Pyogenic_Arthritis and its management ppt

Pyogenic arthritis

1. Pyogenic arthritis By: Muhammad Anas

2. Pyogenic Arthritis: is an inflammatory joint disease caused by bacterial, viral, and fungal infection Route of infection dissemination of pathogens via the blood, from distant site…. (most common) dissemination from an acute osteomylitic focus dissemination from adjacent soft tissue infection, entry via penetrating trauma entry via iatrogenic means

3. What causes Pyogenic Arthritis? Staphylococci. ( S. aureus) >>>>>  Most Common. Haemophilus influenzae. ( in Children) Gram negative bacilli. Streptococci. Gonococci. Viruses.

4. The Infectious agent can enter the body in a number of ways, such as: A broken bone that goes through the skin (open fracture) An infection that spreads from another place on the body, such as the skin or genitals An infected wound Foreign object that goes through the skin Injury that breaks the skin

5. Pathology There is an acute synovitis with a purulent joint effusion and Synovial membrane becomes edematous, swollen and hyperemic, and produces increase amount of cloudy exudates contains leukocytes and bacteria As infection spread through the joint, articular cartilage is destroyed by bacterial and cellular enzymes. If the infection is not arrested the cartilage may be completely destroyed. Pus may burst out of the joint to form abscesses and sinuses. The joint may be become pathologically dislocated

6. Who is at risk for Pyogenic arthritis? A systemic blood-borne infection IV drug use Osteoarthritis Past history of septic arthritis Rheumatoid arthritis Other factors that may increase the risk for Pyogenic arthritis include: HIV Old age Suppressed immune system

7. Clinical presentation/ symptoms: The most common joints affected by septic arthritis are the knee, hip, shoulder, elbow, wrist, and finger. Most often, only one joint is affected. Symptoms can occur a bit differently in each person, but common symptoms include: Fever Joint pain Joint swelling Inspection: Erythema, Effusion, Jt tend to be in Max.Vol position Palpation: Tender, Warm Motion: Inability to tolerate weight, Inability to tolerate PROM

8. Diagnosis ( Imagimg ) Radiograph : May show Jt space widening or effusion Periarticular osteopenia Ultrasound: For confirmation of effusion in large Jt’s For guiding aspirations MRI: detects jt effusion

9. Diagnosis (Studies) CBC: high WBC with left shift ESR: High ( > 30) CRP: High ( > 5) Joiny fluid Aspirate: gold standard for treatment and allows directed antibiotic treatment Should be analysed for Cell count Gram stain Culture Glucose level Crystal analysis

10. Complications: Dislocation: a tense effusion may cause dislocation Epiphyseal destruction : in neglected infants the largely cartilaginous epiphysis may be destroyed ,leaving an unstable pseudarthrosis. Growth disturbance: physeal damage may result in shortening or deformity Ankylosis: if articular cartilage is eroded healing may lead to ankylosis Secondary osteoarthritis Osteomyleitis / abcess /sinus

11. Treatment General Measures: The first priority is to aspirate the joint and examine the fluid, treatment is then started without further delay. Analgesics and splinting of the involved joint in the position of maximal comfort alleviate pain. Fluid replacement and nutritional support may be required. Other foci of infection and any coexisting medical conditions must be identified and treated appropriately Intravenous antibiotics should be given empirically and started as soon as joint fluid and blood sample have been taken for culture

12. If gram –positive organisms are identified , Flucloxacillin is suitable . If in doubt ,a third generation cephalosporin will cover both game+ and gram- organisms. Children less than 4 yr ( if suspicion of H.Infl ) treated with Ampicillin . Once the bacterial sensitivity is known the appropriate drug is substituted. Intravenous administration is continued for several weeks and is followed by oral antibiotics for a further 2 or 3 weeks .