Septic Arthritis
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Basics
Description
Microbiologic infection and inflammation of the usually sterile joint space
Epidemiology
- Most common age: toddler and school age (2 to 6 years)
- Predominant sex: male (2:1 female)
- Most common location: lower extremities (hip, knee, and ankle) and large joints (hip, shoulder, elbow)
Pathophysiology
- Entry of bacteria into joint space
- Hematogenous spread (seeding during transient bacteremia) most common
- Direct inoculation (penetrating trauma or during surgery)
- Extension from bone infection (mainly in children <1 year old when vessels cross from metaphysis to epiphysis)
- In response to cytokines, influx of inflammatory cells and release of proteolytic enzymes
- Leads to destruction of synovium and cartilaginous structures
Etiology
- Most common causes by age:
- Neonates: group B Streptococcus, Staphylococcus aureus, Escherichia coli, and Candida albicans
- Older children: S. aureus, group A Streptococcus, Kingella kingae in toddlers, Haemophilus influenzae
- Also consider
- Salmonella: in patients with sickle cell
- Neisseria gonorrhoeae: in sexually active adolescents and in neonates
- Neisseria meningitidis
- Mycobacterium tuberculosis
- Anaerobes (rare)
- Rubella
- Parvovirus
- Hepatitis B or C
- Mumps
- Herpesviruses (Epstein-Barr virus, cytomegalovirus, herpes simplex virus, varicella-zoster virus)
- Fungal etiologies (e.g., coccidioidomycosis, rarely candida)
Commonly Associated Conditions
- Sickle cell disease: Salmonella
- Immunocompromised patients: Mycoplasma, Ureaplasma, Klebsiella, or Aspergillus infection
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Basics
Description
Microbiologic infection and inflammation of the usually sterile joint space
Epidemiology
- Most common age: toddler and school age (2 to 6 years)
- Predominant sex: male (2:1 female)
- Most common location: lower extremities (hip, knee, and ankle) and large joints (hip, shoulder, elbow)
Pathophysiology
- Entry of bacteria into joint space
- Hematogenous spread (seeding during transient bacteremia) most common
- Direct inoculation (penetrating trauma or during surgery)
- Extension from bone infection (mainly in children <1 year old when vessels cross from metaphysis to epiphysis)
- In response to cytokines, influx of inflammatory cells and release of proteolytic enzymes
- Leads to destruction of synovium and cartilaginous structures
Etiology
- Most common causes by age:
- Neonates: group B Streptococcus, Staphylococcus aureus, Escherichia coli, and Candida albicans
- Older children: S. aureus, group A Streptococcus, Kingella kingae in toddlers, Haemophilus influenzae
- Also consider
- Salmonella: in patients with sickle cell
- Neisseria gonorrhoeae: in sexually active adolescents and in neonates
- Neisseria meningitidis
- Mycobacterium tuberculosis
- Anaerobes (rare)
- Rubella
- Parvovirus
- Hepatitis B or C
- Mumps
- Herpesviruses (Epstein-Barr virus, cytomegalovirus, herpes simplex virus, varicella-zoster virus)
- Fungal etiologies (e.g., coccidioidomycosis, rarely candida)
Commonly Associated Conditions
- Sickle cell disease: Salmonella
- Immunocompromised patients: Mycoplasma, Ureaplasma, Klebsiella, or Aspergillus infection
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