Septic arthritis: Difference between revisions
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==Gonococcal Arthritis== | |||
Healthy, young sexually active adults | Healthy, young sexually active adults | ||
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Knee, wrist, ankle | Knee, wrist, ankle | ||
==Arthritis-Dermatitis Syndrome== | |||
===Diagnosis=== | |||
-Triad: dermatitis, tenosynovitis, migratory polyarthritis (hematogenous spread of bacteria and immune complexes) | -Triad: dermatitis, tenosynovitis, migratory polyarthritis (hematogenous spread of bacteria and immune complexes) | ||
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DiagnosisCx everything - jt, mucosal surfaces, lesions | DiagnosisCx everything - jt, mucosal surfaces, lesions | ||
===Treatment=== | |||
CTX 1gIV qd OR | |||
Cefotax 1g q8 | Cefotax 1g q8 | ||
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Empirically treat Chlamydia | Empirically treat Chlamydia | ||
==Nongonococcal Arthritis== | |||
===Background=== | |||
Fulminant presentation (abrupt, swelling, toxicity and fever) unless elderly | Fulminant presentation (abrupt, swelling, toxicity and fever) unless elderly | ||
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-Postop | -Postop | ||
===Causes=== | |||
Bacterial | |||
Mycobacterial | Mycobacterial | ||
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Postinfectious | Postinfectious | ||
===Diagnosis=== | |||
Synovial fluid aspiration | |||
Cx - if only one test, use BCx bottles (may enhance yield) | Cx - if only one test, use BCx bottles (may enhance yield) | ||
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Cell count with dif - >50,000-150,000; PMN > 90% | Cell count with dif - >50,000-150,000; PMN > 90% | ||
===Treatment=== | |||
PCN-ase resistant synthetic PCN: | |||
Nafcillin 1-2g | Nafcillin 1-2g | ||
Revision as of 19:24, 11 June 2011
Gonococcal Arthritis
Healthy, young sexually active adults
Women > men
Suppurative monoarthritis (may be preceded by polyarthralgias)
Knee, wrist, ankle
Arthritis-Dermatitis Syndrome
Diagnosis
-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
Treatment
CTX 1gIV qd OR
Cefotax 1g q8
Empirically treat Chlamydia
Nongonococcal Arthritis
Background
Fulminant presentation (abrupt, swelling, toxicity and fever) unless elderly
-Hematogenous
-Contiguous
-Direct traumatic implantation
-Postop
Causes
Bacterial
Mycobacterial
Spirochete (lyme, syphilis)
Fungal
VIral (HIV, Hep B, Rubella, etc)
Postinfectious
Diagnosis
Synovial 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%
Treatment
PCN-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