Septic Arthritis

Question 1

Definition:

Answer 1

Piogenic arthritis characterized by supurative inflamatory process in the sinovial membrane

Question 2

Epidemiology:

Answer 2

Incidence of 2-10/100.000/year

Question 3

Etiologia:

Answer 3

S. aureus, N. gonorrheae, Beta-hemolytic streptococcus, Gram-negative aerobic and anaerobic bacteria

Question 4

Pathophysiology:

Answer 4

Contiguous spread or via the bloodstream -> Sinovial membrane -> Bacterial proliferation -> Loss of glycosaminoglycans -> Hydrolysis of essential collagen -> non reversible joint destruction

Question 5

Classification:

Answer 5

Gonococcal and Nongonococcal

Question 6

Quadro Clínico:

Answer 6

Monoartrite aguda, tenossinovite, limitação acentuada dos movimentos, claudicação, febre e pústulas indolores

*Joelhos, quadris, ombros, tornozelos, punhos e cotovelos

Question 7

Critérios Diagnósticos (Kocher, 1999):

Answer 7

Impossibilidade de apoiar membro, febre, VHS+40, Leuc +12.000

Question 8

Exames Complementares:

Answer 8

HC, VHS, PCR, Hemocultura, eletrólitos, ácido úrico, função renal, função hepática, *Rx articular bilateral, US, **Artrocentese , Coloração Gram, Hemocultura e Cultura do líquido sinovial

• Edema de partes moles periarticulares, osteopenia periarticular e redução do espaço articular difusamente
• *Líquido sinovial turvo ou purulento com baixa viscosidade e Leucócitos +50.000

Question 9

Diagnóstico Diferencial:

Answer 9

Gota, Pseudogota, Febre reumática, Artrite reumatóide e Púrpura de Henoch-Schoenlein

Question 10

Tratamento (Current, 2014):

Answer 10

Internar por 1-2d -> Repouso, Imobilização articular, Drenagem articular, Lavagem artroscópica, Debridamento e *Ceftriaxona 1000mg IM 24/24h por 1-2d -> Fluorquinolona VO por 4sem —> **Artrotomia

*Oxacilina 2000mg IV 4/4h

**1ª linha no Quadril

Question 11

Risk factors:

Answer 11

Trauma, Atividade sexual desprotegida, use of prosthetic joints, uso de glicocorticoides e uso de drogas injetáveis

Question 12

Diseases that are risk factors:

Answer 12

Osteomielite, Osteoartrite, Artrite reumatóide and Gota

Question 13

Most common pathogen (75% of cases) among younger sexually active individuals:

Answer 13

N. gonorrhoeae

Question 14

Most common pathogen in adults and in children older than 2 years:

Answer 14

S. aureus

Question 15

The increased incidence of S. aureus is directly proportional to:

Answer 15

the increase of prosthetic joints and the use of immunosuppressive agents

Question 16

The pathogen in 80% of infected joints affected by rheumatoid arthritis:

Answer 16

S. aureus

Question 17

Polymicrobial joint infections (5-10% of cases) and infection with anaerobic organisms (5% of cases) are usually a consequence of:

Answer 17

Trauma or Abdominal infection

Question 18

Most common route that the pathogens invade the joint:

Answer 18

Via bloodstream