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    Septic Arthritis

    Septic Arthritis is a topic covered in the 5-Minute Pediatric Consult.

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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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    Citation

    Cabana, Michael D., editor. "Septic Arthritis." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617393/all/Septic_Arthritis.
    Septic Arthritis. In: Cabana MD, ed. 5-Minute Pediatric Consult. 8th ed. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617393/all/Septic_Arthritis. Accessed April 24, 2019.
    Septic Arthritis. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult. Available from https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617393/all/Septic_Arthritis
    Septic Arthritis [Internet]. In: Cabana MD, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617393/all/Septic_Arthritis.
    * Article titles in AMA citation format should be in sentence-case
    TY - ELEC T1 - Septic Arthritis ID - 617393 ED - Cabana,Michael D, BT - 5-Minute Pediatric Consult UR - https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617393/all/Septic_Arthritis PB - Wolters Kluwer ET - 8 DB - Pediatrics Central DP - Unbound Medicine ER -