Septic arthritis

Posted by e-Medical PPT
Septic arthritis is the purulent invasion of a joint by an infectious agent which produces arthritis.People with artificial joints are more at risk than the general population but have slightly different symptoms, are infected with different organisms and require different treatment.Septic arthritis is considered a medical emergency. If untreated, it may destroy the joint in a period of days.
The usual etiology of septic arthritis is bacterial, but viral, mycobacterial, and fungalarthritis occur occasionally.
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 bovine tb).
Micro-organisms must reach the synovial membrane of a joint. This can happen in any of the following ways:
    * dissemination of pathogens via the blood, from abscesses or wound infections, or from an unknown focus
    * dissemination from an acute osteomyelitic focus,
    * dissemination from adjacent soft tissue infection,
    * entry via penetrating trauma
    * entry via iatrogenic means
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.
The diagnosis of septic arthritis is based on clinical assessment and prompt arthrocentesis. Imaging can sometimes be used to aid in the diagnosis of septic arthritis.
Native X-ray of the joint is neither sensitive nor specific. Ultrasound can detect joint-swelling. MRI findings include: synovial enhancement, perisynovial edema and joint effusion.
Therapy is usually with intravenous antibiotics, analgesia and washout/aspiration of the joint to dryness. Among pediatric patients with an acute hematogenous septic arthritis a short total course of 10 days of antimicrobials is sufficient in uncomplicated cases.

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