Septic arthritis overview: Difference between revisions
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== Classification == | == Classification == | ||
Septic arthritis broadly classified based on the etiology as gonococcal or non-gonococcal arthritis and based on the clinical presentation as mono articular septic arthritis or poly articular septic arthritis.<ref name="pmid12364368">Shirtliff ME, Mader JT (2002) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12364368 Acute septic arthritis.] ''Clin Microbiol Rev'' 15 (4):527-44. PMID: [https://pubmed.gov/12364368 12364368]</ref><ref name="pmid8412643">Dubost JJ, Fis I, Denis P, Lopitaux R, Soubrier M, Ristori JM et al. (1993) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8412643 Polyarticular septic arthritis.] ''Medicine (Baltimore)'' 72 (5):296-310. PMID: [https://pubmed.gov/8412643 8412643]</ref> | |||
==Causes== | ==Causes== |
Revision as of 19:46, 16 January 2017
Septic arthritis Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Jumana Nagarwala, M.D., Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital; Cafer Zorkun, M.D., Ph.D. [2]
Overview
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).
Historical Perspective
Classification
Septic arthritis broadly classified based on the etiology as gonococcal or non-gonococcal arthritis and based on the clinical presentation as mono articular septic arthritis or poly articular septic arthritis.[1][2]
Causes
Septic arthritis develops when bacteria or other tiny disease-causing organisms (microorganisms) spread through the bloodstream to a joint. It may also occur when the joint is directly infected with a microorganism from an injury or during surgery. The most common sites for this type of infection are the knee and hip. Most cases of acute septic arthritis are caused by bacteria such as staphylococcus or streptococcus. Chronic septic arthritis (which is less common) is caused by organisms such as Mycobacterium tuberculosis and Candida albicans.
Diagnosis
History and Symptoms
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.
Diagnostic Evaluation
Hot, swollen joint suspecting septic arthritis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Joint aspiration send synovial fluid for Gram stain, culture and cell count | If dry tap: Do image guided joint apiration with ultrasound or CT | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Inflammatory/Purulent joint fluid Presence of PMN 50,000-150,000 cells and mostly neutrphils | Non-inflammatory fluid/Crystals Suspect non bacterial arthritis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Gram positive cocci Start empiric Vancomycin or Nafcicillin | Gram negative bacilli Start empiric 3rd generation cephalosporins + aminoglycosides | Negative Gram stain | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Follow-up with synovial fluid culture results | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
If culture positive ❑ Treat for septic arthritis ❑ Change antibiotics according to the culture results ❑ Joint drainage | If culture negative ❑ Assess for true or false positivity of Gram stain ❑ Assess for clinical response | Immunocompromised start empiric Vancomycin and 3rd generation cephalosporins | Immunocompetent start empiric varncomycin | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Wait for culture results | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
If culture positive, ❑ Treat for septic arthritis ❑ Change antibiotics according to the culture results ❑ Joint drainage | If culture negative Confirmed non bacterial arthritis and look for alternative diagnosis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CT
CT is more sensitive than plain films for the detection of early bone destruction and effusion.
MRI
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.
Treatment
Medical Therapy
Therapy is usually with intravenous antibiotics, analgesia and washout/aspiration of the joint to dryness.
Primary Prevention
Preventive (prophylactic) antibiotics may be helpful for people at high risk.
References
- ↑ Shirtliff ME, Mader JT (2002) Acute septic arthritis. Clin Microbiol Rev 15 (4):527-44. PMID: 12364368
- ↑ Dubost JJ, Fis I, Denis P, Lopitaux R, Soubrier M, Ristori JM et al. (1993) Polyarticular septic arthritis. Medicine (Baltimore) 72 (5):296-310. PMID: 8412643