Septic arthritis

Medicine1

Pus forming microorganisms within a joint diseased by arthritis is classified as septic arthritis.

CLINICAL SEQUELAE

Arthroempyesis is dangerous disease with complicated course form, which causes arthrosis and contracture. Also, inflectional consequences of the disease may cause occurrence of dangerous disease:

  • Sepsis – malignant bacteria and microorganism penetrate blood (blood poisoning);
  • Phlegmon – adipose tissue damage has an ability to affect surrounding tissue;
  • Abscess – space filled with push, which located in surrounding tissue;
  • Osteomyelitis – inflammatory process in skeleton system.

TYPES

Septic arthritis has two types of progression – primary and secondary.Septic bacteria

Primary

In case of primary type of the disease, infectious agent gets right into joint cavity through wounds, open fracture and also after surgical operation or during arthrocentesis.

Secondary

Secondary progression type is caused by blood poisoning (sepsis), which was caused by infection of external tissue. Scratch or non-penetrating wound around a joint may become a factor of development of this disease. Secondary disease type is more frequent than primary.

CAUSES AND LOCALIZATION

Septic arthritis usually affects large joints constructions – knee, hip, shoulder. Closed cavity makes possible for pus to accumulate around all joint sections. Purulent process affects:

  • Joint capsule;
  • Cartilage and bones;
  • Synovial membrane;

Staphylococcus and streptococcus are the first pathogen of septic arthritis. Also these microorganisms may cause diseases:

  • Escherichia oli or proteus;
  • Pneumococcus and gonococcus;
  • Klebsiella and salmonella.

Undressed wounds, open fractures and low lever of resistance to somatic diseases caused by immune system disorder are the factors which increase chance of arhtroempyesis occurrence.

SIGNS AND SYMPTOMS

Septic arthritis symptoms characterized by severe signs:Arthritis symptoms

  • Acute at the start, following with pulsing pain;
  • Edema, with reddening and warmth around affected area;
  • Inflammation source do a lot of pain to patient when touched;
  • Edema affects surrounding tissue during disease progression;
  • Joint motion function disorder;
  • Weak body state, intoxication;
  • Heart acceleration, high body temperature, fever;
  • Headache and unconsciousness are possible.

DIAGNOSTICS

All the evident symptoms allow exact differentiating of the disease. While typical clinic signs can be confirmed by:

  • blood test which shows increased ESR and left shift leukogram;
  • arthrocentesis is used for diagnosing the inflammatory process of synovial fluid.

Gram staining, fluid which was taken during arthrocentesis, helps to differentiate septic arthritis.

Provisional diagnosis “septic arthritis” gives a reason to a patient to make X-ray analysis. This analysis shows joint space deformation (narrowing or extension), subchrondal bone loss and periarticular osteoporosis.

If patient has disease of infectious type in anamnesis, it’s recommended to consult internist, infectiologist, pulmonologist, and gastroenterologist.

TREATMENT

Immediate Hospitalizing of patient with septic arthritis is necessary. Emergent antibiotic therapy is administered.

Early stage (no pus formation) is limited with conservative methods of treatment.  Casting and arthrocentesis are recommended.

In case of pus accumulation in joint and typical intoxication, arthrotomy and further joint drainage required.Drainage

Open septic wounds, fractures referred to this type of arthritis treated with surgical operation:

  • Wound edges cut;
  • Bone fractures and extraneous matters are removed if necessary;
  • Necrotic tissue cut of;
  • Arthrotomy provided;
  • Pus accumulations lanced.

If septic arthritis was caused by sepsis, surgical interference is inevitable, usually arthrotomy is used.

PREVENTION

First of all, patients who suffer from arthritis must debride their wounds. Also any infectious disease can be treated in order to not allow occurring of chronic form which may damage joints.

 

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