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Septic arthritis is the infection of a joint, typically caused by bacteria, but can also be due to fungi or viruses.
Commonly affects large joints like the knee and hip, but any joint can be involved.
Epidemiology
Higher risk in individuals with joint prostheses, rheumatoid arthritis, recent joint surgery, and immunocompromised states.
Aetiology and Pathophysiology
Most commonly caused by Staphylococcus aureus, but other bacteria like Streptococci, and in sexually active individuals, Neisseria gonorrhoeae, can also cause infection.
The infection can reach the joint through the bloodstream, from a nearby infection, or directly through trauma or surgical procedures.
Bacterial toxins and the bodyβs inflammatory response lead to joint damage.
Clinical Features π‘οΈ
Clinical Features
Rapid onset of severe joint pain, swelling, redness, and warmth.
Reduced range of motion in the affected joint.
Fever and systemic symptoms may be present.
In gonococcal arthritis, may be associated with dermatitis and tenosynovitis.
Investigations π§ͺ
Tests
High clinical suspicion based on symptoms and patient history.
Joint aspiration is crucial for diagnosis, showing purulent synovial fluid, high leukocyte count, and positive culture.
Blood cultures and other investigations to identify the source of infection.
Imaging (X-ray, MRI, ultrasound) to assess joint damage.
Management π₯Ό
Management
Immediate empirical antibiotic therapy, later adjusted based on culture results.
Antibiotics often given intravenously initially, followed by oral antibiotics.
Duration of treatment varies but typically lasts for several weeks.
Surgical drainage may be necessary in some cases, especially if there is a large effusion or if the infection is in a prosthetic joint.
Complications
Rapid joint destruction and irreversible damage if not treated promptly.
Potential for osteomyelitis and systemic spread of infection.
Septic shock in severe cases.
Key Points
Septic arthritis is the infection of a joint, commonly caused by Staphylococcus aureus.
Early diagnosis and management is crucial to prevent rapid joint destruction and irreversible damage.
The main clinical presentation is a severely painful, swollen, warm and red joint.
Diagnosis is primarily through clinical history and examination, with joint aspiration required to determine diagnosis.
Immediate intravenous empirical antibiotic therapy is required, later adjusted to cultureΒ results, followed by oral antibiotics.