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Septic Arthritis, Gonococcal Arthritis - Coggle Diagram
Septic Arthritis
Epidemiology
Infection of (native) joint space
Can affect one or multiple joints
Medical emergency
Inappropriate treatment can cause...
Joint destruction
Severe sepsis
death
Fatality rate
11% for monoarticular
50% for polyarticular
Most common in elderly and young children
Risk Factors
Joint disease
Rheumatoid arthritis
Osteoarthritis
Gout
Risk of bacterial infection
Surgery
Joint injection
Skin infection
Ulcers
Endocarditis
Haemodialysis
IV drug use
Blood stream infections
Immunosuppressed
Age >80 yrs
Diabetes mellitus
Causative organisms
Neonates
Staph. aureus
Group B streptococcus
Gram - bacilli
E. coli
Children
Staph. aureus
Beta-haemolytic streptococci
Gram - bacilli
E. coli
Klebsiella
Anaerobes
N. gonorrheae
Adults
Staph. aureus
Group A streptococcus
S. pneumoniae
H. influenzae
Kingella kingae
Immunocompromised
Gram - bacilli
Salmonella
Mycobacteria
Fungi
Clinical Manifestations
Local
Joint pain
Swelling
Edema
Heat over joint
Severe pain on movement
Systemic
May be absent in adults
Fever
Sepsis
Children
Usually acutely unwell
Fever
Limp
Pseudoparalysis
Due to pain
Pathogenesis
Haematagenous spread
Most common
Bacteria enters bloodstream elsewhere
Bacteria can seep into joint
Bacteria colonizes in joint
Direct inoculation
Trauma
Joint injections
Arthroscopy
Contiguous spread
From soft tissue infection
Diagnosis
History
Risk factors
Metal work
Examination
Examine joint
Examine heart for murmur
Investigations
Identify causative organism to guide treatment
Blood cultures
Always take if
fever
present
Synovial fluid aspiration
Cell count
Look for WBCs
Gram stain
Culture
No growth
Molecular testing
Sensitivity testing
Radiology
X-ray
Ultrasound
MRI
Not diagnostic, can be supportive
Treatment/Prevention
Removal of infected material from joint
Drain pus
IV antibiotics
Can hold off if patient is relatively well until culture results
Empiric therapy
Staph. aureus
Group A streptococci
Flucloxacillin +/- Benzylpenicillin
If risk for gram - infection
Add Ciprofloxacin/Ceftriaxone
Other streptococci
MRSA
Vancomycin
Child < 3 months
Staph. aureus
Flucloxacillin +/- Cefotaxime
Group B streptococci
E. Coli
Child > 3 months
Staph. aureus
Flucloxacillin +/- Ceftriaxone
Streptococci
H. influenzae
Kingella kingae
Gonococcal Arthritis
Epidemiology
Causative organism:
N. gonorrheae
Most common in sexually active adults <35 yrs
Pathogenesis
Occult bacteremia
Secondary to mucosal infection
Disseminated gonococcal infection
Dermatitis arthritis syndrome (60%)
Dermatitits
Tenosynovitis
Migratory polyarthritis/polyarthralgia
Septic gonococcal syndrome (40%)
Knees
Wrists
Ankles
Treatment/Prevention
Treated with antibiotics alone
