Q Report is on Discussion on a Case of Septic Arthritis is also known as infectious arthritis&usually caused by bacteria Home, - Discussion on a Case of Septic Arthritis Discussion on a Case of Septic Arthritis INTRODUCTION Septic arthritis is also known as infectious arthritis and is usually caused by bacteria or fungi. Joints can become infected by direct injury or blood-borne infection from an infected skin lesion or other site. This is typically seen in my patient. Chronically inflamed joints (e.g. in rheumatoid arthritis) are more prone to infection than are normal joints. Individuals who are immunosupressed, by AIDS or immunosuppressive agents, are particularly at risk, as are infants, the elderly and those who abuse alcohol. Artificial joints are also potential sites for infection. As presented by patient, septic arthritis typically affects one joint in the body, such as the knee, hip or elbow. It rarely affects multiple joints in except in chronic states when untreated. AETIOLOGY The organism that most commonly causes septic arthritis is Staphylococcus aureus. This is typical in this patient. Other organisms include streptococci, other species of staphylococcus, Neisseria gonorrhoeae, Haemophilus influenza in children, and these and other Gram-negative organisms in the elderly or complicating rheumatoid arthritis. EPIDEMIOLOGY In the United States, Septic Arthritis (SA) is more common in children than adults, but the actual incidence is unknown. From 1979-1996, a tertiary-care children’s hospital reported just 82 children with either confirmed or suspected SA of the hip. From 2000-2004, 34 such cases were diagnosed at a separate tertiary-care children’s hospital. Data from older studies are somewhat obsolete, because effective vaccines have virtually eliminated the most common etiologic agent, Haemophilus influenzae type B. With the dramatic increase in MRSA-CA, the clinical impression of pediatricians and pediatric emergency medicine physicians is that a corresponding increase in the incidence of SA has been observed. Large, population-based studies to prove this trend are lacking. A higher incidence of SA is reported among boys than girls; some series report that boys are affected twice as frequently as are girls. However, a series of 82 children with SA of the knee found no sex predilection. SA occurs among all age groups but is most common in younger children, peaking in those younger than age 3 years. CLINICAL FEATURES Suspected Septic Arthritis is a medical emergency. In young and previously fit people, the joint is hot, red, swollen, and agonizingly and held immobile by muscle spasm. There is usually high grade fever. INVESTIGATIONS Incision and drainage: The joint and send the fluid for urgent Gram staining and culture. The fluid is usually frankly purulent. The culture techniques should include those for gonococci and anaerobes. This was done for my patient and result was positive of staphylococcus aureus. Blood cultures are often positive. But was not done in this patient. Leucocytos is usual, unless the person is severely immunosupressed. This was confirmed in my patient in her FBC which showed raised WBC of 21.70x103/ ul with Neutrophilis of 78.3% (45% - 74%) X-rays are of no value in diagnosis in acute septic arthritis. Skin wound swabs; sputum and throat swab or urine may be positive and indicate the source of infection. TREATMENT Empirical treatment should be started with a broad spectrum antibiotics immediately on presentation because joint destruction occurs in days. The joint should be immobilized initially and then physiotherapy started early to prevent stiffness and muscle wasting. Intravenous antibiotics should be given for 1-2 weeks. It is usual to give two antibiotics to which the organism is sensitive for 6 weeks, then one for a further 6 weeks orally. Monitor clinically and with the ESR. This is started before the results of culture are obtained. Change the antibiotics if the organism is not sensitive. Drainage of the joint and arthroscopic joint washouts are helpful in relieving pain. My patient was initially placed of IV ceftriazone and then added oral flucloxacillin. PROGNOSIS Time to diagnosis is the most important prognostic factor in Septic Arthritis (SA). Early institution of therapy helps to prevent degenerative arthritis. Diagnosis may be delayed in young infants, which leads to a poorer outcome. In my patient, it was diagnosed early and prognosis is good. Other prognosis factors include infection of the hip join, which may lead to aseptic necrosis of the femoral head; infection with S aureus; and a prolonged passage of time before the synovial fluid is sterilized. Meningitis (10-30%), osteomyelitis (5-10%), cellulitis (10-30%), and pneumonia (5%) are potential complications in young children with septic arthritis resulting from hematogenous spread of H influenza type B. Ostonecrosis, growth arrest, and sepsis are potential complications from SA of any etiology. Because of the availability of antibiotics, children rarely die from septic arthritis or its complications. Although chronic arthritis is uncommon, the short term morbidity and costs, in terms of prolonged antibiotic therapy and hospitalizations, may be substantial.