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Bone and Joint Infections (Septic arthritis) (Clinical Presentation…
Bone and Joint Infections (Septic arthritis)
Treatment
Stop Immunosuppressants (Methotrexate and anti-TNF alpha)
Double prednisolone dose. As they will not be able to increase their own steroids needed for a flight or fight response
Physiotherapy
START ANTIBIOTICS (2 weeks) AFTER JOINT ASPIRATION
IV Flucoxacillin (gram negative i.e E.coli)
IV Erythromycin/Clindamycin (if allergic to penicillin)
IV Cefotaxime (gram negatives or gonococcal
IV Vancomycin for MRSA
IMMUNOCOMPROMISED: use IV Flucloxacillin and Gentamicin
Surgical washout or repeat another joint aspiration
NSAIDs i.e Ibuprofen
Diagnosis
Skin,throat or urine swabs used for a gonnococcal infection
URGENT JOIN ASPIRATION
Send for gram staining and culture
Will be thick and purulent with High WCC mass (looks like cream)
Light microscopy to exclude gout
ESR, CRP and WCC will all be raised. However, these can be raised normally in RA . However, always attribute a level of more than 150 to infection
Blood Culture
Septic Arthritis is a medical emergency!!!
Most common joint affected is the knee
How can it be infected?
Direct injury
Blood-borne infection
If a joint is severely inflamed it can be destroyed within 24 hours
Definition
Some viruses like rubella, mumps and hep B infections can be associated with self limiting arthritis
but not direct joint involvement
The infection of the joint is normally caused by bacteria and rarely fungi
Epidemiology
Main causes: Staph Aureus!!!! Grows on blood agar
Streptococci
Neisseria gonorrhoea
Haemophilus influenzae in children
Gram-Negative Bacteria e.g. E.coli or Pseudomonas Aeruginosa in the elderly, young or immunocompromised
Increases with age. 45% of cases are above 65 years old
Note Haemophilus influenza is now a rare occurrence in children due to the childhood vaccine schedule
Septic prosthetic arthritis is higher than those in native joints
Immuno supressed
Mycobacterium marinum
Synovial Biopsy
Risk Factors
Diabete mellitus
Immunosupression i.e HIV
Pre-existing joint problems i.e RA (or chronically inflammed joints)
Chronic Renal failure
Prosthetic joints
Trauma
DIfferential diagnosis
Gout (monosodium urate crystals)
Pseudogout (calcium pyrophosphate cyrstals)
Clinical Presentation
In the elderly and immunosuppressed the signs may be muted
Children may not use their joint or protect it
Young and previously well: agonising, painful, red swollen and hot joints
Monoarthritis
Common in the hip joint
Shoulder joint
Knee joint
BUT can occur in any joint
Fever
Early onset
Joint effusion
Loss of function and pain
Wound inflammation
Late onset
Pain
Mechanical dysfunction