Septic arthritis

Septic Arthritis

Gonococcal Arthritis

Healthy, young sexually active adults

Women > men

Suppurative monoarthritis (may be preceded by polyarthralgias)

Knee, wrist, ankle

Arthritis-Dermatitis Syndrome

-Triad: dermatitis, tenosynovitis, migratory polyarthritis (hematogenous spread of bacteria and immune complexes)

-Skin lesions: scattered small painless erythematous macules or petechiae-->pustular -->necrotic lesions

-Transient painful extensor tenosynovitis (writs, hands, ankles)

-Asymmtric polyarthralgia of extremity joints

DiagnosisCx everything - jt, mucosal surfaces, lesions

TreatmentCTX 1gIV qd OR

Cefotax 1g q8

Empirically treat Chlamydia

Nongonococcal Arthritis

Fulminant presentation (abrupt, swelling, toxicity and fever) unless elderly

-Hematogenous

-Contiguous

-Direct traumatic implantation

-Postop

CausesBacterial

Mycobacterial

Spirochete (lyme, syphilis)

Fungal

VIral (HIV, Hep B, Rubella, etc)

Postinfectious

DiagnosisSynovial fluid aspiration

Cx - if only one test, use BCx bottles (may enhance yield)

Grm stain - 80% positive in gram-positive infxn; less sens in gram-negative

Cell count with dif - >50,000-150,000; PMN > 90%

TreatmentPCN-ase resistant synthetic PCN:

Nafcillin 1-2g

Cefazolin 1-2g

AND

3rd gen ceph

OR

Vanc*

• new evidence suggests significantly increased rate of MRSA septic arthritis

• • cell counts are as low as 20,000 in MRSA Cx + synovial fluid