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