Septic Arthritis

Septic Arthritis or infectious arthritis is an infectious disease of joints, where the joint space is infected by various pathogens like bacteria, mycobacteria, viruses and fungi. This condition is more prevalent in prosthetic joints because of their wide use nowadays, but shows a bit different symptoms. The disease causes severe joint pain, associated with fever and irregular motions. Most commonly, knee joint is infected in this disease, but other joints like those of ankle, wrist, elbow, shoulder and hip may also be victimized. Young children and elderly people are most prone to this disease. septic arthritis in children, mostly hip joint is infected while in adults, it is the knee joint, which is affected most of the time. Back, neck and head joints can get affected, but very rarely.

People with existing joint problems, or on the treatment of rheumatoid arthritis, or with skin sensitivity and or having weakened immunity are more at risk of this disease.Infectious arthritis may give rise to reactive arthritis, which is a sterile inflammatory process, in some other part of the body.The disease can be caused by variety of pathogens. If the disease remains unidentified or treated wrongly, it may give rise to significant morbidity and even death. But if it is identified quickly within a week and treated appropriately, it is cured completely.

Septic arthritis is caused when the micro-organisms reach the synovial membrane of the joint. This takes place when they enter the body in various ways. They can enter the body via blood, abscesses, infected wounds or some unknown gateway. They can also reach the joint when the patient is already suffering from a bone or bone marrow infection, which is called osteomyelitis. If the nearby soft tissue is infected, then too the infection can reach the joint. So also, penetrating trauma, which means, the injury because of some harshly penetrated object, and iatrogenesis, meaning the adverse effects of wrong treatment given by healthcare professionals, can also mediate the access of pathogens to the synovial membrane of the joint.

It is difficult to diagnose this disease as there is no test available which can rule out the possibility completely. Monoarthritis is more common, in which only one joint is infected. But several joints can get infected at a time and it generally happens in case of infection by staphylococcus or gonococcus bacteria. Several factors are considered while considering the possibility of the disease, like in children, temperature more than 38.5 C, no weight-gaining, serum WBC count more than 12 x 10^9, ESR more than 40 mm/hr and CRP more 20 mg/dL are considered. Usually a triad of pain, fever and impaired range of motions is the most common in the patients with the disease.

The treatment of the disease usually contains intravenous injection of antibiotics, analgesia and washout of the joint to dryness. In children, if the case is uncomplicated, a 10 days course of antimicrobials is enough.

In case of prosthetic joint infection, usually surgical removal or arthrotomy is advised. The new prosthesis is not inserted immediately, to let antibiotics do their job of clearing out the infection first. septic arthritis patients who cannot undergo surgery are kept on long-term antibiotic treatment.

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