Septic arthritis

Description:

Septic arthritis would represent the Disease meets everywhere. Children are surprised preferential and persons are more senior than 60 years.

Annual frequency makes 2–10 cases on 100 000 population, and among patients with the pseudorheumatism (P) and recipients of valve prostheses these values reach 30–70 on 100 000. Despite an extensive arsenal of the antimicrobic means developed and implemented in clinical practice and snowballing of surgical technology, irreversible defunctionalization of a joint develops at 25–50% of patients. Frequency of lethal outcomes significantly did not change for the last 25 years and makes 5–15%.

Symptoms of Septic arthritis:

As a rule, septic arthritis is characterized by the acute beginning with a megalgia, a swelling, a dermahemia and a hyperthermia of the affected joint. In most cases (60–80%) fever takes place. However body temperature can be subfebrile and even normal that meets at damage of hip and sacroiliac joints, against the background of active antiinflammatory therapy concerning a basic disease more often, and also at patients of advanced age. In 80–90% of cases the only joint is surprised (more often – knee or coxofemoral). Development of infectious process in joints of brushes generally has traumatic genesis (the getting chipped wounds or stings). Oligo-or the polyarticulary type of defeat is more often observed at development of septic arthritis in sick RA, systemic lesions of connecting fabric, and also at the addicts entering drugs intravenously. In addition, at "intravenous" addicts septic arthritis is characterized by slower beginning, a long current and frequent defeat of syndesmoses of a trunk (sacroiliac and grudino-clavicular joints, a pubic union). Small children the only manifestation of a bacterial coxitis can have a sharp oxycinesia with fixing of a hip joint in the provision of bending and outside rotation. Unlike gonococcal arthritis for septic arthritis defeat of circumarticular soft tissues is unusual.

Reasons of Septic arthritis:

Theoretically all known bacteria can cause septic arthritis. The most widespread etiological agent is S. aureus to which share about 80% of cases of infections of joints at sick RA and a diabetes mellitus fall. This pathogen is also the basic at an infectious coxitis and polyarticulary options of septic arthritis. On allocation frequency at patients streptococci (first of all, a hemolitic streptococcus of group A) which, as a rule, are associated with background autoimmune diseases, persistent infection of skin and the previous injury OH are in the second place. Occurrence of S. pneumoniae as the OH activator significantly decreased in recent years. Streptococci of other groups (B, G, C and F – in decreasing order) are allocated at OH at patients with immune insufficiency, malignant new growths, and also infectious pathology of a digestive and urogenital tract. Gram-negative sticks – the reason OH at elderly patients, addicts entering drugs intravenously and also at patients with an immunodeficiency. Anaerobe bacterias appear as OH activators at recipients of joint prostheses, persons with deep infections of soft tissues and patients with a diabetes mellitus more often. The most significant etiological agents OH among children – S. aureus and Str. pyogenes. The role of H. influenzae which was earlier found rather often at septic arthritis at children znachitelnoumenshitsya in connection with broad implementation of a specific vaccine in recent years. At the same time a number of researchers note growth of occurrence at septic arthritis of a gram-negative stick of K. kingae, being the normal inhabitant of an oral cavity at children up to 2 years. In table 2 data on the most often found OH causative agents depending on categories of patients are summed up.

Treatment of Septic arthritis:

Treatment of septic arthritis – complex, including antimicrobic and symptomatic therapy, a drainage of the infected SZh and physiotherapy exercises. Antimicrobic therapy is carried out within the first 1–2 days empirically taking into account age of the patient, a clinical picture of a disease and results of a research of smears of SZh on Gram, further – taking into account the allocated activator and its sensitivity to antibiotics. Antibiotics should be entered preferential parenterally, their intra joint use is inexpedient. Lack of positive dynamics in 2 days dictates need of change of an antibiotic. The remaining accelerated SOE serves as the indication to extension of terms of treatment which averages 3–4 weeks (sometimes to 6 weeks), but not less than 2 weeks after elimination of all symptoms of a disease. In addition to antimicrobic therapy appoint analgetics and non-steroidal anti-inflammatory drugs (diclofenac, ketoprofen, etc.). The drainage of the infected joint is made (sometimes several times a day) method of the closed aspiration through a needle. For the purpose of assessment of efficiency of treatment every time is carried out by calculation of leukocytes, coloring across Gram and crops of SZh.