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Septic Arthritis and gonococcal arthritis
Terms in this set (42)
What are risk factors for non-gonococcal acute bacterial arthritis?
damaged or prosthetic joints
loss of skin integrity
What pts often have bacteremia?
IV drug users
pts with infection at other sites
Who may have loss of skin integrity?
pts with decubitus ulcers
pts with eczema or psoriasis
What is the most common etiologic agent of septic arthritis in adults and kids?
What 2 organisms are increasing in frequency for causing non-gonococcal septic arthritis?
MRSA and group B strep
What are the gram negative organisms that cause septic arthritis?
pseudomonas aeuruginosa and E. coli
Who gets gram negative septic arthritis infections?
IV drug users
very old and very young
What are 3 ways organisms can infect a joint?
What is the most common means of getting non-gonococcal septic arthritis?
What is contiguous spread?
spread from nearby areas like skin, soft tissue, or bone
What presents with sudden pain, swelling, and warmth which progresses rapidly?
non-gonococcal septic arthritis
What joint is most frequently involved with non-gonococcal septic arthritis?
What joints are commonly affected by septic arthritis?
hip, wrist, shoulder, ankle
Who gets non-gonococcal septic arthritis in the hip and SI joint?
IV drug users
Who is more likely to have more than one joint infected with non-gonococcal septic arthritis?
infection with group B strep
What is seen with arthrocentesis of non-gonococcal septic arthritis?
leukocyte count >50,000
gram stain positive
blood cultures positive 50% of the time
What will x-ray reveal in early non-gonococcal septic arthritis?
What imaging should be done on non-gonococcal septic arthritis?
CT or MRI- especially where PE may not reveal effusion
Who cannot get an MRI?
pts with joint prosthesis
What should be done when a pt with a joint prosthesis gets septic arthritis in that joint?
take out the prosthesis
All patients with non-gonococcal septic arthritis receive what?
What antibiotics are effective against staph, strep, and gram negatives
3rd gen cephalosporins
How long does non-gonococcal septic arthritis get treated for?
Which organism tends to have a poorer outcome in non-gonococcal septic arthritis?
What is the mortality rate of non-gonococcal septic arthritis if more than one joint is involved?
What is the most common type of septic arthritis in the US?
When are women more likely to get gonococcal arthritis?
during menses and pregnancy- infection becomes more disseminated
What other symptoms do men who partake in MSM have with gonococcal arthritis?
gonococcal pharyngitis and gonococcal proctitis
How is gonococcal arthritis spread?
What areas of the body does gonococcal arthritis affect?
knee, ankle, wrist, elbow
Is gonococcal arthritis usually symmetric or asymmetric?
What are the two forms of gonococcal arthritis?
Bacteremic and Septic Arthritis
Where does tenosynovitis occur with Bacteremic gonococcal arthritis?
dorsum of wrist, fingers, ankles, toes
What type of skin lesions occur with bacteremic gonococcal arthritis?
small necrotic pustules over the extremities, especially palms and soles
What occurs with the septic arthritis form of gonococcal arthritis?
purulent monarthritis in knee, wrist, elbow, and ankle
red, hot, swollen, and limited ROM
CBC will reveal what on analysis of gonococcal arthritis?
mild elevation of WBCs
ESR will be _________________ in gonococcal arthritis
Synovial fluid analysis of gonococcal arthritis will show what?
WBC between 30,000 and 60,000 with PMNs >90%
only 1/4 show gram negative organism on gram stain
less than half grow out N. gonorrheae on culture
Are blood cultures typically positive in gonococcal arthritis?
Where should cultures and sensitivity be done in all patients to confirm gonococcal arthritis?
open skin lesions
How do you treat gonococcal arthritis?
IV 3rd gen cephalosporin
daily arthrocentesis if purulent effusion
immobilization for pain
Is permanant damage to the joint common in gonococcal arthritis?
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