Pyogenic arthritis – bacteria and viruses able to affect the joints

If the causes of rheumatoid arthritis today is still unknown and presumably associated with a pathological failure of the immune system, genetic heredity and some undiagnosed mysterious infection, this type of arthritis has a more precise scientific definition. Talking about infectious arthritis (IA) is an inflammatory joint disease of bacterial or viral infection.

However, this does not mean that infectious arthritis is much easier to diagnose too many microorganisms can cause:

The direct cause of IA may be the following pathogens:

  • Staphylococci:
    • Staphylococcus aureus permeation through the skin damage and causes slow destruction of the joints
    • Staphylococcus epidermidis this microbe penetrates through the skin epidermis and is a common cause of inflammation in the denture and causes of infectious arthritis in drug-dependent persons
  • Streptococci:
    • Streptococcus haemolyticus (group a)
      • β-hemolytic Streptococcus pyogenic nature related to gram-positive bacteria and leading to destruction of erythrocytes
      • Enters through the respiratory tract, and skin
      • Is the most dangerous, as it leads to such diseases as tonsillitis, scarlet fever, rheumatism, bronchitis, pericarditis, myocarditis, glomerulonephritis
      • Require antibiotic treatment
    • An additional 20 subtypes of β-Streptococcus belonging to other groups
      • They penetrate through the skin, the circulatory system in urogenital infections
      • Causes of infection in immunodeficiency, the presence of endoprostheses, drug
      • The antibiotics to cure not required — we just need to support the immune system, which is able to defeat infectious arthritis by destroying the pathogens that caused it

Streptococcal or staphylococcal infectious arthritis are more inclined to develop after 15 years

  • Gonorrhea:
    • Neisseria gonorrhoeae — gram-negative intracellular diplococci that cause gonorrhea, a sexually transmitted disease, mostly in adults
    • Gonococcal infectious arthritis occurs in 0.7% of males and 3% of women suffering from gonorrhea
  • Gram-negative intestinal bacteria:
    Cause of infectious arthritis for the following reasons:
    • Older age of the patient (risk of disease increases with prolonged hospitalization)
    • A weak immune system, regardless of age
    • Hematogenous spread of a urinary infection
  • Gram-negative respiratory infections caused by the pathogen Haemophilus influenzae
    • This type of infection very often occurs in young children, early switched to artificial feeding: cause — the deprivation of the child’s natural immunity, which gives mother’s milk
  • Meningococcus (Neisseria meningitidis):
    • This gram negative bacterium penetrates through the nasopharynx into the brain, causing inflammation of the meninges

Gram negative infections are particularly susceptible to children under the age of 14

  • Multimicrobial, anaerobic infections:
    • Rarely, mainly in patients with AIDS or persons who have been made joint replacement

Reasons that increase the risk of IA, are:

  • Complications after injuries
  • An endoprosthesis exhausted their time resource
  • Purulent sepsis
  • Immunodeficiency
  • Cancer processes
  • Diabetes
  • Drug or alcohol dependence

Infectious arthritis can have a clear joint symptoms and extra-articular symptoms, often complicating the diagnosis

  • Arthralgia occurs in one or more joints with symptoms of local inflammation:
    • Swelling, redness, increased temperature of the skin surface
    • When NSAIDs usually these symptoms are smoothed out
  • Usually there are lesions of the knee (most often), hip, wrist, shoulder, and small parts of the foot or wrist
    • The defeat of the sacroiliac joint — the symptoms of drug addicts
  • Gonococcal infectious arthritis often has practically no articular symptoms:
    • The primary symptoms with gonorrhea are infectious local inflammatory processes in the genital organs (cervix, endometrium). Further spread of the pathogen throughout the body promotes menstruation
  • Further symptoms of periarthritis combined with migratory polyarthralgia and dermatitis in the form of maculopapular rashes, eventually turning into vesiculo-pustular
  • With the defeat gonococcus joints have symptoms of exudative mono – or oligoarthritis

Complications of infectious arthritis may include:

  • Ankylosis
  • Osteomyelitis
  • Asymmetry of the limbs, for example, different length

Before treatment diagnostic tests:

  • General analysis of blood:
    • When the disease IA of leukocytes and ESR limits are exceeded
  • Is done in arthrocentesis, the aim of which is analysis of the synovial fluid and removal of accumulated pus:
    • In the affected joint fluid is turbid, with purulent inclusions
    • The analysis reveals leukocytosis with a high content of immature white blood cells (neutrophils) and increased erythrocyte sedimentation rate
    • Of glucose in the synovial fluid in two times less than in serum
    • Puncture, in particular a knee joint, are usually done using arthroscopy
    • If you accumulate a lot of fluid or a difficulty of penetration into the joint with a needle (this is typical of the hip joint), the articular cavity at the time enter the drain pipe
  • To reduce pain at the knee joint can be a splint
  • Is bacteriological examination of the liquid with the coloring on the Brink, however, not all bacteria are determined in such a way, especially the gonococcus. This complicates the diagnosis and subsequent treatment
  • For full verification of the diagnosis, in addition to the study of joint fluid, may require bacteriological tests:
    • Blood, sputum, genital smear, urine, cerebrospinal fluid

Laboratory diagnosis can be supplemented by special studies:

  • X-rays or CT periarticular tissues
  • Radioisotope scanning with the introduction of contrast agents — Galia or technetium polyphosphonate

Depending on the type of infection that triggered the disease, are selected either antibiotics or antifungals:

  • If there is a Streptococcus, then antibiotics are used:
    • penicillin — 10 000 000 units per day
    • vancomycin 2 g / day
  • Staphylococci:
    • cephalothin is 6-8 grams per day
    • clindamycin — 1-2 g
    • vancomycin 2 g
    • nafcillin — 30 mg / kg intravenously every four hours
  • Gonococci or meningococci:
    • Penicillin is 50 000 every four hours
    • Ceftriaxone 1 g once a day in\m or\
  • Gram-negative bacteria:
    • Gentamicin (1.5 mg / kg every eight hours\m) in combination with penicillin or ampicillin
  • Microorganisms Haemophilus:
    • Levomitsetin

Surgical treatment inektsionnogo arthritis is carried out:

  • When infection of the hip joint, especially in children
  • If the source of infection is the prosthesis, in this case it is necessary to conduct revision surgery with removal of the infected articular surfaces