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Joint InfectionJoint Infection General InformationThe Septic Arthritis is an infection in a joint, a consequence of the invasion of the synovial by living microorganisms. It is considered a medical emergency because it severely affects the articular functioning. However, the disorder can also have lethal effects when it is associated with bacteremia and septic shock. The diagnosis of Septic Arthritis is difficult and variable as it depends on the identification of the germ (this is crucial to the success of treatment). All ages might be affected with this disorder; however, the proportion of subjects over 60 years appears to be increasing. Men and women are equally affected with a slight tendency toward males. The invasion of the synovial follows three mechanisms: blood, contiguity or direct inoculation. In humans, the majority of articular infections occur through blood as a result of bacteremia. The development of an infectious arthritis is multi factorial and depends on the interaction between the officer and the invasive defense reactions in the body. As a first step, the bacteria will bind to proteins of the extra-cellular matrix with specific receptors. Then, it will multiply. Within 24 to 48 hours after the penetration of the germ, the immune system sends an influx of leukocytes and monocytes to the affected area that will differentiate into macrophages. Immunity to this disorder is secondarily acquired and is mainly mediated by the T cells. The role of NO in Septic Arthritis was studied through the inhibition of NO synthase (NOS). The destruction of the cartilage paradoxically results from the action of the immunitary system that was meant to eradicate the infection (through production of cytokines, metalloproteinases and superoxides).Joint Infection SymptomsThe Septic Arthritis typically manifests itself through a mono-arthrite syndrome with acute infectious symptoms. No one knows the precise reasons for which joints are most frequently affected (especially the knee and hip). The onset is abrupt, preceded by severe shivers. The pain is intense and it is known to quickly lead to a complete functional impotence. The articulation is hot, red and swollen. The passive and active mobilization is painful, if not impossible. Other clinical symptoms of variable intensity include fever, chills, pallor, sweating and fatigue. If the patient presents septic shock and DIC, he or she requires immediate transfer to intensive care – this complication is seen especially in the case of streptococcal infections caused by Topic A. The adequate study of the individuals’ bacteriological synovium is also useful for the proper diagnosing of tuberculosis, brucellosis or mycotic infections, but far less in purulent arthritis. The cytological analysis of an individual who is suffering from this particular medical condition ought to show more than 20000 cells / mm 3. Most of them are polycyclic altered – this fact is very suggestive but not pathognomonic. On the other hand, a very small amount of liquid cell does not preclude a Septic Arthritis, especially among drug addicts or in the case of individuals who present cancer, patients who are following an immunosuppressive treatment, and so on. For further information regarding Septic Arthritis and the symptoms that a patient who is suffering from it might present, we strongly advise you to seek further help at your personal health care provider’s office, to the nearest medical care centre or to the local pharmacy.Joint Infection TreatmentThe occurrence of a Septic Arthritis is a medical emergency. Most of the recommendations are based on empirical attitudes based on the experience of practitioners. Nevertheless, the treatment of a Septic Arthritis covers several areas. It must not be disregarded because it participates in the general malaise and discomfort of the patient. Do not use nonsteroidal anti-inflammatory drugs if the diagnosis is not established. An antibiotic therapy is essential, the choice of molecules and the route of administration are carried out according to four main criteria: the bacterium in question and its resistance profile, the characteristics of the susceptibility testing, the type of infection, Topic characteristics (age, comorbidity, intolerance or allergies, and so on). The concept that intravenous antibiotic therapy is more effective than a treatment with oral antibiotics often misleads the patients. The strategy most commonly used is to prescribe antibiotic therapy. After the completion of the treatment, further tests are done to see if any changes have occurred in the patient’s general health condition. The optimal duration of antibiotic therapy is not consensual. The duration of phase intravenous depends only on the pharmacokinetic characteristics of the antibiotic, rather than on the severity of the infection. A therapy for this type of medical condition tries to cope with several objectives: to identify the germ in question during diagnosis, to relieve the patient’s unpleasant symptoms by reducing the intra-articular pressure, to effectively relieve the inflammatory liquid that participates in the articular destruction. The most effective therapy method (that involves the drainage of the articular area) is still widely discussed, as there are various types of popular methods / procedures. Your physician will know which type of these procedures suits your health condition best. The detention has a beneficial effect that can be noticed almost immediately. This advantage is known to add to its analgesic action, thus helping in the acceleration of the healing process. However, this technique has some disadvantages. Some types of rheumatism disorders (PR, spondylarthropathie, lupus, and so on) may begin with a mono-arthritis. That is why the articular fluid analysis should include a systematic study of the bacteria - in the case of rheumatism it remains sterile. The rehabilitation with isometric passive mobilization is undertaken quickly, as soon as pain allows the patient to follow this therapeutic procedure. The mortality of Septic Arthritis remains quite high, as an average of 8 patients out of 100 does not survive. Some factors that enhance the risk of a poor prognosis have been established. They include: an age (over 65 years), the existence of a prior damage, a PR, on prosthesis infection. Nearly half of all patients also present functional sequelae. The Septic Arthritis is a medical emergency because any delayed diagnostic weigh heavily on the future of the functional articulation. |
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