This generally refers to bacterial arthritis although it may be tuberculous. Pus is extremely chondrolytic and leads to rapid destruction of cartilage in septic arthritis. Untreated the condition can cause rapid destruction of the joint and therefore septic arthritis requires rapid decompression of the joint to preserve the articular cartilage followed by a prolonged course of antibiotics.
The organisms involved are: Staphylococcus aureus and S. epidermidis, Streptococcus, Pseudomonas, Gonococcus. In patients less than 3 years of age H. influenzae is the commonest organism whereas in all patients older than 3 years of age, Staphylococcus aureus is the commonest. Hence empirical treatment initially starts with broad-spectrum antibiotics to cover these commonest organisms. In immunosuppressed individuals fungi and mycobacteria are important causative organisms, as well as coliforms and tuberculous (Fig. 22.30). Their mode of spread is haematogenous (from cardiac valves, skin, oral cavity, genitourinary or respiratory tract), direct
penetration of the joint from the exterior usually due to trauma/surgery, and contiguous spread from an adjacent focus of osteomyelitis (Figs 22.31 and 22.32). Predisposing factors are:
• immunosuppressive agents,
• lymphoproliferative disorders,
• human immunodeficiency virus (HIV) infection,
The offending organism bulges in the synovium of the joint causing inflammation. This results in a purulent synovitis with purulent exudate forming within the joint cavity. Enzymes within the exudate rapidly destroy the articular cartilage matrix, especially when under pressure within the confined joint space. This results in early destruction of the joint with fibrosis and/or ankylosis leading to early degenerative changes.
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