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Septic Arthritis (SA)

Septic Arthritis (SA): Causes, Symptoms, Diagnosis, and Treatment

Septic arthritis (SA) is a medical emergency caused by bacterial, viral, or fungal infection within a joint, leading to rapid inflammation and potential permanent damage if untreated. Prompt diagnosis and treatment are critical to prevent long-term complications.

Causes of Septic Arthritis

SA occurs when pathogens enter the joint via:

1. Bloodstream Spread: Bacteria (e.g., Staphylococcus aureus, Streptococcus) from infections in other parts of the body (e.g., skin, urinary tract)146.
2. Direct Inoculation: Trauma, surgery, or injections that breach the joint235.
3. Contiguous Spread: Nearby infections (e.g., osteomyelitis)6.

Common Pathogens:

• Bacteria: Staphylococcus aureus (most common), Neisseria gonorrhoeae (sexually active adults), Haemophilus influenzae (children)146.
• Viruses/Fungi: Rare causes, often in immunocompromised individuals17.

Symptoms of Septic Arthritis

Symptoms develop rapidly (hours to days):

• Severe Joint Pain: Sudden onset, worsens with movement257.
• Swelling, Redness, and Warmth: Over the affected joint357.
• Fever: High temperature (≥38.5°C/101.3°F)257.
• Limited Mobility: Reduced range of motion47.
• Systemic Symptoms: Fatigue, chills, or loss of appetite7.

Special Cases:

• Prosthetic Joints: Symptoms may be subtle (e.g., mild pain, loosening) and delayed35.
• Tuberculosis (TB): Slow onset, chronic inflammation26.

Diagnosis

1. Clinical Evaluation: History of trauma, fever, or recent infections25.
2. Joint Fluid Analysis:
   • Appearance: Cloudy or purulent fluid14.
   • Cell Count: Elevated white blood cells (>50,000/mm³)14.
   • Culture: Identifies pathogens (e.g., S. aureus)16.
3. Imaging: X-rays or MRI to assess joint damage34.

Treatment

Immediate Intervention Required:

1. Antibiotics:
   • Empirical Therapy: Vancomycin (covers MRSA) + ceftriaxone (covers Neisseria) until culture results146.
   • Targeted Therapy: Adjusted based on pathogen sensitivity46.
2. Joint Drainage:
   • Needle Aspiration: Repeated to remove infected fluid34.
   • Surgical Debridement: For severe cases or prosthetic joints34.

Duration: Antibiotics for 2–6 weeks, depending on pathogen and response46.

Risk Factors

• Age: Infants, older adults, or immunocompromised individuals36.
• Chronic Conditions: Rheumatoid arthritis, diabetes, or liver/kidney disease67.
• Prosthetic Joints: Higher risk of delayed infection35.

Complications

• Joint Destruction: Cartilage and bone damage within days if untreated37.
• Systemic Sepsis: Spread of infection to vital organs57.

Conclusion

Septic arthritis is a life-threatening emergency requiring urgent medical care. Early diagnosis via joint fluid analysis and aggressive antibiotic therapy are critical to prevent irreversible joint damage.

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References

1. WebMD: Septic Arthritis
2. Patient.info: Septic Arthritis
3. Mayo Clinic: Septic Arthritis
4. Cleveland Clinic: Septic Arthritis
5. Versus Arthritis: Septic Arthritis
6. Johns Hopkins Medicine: Septic Arthritis
7. Medical News Today: Infectious Arthritis
8. Chulalongkorn University: Septic Arthritis (Thai)