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Decoding Septic Arthritis Causes, Symptoms, and Treatment | Comprehensive Guide + Assignment Help
- 2. INTRODUCTION Septic arthritis causes joint inflammation that is caused by the invasion of infectious agents in the joints Problems of septic arthritis not only include heat, pain and redness in the joint but also decrease the ability of a person to move the joint In the case of John D’Souza, septic arthritis is diagnosed in his right knee The study explains and discussed the pathogenesis that has resulted in the clinical manifestation in this case of Mr D’Souza.
- 3. PATHOGENESIS CAUSING CLINICAL MANIFESTATION OF MR D’SOUZA Overview The painful infection of septic arthritis in the joint is likely to occur more in infants and older adults Although it commonly affects knees, it can also affect shoulders, hips and other joints of the body In the case of Mr D’Souza, his right knee is affected and is red, hot, swollen and painful which care common symptoms of the issue According to the study of Arshi et al. (2016), prompt understanding and treatment are significant because septic arthritis can severely and quickly damage bones and cartilages within the joint.
- 4. CONT… Pathogenesis Pathogenesis of septic arthritis can be considered multifactorial and depends on host immune response interaction and invading pathogen The bacterial colonisation steps, induction of inflammatory response of host and infection can help in providing a greater understanding of the joint disease.
- 5. CONT… In the majority of cases and in most nations, septic arthritis is caused by S. aureus and therefore it is extensively studied and discussed for its role in the disease (Boff et al. 2018) The disease can be caused by Staphylococcus aureus and even by other organisms like Proteus, E.coli, and Streptococcus. Some of the predisposing factors of the disease can be a chronic disorder, AIDS, intravenous drug abuse, Immunosuppressive drug therapy or Rheumatoid arthritis like Mr D’Souza. In the discussion of pathogenesis, the study of Castellazzi, Mantero & Esposito (2016) has highlighted that the Bacteria can enter a human joint via 3 main routes.
- 6. CONT… Haematogenous spread It is the spread of the bacteria through the blood to other body parts This can cause infections in a place away from the original infection site as observed in the case of Osteomyelitis and endocarditis It is the most common way by which the disease spreads and usually affects people with medical problems For Mr D’Souza, the haematogenous spread can be considered potential pathogenesis of Septic Arthritis because while being examined, he was already suffering from a pre-Syncopal episode.
- 7. CONT… Direct Inoculation It is the spread of bacteria during surgical procedures or during diagnostic like intra-articular injection or arthroscopy This may also result from penetrating trauma (Coiffier et al. 2019) However, the change of direct inoculation pathogenesis of the bacteria is less for Mr D’Souza as there is no history of surgical procedures in his case study.
- 8. CONT… Direct spread from infection adjacent focal This type of pathogenesis of the bacteria of Septic Arthritis is commonly seen in children. One the bacteria are colonised, they are able to activate and proliferate acute inflammatory response which promotes the spread of disease very quickly. The synovial membrane is the connective specialised tissue that lines the inner capsule surface of tendon sheath and synovial joints of the body. This membrane is vascularized and therefore it can allow bacteria to enter the synovial joints of a person through bloodstreams (Bohu et al. 2019) When the bacteria reach or enter a body there can be an inflammatory reaction with body’s seropurulent exudate and can increase synovial. It results in the formation of pus. In some cases, there is the appearance of pus in the joint. This destroys and erodes the articular cartilage also partly by bacterial enzymes or the enzyme released from pus, inflammatory cells or synovium. In old age adults like Mr John D’Souza, it can cause a confined effect on the articular cartilage.
- 9. CONT… Bacterial products and pathogenic role It is generally observed that while bacterial attachment proteins initiate the process of infection and promote colonisation a number of different bacterial products can activate the immune system of the host and can increase the damage of tissue in Septic Arthritis (Fazili, Sharngoe & Javaid (2016) This can be considered as the important pathogenic role played in case of Mr D’Souza which led to the deteriorated condition of his right knee and also in the deformation of metacarpophalangeal and proximal interphalangeal joints and writs on his both hands.
- 10. CONT… In the host virulence, the S. aureus has factors that can be implicated. Many of these factors are actually tested because of their ability to increase mortality and morbidity associated with the disease concerned in the case study In some of the studies, it has been also noted and observed that bacterial superantigens like enterotoxins and staphylococcal TSST-1 can play an important role in the host inflammatory response potent activation (Cardoso et al. 2017). From analysis and discussion of pathogenesis of the bacteria, it has been found that S. aureus elicits and infects a strong response of native immune, high T cell activation and cytokine release There are a number of immune avoidance strategies that this pathogen is able and liable to use during the time when the immune system of the host cause damage to the blood vessels and “self” tissue in the infected area.
- 11. CONT… Risk factor In the pathogenesis of the Septic Arthritis bacteria, the risk of age cannot be denied People older than the age of 60 years and has suffered from certain medical conditions from predisposing joints to the nongonococcal infection and bacteremia is also at high risk of Septic Arthritis (Gobao et al. 2019) From this fact, it can be stated that Mr D’Souza was already at a high risk of getting infected and affected by Septic Arthritis as he was 83 years old and also had other medical conditions like rheumatoid arthritis.
- 12. CONT… Some of the common predisposing conditions are can form a high risk of Septic Arthritis. Studies have found that patients suffering from rheumatoid arthritis approximate have more than 10 fold higher incidence chance of Septic Arthritis (Cohen-Rosenblum et al. 2019) From this, the condition of rheumatoid arthritis can be also considered as an important factor for the incidence of Septic Arthritis in Mr John D’Souza Apart from these issues and health problems, there are also some high risks factors associated like hypogammaglobulinemia, granulomatous diseases, renal disease, cancer, diabetes mellitus, cirrhosis, leukaemia and others that can also cause this disease and can cause the spread of the bacteria Therefore understanding the clinical symptoms and diagnosis of the disease are essential at the correct stage.
- 13. CONCLUSION The disease of Septic Arthritis is a serious injection that needs to be diagnosed and treated as soon as possible Delay in the treatment of Septic Arthritis can cause permanent damage and degeneration of joints in the body In the case of Mr D’Souza, there has been a number of reasons and pathogenesis found for the disease. Most important reason is the old age of the patient and the history of rheumatoid arthritis in the patient The medical complications in the health of the patient and deformities in the joints and the wrists of hands can also be the result of the disease in the patient.
- 14. REFERENCES Arshi, S., Suhail, M., Masoodi, T., Majeed, H., Yousuf, R., Khursheed, S., ... & Qayoom, S. (2018). Microbiological Characteristics of Septic Arthritis: A Study from a Tertiary Care Hospital. Microbiology Research Journal International, 1-5. Retrieved on 20th July 2020, from: http://journalmrji.com/index.php/MRJI/article/download/29614/55680 Boff, D., Crijns, H., Teixeira, M. M., Amaral, F. A., & Proost, P. (2018). Neutrophils: beneficial and harmful cells in septic arthritis. International journal of molecular sciences, 19(2), 468. Retrieved on 20th July 2020, from: https://www.mdpi.com/1422-0067/19/2/468/pdf Castellazzi, L., Mantero, M., & Esposito, S. (2016). Update on the management of pediatric acute osteomyelitis and septic arthritis. International journal of molecular sciences, 17(6), 855. Retrieved on 20th July 2020, from: https://www.mdpi.com/1422-0067/17/6/855/pdf Coiffier, G., Couderc, M., Seror, R., Bart, G., Darrieutort-Laffite, C., & Le Goff, B. (2019). Is it currently reasonable to offer short, 14-day antibiotic therapies after a surgical synovectomy in native joint septic arthritis?. Annals of the Rheumatic Diseases, annrheumdis-2019. Retrieved on 24th July 2020, from: https://ard.bmj.com/content/annrheumdis/early/2019/07/04/annrheumdis-2019-215887.full.pdf Fazili, T., Sharngoe, C., & Javaid, W. (2016). An 86-year-old man with septic arthritis of the knee. Canadian Journal of Infectious Diseases and Medical Microbiology, 25. Retrieved on 24th July 2020, from: http://downloads.hindawi.com/journals/cjidmm/2014/238054.pdf Cardoso, L., Alves, P., Santos, F., & Ross, J. J. (2017). Septic arthritis of the pubic symphysis. Case Reports, 2017, bcr2016216784. Retrieved on 24th July 2020, from: https://pdfs.semanticscholar.org/576f/e855bab6d5b57e5283c6badf9fd4dd7b51c2.pdf Gobao, V., Alfishawy, M., Shah, N., Byers, K., Yassin, M., & Urish, K. (2019, October). 393. Changing Trends, Risk Factors, and Treatment Challenges in Staphylococcus aureus Septic Arthritis. In Open Forum Infectious Diseases (Vol. 6, No. Supplement_2, pp. S202-S202). US: Oxford University Press. Retrieved on 25th July 2020, from: https://academic.oup.com/ofid/articlepdf/6/Supplement_2/S202/30269056/ofz360.468.pdf Bohu, Y., Klouche, S., Herman, S., de Pamphilis, O., Gerometta, A., & Lefevre, N. (2019). Professional athletes are not at a higher risk of infections after anterior cruciate ligament reconstruction: incidence of septic arthritis, additional costs, and clinical outcomes from the French prospective anterior cruciate ligament study (FAST) cohort. The American journal of sports medicine, 47(1), 104-111. Retrieved on 25th July 2020, from: https://journals.sagepub.com/doi/pdf/10.1177/0363546518810527 Cohen-Rosenblum, A., Barnett, S. A., Dewitz, R., Melton, S. J., Figueroa, J. E., Krause, P. C., & Dasa, V. (2019). Prosthetic Septic Arthritis: Etiology, Clinical Aspects, and Management. In Infections and the Rheumatic Diseases (pp. 63-73). Springer, Cham. Retrieved on 25th July 2020, from: https://www.researchgate.net/profile/Juan_Garcia- Robledo/publication/336076549_Salmonella_Arthritis/links/5e3babed299bf1cdb91161a1/Salmonella-Arthritis.pdf#page=77
Editor's Notes
- Septic arthritis causes joint inflammation that is caused by the invasion of infectious agents in the joints. Problems of septic arthritis not only include heat, pain and redness in the joint but also decrease the ability of a person to move the joint. In the case of John D’Souza, septic arthritis is diagnosed in his right knee. The study explains and discussed the pathogenesis that has resulted in the clinical manifestation in this case of Mr D’Souza.
- The painful infection of septic arthritis in the joint is likely to occur more in infants and older adults. Although it commonly affects knees, it can also affect shoulders, hips and other joints of the body. In the case of Mr D’Souza, his right knee is affected and is red, hot, swollen and painful which care common symptoms of the issue. According to the study of Arshi et al. (2016), prompt understanding and treatment are significant because septic arthritis can severely and quickly damage bones and cartilages within the joint.
- Pathogenesis of septic arthritis can be considered multifactorial and depends on host immune response interaction and invading pathogen. The bacterial colonisation steps, induction of inflammatory response of host and infection can help in providing a greater understanding of the joint disease.
- In the majority of cases and in most nations, septic arthritis is caused by S. aureus and therefore it is extensively studied and discussed for its role in the disease (Boff et al. 2018). The disease can be caused by Staphylococcus aureus and even by other organisms like Proteus, E.coli, and Streptococcus. Some of the predisposing factors of the disease can be a chronic disorder, AIDS, intravenous drug abuse, Immunosuppressive drug therapy or Rheumatoid arthritis like Mr D’Souza. In the discussion of pathogenesis, the study of Castellazzi, Mantero & Esposito (2016) has highlighted that the Bacteria can enter a human joint via 3 main routes.
- Haematogenous spread It is the spread of the bacteria through the blood to other body parts. This can cause infections in a place away from the original infection site as observed in the case of Osteomyelitis and endocarditis. It is the most common way by which the disease spreads and usually affects people with medical problems. For Mr D’Souza, the haematogenous spread can be considered potential pathogenesis of Septic Arthritis because while being examined, he was already suffering from a pre-Syncopal episode.
- Direct Inoculation It is the spread of bacteria during surgical procedures or during diagnostic like intra-articular injection or arthroscopy. This may also result from penetrating trauma (Coiffier et al. 2019). However, the change of direct inoculation pathogenesis of the bacteria is less for Mr D’Souza as there is no history of surgical procedures in his case study.
- Direct spread from infection adjacent focal This type of pathogenesis of the bacteria of Septic Arthritis is commonly seen in children. One the bacteria are colonised, they are able to activate and proliferate acute inflammatory response which promotes the spread of disease very quickly. The synovial membrane is the connective specialised tissue that lines the inner capsule surface of tendon sheath and synovial joints of the body. This membrane is vascularized and therefore it can allow bacteria to enter the synovial joints of a person through bloodstreams (Bohu et al. 2019). When the bacteria reach or enter a body there can be an inflammatory reaction with body’s seropurulent exudate and can increase synovial. It results in the formation of pus. In some cases, there is the appearance of pus in the joint. This destroys and erodes the articular cartilage also partly by bacterial enzymes or the enzyme released from pus, inflammatory cells or synovium. In old age adults like Mr John D’Souza, it can cause a confined effect on the articular cartilage.
- Bacterial products and pathogenic role It is generally observed that while bacterial attachment proteins initiate the process of infection and promote colonisation a number of different bacterial products can activate the immune system of the host and can increase the damage of tissue in Septic Arthritis (Fazili, Sharngoe & Javaid (2016) This can be considered as the important pathogenic role played in case of Mr D’Souza which led to the deteriorated condition of his right knee and also in the deformation of metacarpophalangeal and proximal interphalangeal joints and writs on his both hands.
- In the host virulence, the S. aureus has factors that can be implicated. Many of these factors are actually tested because of their ability to increase mortality and morbidity associated with the disease concerned in the case study. In some of the studies, it has been also noted and observed that bacterial superantigens like enterotoxins and staphylococcal TSST-1 can play an important role in the host inflammatory response potent activation (Cardoso et al. 2017). From analysis and discussion of pathogenesis of the bacteria, it has been found that S. aureus elicits and infects a strong response of native immune, high T cell activation and cytokine release. There are a number of immune avoidance strategies that this pathogen is able and liable to use during the time when the immune system of the host cause damage to the blood vessels and “self” tissue in the infected area.
- Risk factor In the pathogenesis of the Septic Arthritis bacteria, the risk of age cannot be denied. People older than the age of 60 years and has suffered from certain medical conditions from predisposing joints to the nongonococcal infection and bacteremia is also at high risk of Septic Arthritis (Gobao et al. 2019). From this fact, it can be stated that Mr D’Souza was already at a high risk of getting infected and affected by Septic Arthritis as he was 83 years old and also had other medical conditions like rheumatoid arthritis.
- Some of the common predisposing conditions are can form a high risk of Septic Arthritis. Studies have found that patients suffering from rheumatoid arthritis approximate have more than 10 fold higher incidence chance of Septic Arthritis (Cohen-Rosenblum et al. 2019). From this, the condition of rheumatoid arthritis can be also considered as an important factor for the incidence of Septic Arthritis in Mr John D’Souza. Apart from these issues and health problems, there are also some high risks factors associated like hypogammaglobulinemia, granulomatous diseases, renal disease, cancer, diabetes mellitus, cirrhosis, leukaemia and others that can also cause this disease and can cause the spread of the bacteria. Therefore understanding the clinical symptoms and diagnosis of the disease are essential at the correct stage.
- The disease of Septic Arthritis is a serious injection that needs to be diagnosed and treated as soon as possible. Delay in the treatment of Septic Arthritis can cause permanent damage and degeneration of joints in the body. In the case of Mr D’Souza, there has been a number of reasons and pathogenesis found for the disease. Most important reason is the old age of the patient and the history of rheumatoid arthritis in the patient. The medical complications in the health of the patient and deformities in the joints and the wrists of hands can also be the result of the disease in the patient.