to dryness.
| | ==Case Studies== |
| | | [[Septic arthritis case study one|Case #1]] |
| ==Radiologic Findings== | |
| Traditionally, the diagnosis of septic arthritis was based on clinical assessment and prompt [[arthrocentesis]]. However, the clinical picture may be obscured by multiple confounding factors and a paucity of specific findings especially for the deep joints, ie. the hip or shoulder. Imaging can be used to confirm the diagnosis of septic arthritis and more importantly, imaging findings suggestive of septic arthritis can direct the clinician to a diagnosis that may not have been considered.
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| Plain film findings of septic arthritis include: joint effusion, soft tissue swelling, periarticular osteoporosis, loss of joint space, marginal and central erosions and bone [[ankylosis]]. CT is more sensitive than plain films for the detection of early bone destruction and effusion.
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| The role of [[MRI]] in the diagnosis of septic arthritis has been increasing in recent years in an effort to detect this entity earlier. Findings are usually evident within 24 hours following the onset of infection and include: synovial enhancement, perisynovial edema and joint effusion. Signal abnormalities in the bone marrow can indicate a concomitant osteomyelitis. The sensitivity and specificity of MRI for the detection of septic arthritis has been reported to be 100% and 77% respectively.
| | ==Related Chapters== |
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| ==See also== | |
| * [[Arthritis]] | | * [[Arthritis]] |
| * [[Human biting injuries]] | | * [[Human biting injuries]] |
| * [[Transient synovitis]] | | * [[Transient synovitis]] |
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| ==References==
| | {{WikiDoc Help Menu}} |
| <references/>
| | {{WikiDoc Sources}} |
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| ==Additional Resources==
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| *[http://uwmsk.org/moodle/mod/resource/view.php?id=368 Septic arthritis] by William Brinkman, M.D., University of Washington Department of Radiology
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| *Karchevsky M, Schweitzer ME, Morrison WB, Parellada JA. MRI findings of septic arthritis and associated osteomyelitis in adults. AJR 2004; 182:119-122.
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| *Resnick D. ''Bone and joint imaging''. Philadelphia, PA: WB Saunders Co; 1989; 744-749
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| *Stoller DW, Tirman P, Bredella MA. ''Diagnostic imaging orthopaedics''. Salt Lake City, UT: Amirsys; 2004; 4-99.
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| *Edwards MS. "Osteomyelitis and Septic Arthritis"
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| {{SIB}} | |
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| [[Category:Arthritis]] | | [[Category:Arthritis]] |
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| [[Category:Medical emergencies]] | | [[Category:Emergency medicine]] |
| [[Category:Signs and symptoms]] | | [[Category:Emergency mdicine]] |
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| | [[Category:Infectious disease]] |
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| | [[Category:Orthopedics]] |
