introduction

• Septic arthritis is infection of joint tissues caused by bacterial infection.

Septic arthritis can develop when an infection, such as a skin infection or
urinary tract infection, spreads through your bloodstream to a joint.
Viruses and fungi can also Couse septic arthritis like parvovirus or flavivirus
Epidemiology
The estimated incidence of septic arthritis is 2-10 cases per 100,000 per year
world wide . The incidence of septic arthritis appears to be increasing. This
may be due to an aging population, the use of immunosuppressive therapies,
and resistance to antibiotics.
Main bacteria that couse septic arthritis
• Strep aglactiae: affect neonate mostly
• Stap aureus: in aduld age for both sex
• N gonorrhoea: multiple sex partners are likery
• S epidermis: affect mostly prosthetic joint
• S aureginosa: especially in iv drug users
pathophysiology
• Damaged joints, especially those damaged by rheumatoid arthritis are most
susceptible to infection, synovial membranes of these joints exhibits
neovascularization and increased adhesion factors.
• Those condition increase the chance to bacteremia resulting in joint infection it
spread to joint by hematogenous spread from lungs or skin. S aureus readily bind
to articular sialoprotein, fibronectin, collagen or elastin via specific tissue adhesion
factors
• Chondrocyte proteases of s aureus as well as polymorphonuclear leukocytes
response. The cell stimulate synthesis of cytokines and other anti inflammatory
products
• Continuation of destruction can result into pannus formation and cartilage erosion
and septic necrosis of bone.
Risk factors
• Poverty
• People with disease that weakened immune system like:
Diabetes
HIV
TB and
People with joint trauma, animal bite or any cut around joint
Are at high risk of infections
Clinical presentation of septic arthritis
• Acute infection present with onset monoarticular joint pain, redness
and warmth of joints, swelling, fever, and joint stiffness
• Fever present in 40 – 60 % of patient, some patient present with no
fever
• Mainly patient present with triad ( fever, pain and impaired range of
motion)
• For sever septic arthritis infection, there is multiple joints pain,
difficult in active and passive movement
Differential diagnosis
• Gout
• Pseudogout
• Osteoarthritis
• Osteonecrosis
• Cellulitis
• Crystal induced arthropathies
diagnosis
• The gold standard test is synovial fluids
• Table below show categories of different findings in monoarticular
arthritis
Synovial fluid Noninflammat
measure Normal fluid ory Hemorrhagic Inflammatory Septic
Color Clear Yellow Red Yellow Yellow/green
Clarity Transparent Transparent Bloody Translucent- Opaque
opaque
Viscosity High High Variable Low Variable
White blood < 2 × 109/L < 2 × 109/L < 2 × 109/L 2–100 × 109/L 10–100 × 109/L
cells
Percentage of < 25% < 25% 50–75% > 50% > 75–80%
PMNs
Culture result Negative Negative Negative Negative Usually positive
• White blood cell count rises 50,000 cells/mm3

In normal synovial fluid wbc count is less than 200 cell/ ml

• Synovial polymorphonuclear cells (sPMN) can also be significantly

elevated in cases of septic arthritis
• Synovial protein and glucose do not significantly change the
likelihood of septic arthritis
• There is elevation of ESR and CRP,
imaging
• Plain radiograph
• may be normal in the very early stage of the disease
• Joint effusion may be seen
• Justa- articular osteoporosis may seen due to hyperemia 
• narrowing of the joint space due to cartilage destruction in
the acute phase
• destruction of the subchondral bone on both sides of a joint
• if left untreated, reactive juxta-articular sclerosis and, in
severe cases, ankylosis will develop 
• Ultrasound
• useful in superficial joints and in children
• shows joint effusion
• echogenic debris may be present
• color Doppler may show increased peri-synovial vascularity 
• can be used to guide joint aspiration
management
• Drug medication
• For acute treatment antibiotic can manage SA
• intravenous vancomycin ( 15 mg/kg in 12 hrs. ) , ceftriaxone, and
ceftazidime
• Treatment can then be changed to oral antibiotics such as cefixime or
ciprofloxacin ( 400 mg/kg iv for 8 hrs. in 7 to 14 days) for at least one
week
• for smaller joints, needle drainage or aspiration to
decompress the joint,
• followed by antibiotics may be adequate. For larger joints or
persistent infection, surgical debridement and washout will
be required
prognosis
• unrecognized and left untreated, septic arthritis can result in
irreversible joint damage 
• conversely, approximately 90% of patients with septic
arthritis will recover with appropriate
antibiotic treatment. Therefore, timely diagnosis and
treatment are critical.