4_3023_1087.doc - Septic Arthritis DR Alaa Abdul Hussein...

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Septic Arthritis page (1) DR. Alaa Abdul Hussein Al-algawy Lecture (7) Septic Arthritis Septic arthritis is an infection of the joint. In infants, the capillaries penetrating the physeal plate into the epiphysis (transphyseal vessels) persist until age 18 months, so spread of infection may occur from the metaphysis indirectly to the epiphysis and then to the joint. Possible irreparable damage to growth plate occurs. Classification : Polyarticular septic arthritis is seen in ~5% of all patients with septic arthritis. General Prevention: Treatment of systemic infections and prevention of gonorrhea may decrease the risk of septic arthritis. Most important to recognize and treat the condition early, to avoid complications. Epidemiology: . It can affect any joint , at any age. No gender preference in monarticular septic arthritis Gonococcal septic arthritis is 4 times more common in females than in males Incidence: Occurs in <0.5% of infants. Variable incidence in children and adults. Risk Factors: Neonates with multiple potential sources of infection. Concurrent rheumatologic disease, joint prostheses, HIV infection, diabetes mellitus, hemophilia, sickle cell anemia (Staphylococcus aureus or Salmonella), or intravenous drug abuse (Gram- negative organisms). Etiology In the first 6 months of life. S. aureus causes 80% of cases of septic arthritis. Neonatal septic arthritis also is caused by group B streptococci , Candida, and Gram-negative enteric bacteria. In children <2 years old, Haemophilus influenzae is a cause. (Since 1989, vaccination against H. influenzae has become nearly universal and is protective against this source.) In children >2 years, Gram-negative bacilli, Streptococcus, or Neisseria meningitidis is the most common cause. Young adults: Neisseria gonorrhoea is the most common cause. S. aureus is the next most common cause. Other causes include Gram-negative bacilli, Pseudomonas, and Streptococcus. In patients with sickle cell anemia, Salmonella is the cause in 50% of infections.
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Diagnosis : page (2) Signs and Symptoms Children generally are febrile, irritable, and apprehensive; they may be lethargic and have decreased appetite. However, some children may appear healthy with fever of unknown origin and findings localized to a given extremity.
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