125 - Infective Arthritis Flashcards
Acute infectious arthritis usually affect a __ joint. In patients with __ the infection can spread to __ joints
single
RA
multiple
What are the main pathogens that cause infectious arthritis?
staph aureus
neisseria gonorrhea
mycobacteria
subacute or chronic monoarticular arthritis main pathogens are usually 2
fungal
mycobacteria
Episodic infectious arthritis main pathogens:
syphilis
Lyme disease
reactive arthritis
Normal synovial fluid may contain up to __ cells/ microliter, mostly __. A definitive diagnosis should be after identifying the pathogen in __,__
180
mononuclear
culture
PCR
In acute infectious arthritis the synovial fluid will contain - cells/microliter with >_% neutrophils
25k-250k
90
The most common joints get infected is the __ pathway
hematogenic
Cartilage will start to degenerate __ hours after the bacteria infiltration to the synovium
48
Different age groups are affected from different pathogens:
infants-
children-
adolescence-
GBS, SA, G(-) enteric bacilli
like infants + Kingella kingae
neisseria gonorrhea, SA
Most often, nongonococcal bacterial infection affects patients with risk factors, mostly __. Other risk factors include: 5
RA diabetes dialysis malignancy steroids vasculitis
Most patients suffering from infective arthritis have monoarthritis (%). The most common joints are:>>>_
knee
hip
shoulder
wrist/elbow
IVDU with infective arthritis usually suffer from infected __ and __ joints
sacroiliac
sternoclavicular
Blood culture will be positive in -% of cases with SA, but much less with other pathogens
50-70
When treating infectious arthritis __ treatment should be administrated immediately after __ together with __ the joint
empiric
cultures
draining
How should you treat an adult with community acquired infectious arthritis with no organism on blood film?
What if G(+) is found?
if pseudomonas/IVDU are suspected?
3rd gen cephalosporine IV
add- vancomycin or oxacillin/nafcillin/cefazolin
aminoglycoside / 3rd gen cephalosporine IV
Gonococcal arthritis is the most common type (_%) for people < _. More in __
70
40
women 1
What is DGI?
Disseminated gonococcal infection
What are the symptoms for DGI? 4
fever
shivering
rash (papular->pustular)
joint symptoms (migratory arthritis)
DGI blood cultures are positive in _%, and __ cultures usually come back negative
45
synovial
What is the recommended treatment for DGI?
ceftriaxone IM/IV -> after symptoms relieve ->fluoroquinolone PO
Spirochetal arthritis are caused by __ and __. Treatment will be __ and __ respectively
Lyme disease
Syphilitic arthritis
ceftriaxone/amoxicillin/doxycycline
penicillin
What is Poncet’s syndrome?
polyarthritis that occurs during acute tuberculosis infection
What is Reiter’s syndrome?
reactive arthritis that produces pain swelling redness and heat in the joints several weeks after nongonococcal urethritis or enteric infections
Reiter’s syndrome is usually __, affecting the __or __
asymmetric
lower limb
sacroiliitis
