Sandbox:septic arthritis: Difference between revisions
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Septic arthritis is due to intra articular seeding of living microorganisms. The most common etiological agent of all nongonococcal causes of septic arthritis in the United States is Staphylococcus aureus.<ref name="pmid2283490">Deesomchok U, Tumrasvin T (1990) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2283490 Clinical study of culture-proven cases of non-gonococcal arthritis.] ''J Med Assoc Thai'' 73 (11):615-23. PMID: [https://pubmed.gov/2283490 2283490]</ref> | Septic arthritis is due to intra articular seeding of living microorganisms.<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> The most common etiological agent of all nongonococcal causes of septic arthritis in the United States is Staphylococcus aureus.<ref name="pmid2283490">Deesomchok U, Tumrasvin T (1990) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2283490 Clinical study of culture-proven cases of non-gonococcal arthritis.] ''J Med Assoc Thai'' 73 (11):615-23. PMID: [https://pubmed.gov/2283490 2283490]</ref> | ||
Gram-negative bacilli account for 10 to 20% of septic arthritis causes.<ref name="pmid2283490">Deesomchok U, Tumrasvin T (1990) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2283490 Clinical study of culture-proven cases of non-gonococcal arthritis.] ''J Med Assoc Thai'' 73 (11):615-23. PMID: [https://pubmed.gov/2283490 2283490]</ref> ~10% of patients with nongonococcal septic arthritis are due to polymicrobial cause of infections. Anaerobes are also can cause septic arthritis in few cases. | Gram-negative bacilli account for 10 to 20% of septic arthritis causes.<ref name="pmid2283490">Deesomchok U, Tumrasvin T (1990) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2283490 Clinical study of culture-proven cases of non-gonococcal arthritis.] ''J Med Assoc Thai'' 73 (11):615-23. PMID: [https://pubmed.gov/2283490 2283490]</ref> ~10% of patients with nongonococcal septic arthritis are due to polymicrobial cause of infections. Anaerobes are also can cause septic arthritis in few cases. | ||
Revision as of 17:53, 10 January 2017
Overview
Septic arthritis is a an important consideration in adults presenting with monoarticular arthritis in 80 to 90% of patients. It can involve any joint, but most commonly involves knee > hip > shoulder > ankle.[1] Other joints such as sacroiliac joint, sternoclacicular or costoclavicular joints may be involved in patient with history of intravenous drug abuse (IVDA), penetrating trauma, animal or human bites and local steroid injections.
Defintion
Historical perspective
Causes
Septic arthritis is due to intra articular seeding of living microorganisms.[2] The most common etiological agent of all nongonococcal causes of septic arthritis in the United States is Staphylococcus aureus.[3] Gram-negative bacilli account for 10 to 20% of septic arthritis causes.[3] ~10% of patients with nongonococcal septic arthritis are due to polymicrobial cause of infections. Anaerobes are also can cause septic arthritis in few cases.
Most common cause of septic arthritis in children age < 2 years are Haemophilus influenzae (in immunized children), Staph. aureus, group A Streptococcal infections and Kingella kingae.[4]
Pathophysiology
Hematogenous spread: Septic arthritis most commonly develop as a result of hematogenous spreading bacteria into the vascular synovial membrane.[5]
Direct inoculation: Direct inoculation of microorganisms may occur during joint surgery, particularly in association with knee and hip arthroplasties.
Contiguous spread: Bone infection can spread by breaking through its outer cortex and then into the intracapsular region that lead to joint infection. This kind of spread is more common in children as the small capillaries can cross the epiphyseal growth plate and permit extension of infection into the epiphysis and joint space.[1][6]
Risk Factors
Common Risk Factors
Common risk factors that predespose septic arthritis are as follows:[7][8][9][10]
- Age >60 years
- Recent history of bacteremia
- Degenerative joint diseases such as rheumatoid arthritis ( Prosthetic joint > Rheumatoid arthritis > Osteoarthritis)[8]
- Corticosteroid therapy
- Diabetes mellitus
- Leukemia
- Cirrhosis
- Granulomatous diseases
- Hypogammaglobulinemia
- Intravenous substance abuse
- Chronic kidney disease
- Cytotoxic chemotherapy
| Microorganism | Associated risk factors |
|---|---|
| Staphylococcus aureus | |
| Streptococcus pyogenes
Streptococcal pneumonia |
|
| Groups B Streptococcal infection |
|
| Neisseria gonorrhoeae |
|
| Gram-negative bacilli
Most common gram-negative organisms are Pseudomonas aeruginosa and Escherichia coli. |
|
| Haemophilus influenzae |
|
| Anaerobes |
|
- Recent history of joint aspiration or local corticosteroid joint injection.[16][5]
- History of Rhematoid arthritis[11]
- History of diabetes mellitus[9]
Epidemiology and Demographics
Females are more at risk in getting gonorrheal arthritis and four fold risk compared to men, due to the asymptomatic nature of gonorrheal infection in women.
In children hip is most commonly involved.
Diagnosis
History and Symptoms
Phaysical Examination
Appearance of the Patient
Patient with septic arthritis usually appears toxic and with joint pain that involved
Vital Signs
- Low grade fever
- Hyperthermia over the joint involved
- Tachycardia
- Tachypnea
Skin
- Warm over the joint
- Erythema over the around the joint that involved
HEENT
Neck
Lungs
Heart
Abdomen
Back
Genitourinary
Extremities
Most commonly involves knee > hip > shoulder > ankle.[1] Other joints such as sacroiliac joint, sternoclacicular or costoclavicular joints may be involved in patient with history of intravenous drug abuse (IVDA), penetrating trauma, animal or human bites and local steroid injections.
- Swelling of the joint that involved
- Decreased range of motion
Neuromuscular
Laboratory Tests
Diagnosis of septic arthritis depends maily on the arthrocentesis and isolation of the pathogen from aspirated joint fluid.[17]
References
- ↑ 1.0 1.1 1.2 Barton LL, Dunkle LM, Habib FH (1987) Septic arthritis in childhood. A 13-year review. Am J Dis Child 141 (8):898-900. PMID: 3498362
- ↑ 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
- ↑ 3.0 3.1 3.2 Deesomchok U, Tumrasvin T (1990) Clinical study of culture-proven cases of non-gonococcal arthritis. J Med Assoc Thai 73 (11):615-23. PMID: 2283490
- ↑ Yagupsky P, Bar-Ziv Y, Howard CB, Dagan R (1995) Epidemiology, etiology, and clinical features of septic arthritis in children younger than 24 months. Arch Pediatr Adolesc Med 149 (5):537-40. PMID: 7735407
- ↑ 5.0 5.1 Klein RS (1988) Joint infection, with consideration of underlying disease and sources of bacteremia in hematogenous infection. Clin Geriatr Med 4 (2):375-94. PMID: 3288326
- ↑ Buckholz JM (1987) The surgical management of osteomyelitis: with special reference to a surgical classification. J Foot Surg 26 (1 Suppl):S17-24. PMID: 3559051
- ↑ Dickie AS (1986) Current concepts in the management of infections in bones and joints. Drugs 32 (5):458-75. PMID: 3792229
- ↑ 8.0 8.1 Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA (1995) Risk factors for septic arthritis in patients with joint disease. A prospective study. Arthritis Rheum 38 (12):1819-25. PMID: 8849354
- ↑ 9.0 9.1 9.2 Morgan DS, Fisher D, Merianos A, Currie BJ (1996) An 18 year clinical review of septic arthritis from tropical Australia. Epidemiol Infect 117 (3):423-8. PMID: 8972665
- ↑ Rozadilla A, Nolla JM, Mateo L, del Blanco J, Valverde J, Roig D (1992) [Septic arthritis induced by pyogenic germs in patients without parenteral drug addiction. Analysis of 44 cases.] Med Clin (Barc) 98 (14):527-30. PMID: 1602850
- ↑ 11.0 11.1 Goldenberg DL, Cohen AS (1976) Acute infectious arthritis. A review of patients with nongonococcal joint infections (with emphasis on therapy and prognosis). Am J Med 60 (3):369-77. PMID: 769545
- ↑ 12.0 12.1 Le Dantec L, Maury F, Flipo RM, Laskri S, Cortet B, Duquesnoy B et al. (1996) Peripheral pyogenic arthritis. A study of one hundred seventy-nine cases. Rev Rhum Engl Ed 63 (2):103-10. PMID: 8689280
- ↑ Vassilopoulos D, Chalasani P, Jurado RL, Workowski K, Agudelo CA (1997) Musculoskeletal infections in patients with human immunodeficiency virus infection. Medicine (Baltimore) 76 (4):284-94. PMID: 9279334
- ↑ Schattner A, Vosti KL (1998) Bacterial arthritis due to beta-hemolytic streptococci of serogroups A, B, C, F, and G. Analysis of 23 cases and a review of the literature. Medicine (Baltimore) 77 (2):122-39. PMID: 9556703
- ↑ De Jonghe M, Glaesener G (1995) [Type B Haemophilus influenzae infections. Experience at the Pediatric Hospital of Luxembourg.] Bull Soc Sci Med Grand Duche Luxemb 132 (2):17-20. PMID: 7497542
- ↑ Hunter JA, Blyth TH (1999) A risk-benefit assessment of intra-articular corticosteroids in rheumatic disorders. Drug Saf 21 (5):353-65. PMID: 10554051
- ↑ Bayer AS (1980) Gonococcal arthritis syndromes: an update on diagnosis and management. Postgrad Med 67 (3):200-4, 207-8. PMID: 7355135