Septic Arthritis

This identification will be made by hemocultures if the germ was transmitted by blood, by samples taken from the bladder, the throat or other possible focars. The principal causes of septic arthritis are gonococcal and nongonococca bacteria. The most common causes are Neisseria gonorrhoeae and Staphylococcus aureus but cases caused by Streptococcus viridians, Streptococcus pneumonia, and other streptococcal species were also reported.

The infection may appear directly through the joint, through blood or from infected periarticular tissue.

When diagnose, very important are the following symptoms : the type of pain (chronic or not ), medical history(another joint disease may exist, like rheumatoid arthritis), previous injury, the patient is a possible drug consumer, the type of process monoarticular or polyarticular. The knee is the most common affected joint. After the knee comes the hip, the shoulder, the ankle and the wrist. The sacroiliac joints also can be affected but rarely. Usually the sacroiliac joints are infected by group B streptococci.

If the joints are infected by onococcal musculoskeletal, the will present skin lesions, fever. Other possible causes are : Pasteurella multocida, Eikenella corrodens, anaerobes, Aeromonas hydrophila, S aureus, Candida common for drug use, S schenckii. Salmonella is not a cause for septic arthritis.

To determine if a joint is infected or not, the joint fluid may be analyzed. A normal joint fluid is colorless, an infected one is yellow. The most safe way to diagnose septic arthritis is a culture of synovial tissue. MRIs and CT scans are sometimes used especially for patients who have sacroiliac or sternoclavicular joint infection. Also a biopsy may be needed.

The main step of the treatment is the drainage of the infected fluid (the drainage can be performed by surgery also ) and pain control through immobilization. Antibiotics are used (better if the antibiotic is bactericidal ). After 5 days if the joint starts to improve then the antibiotic may be replaced with anti-inflammatory drugs. If the patient still has fever and synovial purulence then the treatment has to be reevaluated.

The doctor who is indicated in septic arthritis is the rheumatologist or the orthopedic surgeon. The outcome of this condition is rather negative because many patients presented with chronic pain or other problems after an infection .

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