Acute infectious arthritis

Description:

Acute infectious arthritis (septic, purulent) - the damage of a joint caused by direct hit of microorganisms in his cavity from any primary centers or at an open injury (puncture) of a joint. Various microbes can be etiological factors, but staphylococcal (Staphylococcus epidermidis et aureus), streptococcal on the first place (a hemolitic streptococcus of group A, the green streptococcus) the infection and gram-negative microbes are (Escherichia coli, Proteus vulgaris, Klebsiella pneumoniae, Pseudomonas pseudomallei, Aeromonas hydrofhila). Infectious arthritis can be sometimes caused also by a direct invasion in a joint of such microorganisms as shigellas, salmonellas, iyersiniya.

Symptoms Acute infectious arthritis:

In most cases one are surprised or two joints. Arthritis begins sharply with the sharpest pains, a swelling of a joint, a hyperemia and its hyperthermia, only sometimes these phenomena for several days are preceded by the migrating polyarthralgia. Along with development of a joint syndrome fever of gektichesky type, oznoba, pouring sweats are observed. In blood reveal a leukocytosis with the expressed deviation to the left, increase SOE and other indicators of inflammatory activity. At the elderly and extremely weakened patients arthritis can gradually begin, being shown by moderate general and local signs of an inflammation and getting a chronic current. Most often knee and hip joints (usually at children), and also shoulder, elbow, radiocarpal, ankle joints, a backbone and ieosacral joints are surprised.

At a research of synovial fluid find a high cytosis (20·109/ml) with dominance (to 90%) neutrophils. Liquid muddy, its viscosity is reduced, a mutsinovy clot friable, breaking up, in it microorganisms are found. At the earliest stages of a disease synovial fluid has sometimes no purulent character, and its repeated aspirations for obtaining informative results are required.

Reasons Acute infectious arthritis:

Acute infectious arthritis can arise against the background of a furunculosis, peritonsillar abscess, quinsy, scarlet fever, an inflammation of a middle ear, pneumonia, an infectious endocarditis, at contaminated wounds of any localization, after a tsistoskopiya, abdominal organs operations and urinogenital system and so forth. Sometimes primary center does not manage to be revealed. The old men, persons weakened by such general diseases as blood diseases, malignant tumors, PA, hard currency, especially are predisposed to development of infectious arthritis if they were on long corticosteroid or immunodepressive therapy, and also premature children and alcoholics.

Apparently from stated, in all these cases it is about development of primary or secondary immunodeficience.

Treatment Acute infectious arthritis:

The extremity immobilization in the provision of extension for the short term (1-2 weeks) is necessary; at improvement of a condition of the patient start active development of movements in a joint.

The basis of therapy is made by antibiotics which it is necessary to appoint whenever possible taking into account sensitivity to them microbic flora. At a streptococcal and staphylococcal infection use penicillin on 250000 PIECES / (kg · days), on average for adult 12000000-20000000 PIECES intravenously, having distributed a dose on 4 introductions. Duration of a terpiya is individual - 3-6 weeks. It is possible to apply also antibiotics of a broad spectrum of activity, for example, цепорин on 60-100 mg / (kg · days) in 2-3 receptions.

At a gram-negative indestinal flora gentamycin in a dose of 3 mg / (kg of days), distributed on 3 receptions is shown. Treatment is carried out during 2-3 weeks, replacing gentamycin with ampicillin (6-10 g/days in 4-6 receptions) or цепорин.

The daily drainage of a joint is shown: aspiration of pus through a wide needle and intra joint introduction of antibiotics. The drainage of a joint is carried out until synovial fluid does not become pure.

The positive take of such conservative therapy has to be in most cases received already by the end of the first week, however active therapy has to continue before full treatment. When the microorganism, caused development of arthritis, is steady against antibiotics, sanitation of a joint is complicated if in 2-3 weeks of therapy permanent improvement is not noted and the risk of development of destructive changes in a joint increases, resort to a surgical drainage. The last is especially shown at children with defeat of hip joints. At the come destruction of a joint it is necessary to remove in the surgical way nekrotizirovanny fragments and the centers of an infection in soft periartikulyarny tissues. All patients with infectious arthritis are subject to observation and treatment at hirurgovortoped.