Post on 16-Jan-2016
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INTRODUCTION:
Septic arthritis, also known as infectious arthritis, may represent a direct
invasion of joint space by various microorganisms, most commonly caused by a
variety of bacteria .However, viruses, mycobacteria, and fungi have been
implicated. Reactive arthritis is a sterile inflammatory process that usually
results from an extra-articular infectious process. Bacteria are the most
significant pathogens because of their rapidly destructive nature. For this
reason, the current discussion concentrates on the bacterial septic arthritides.
Failure to recognize and to appropriately treat septic arthritis results in
significant rates of morbidity and may even lead to death.
ETIOLOGY
Staphylococcus aureus infection is the cause of the vast majority of
cases of acute bacterial arthritis in adults and in children older than 2 years.The
increased incidence of this pathogen parallels the increase in presence of
prosthetic joints and in the use of immunosuppressive agents. This pathogen is
the cause in 80% of infected joints affected by rheumatoid arthritis.
Streptococcal species, such as Streptococcus viridans, S pneumoniae,
and group B streptococci, account for 20% of cases. Aerobic gram-negative rods
are involved in 20-25% of cases. Most of these infections occur in people who
are very young, who are very old, who are diabetic, who are immunosuppressed,
and who abuse intravenous drugs.
Infection of the sternoclavicular and sacroiliac joints
with Pseudomonas aeruginosa or Serratia species occurs almost exclusively in
persons who abuse intravenous drugs. Persons with leukemia are predisposed
to Aeromonas infections.
TYPES OF ARTHRITIS ;
1. Septic arthritis
2. Rheumatoid arthritis
3. Lyme disease
4. Tuberculosis arthritis
CLINICAL MANIFESTATION
Acuteness of onset of the joint pain
Whether the pain is superimposed on chronic pain
Previous history of joint disease or trauma, whether accidental or
iatrogenic (eg, infection complicates 0.4% of arthrocenteses)
The presence of extra-articular symptoms
Whether the patient has had vascular invasion due to catheterizations or
intravenous drug abuse
contribution of these diseases to the clinical presentation..
fever (40-60% of cases),
pain (75% of cases),
and impaired range of motion. These symptoms may evolve over a few days to
a few weeks. Fever is usually low-grade (< 102°F), with rigors present in only
20% of cases. Spiking fevers and chills are much more common with crystalline
arthritis.
Lyme disease
Months after infection onset, 60% of patients with untreated Lyme disease
develop swelling and pain, chiefly affecting the large joints. Usually, Lyme
disease affects 1-2 joints at a time, with the knee involved most commonly.
eactive arthritis usually begins several weeks after the underlying infection has
resolved. Few concurrent systemic symptoms occur.
Symptoms of tuberculous arthritis are quite indolent; the diagnosis may be
delayed for several years. Usually, the purified protein derivative (PPD) results
are negative, and no signs, past or present, of pulmonary tuberculous exist.
Viral septic arthritis
1 Obtain at least 2 sets of blood cultures to rule out a bacteremic origin of
the septic.
2. Plain radiography is of limited value in evaluating a joint for infection
3. soft-tissue swelling is the most common finding.
4.the x-ray
MANAGEMENT
I.MEDICAL MANAGEMENT
a) SURGICAL TEATMENT
Arthrotomy-Surgical opening and depritment
b) ANTIBIOTIC PROPHYLAXIS - with an antistaphylococcal antibiotic has
been demonstrated to reduce wound infections in joint replacement
surgery.
II.NURSING MANAGEMENT