Septic Arthritis

Infectious Arthritis
Septic
Gonococcal
Viral
Fungal
Tuberculous
 Definition
 Acute joint infection due to bacterial agents
 Medical emergency
 Epidemiology
:Incidence 
yr in Prosthetic joint /40-68/100000 
yr in RA /100000 /28-38 
yr in Children /100000 /12 -5 

In Adult: 75% with risk factor 

 Risk factors:
 Systemic:
 Old age (>80 Y)
 RA
 DM
 Immunosuppressive
 Hemodyalisis
 Malignancy
 Local:
 RA
 OA
 Prosthetic joint
 Etiology (microbiology)
 Microbial agent:
 Staphylococcus aureus: most common (75-80%)
 Other organism in special patients:
 Sexually active woman: Neisseria gonorrheae
 Elderly, IV drug abuser, immunocompromised, UTI: Gram
negative (p. aeruginosa and E.coli)
 SLE: Salmonella
 HIV: Pneumococci, Salmonella, H. influenzae
 Alcoholism, Humeral immunity abnormality,
Hemoglobinopathies: Pneumococcal infections
 Primary immunoglobolin deficiency: Mycoplasma
 Root of infection:
 Blood stream
 Contiguous infection

 Direct inoculation:
 Injection: 0.0002
 Arthroscopic surgery: < 0.005

 Animal or human bite

:Site of involvement 
Mono (80-90%) 
Knee: 55% 
Ankle: 10% 
Wrist: 9% 
Shoulder: 7% 
Hip: 5% 
Elbow: 5% 
Foot joints: 2% 
Poly (more than 1 joint): RA 
 Pathogenesis
Microbial Factors: virulence
Host Factors: Immune response
 Immune response:
 Synovial cell:
 IL1- IL6 (influx of immune cell)
 Immune cells:
 Early cytokines: Clearance of organism
 Late cytokines: may amplify the destruction
 Clinical manifestations
Fever (toxic)
Acute
Sever pain
Sever swelling of one joint
Sever tenderness
Warmth
Sever effusion
Sever limited ROM
 Acute Monoarthritis

Sepsis workup Synovial Fluid

Biochemist Aspiration

Smear- Culture Light microscope

 Radiography
 Early:
 Soft tissue swelling Joint space widening

 Predisposing agent

 Late (2-3 w):

 Erosion

 Joint space narrowing

 TREATMENT

Antibiotic Joint Drainage

Empiric (IV): Closed needle Arthrotomy:

Smear Aspiration Hip, Shoulder
Age or Risk factors
Extra articular site

Definitive therapy;
based on culture
 TREATMENT

Antibiotic Joint Drainage

Empiric (IV): Closed needle Arthrotomy:

Smear Aspiration Hip, Shoulder
Age or Risk factors
Extra articular site
Arthroscopic Drainage:
Symptom
Definitive therapy; S. fluid volume
based on culture S. fluid WBC
S. fluid smear & culture