Septic (bacterial) arthritis is a rapidly progressive, often destructive lesion of the joints, due to direct invasion of the synovial membrane by pyogenic microorganisms. Propagation of microorganisms contributes to the development of the inflammatory process, which, in turn, leads to rapid destruction of the joint. The main problems remain errors in the early diagnosis and treatment of AS, which are the main causes of not only the development of severe functional failure of the joint, but also a significant increase in fatal outcomes.
| Septic arthritis | |
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| ICD-10 | M 00.9 |
| ICD-10-KM | and |
| ICD-9-KM | , , , , , , , , , and |
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Content
Epidemiology
The incidence is 2-10 cases per 100,000 in the general population and 30-70 per 100,000 among patients with previous joint diseases or undergoing endoprosthetics. Most often, children and persons of older age groups fall ill.
Etiology
S.aureus remains the most common etiological agent for SA. It is the cause of 80% of cases of joint infections in patients with rheumatoid arthritis and diabetes . In second place in frequency are streptococci , in particular Ξ²-hemolytic streptococcus of group A. Most often, this pathogen is associated with some kind of background autoimmune disease .
Theoretically, all known bacteria can cause SA, so the table below shows data on the most common pathogens:
| Pathogen | Frequency% |
|---|---|
| S.aureus | 37-56 |
| Streptococcus spp. | 10-28 |
| H. influenzae | 4-7 |
| E. coli | 6-9 |
| N. gonorrhoeae | 0.6-12 |
| Anaerobes | 1.3-3 |
| Not identified | 10-20 |
Pathogenesis
In a healthy body, the successful functioning of the immune system - phagocytes of the synovial membrane and synovial fluid, can ensure the sterility of articular tissues. When the body's defenses are weakened, the joint is invaded and infected with a bacterial agent. The following reasons contribute to this:
- elderly age
- severe concomitant diseases ( diabetes mellitus , cirrhosis of the liver , oncological diseases , chronic renal failure )
- the presence of primary foci of infection ( pneumonia , pyelonephritis )
- background articular pathology ( rheumatoid arthritis , hemarthrosis , osteoarthritis , joint prostheses)
In the period of persistent bacteremia, the pathogen enters the joint through the hematogenous route. The pathogen enters the joint via the lymphogenous pathway from the foci nearest to the foci of infection. Also, direct contact with injuries and medical procedures (arthrocentesis, arthroscopy ) is possible.
The invasion of the pathogen into the synovial membrane entails an active inflammatory process. Under the influence of bacterial vital products, the immune response is stimulated and various inflammatory mediators are released, the accumulation of which leads to inhibition of cartilage synthesis and its degradation, followed by destruction of cartilage and bone tissue and the formation of bone ankylosis [4] .
Clinical picture
The disease is characterized by an acute onset with severe pain. The affected joint is hyperemic, swollen, hot to the touch. The pain occurs at rest and with motor load. In 80% of patients there is a febrile syndrome , which is accompanied by chills [5] .
Diagnostics
In a blood test in patients, as a rule, leukocytosis with a shift in the leukocyte formula to the left and an increase in ESR are detected. The gold standard in the diagnosis of CA is a detailed analysis of synovial fluid (SJ) obtained by puncture aspiration from the affected joint. SG should be stained according to Gram and conduct a cultural study. It is positive in approximately 90% of SA, although initial Gram staining gives a positive result in only 50% of cases [4] .
Treatment
The treatment of septic arthritis is complex, which includes:
- Antimicrobial and symptomatic therapy.
- Adequate drainage (recommended to perform daily aspiration of the joint to reduce effusion).
- Early active rehabilitation .
As a first-line antibiotic therapy, fluxloxacillin is recommended, which can act on both staphylococcal and streptococcal infections until a pathogen is established [3] .
Notes
- β 1 2 3 4 5 6 7 8 9 10 Disease Ontology release 2019-05-13 - 2019-05-13 - 2019.
- β 1 2 3 4 5 6 7 8 9 10 11 Monarch Disease Ontology release 2018-06-29sonu - 2018-06-29 - 2018.
- β 1 2 Boris Sergeevich Belov. Bacterial (septic) art r and t and prosthetic joint infection in a: modern aspects // S O V PE M E N N A I R E V M A T O L O G I No. 3 '1 0. - 2010. - S. 10-17 .
- β 1 2 Davidson, ed. Mukhina N.A. Internal Medicine According to Davidson. - 1. - GEOTAR-Media, 2010 .-- S. 191-192. - 240 p. - ISBN 978-5-91713-002-4 .
- β O.V. Teplyakova. Septic arthritis in adults // Wedge microbiol antimicrobial chemotherapy 2015, Volume 17, No. 3. - 2015. - P. 187-203 .