Infectious Arthritis Flashcards
(47 cards)
Acute Bacterial Arthritis
-medical emergency that warrents rapid, accurate diagnosis w/immediate treatment along with appropriate consultation with additional specialists as needed
Most instances of native joint infection are the result of?
bacteremic seeding
Most frequent microorganism in adult nongonoccal septic arthritis?
staphyloccus aureus
What do you do with infected joint?
- drain, abx course,
- surgical drainage but only if needle aspirations don’t work
Poor prognostic factors in bacterial joint infections?
- old age
- underlying rheumatoid arthritis
- infection in a prosthetic joint
What to do with patients with early prosthetic joint infections?
debridement, abx, implant retention
What to do with late prosthetic joint infections?
- abx directed at isolated microorganism
- complete removal of prosthesis and get rid of infection before new prosthesis
To avoid prosthetic joint infections?
preoperative evaluation, abx abx prophylaxis (for dental procedures)
Clinical Features of Bacterial Arthritis
- monoarticular (knee joint)
- polyarticular occures in 5-8% or pediartic and 10-19% of adult nongonoccal cases
- DDX: trauma, infection, crystal-induced synovitis like gout
What patients is polyarticular arthritis seen in?
- systemic inflammatory disorders
- spondyloarthropathies, RA, SLE other CT diseases or patients with overwhelming sepsis
What is Lyme disease caused by?
-infection with tick-transmitted spirochetes of the genus Borrelia burgdorferi sensu lato and has worldwide distribution
Lyme Disease Begins with?
-expanding macular skin lesion erythema migrans
Early recongniton/treatment of lyme disease has lead to a decrease in?
- Carditis
- Acute Neurologic Disease
- Late disease manifestations
Lyme disease with musculoskeletal manifestations?
- occure in more that 50% of patients and at all stages of infection
- frank arthritis is a sign of late disease and is uncommon (<10%)
Diagnosis of Lyme disease?
-should be suspected when a patient who lives, works, vacay in an endemic area presents with signs & symptoms
Test for Lyme disease?
-two-tiered serologic test (enzyme-linked immunosorbent assay and immunoblot) can be negative with early infection but become positive in most patients with infection of >1month duration
How long to cure Lyme disease?
- most cured in 2-4 weeks of antibiotic therapy
- time to disease resolution may extend beyond the duration of therapy and irreversible tissue damage may occure
Antibiotic-refractory arthritis?
-occurs in less that 10% of patients with Lyme arthritis, responds to disease-modifying antirheumatic drugs, and typically resolves within 4 to 5 years
Post-Lyme disease syndrome
- persistent debilitating complaints of fatigue, mild cognitive dysfunction, and musculoskeletal pain
- antibiotic treatment for Lyme disease occurs in a minority of patients
- B. burgdorferi cannot be detected in these patients, and controlled treatment trials show no benefit of prolonged antibiotic therapy over placebo
TB
global rates have increased due to expanding human immunodeficiency virus pandemic and problem of drug resistance
-increase in TB in response to expanded use of anti-tumor necrosis factor (TNF) agents
Musculoskeletal TB
-typically presents as a chronic localized infection, most commonly involving the spine, less often the hips or knee
Diagnosis for Muscluoskeletal TB
-difficult and often requires biopsy for histopathology and culture of the bone or synovium; rapid diagnostic test techniques have not yet proven reliable in bone and joint specimens
TB skin test
-helpful in identifying latent tuberculosis before treatment with anti-TNF agents, but it is limited by false-positive and false-negative results; the availability of interferon-γ release assays, when available, may be a useful alternative screening procedure
TB Treatment
- multiple agents selected on the basis of susceptibility testing for 6 to 9 months and has been complicated by the increasing incidence of drug resistance
