Septic Arthritis
These slides give you information about septic arthritis and its treatment and how to diagnose it clinically and by arthrocentesis or serum labs.
2. OVERVIEW
Inflammation of one or more joints due to an
infection.
Generally it is monoarticular.
most commonly affecting the knee, hip, and
shoulder.
Leads to rapid joint destruction if untreated.
Septic arthritis can originate from anywhere in
the body.
May begin as a result of open wound, trauma,
3. WHO IS AT RISK?
I. joint damaged patients: OA, RA.
II. Immunosuppression: neutropenia,
DM…
III. IV drugs abusers.
IV. Prosthetic joint.
4.
5.
6. GONOCOCCAL SEPTIC ARTHRITIS
Gonnococcal infections are less
destructive and more responsive to ABs.
Neisseria gonorrhea: sexually
transmitted gram –ve. It causes what is
known Disseminated gonococcal infection
(DGI).
7. NON-GONOCOCCAL SEPTIC
ARTHRITIS
S. Aureus : most common.
S. epidermidis: common in prosthetic
joints and IV..
Streptococci
Gram –ve enterococci: in hospitalized
and immunocompromised patients (esp.
with UTIs).
H. influenza: in kids bw 6 months – 2
8. CLINICAL FEATURES OF DGI
At first it starts as genitourinary symptoms before it
disseminates and causes:
I. Arthritis-dermatitis syndrome: fever,
migratory polyarthralgia, tenosynovitis and
dermatitis.
II. Monoarhtritis.
9. NON-GONOCOCCAL CLINICAL
FEATURES
Acute pain, tenderness, swelling, warmth
and erythema.
Some patients have evidence of the source
responsible for septicemia ( skin, pharynx,
cardiac valve, lung).
SA is acute in onset (rule out OA).
12. S.A DIAGNOSIS
Synovial ultra sound guided arthrocentesis, WBCs
more than 50k/mm^3 and most of it are neutrophils.
Culture is also done.
Note that synovial fluid will be less viscous than
normal.
Serum labs include high ESR, CRP, WBCs.
Ultrasound can document the presence of an effusion
which would be amenable to drainage.
16. SEPTIC ARTHRITIS TREATMENT
Antibiotics should be started before culture
results.
Vancomycin for gram +ve
Ceftriaxone, ceftiazidime for gram –ve
IV Antibiotics for 6 weeks.
Don’t give antibiotic before the sample!!
Drainage.
18. SEPTIC ARTHRITIS COMPLICATIONS
Chondrolysis: lysis/break down of cartilage.
Septic dislocation of the joint.
Avascular necrosis especially for femoral head.
Shortening of limbs because of cartilage
destruction.
Late degenerative changes may lead to
osteoarthritis.
19. SEPTIC ARTHRITIS IN PEDIATRICS
Pediatric Septic Hip Arthritis is an intra-
articular infection in children, peaks in the first
few years of life.
Affects 4-5 per 100,000 children annually.
surgical emergency and requires prompt
recognition and urgent surgical incision and
drainage followed by IV antibiotics.
20. MOST COMMON SITE
Hip is the most common site, knee is more
frequently affected in older children.
21. CLINICAL FEATURES
Septic arthritis presents as a painful joint, often
accompanied by fever, irritability, and refusal to
bear weight.
On examination, range of motion is clearly
limited and The joint is tender and may be
visibly swollen.