Infection of Locomotor Tissues Flashcards
what is the mortality of septic arthritis
10%
what are risk factors for septic arthritis
Extremes of age
Pre-existing joint disease (Principally RA)
IVDU
Immunosuppression (Including DM)
Recent procedures on the joint
what organism most commonly causes septic arthritis
staph aureus
apart from staph aureus, what are is an important differential for the causative organism for septic arthritis in young adults and children
young adults - disseminated gonoccocal infection
children - streptococcal, Hib
how should you investigate septic arthritis
joint aspiration - gram stain + culture + crystal analysis
blood cultures
FBC/clotting/ESR/CRP/Uric acid/Clotting
what is the guidance for aspirating prosthetic joints
only do it in theatre
how do you manage confirmed septic arthritis
A-E resus + sepsis 6 if required
Admission under ortho
IV Flucloxacillin (2g 6 hourly) AFTER cultures/aspiration
Continued for 2-3 weeks
Followed by 6 weeks of oral treatment
Guided by CRP/ESR
Adequate pain relief
Early source control with theatre washout
Early active rehab
how does chronic joint/bone sepsis present
Acute/subacute monoarthritis with a hot swollen erythematous joint
Joint is held in ‘loose pack’ position (knee flexed)
what would you expect to find on examination with joint/bone sepsis
Fever and systemic symptoms
Demonstratable effusion
Loss of movement of the joint
Extreme pain even with passive movement
which joints are most commonly affected by joint/bone sepsis
knee or hip joint
what are important differentials for joint/bone sepsis
Crystal arthritis
Osteomyelitis
Reactive arthritis
Monoarticular seropositive or seronegative rheumatological disease (RA/AS/CTD)
what is the pathology for locomotor sepsis
Haemotological spread of infection through eruption of a bone abscess or directly through a penetrating wound
Infection spreads throughout a joint and the cartilage is destroyed
Pus bursts out the joint to form abscesses and sinuses
With healing the raw articular surfaces may adhere causing ankylosis
what are features of viral arthropathy
Viral arthralgia can be caused by basically any viral infection
Tends to occur during prodromal phase, along with a viral rash
Tends to be symmetrical and non destructive
Investigations – viral titres/antigens and also RF
