• Cecil Medicine, 23rd ed

• Harrison's Principles of Internal Medicine, 17 Edition

• Nelson Textbook of Pediatrics 18th Edition

• Campbell's Operative Orthopaedics, 11th ed

• Last literature review version 19.1: January 2011 |UpToDate

• 1-Gonococcal Arthritis

• 2-N0N Gonococcal Arthritis

• 3-TB

• 4-FUNGAL

• 5-VIRAL

• 1-ACUTE=BAC

• 2-CHRONIC=TB/FUNGAL

1-hematogenous1-hematogenous Why Why joints are affected and other joints are affected and other vulnerable organs lack of a vulnerable organs lack of a

limiting basement membrane limiting basement membrane in the capillaries of synovium in the capillaries of synovium

ترین ترین شایع شایع

• نومونی1مثل=

• کورک-2

2-inoculation2-inoculation

3-adjacent3-adjacent site of osteomyelitis site of osteomyelitis or cellulitisor cellulitis

PATHOLOGYPATHOLOGY

• سینویوم به باکتری ورود

• PMN ARRIVE

• PANUS FORMATION=

• SYNOVIALL CELL PROLIFERATION+PMN INFILTRATION

• PROTEASE +COLAGENASE DESTROY JOINN IN 48 Hr

• DSC00019(1).JPG

infantinfant

• 1=umbilical cord

• 2=femoral venipuncture = Septic arthritis of the hip can result from femoral venipuncture

• 1-Age greater than 80 years 2-Diabetes mellitus 3-Rheumatoid arthritis 4-Prosthetic joint 5-Recent joint surgery 7-Skin infection, 8-cutaneous ulcers 9-IV drug abuse, 10-alcoholism 11-Previous intra-articular corticosteroid injection

• نمیگیره مفصلی عفونت سالم !آدم

های • منفی گرمطلب فرصت

• The lower extremity weight bearing joints are predominantly affected (61% to 79%

• شایعترین= زانو

• 2رتبه =hip

• +3رتبه + آرنج= مچ شانه

Acute septic arthritis of the Acute septic arthritis of the sternoclavicular jointsternoclavicular joint

• Among IV drug users, infections of the spine, sacroiliac joints, or sternoclavicular joints (Fig. 328-1) are more commo

• Polyarticular infection is most common among patients with rheumatoid arthritis

• In the first few days of infection, radiographs usually are normal; however, they may be helpful in that they may show soft-tissue swelling, displacement of the fat pad, or joint space widening from localized edema

• As the infection progresses, joint space narrowing from the destruction of cartilage

• The usual presentation consists of moderate to severe pain that is uniform around the joint, effusion, muscle spasm, and decreased range of motion. Fever in the range of 38.3°–38.9°C

• The inflamed, swollen joint

A focus of extraarticular infection, such as a boil or pneumoni

• aspiration before antibiotic therapy is initiated Gram staining, culture, cell counts, and crystal analysis synovial leukocyte counts greater than 50,000/mm3 indicate infectious arthritis polymorphonuclear neutrophils, if greater than 90%, indicates infection.

• extremely elevated synovial WBC (>100,000/mm3) are not always due to infection. Sterile processes that can cause this degree of leukocytosis, sometimes termed "pseudoseptic arthritis", include: reactions to intraarticular injections (eg, hyaluronans), flares of rheumatoid arthritis, leukemic infiltration, and gout [8

• متوسط 250تا 25لکوسینور = هزار100هزار• PMN=90%

• =اسمیر• 1=GRAM + CLUSTER =STAPH

• 2=GRAM – DIPLOCOC= N.G

• ESR+CRP RISE

استافاستاف

• Blood cx=50%

• Smear=75%

• Fluid cx=90%

منفی منفی گرم گرم

• Smear=50%

Glucose + LDH are not specific for infection, and measurement of these levels is not necessary to make the diagnosis.

• The synovial fluid should be examined for crystals, because gout and pseudogout can resemble septic arthritis clinically, and infection and crystal-induced disease occasionally occur together

ClarityClarity

• abnormally large numbers of nucleated or red blood cell

ViscosityViscosity  

• produce a long string-like extension as it falls you should do this not lab

است منفی کشت اغلب ایران است در منفی کشت اغلب ایران در

• A positive synovial culture should be indicative of septic arthritis in 100 percent of cases if laboratory error and contamination can be excluded.

• Gold=1-masachoset=cx

• 2-hasanchset= cell cout

• Negative cultures may occur in those who have received recent antimicrobial therapy or are infected with a fastidious organism such as some streptococci or mycoplasma.

درماندرمان

• (1) The joint must be adequately drained, (2) antibiotics must be given to diminish the systemic effects of sepsis, and (3) the joint must be rested in a stable position

• the joint should be splinted! in a position of function . If the response is not favorable and repeat aspiration does not show a decrease in the synovial leukocyte count within 24 to 48 hours, open surgical drainage is necessary

• direct instillation of antibiotics into the joint is not necessary to achieve adequate levels in synovial fluid and tissue

The three procedures usedThe three procedures used

• The three procedures used are needle aspiration (single or multiple), arthroscopic drainage, or arthrotomy (open surgical drainage). daily aspiration may be necessary

• Because the knee is a superficial joint, it can be aspirated easily

• باشد وریدی باید حتما باید درمان• ندارد سودی کورتون• باید ولی کند بیرینگ ویت مفصل روی نباید بیمار

دهد انجام را باسیو .حرکات

اسمیر با اولیه اسمیر درمان با اولیه درمان

• 1- = = سفتریاکسون گنوکوک منفی اسمیر• نافسیلین += =2 گرم کوکسی• 3= وانکو = بیمارستانی مقاومت• 4= + جنتا= کلوگزاسیلین معتاد

قطعی قطعی درمان درمان

• وانکو 4استاف= هفته• سیلین 2استرب= بنی هفته• = منفی یا 4گرم سفتریاکسون هفتهفلوروکینولون

• +2سودوموناس= جنتا مزلوسیلین هفته

• + جنتا سفتازیدم یا

DGIDGI

• Women are at greatest risk during menses and during pregnancy and overall are two to three times more likely than men to develop disseminated gonococcal infection (DGI) and arthritis syndrome of fever, chills, rash, and articular symptoms.

Small numbers of papules that progress to hemorrhagic pustules develop on the trunk and the extensor surfaces of the distal extremities

• است منفی بوست و مایع .کشت

• BLOOD CX=45%

• شود می گرفتار دست اغلب

• Migratory arthritis

consequence of an immune reaction to circulating gonococci and immune-complex deposition in tissues. Thus, cultures of synovial fluid are consistently negative, and blood cultures are positive in <45% of patients

Synovial fluid may be difficult

to obtain from inflamed joints

and usually contains only

10,000–20,000 leukocytes/

True gonococcalTrue gonococcal

• True gonococcal septic arthritis is less common than the DGI syndrome

A single joint, such as the hip, knee, ankle, or wrist, is usually involved

Synovial fluid, which contains >50,000 leukocytes

cultures of synovial fluid are positive in <40% of cases. Blood cultures are almost always negative.

• BLOOD Cx=always manfi

• Smear=40%

• Tx=7D ceftriaxone1gr IV per 24Hr

• کنه می معجزه گنوکوک در !سفتریاکسون

• + doxycycline = کالمیدیا

• Tuberculous accounts for ~1% of all cases of tuberculosis and for 10% of extrapulmonary cases

chronic granulomatous monarthritis

• systemic symptoms are seen in only half of all cases. cell count of 20,000/ L, with ~50% neutrophils !؟ Acid-fast staining of the fluid yields positive results in fewer than one-third of cases cultures are positive in 80%. Culture of synovial tissue taken at biopsy is positive in ~90% Therapy for tuberculous arthritis is the same as that for tuberculous pulmonary disease, smear=30%

Fungal Arthritis Fungal Arthritis

Viral ArthritisViral Arthritis

• ترین paro B19=شایع

• Mump

• RUBELLA

• HBV

• HIV

• complicates 1–4% of total joint replacementsThe majority of infections are acquired intraoperatively or immediately postoperatively as Treatment includes surgery and high doses of parenteral antibiotics, which are given for 4–6 weeks because bone is usually involved.

• prosthesis must be replaced . Implantation of a new prosthesis is best delayed for several weeks or months

• deeply situated in a joint, such as the shoulder or hip, open surgical drainage should be done.