Causes
- Staphylococcus aureus in majority of cases
- Streptococcus pyogenes and pneumococci
- Haemophilus influenzae in infants
- Salmonella in sickle cell disease
Signs and symptoms
- Joint pain and stiffness
- Fever and chills
- Fatigue and generalized weakness
- Redness of the skin around the joint.
- Joint inflammation: swelling, effusion, warmth, tenderness and limitation of movement
Differential diagnosis
- Gonococcal arthritis
- Gout and pseudogout
- Rheumatic fever
- Rheumatic arthritis
- Viral arthritis
- Osteoarthritis
- Clotting disorders
Complications
- Dysfunctional joints
- Osteomyelitis
- Sepsis
- Osteonecrosis
- Fatality
Investigations
- FBC
- ESR
- Radiograph of affected joints
- Sickling /Hb electrophoresis
- Aspiration of joint effusion (fluid is turbid with polymorphs) for Gram stain, microscopy, culture and sensitivity
- Blood culture
- Urethral swab
Treatment objectives
- Relieve pain
- Treat infection
- Prevent joint damage
Non-pharmacological treatment
- Rest affected joint e.g. splinting or traction during acute phase
- Therapeutic joint aspiration
Pharmacological treatment
Cloxacillin IV
Adult:
500 mg intravenously every 6 hours for up to 2 weeks
Child:
5-12 years: 250 mg every 6 hours
1-5 years: 125 mg every 6 hours
<1 year: 62.5 mg every 6 hours
OR
Flucloxacillin oral
Adult:
500 mg, PO, every 6 hours
Child:
5-12 years: 250 mg every 6 hours
1-5 years: 125 mg every 6 hours
<1 year: 62.5 mg every 6 hours
OR
Clindamycin IV/oral
Adults
150-300 mg orally or intravenously every 6-8 hours
Child:
3-6 mg/kg orally or intravenously every 6 hours
In children with sickle cell disease and suspected Salmonella infection
ADD
Ciprofloxacin oral
10 mg/kg every 12 hours
Paracetamol oral
Adults
500 mg-1g every 6-8 hours
Child
10mg/kg every 6-8 hours
OR
Ibuprofen oral
Adults
400 mg every 8 hours
Child
10 mg/kg every 8 hours
Referral
Refer patients with large effusions to a specialist for joint aspiration.