Septic Arthritis

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Introduction

  • Septic arthritis is accompanied by articular manifestation due to presence of pathogen within a joint.
  • Mostly due to bacteria, but can also be due to fungal, viral, or protozoan agent, rickettsia
  • Two major entities – gonococcal and Non – gonococcal
  • Staphylococcus aureus is the commonest organism but other organisms as well viz Streptococci, pseudomonas, anaerobes
  • Joint infection mostly as a result of haematogenous seeding during a bacteriaenic episode
  • May also occur secondary to penetrating Cutaneous trauma
  • Uncommonly, iatrogenic from local corticosteroid joint injection

Risk Factors

  • Extremes of life – very young and persons above 80yrs
  • Immunosuppressive/ cytotoxic agents
  • Immunosuppression – HIV, chronic renal, failure, hypogammaglobulinaemia
  • Diabetes mellitus
  • Previous intra – articular steroid
  • Osteoarthritis
  • Alcoholism
  • Haemoglobinopathies
  • Trauma to the joint
  • Rheumatoid arthritis
  • SLE

Clinical Features

  • Usually monoarticular
  • Acutely swollen joint
  • Joint hot to touch, extremely painful
  • Tenderness on palpation and movement
  • High fever
  • Rigors, diaphoresis

Differential Diagnosis

  • Gout
  • Pseudogout
  • Reactive arthritis
  • Haemarthrosis – possibly from aspirin
  • Osteoarthritis
  • Intra articular injury
  • Osteonecrosis
  • Metastic, carcinoma
  • Fracture around the joint

Investigations

  • Haematocrit, white blood cell count and differentials
  • Joint aspirate – microscopy, culture and sensitivity
  • Blood culture
  • ESR, CRP
  • X-ray of affected joints
  • CT, MRI

Treatment

  • Antibiotic treatment depending on bacteria isolated
  • Cloxacillin or Flucloxacillin 
    • 25 mg/kg up to 1 g by IV every 6 hours
  • Vancomycin for MRSA resistant staphylococcus
    • 0.5 - 2 g/day orally divided every 6 - 8 hours
  • Ceftriaxone
    • 1 – 2gm once daily (IM or IV) for suspected gonococcus or meningococcus
  • NSAIDs
  • Surgical
  • Daily needle aspiration
  • Open drainage
  • Arthroscopic debridement with lavage

Intravenous therapy for 10 -14 days and then oral antibiotics for up to 6 weeks

Complications:

  • Septicaemia
  • Joint ankylosis