gangguan muskuloskeletal

1. Arthritis Sepsis
Inflammation of a synovial membrane with
purulent effusion into the joint capsule, often due
to bacterial infection

2. Risk Factor and Etiology
• Previous arthritis
• Trauma
• Diabetes Mellitus
• Immunosupression
• Bacteremia
• Sickle cell anemia
• Prosthetic joint

3. PATHOGENESIS
• Hemotogenous spread
• Spread through adjacent
tissues
• Direct
inoculation(aspiration/art
hrotomy)
Clinical Presentation: “red,
hot, painful joint”
• Fever
• Erythema
• Edema
• Heat
• Pain
• Markedly decreased passive
and active ROM

4. Diagnosis
• Needle aspiration, open
drainage and lavage
(arthroscopically or
arthrotomy)
Contraindications to
arthrocentesis:
1. avoid aspirating from an
area that has overlying soft
tissue infection
2. Bleeding disorders
3. Anticoagulation therapy
• CBC with diff: leukocytosis and
left shift
• ESR: monitor treatment
• CRP: monitor treatment
• Blood cultures: may be + in 50%
S aureus
• Urethral, cervical , pharyngeal and
rectal swabs: N gonorrheae
• Synovial fluid analysis: Gram
stain, culture, cell count, and
crystal analysis

5. Treatment
• <5 year-old: 2nd and 3rd
generation cephalosporins
• >5 year-old and adults: cefazolin,
2nd gen. cephalosporins
• S. aureus→cefazolin/vancomycin
• Adults: ciprofloxacin+rifampin
• N. gonorrhoeae→cefriaxone,
• Gram-negative bacilli→3rd gen.
cephalosporin+ aminoglycoside
• Gram-positive
– Streptococcus, methicillin-
sensitive staphylococcus
• Cefazolin 3x2 gram,
Sulbactam/ampicillin 4x2
gram
– Meticillin-resistant
staphylococcus
• Vancomycin 2x1 gram
• Gram-negative
– Ceftriaxone 1x2 gram

6. Prognosis and complications
• Poor prognosis factors
– Immunodeficiency, RA, prematurity, osteomyelitis, hip,
prosthetic infections, + blood cultures, symptoms >1 week, >4
joints, + cultures after aspiration after 7 days of abx tx
• Complications:
– Mortality 8%-15% in three series
– arthritis stiffness, dislocation, subluxation, AVN, local growth
distrubance, osteomyelitis, postinfection synovitis
• Favorable outcome in 50%-80% of cases