Table of contents
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Septic Arthritis
- ACUTE monoarticular arthritis is septic arthritis until proven otherwise.
- Requires URGENT medical management, ANTIBIOTICS ARE NOT ENOUGH.
- Investigations
- Infection Picture (elevated WBCs, fever, soft BP)
- Joint Aspiration
- MUST BE PERFORMED to rule out infection
- Send for (3 C's)
- Cells (Count and Diff):
- Inflammation > 2000/mm^3
- Neutrophils >90% consistent with infection
- Typically Infections Arthritis will have WBCs > 50,000
- Crystals
- Seeing rhomboid positive birefringent crystals (CPPD) is common, still rule out infection. (infection releases CPPD from cartilage)
- Culture & Gram Stain
- Gram Stain does not rule out infection (only positive 20% of septic arthritis), must cover with broad abx and await culture.
- Cells (Count and Diff):
- Organisms:
- MRSA & S. aureus
- Klebsiella pneumoniae
- Neisseria gonorrhoeae
- Management:
- Causes irreversible joint damage
- Antibiotics (but not enough)
- First Line: Vancomycin & Ceftriaxone
- Vancomycin for MRSA, Ceftraixone for Gram +'s and Gram -'s (including N.gonorrhea)
- Isolation of organism.
- Find the source (hematologic spread from somewhere like IVDU)
- Frequent joint aspirations
- Surgical consult
- Possibility of surgical management
- May need irrigation & debridement
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