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Septic Arthritis

Updated : February 5, 2024





Background

Septic arthritis is a joint inflammatory condition caused by an infectious etiology, most commonly bacterial, mycobacterial, fungal, viral, or other unusual pathogens. Septic arthritis is typically monoarticular, involving a single big joint such as the knee or hip.

Polyarticular septic arthritis affecting many or smaller joints can occur. Septic arthritis, however rare, is an orthopedic emergency that might cause considerable joint destruction, increasing mortality and morbidity.

Epidemiology

The incidence of septic arthritis ranges from 2-6 instances per 100,000 people, but this varies depending on the proximity of risk factors. Children are more likely than adults to develop septic arthritis. The prevalence is highest between 2 and 3 years, with a male predominance of 2:1. Neonates, hemophiliacs, immunocompromised children with sickle cell anemia, HIV infection, and those receiving chemotherapy are all at increased risk.

Age above 80, rheumatoid arthritis, cutaneous ulcers, recent joint surgery, diabetes mellitus, joint prosthesis, prior intra-articular injection, osteoarthritis, skin infections, Human immunodeficiency virus, sexual activity, particularly in instances of suspected gonococcal septic arthritis, and other etiologies of sepsis are risk factors in adults.

Anatomy

Pathophysiology

The vascularized joint synovium is susceptible to systemic infection through hematogenous seeding because it lacks a limiting basement membrane. Puncture wounds, direct trauma, and intra-articular injections can all cause septic arthritis. Neighboring osteomyelitis can spread contiguously.

The contiguous spread might cause damage to the hip and shoulder. A bacterial infiltration of the synovium and joint space is followed by an inflammatory process resulting in septic arthritis. Proteases and inflammatory cytokines mediate joint degradation.

Bacterial toxins based on animal models and microbial surface substances like staphylococcal adhesins, which encourage the adhesion of the bacteria to intra-articular proteins, are additional factors that contribute to joint destruction.

Etiology

Etiology in Children

There are numerous etiologies for arthritis or joint inflammation in children. In general, Staphylococcus aureus is the most prevalent bacterial pathogen. Specific etiologic agents are linked to certain age groups and underlying illnesses.

The most frequent gram-negative bacterial cause in children under the age of three is Kingella kingae. Neonates frequently contract staphylococcus aureus, gram-negative bacilli, Neisseria gonorrhea, and Group B Streptococcus. In sexually active adolescents, Neisseria gonorrhea is a risk.

Sickle cell disease and salmonella species infection are related to infection. Patients who receive long-term antibiotic treatment are susceptible to fungus infections. Pseudomonas aeruginosa-caused joint infections are linked to injectable medication usage and puncture wounds. Hip joint disorders most frequently impact children.

Etiology in adults

Adults are most infected with Staphylococcus aureus. Although less frequent, streptococcus pneumonia is still a substantial source of infection in adults. N. gonorrhea samples should be collected from different locations in high-risk patients, such as the oropharynx, cervix, vagina, anus, or urethra, as the organism develops poorly in synovial fluid.

Insidiously presenting fungi and mycobacteria may be more challenging to identify. While a synovial biopsy is positive in 95% of instances, the acid-fast smear of synovial fluid is frequently negative. Adults most frequently have joint pain in the hip and knee. Around 5% of patients develop polymicrobial joint infections due to an infection in the abdomen or trauma.

Patients who take intravenous drugs develop sacroiliac and sternoclavicular joint infections, typically involving Pseudomonas and Serratia. Leukemia patients are particularly vulnerable to Aeromonas infections. In individuals with rheumatoid arthritis, previously damaged joints are very prone to infection. The organisms harm the articular cartilage on the lateral borders of the joint.

Genetics

Prognostic Factors

With patient age, concurrent diseases such as the history of joint disease and preliminary synthetic intra-articular material increase mortality.

This emphasizes the importance of having a high index of early diagnosis, suspicion of septic arthritis, and immediate treatment, especially in patients with established predisposing risk factors and concomitant diseases.

Neisseria infection rarely results in death, whereas staphylococcus infection can have a fatality rate of more than 50%.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK538176

Septic Arthritis

Updated : February 5, 2024




Septic arthritis is a joint inflammatory condition caused by an infectious etiology, most commonly bacterial, mycobacterial, fungal, viral, or other unusual pathogens. Septic arthritis is typically monoarticular, involving a single big joint such as the knee or hip.

Polyarticular septic arthritis affecting many or smaller joints can occur. Septic arthritis, however rare, is an orthopedic emergency that might cause considerable joint destruction, increasing mortality and morbidity.

The incidence of septic arthritis ranges from 2-6 instances per 100,000 people, but this varies depending on the proximity of risk factors. Children are more likely than adults to develop septic arthritis. The prevalence is highest between 2 and 3 years, with a male predominance of 2:1. Neonates, hemophiliacs, immunocompromised children with sickle cell anemia, HIV infection, and those receiving chemotherapy are all at increased risk.

Age above 80, rheumatoid arthritis, cutaneous ulcers, recent joint surgery, diabetes mellitus, joint prosthesis, prior intra-articular injection, osteoarthritis, skin infections, Human immunodeficiency virus, sexual activity, particularly in instances of suspected gonococcal septic arthritis, and other etiologies of sepsis are risk factors in adults.

The vascularized joint synovium is susceptible to systemic infection through hematogenous seeding because it lacks a limiting basement membrane. Puncture wounds, direct trauma, and intra-articular injections can all cause septic arthritis. Neighboring osteomyelitis can spread contiguously.

The contiguous spread might cause damage to the hip and shoulder. A bacterial infiltration of the synovium and joint space is followed by an inflammatory process resulting in septic arthritis. Proteases and inflammatory cytokines mediate joint degradation.

Bacterial toxins based on animal models and microbial surface substances like staphylococcal adhesins, which encourage the adhesion of the bacteria to intra-articular proteins, are additional factors that contribute to joint destruction.

Etiology in Children

There are numerous etiologies for arthritis or joint inflammation in children. In general, Staphylococcus aureus is the most prevalent bacterial pathogen. Specific etiologic agents are linked to certain age groups and underlying illnesses.

The most frequent gram-negative bacterial cause in children under the age of three is Kingella kingae. Neonates frequently contract staphylococcus aureus, gram-negative bacilli, Neisseria gonorrhea, and Group B Streptococcus. In sexually active adolescents, Neisseria gonorrhea is a risk.

Sickle cell disease and salmonella species infection are related to infection. Patients who receive long-term antibiotic treatment are susceptible to fungus infections. Pseudomonas aeruginosa-caused joint infections are linked to injectable medication usage and puncture wounds. Hip joint disorders most frequently impact children.

Etiology in adults

Adults are most infected with Staphylococcus aureus. Although less frequent, streptococcus pneumonia is still a substantial source of infection in adults. N. gonorrhea samples should be collected from different locations in high-risk patients, such as the oropharynx, cervix, vagina, anus, or urethra, as the organism develops poorly in synovial fluid.

Insidiously presenting fungi and mycobacteria may be more challenging to identify. While a synovial biopsy is positive in 95% of instances, the acid-fast smear of synovial fluid is frequently negative. Adults most frequently have joint pain in the hip and knee. Around 5% of patients develop polymicrobial joint infections due to an infection in the abdomen or trauma.

Patients who take intravenous drugs develop sacroiliac and sternoclavicular joint infections, typically involving Pseudomonas and Serratia. Leukemia patients are particularly vulnerable to Aeromonas infections. In individuals with rheumatoid arthritis, previously damaged joints are very prone to infection. The organisms harm the articular cartilage on the lateral borders of the joint.

With patient age, concurrent diseases such as the history of joint disease and preliminary synthetic intra-articular material increase mortality.

This emphasizes the importance of having a high index of early diagnosis, suspicion of septic arthritis, and immediate treatment, especially in patients with established predisposing risk factors and concomitant diseases.

Neisseria infection rarely results in death, whereas staphylococcus infection can have a fatality rate of more than 50%.

https://www.ncbi.nlm.nih.gov/books/NBK538176

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