Septic arthritis: Difference between revisions
From IDWiki
(added management) |
mNo edit summary |
||
(3 intermediate revisions by the same user not shown) | |||
Line 1: | Line 1: | ||
⚫ | |||
− | |||
==Background== |
==Background== |
||
Line 11: | Line 9: | ||
**[[Streptococcus pneumoniae]], more common in patients with [[hyposplenia]] |
**[[Streptococcus pneumoniae]], more common in patients with [[hyposplenia]] |
||
**[[Enterobacteriaceae]], especially if GI illness, or immunocompromised patients and those who inject drugs |
**[[Enterobacteriaceae]], especially if GI illness, or immunocompromised patients and those who inject drugs |
||
− | **[[Pseudomonas |
+ | **[[Pseudomonas]], more common in [[diabetes]], immunocompromised, trauma, or water exposures |
− | **[[Aeromonas |
+ | **[[Aeromonas]], more common after exposure to brackish water |
− | **[[Salmonella |
+ | **[[Salmonella]], especially in patients with [[sickle cell disease]] or [[HIV]] |
− | **[[Eikenella corrodens]] and [[Peptostreptococcus |
+ | **[[Eikenella corrodens]] and [[Peptostreptococcus]], especially if recent bite or other oral flora contamination |
**[[Pasteurella multocida]], after cat bite |
**[[Pasteurella multocida]], after cat bite |
||
− | **[[Capnocytophaga |
+ | **[[Capnocytophaga]], after dog bite |
**[[Mycoplasma hominis]], with postpartum septic arthritis, recent genitourinary tract manipulation, and immunocompromise |
**[[Mycoplasma hominis]], with postpartum septic arthritis, recent genitourinary tract manipulation, and immunocompromise |
||
*Other: |
*Other: |
||
**[[Mycobacterium tuberculosis]] and [[non-tuberculous mycobacteria]] (especially [[Mycobacterium chelonae]] and [[Mycobacterium fortuitum]] |
**[[Mycobacterium tuberculosis]] and [[non-tuberculous mycobacteria]] (especially [[Mycobacterium chelonae]] and [[Mycobacterium fortuitum]] |
||
− | **Fungal infections including [[Candida |
+ | **Fungal infections including [[Candida]], [[Blastomyces dermatitidis]], [[Cryptococcus]], [[Coccidioides immitis]], and [[Sporothrix schenckii]] |
**Viral infections including [[HIV]], [[hepatitis B virus]], [[hepatitis C virus]], [[parvovirus B19]], and alphaviruses including [[chikungunya virus]] |
**Viral infections including [[HIV]], [[hepatitis B virus]], [[hepatitis C virus]], [[parvovirus B19]], and alphaviruses including [[chikungunya virus]] |
||
− | == |
+ | == Investigations == |
+ | * Note: for fluid analysis, 1 cells/microL = 1,000,000 (1E6) cells/L; alternatively 1E9 cells/L = 1,000 cells/microL |
||
⚫ | |||
+ | |||
− | * Gonococcal |
||
+ | ==Management== |
||
⚫ | |||
+ | |||
⚫ | |||
⚫ | |||
− | * Non-gonococcal: |
||
+ | |||
⚫ | |||
+ | === Gonococcal Arthritis === |
||
⚫ | |||
+ | |||
⚫ | |||
⚫ | |||
⚫ | |||
+ | |||
+ | === Non-Gonococcal Arthritis === |
||
+ | |||
⚫ | |||
⚫ | |||
⚫ | |||
[[Category:Infectious diseases]] |
[[Category:Infectious diseases]] |
||
⚫ |
Latest revision as of 11:32, 14 December 2022
Background
Microbiology
- Gonococcal: Neisseria gonorrhoeae, more common in young, sexually active adults
- Non-gonococcal bacterial:
- Staphylococcus aureus, in immunocompetent and immunocompromised people as well as those at risk for Staphylococcus aureus bacteremia; this is the most common causative organism overall
- Group B streptococci, more common in poorly-controlled diabetes
- Streptococcus pneumoniae, more common in patients with hyposplenia
- Enterobacteriaceae, especially if GI illness, or immunocompromised patients and those who inject drugs
- Pseudomonas, more common in diabetes, immunocompromised, trauma, or water exposures
- Aeromonas, more common after exposure to brackish water
- Salmonella, especially in patients with sickle cell disease or HIV
- Eikenella corrodens and Peptostreptococcus, especially if recent bite or other oral flora contamination
- Pasteurella multocida, after cat bite
- Capnocytophaga, after dog bite
- Mycoplasma hominis, with postpartum septic arthritis, recent genitourinary tract manipulation, and immunocompromise
- Other:
- Mycobacterium tuberculosis and non-tuberculous mycobacteria (especially Mycobacterium chelonae and Mycobacterium fortuitum
- Fungal infections including Candida, Blastomyces dermatitidis, Cryptococcus, Coccidioides immitis, and Sporothrix schenckii
- Viral infections including HIV, hepatitis B virus, hepatitis C virus, parvovirus B19, and alphaviruses including chikungunya virus
Investigations
- Note: for fluid analysis, 1 cells/microL = 1,000,000 (1E6) cells/L; alternatively 1E9 cells/L = 1,000 cells/microL
Management
- Empiric: typically treated empirically with vancomycin and ceftriaxone empirically, followed by directed therapy
Gonococcal Arthritis
- Ceftriaxone 1 g IV daily for 7 to 14 days
- Don't forget azithromycin 1 g po once
Non-Gonococcal Arthritis
- Treated with targetted antimicrobials
- Duration is traditionally 4 weeks, including at least 2 weeks of parenteral antimicrobials
- However, can do as short as 2 weeks for hand and wrist septic arthritis