Infectious arthritis
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37 terms
Terms | Definitions |
|---|---|
 What entities cause monoarticular vs. polyarticular joint involvement in infectious arthritis? | Monoarticular--Bacterial, Mycobacterial, Lyme Disease, Fungal Polyarticular--Gonococcal, Meningococcal, Lyme, Acute Reumatic Fever, Bacterial endocarditis, Viral (rubella, hepB, hepC, Parvo, EBV, HIV) |
| In monoarticular arthritis... If the pain comes on suddenly (seconds/minutes) what should you consider? | FRACTURE INTERNAL DERANGEMENT |
| If the pain comes over several hours or 1-2 days? | Consider... Infection Crystal deposition Diseases Inflammatory Arthritis Syndromes Palindromic Rheumatism |
| If the pain comes on insidiously (days to weeks)? | Consider... -Indolent infections (myobacteria, fungi) -Osteoarthritis -Tumor -Infiltrative disease |
| If the joint has ever been overused or damaged? | Trauma |
| If there is hx of IVDA, recent infection? | INFECTION |
| Ever had previous acute attacks of joint pain and swelling that resolved spontaneously in any joint? | Crystal deposition disease Inflammatory joint syndromes |
| Ever received prolonged course of corticosteroids? | Infection Osteonecrosis of bone |
| Had sx of rash, low back pain, diarrhea, urethral discharge, conjunctivitis, mouth sores? | Reactive Arthritis Psoriatic arthritis Enteropathic arthritis |
| Hx of bleeding diathesis? Being tx with anticoagulants? | Hemarthrosis |
| What polyarticular diseases occasionally present w/ monoarticular onset? | RA, JIA, Viral, Sarcoid arthritis, Reactive Arthritis, Psoriatic arthritis, Enteropathic arthritis, Whipple's disease |
| What if chronic monoarticular arthritis? | Sx persisting w/in single joint for > 6 weeks |
| What are some causes of inflammatory vs. noninflammatory chronic monoarticular arthritis? | Inflammatory--Mycobacterial infection, Fungal infection, Lyme Arthritis, Monoarticular RA, Seronegative Spondyloarthropathies, Sarcoid arthritis, foreign body synovitis Non-inflammatory--OA, AVN, PVNS (pigmented vilonodular synovitis) |
| What are the different synovial fluids like? | Normal--Clear, colorless, viscous; Leukocytes <200, <25% PMNs Noninflammatory--Clear, Yellow, Viscous; Leukocytes 200-2000, <25% PMNs Inflammatory--Cloudy, Yellow, Watery, glucose may be low; Leukocytes 2,000-100,000, >50%PMNs Septic--Purulent, glucose very low; Leukocytes >80,000, >75% PMNs |
| Features of Gonococcal septic arthritis? | Most common cause in young adults Migratory polyarthralgias/arthritis early-->Monoarticular Tenosynovitis (dorsum of hands and feet, wrists, achilles) Tender vesicopustular lesions on erythematous base and hemorrhagic papules Positive joint cultures <25% Positive blood cultures--RARE Penicillin-resistant strains--Tx with 3rd gen cephalosporins (Ceftriaxone, cerotaxime) |
| How should specifmens be cultured in Gonoccocal illness? | Thayer Martin media or chocolate agar at the bedside--VERY FRAGILE |
| Features of non-gonococcal septic arthritis? | Children, elderly, immunocompromised Monoarthritis Positive joint cultures >95%--GOLD STANDARD Positive blood cultures 40-50% Pos gramstain 50-70% Abrupt onset swelling and pain |
| What is the clinical picture of septic/infectious arthritis? | Red, hot, swollen joint Fever, increased peripheral WBC (not always--children and elderly) Synovial WBC counds >50,000 but <25,000 can be seen in early stages Neutrophils >90% |
| Which bacteria usually responsible for non gonococcal septic arthritis? | STAPH AUREUS--61% (has collagen adhesion factor) Beta-hemolytic strep--15% Gram-neg bacilli--17% Polymicrobial--4% |
| What are the special groups that non-gonococcal septic arthritis generally happens in? | Gram neg--IV DRUG USERS Staph Epi--PERIOPERATIVE H.Influenzae--NEONATES Streptococci--age 2-15 UNUSUAL ORGANISMS: -Hypogammaglobulinemia--mycoplasma -C5-C9 deficiency--Neisseria -AIDS--TB or fungal |
| What are some specialized radiographic studies for deep-seated sites? | Three phase bone scan-->not specific, Sensitive for inflammation Gallium scan-->More Specific, less sensitive |
| How do you tx non-gonoccocal septic arthritis? | ABX--first 2 weeks IV, then PO Drain Joint Analgesics Physical therapy Critical to start ABX within 7 days!! |
| What are late onset prosthetic infections usually due to? | Bacterial seeding and hematogenous spread **Tx w/ parenteral abx 6-8 weeks Can form biofilm, resistant to abx |
| What are some features of Bursa infections? | Olecranon and prepatellar=MOST COMMON Constant skin trauma (carpenters) IV abx Aspiration After control infection, oral Abx If fail to respond, do bursectomy |
| Features of Osteomyelitis? | Bone infection -Progressive, inflammatory destruction -Relative resistance to tx -Children >adults; metaphysis of femur, tibia, humerus -IV drug users, elderly -Diabetics Dx--Needle or open bx Tx--Parenteral abx early stage (4-6 weeks), chronic refractory and req surgery |
| What are the clinical features of Stage I early Lyme disease? | Erythema migrans Regional lymphadenopathy Flu-like sx |
| What are the clinical features of stage II Early disseminated Lyme Disease? | Multiple or recurrent erythema migrans Migratory arthralgias/arthritis Meningoencephalitis Bell's Palsy Carditis Motor/sensory radiculoneuritis Conjunctivitis Lymphadenopathy Myositis |
| Clinical features of Stage III late Lyme disease? | Acrodermatitis chronica atrophicans Chronic meningoencephalitis or encephalitis Intermittent/chronic oligoarthritis Sensorimotor neuropathies |
| What is joint involvement like in Lyme disease in the early, early disseminated, and late disease? | Early--Arthralgia Early Disseminated--Migratory pain in joints, tendons, bursa, muscle, bone; brief arthritis attacks Late--Chronic oligoarthritis; Intermittent arthritic attacks, peripheral enthesopathy, periostitis or joint subluxations |
| Tx for lyme disease/ | Dox Amox Azithro Neuro and cardia--IV ABX |
| Features of mycobacterial arthritis? | TB--increased in HIV--disseminates to bone and joint Pott's disease--SPINE Poncet's disease--Reactive polyarthritis Peripheral joints--hip, knee, hand/wrist Osteomyelitis--Pain, lytic lesions on radiographs Dx--Bone or synovial bx--granulomatous synovitis, acid-fast Tx--Combo chemo 12-18 months |
| Features of viral arthritides? | Hep C, ParvoB19, HIV, Rubella, Alphaviruses HBV 30% of pts Hep C important--Most common blood-borned infection in US, 6 week incubation, low titer ANA, anti-sm ms Ab, RF **ANY patient suspected of having seropositive RA w/ elevated LFTs must be screened for HCV!! |
| Features of HCV in infectious arthritis? | Associated with MIXED CRYOGLOBULINEMIA -Palpable purpura -Arthralgia -Multi organ invovlement--glomerulonephritis, peripheral neuropathy Associated with SJOGRENS and FIBROMYALGIA |
| Features of Human Parvo B19 in infectious athritis? | Causes viremia 6 days after inoculation--prodrome of rash Trasmitted via resp secretions Arthropathy -Rapid onset symmetrical polyarthritis in peripheral small joints, primarily hands and wrists -Joint sx more common in adults than children -Self-limited but may persist Fifth disease (erythema infectiosum)--children Median duration of illness--10 days Tx--NSAIDS, steroids |
| Features of Whipple's disease in infectious arthritis? | Uncommon--gram pos tropherma whippelii Polyarthritis--migratory, LARGE joints, brief episodic attacks Fever malabsorption CNS manifestations Typical--DIARRHEA, WEIGHT LOSS, ARTHRITIS Common middle aged white men Can involve cardiac, renal Hyperpigmentation 50% Peripheral lymphadenopathy |
| Features of poststreptococcal reactive arthritis and Rhuematic fever/ | Hemolytic group A strep pharyngeal infection--2-4 weeks prior Erythema marginatum--evanescent non-pruritic rash, early, may persist after arthritis settled, assoc w/ carditis Tx--sx, penicillin |
| Major Jones Criteria for Rheumatic fever? | Arthritis, Carditis, Chorea erythema marginatum, nodules |
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