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Pyogenic arthritis 

Pyogenic arthritis

Chapter:
Pyogenic arthritis
Author(s):

Anthony R. Berendt

DOI:
10.1093/med/9780199204854.003.1907
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date: 30 March 2017

Acute pyogenic arthritis may be primary (by haematogenous spread) or secondary (to trauma, surgery, or arthrocentesis). Organisms that cause primary septic arthritis are usually aggressive pathogens: Staphylococcus aureus (most commonly), streptococci, salmonella species (especially in African children) and Gram-negative organisms (neonates and older people). The causes of secondary and chronic septic arthritis are more diverse, including lower-grade pathogens from skin, mycobacteria, and fungi.

Clinical presentation—patients with acute pyogenic arthritis typically present with fever and an acutely painful joint that is swollen (effusion), warm to the touch, tender on palpation, and painful—frequently exquisitely so—on active or passive movement. The host response appears to reduce the risk of bacteraemia and death, but at the cost of joint damage. If not fatal through septicaemia, untreated septic arthritis generally causes joint destruction or fusion, sometimes with sinus formation and persistent infection. Chronic native joint septic arthritis presents in more indolent fashion with a mono- or polyarthropathy.

Diagnosis, management and prognosis—the diagnosis of pyogenic arthritis is established by isolation of a recognized pathogen from samples of synovium or synovial fluid obtained through biopsy or aspiration. After obtaining blood cultures and (whenever possible) synovial fluid, acute pyogenic arthritis should be treated promptly with intravenous antibiotics active against aerobic Gram-positive cocci and, where appropriate, Gram-negative organisms. Two or three weeks of antibiotic treatment is usually given in uncomplicated cases. Urgent consultation with an orthopaedic surgeon is recommended: arthroscopic washout is usually recommended, although some cases can be managed by joint aspiration once or twice daily until clinical response is evident. If acute native joint infection is treated promptly, the prognosis is good. Many patients make a complete recovery, but joint damage is highly likely when the diagnosis is made late. Outcomes are less favourable in prosthetic joint infection.

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