Septic arthritis is caused by pyogenic organisms invading the joint space. Staphylococcus aureus is the most common causative organism. Risk factors include poor hygiene, diabetes, immunosuppression, and intravenous drug use. Symptoms include acute painful swelling of one or more joints. Diagnosis involves joint aspiration and examination of fluid. Treatment requires antibiotics, drainage of purulent fluid, and splinting of the affected joint. Complications can include joint damage, deformity, and ankylosis if left untreated.

1. SEPTIC ARTHRITIS
NUR IZZATUL NAJWA BINTI
SHARUPUDDIN
082015100036

2. INTRODUCTION
• Caused by pyogenic organism
• Present as an acute painful arthritis
• Can be subacute or chronic
• Pyogenic arthritis = Infective arthritis =
Suppurative arthritis

3. CAUSATIVE ORGANISM
Staphylococcus
aureus
Others :
• Streptococcus
•Pneumococcus
•Gonococcus

4. PREDISPOSING FACTOR
• Children and male, more susceptible
• Poor hygiene
• Diabetes mellitus
• Rheumatoid arthritis
• Chronic debilitating disorder
• Intravenous drug abuse
• Immunosuppressive drug therapy
• Acquired immunodeficiency syndrome (AIDS)

5. AETIOPATHOGENESIS
1. HEMATOGENOUS – commonest, through pyoderma, throat
infection, septicemia
2. SECONDARY TO NEARBY OSTEOMYELITIS – common
in joint with intra articular metaphysis ; hip, shoulder
3. PENETRATING WOUNDS – knee being superficial joint
4. IATROGENIC – following intra articular steroid injection /
femoral artery puncture for blood collection
5. UMBILICAL CORD SEPSIS - infants

7. DIAGNOSIS

8. Entire epiphysis
Severely damaged
Articular cartilage
Damaged
Late case?
-extensive erosion due to
synovial proliferation and
ingrowth
Vascular occlusion
Necrosis of epiphyseal bone
Untreated?
Spread to underlying bone OR burst out of the joint abscess & sinus
INFANT ADULT
OLDER
CHILDREN

9. • With healing (may be)
1) Complete resolution and return to normal OR
2) Partial lose of articular cartilage and fibrosis of
joint OR
3) Lose of articular cartilage and bony ankylosis OR
4) Bone destruction and permanent deformity of
the joint

10. Clinical features
Infantsant Septicaemia >joint pain
- Irritable
- Refused to feed
- Rapid pulse
- Fever
Check :
- Joints carefully
- Umbillical cord
- Inflammed IV site
- Chest’s, spine, abdomen
Children Acute pain – single large joint
Ex: knee and hip
- Reluctance to move (pseudoparesis)
- Ill
- Rapid pulse
- Swinging fever
- Overlying skin – red
- Superficial joint swell obvious
- Local warmth
- All movement restricted

11. Adult Superficial joints
(knee, wrist, finger, ankle or toe)
- Painful
- Swollen
- Inflamed
- Movement restricted
*questioned and examination for:
- Gonococcal infection
- Drug abuse
- Rheumatoid arthritis

12. Imaging
• Ultrasound
– most reliable method
• revealing joint effusion
– widening of space between capsule and bone >2cm
• X-ray
– Search for signs:
• Soft tissue swelling
• Loss of tissue plane
• Widening of radiographic ‘joint space’
• Slight sublaxation
– Late features?
• Narrowing and irregularity of joint space

14. INVESTIGATIONS
• Blood
– Neutrophilic leucocytosis
– Increase ESR
• Joint aspiration
– Quickest and best method

16. • MRI and radionuclide imaging
– Helpful in diagnosing arthritis in obscure site
• Sacroilliac joint
• Sternoclavicular joint

17. Differential diagnosis
• Acute osteomyelitis
• Other type of infection
• Psoas abscess and local infection of the pelvis
• Trauma
• Traumatic synovitis may be associated with acute pain and swelling
• Irritable joint
• At the onset the joint is painful and lacks some movement, but the child is not really ill
and there are no signs of infection.
• Haemophillic bleed
• acute haemarthrosis closely resembles septic arthritis. The history is usually conclusive,
but aspiration will resolve any doubt
• Rheumatic fever
• Typically the pain flits from joint to joint
• Juvenile rheumatoid arthritis
• start with pain and swelling of a single joint, but the onset is usually more gradual and
systemic symptoms less severe
• Sickle cell disese
• Gaucher’s disease
• this rare condition acute joint pain and fever can occur without any organism being found
(‘pseudo-osteitis’)
• Gout and pseudogout
• On aspiration the joint fluid is often turbid, with a high white cell count; however,
microscopic examination by polarized light will show the characteristic crystals.

18. Treatment
• The first priority is to aspirate the joint and examine the fluid. If aspirate looks
purulent, joint drainage should be done neglecting the lab results
General
support
ive care
splintag
e
Antibio
tics
Drainag
e
aftercar
e

19. • General Supporative care
• Analgesics for pain and IV fluids for dehydration
• Splintage
• joint should be rest, light splintage for neonates and
infants.
• For hip infection, joint should be abduct ,30 degrees
flexed to prevent dislocation.

20. • Antibiotics Treatment
• Neonates, infants up to 6 months - should be protected
against staphyloccocus aureus, strep gram negative
organisms.
->flucloxacillin + 3rd generation cephalosphorin
(cefotaxime)
• older teenagers and adult
-> flucloxacillin and fusidic acid
-> If the initial examination shows Gram-negative
organisms a third-generation cephalosporin is added.

21. • Drainage
– under anaesthesia small incisions was made , drained and
washed out with physiological saline, small catheter is place
and the wound is closed, suction continue for 2-3 days
– This policy are advisable for
• In very young patients
• when hip is invovle
• if the aspirated pus is thick
– in older children with symptoms less than 3 days , we can do
closed aspiration of the joint

22. • Aftercare
– Mobility after no longer painful is necessary to prevent
stiffness of the joint

23. Complications
Highest incidence occurs for infants below 6 months, most of
which affect the hip
– obvious risk are
• delay diagnosis and treatment >4d
• concomitant osteomyelitis of proximal femur .
• Subluxation /dislocation of the hip /instability of the knee
– prevented by appropriate posturing or splintage
• Damage to the cartilaginous or epiphysis
– Sequelae include retarded growth, complete or partial damage to
epiphysis, joint deformity, bone necrosis, acetabular dysplasia and
pseudarthrosis of the hip.
• articular cartilage erosions
– may cause restricted movements or complete ankylosis of the
joints.

24. SEPTIC ARTHRITIS IN INFANCY
• Septic arthritis of the hip
• Cartilaginous head of femur completely destroyed
• Rapid abscess formation, which burst out and heals
rapidly
• Child complaint of limp without pain
– Examination
• Unstable gait, shorter leg, hip movement increased in
all direction
• Xray : absence head and neck of femur
• Closely resemble cdh, how to differ (xray above and
normally develop round of acetabulum)

25. GONOCOCCAL ARTHRITIS
• Nisseria gonnorrhea is the commonest cause
of septic athritis in sexually active adults and
poor population

26. • Clinical features
– disseminated gonococcal infection
• triad of polyarthritis, tenosynovitis and dermatitis
– septic arthritis of a single joint
• usually the knee, ankle, shoulder, wrist or hand
• Investigation
– ESR and WBC count will be raised.
– If get suspected, the patient should be questioned about possible contacts
during the previous days or weeks and they should be examined for other
signs of genitourinary infection (e.g. a urethral discharge or cervicitis).
– Joint aspiration : high white cell count and typical Gram-negative
organisms
• Treatment
– third-generation cephalosporin iv im
– Ass with chlamydial infection : quinolone antibiotics (ciprofloxacin and
ofloxacin)
– If organism is found to be sensitive to penicillin, treatment with ampicillin,
amoxicillin or clavulanic acid is also effective

27. HIV-1 INFECTION
septic athritis is commonly
seen in HIV & AIDS patients.
staphyloccocus and strep,
any opportunistic infection
C(x)
• painful, inflamed joint.
• Sometime confined to a
single, unusual site such
as the sacroiliac joint
• several joints may be
affected simultaneously
Treatment
• Patients with
staphylococcal and
streptococcal infections
usually respond well to
antibiotic treatment and
joint drainage
• opportunistic infections
may be more difficult to
control.