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What organism may continuly affected the joint but the joint may not be activily infected?
Gonnococcal arthritis may cause microbial debris that persist in the joint and perpetuate an inflammatory response even after the organism is gone.
What may destruction of a joint from another arthritic cause do to a joint inducing infection?
The debris and damage causes a good nidus for infection.
What are the common organisms seen in septic arthritic joints?
Staph aureus and gram negative bacilli
what are the 3 stages of cartilage loss due to hematogenous acute bacterial arthritis?
- 1- liberation of lysosomal enzymes from PMN's and synovial lining cells resulting in the loss of proteogylcan from cartilage.
- 2- increased mechanical stress and inadequate nutrion result in chondrocyte damage.
- 3- Ensymes release from PMN's and synovial lining cells with the altered joint mechanics gradually destroy the collagen network.
What are the common locations of non-gonococcal arthrities?
Knee, hip, ankle
What are the diagnostic tests for septic joint?
Gram stain and culture. A typical joint infection may have purulence and >50000 cells/cmm and more than 90% PMNs.
How often should you do a closed needle aspiration during the tx of septic arthritis?
When should you do surgical drainage for septic arthritis?
after 3-4 days of ab tx that is not resolving.
With tx of septic arthritis what should the pt do?
NWB and no ROM
You aspirate a joint what might be some findings of septic?
- Low sugar leaves, high lactic acid, high WBC, hyperemia, pannus
- Cultures of gram + almost 100%
- Cultures of gonococcal arthritis are only 25-50%
When might you start to see juxta-articular osteopenia with a septic joint?
What what age can hematologic septic joint appear?
<1 year old because after that the vessels no longer crosses the physis until later in life.
What is the MC acute bacterial arthritis?
- Occurs during the dissemination of the gonococcal infection
- Acute migratory polyarthritis and may have a rash. Sexually active
Patients with gonococcal arthrits?
<40 sexually active, with unprotected sex
Primary dx of gonoccocal?
Synovial culture and fluid analysis
WHat are the abx for gonococcal?
- #1 Ceftriaxone (Rocephin) 3rd gen
- Need to cover gram -
Other tx for gonoccocal?
- Joint aspiration
- Joint immobilization
- IV abx
What are some viruses that may cause arthritis?
- Hep B
- Parvovirus B19
What are the signs of TB arthritis?
- Chronic granulomatous reaction with gian Langhan type cellular infiltration.
- Acid fast staining for dx
What does the viscosity of synovial fluid look like in an infection?
- Decreased in inflammation
- Normal can be stretched like a string appearance
- Not clear in inflammation
- Normal has a yellow ting
What are the steps to prepare a gram stain?
- Flame smear
- add crystal violet
- Gram's iodine
- wash with 95% EtOH
What agent in staining would you use to see if it is pigmented villonodular synovitis or hemochromatosis?
What is the mucin clot test?
- Drop of synovial fluid in 5% acetic acid--forming a good clot means good.
- A shredded broke-up clot is bad.
What infection could you get from unpasteurized milk?
TB and vertebral body
What are the obligate aerobes?
What are the abx for TB?
- Isoniazid, Rifampin
- Must be treated for over 6 months
What systemic infection effects lymphocytes and other cells with CD4?
What are some common diseases seen in HIV pts?
TB, Pnuemona, Cytomegalovirus, Kaposis, Peripheral Neuropathy, Histoplasmosis, Candidiasis, Varicella zoster, Human paillomavirus, seborrheic dermatitis
What can you use to tx candidiasis?
- Oral azole
- Topical nystatin, acyclovir