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Rheumatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Numerous pathogens can cause septic arthritis. The pathogen will depend in part upon the mechanism of infection and predisposing factors. Patients with RA are of greater risk of septic arthritis. Septic arthritis is usually monomicrobial. Staphylococcus aureus is the most common cause of septic arthritis in adults. TB should be suspected in the immunocompromised and if there is involvement of the spine.
Synovial Fluid
Published in Verna Wright, Eric L. Radin, Mechanics of Human Joints, 2020
Pierre Geborek, Frank A. Wollheim
The risk of introducing bacteria into the joint during arthrocentesis should not be overemphasized. Some bacteria areprobably always introduced into the joint by this procedure, but the dose is apparently too small to cause infection in most cases (31). However, joints injected with a crystalloid glucocorticoid preparation may have increased susceptibility to develop septic arthritis in the months following injection (78). Of nine septic arthritis rheumatoid patients identified in a 4 year survey, six had received an intraarticular glucocorticoid injection into the actual joint within 3 months. Only one developed septic arthritis in direct relation to the local treatment, whereas the late cases occurred 2–12 weeks after the injection. The risk of septic arthritis in this RA cohort was about 1 in 1700 injections if the late septic arthritis cases (78) were compared with the currently given frequency of 1 in 14,000 injections in direct relation to arthrocentesis (30).
The limbs and soft tissues
Published in Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague, Paediatric Surgical Diagnosis, 2018
Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague
The signs and symptoms of septic arthritis are similar to those of osteomyelitis. The pain and tenderness are localised over the distended capsule of the joint and there is restriction of all movement. In infants the inflammatory signs may spread to the overlying skin. The treatment of septic arthritis is surgical lavage of the joint cavity and high-dose intravenous antibiotics.
Novel strategies to diagnose prosthetic or native bone and joint infections
Published in Expert Review of Anti-infective Therapy, 2022
Alex Van Belkum, Marie-Francoise Gros, Tristan Ferry, Sebastien Lustig, Frédéric Laurent, Geraldine Durand, Corinne Jay, Olivier Rochas, Christine C. Ginocchio
Septic arthritis is an inflammation of a joint that is caused by infection. Typically, septic arthritis affects one large joint in the body, such as the knee or hip. Risk factors for septic arthritis include hematogenous spread of pathogens (due to skin infection, cutaneous ulcers, or adjacent osteomyelitis), direct inoculation of pathogens (penetrating trauma, intrauricular injection, recent joint surgery) and higher age. Early stages of the disease include soft tissue swelling, purulence, and widening of joint space. If the disease is untreated it can progress to cartilage destruction, narrowing and irregularity of the joint space, bone destruction, and growth disturbances. Symptoms include pain, fever, restricted movement, swelling, effusion, and erythema. This category of infections is frequently culture negative (between 4.5% and 64%) [13]. Microorganisms involved most commonly are Staphylococcus aureus, coagulase-negative staphylococci, streptococci, enterococci, and several species of gram-negative bacteria and anaerobes. Acute arthritis in children less than 4 years old is frequently due to Kingella kingae and requires rapid antibiotic administration [14]. Neisseria gonorrhoeae, Neisseria meningitidis, or Mycobacterium spp. are less frequently isolated from arthritic patients [15]. Diagnosis mostly relies on arthrocentesis, i.e. joint fluid punctate analysis [16]. Synovial fluid examination includes microbiological, histological, and biochemical analyses. Time to result is key to rapidly initiating targeted antibiotic therapy.
Autologous conditioned serum for degenerative diseases and prospects
Published in Growth Factors, 2021
Seyed Kazem Shakouri, Sanam Dolati, Jessica Santhakumar, Avnesh S. Thakor, Reza Yarani
From the collective examination of ACS treatment during the last 15 years, it can be concluded that ACS is safe enough to be used for clinical applications. Compared to current synthetic IL-1Ra anakinra, ACS is superior since it is derived from the patient’s own blood (Chevalier et al. 2009). This attribute provides an excellent safety profile that minimizes adverse effects and cost of production (Chevalier et al. 2009). Side effects are rare, transient, and local inflammatory responses. The most common adverse effect was pain and swelling in the subsequent days after performing ACS injection (Evans et al. 2016). No serious complications, such as infection, marked muscle atrophy, deep vein thrombosis, fever, hematoma, tissue hypertrophy, adhesion formation, or other major adverse events occurred by ACS use (Ravi Kumar, Goni, and Batra 2015). Though the risk of septic arthritis exists with any form of intra-articular injection (Steel, Pannirselvam, and Anderson 2013), it is rare after ACS injection (Marques-Smith, et al. 2020).
Paediatric scurvy: frequently misdiagnosed
Published in Paediatrics and International Child Health, 2021
Husna Musa, Imma Isniza Ismail, Nurul Hazwani Abdul Rashid
Following extensive laboratory and radiological investigation, the initial differential diagnoses included inflammatory arthritis and septic arthritis. He underwent bilateral hip arthrotomy washout and biopsy which revealed minimal haemarthrosis with no bone abnormalities. The synovial fluid culture was negative (without preceding antibiotic treatment) and histopathological examination demonstrated mild chronic synovitis. In view of minimal improvement, further enquiry about his diet revealed that the child consumes hardly any fruit or vegetables. There had also been intermittent gum swelling and bleeding in the past 3 months. At this point, the diagnosis of scurvy was considered and blood was sent for quantification of ascorbic acid levels. The ascorbic acid level was subsequently found to be <5 µmol/L (28–120).