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37 Cards in this Set
- Front
- Back
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Cause of acute bacterial arthritis? |
mostly through hematogenous seeding from and extra articular site of infection, particularly with high grade bacteremia as occurring in endocarditis of infected intravascular catheters |
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Risk factors for acute septic arthritis? |
advanced age (matt) prosthetic joints (matt) damaged joint (from RA)
also those with diabetes, liver cirrhosis, and others with impaired immune systems |
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Most common pathogen in septic arthritis? |
S. aureus, less common S. pneumoniae and gram nigs |
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Clinical features of septic arthritis? |
-rapid onset of single swollen, painful joint (80-90% monoarticular) -restricted ROM -fever and leukocytosis (not always present) -favors large joints: knee> hip>shoulder> smaller joints |
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Synovial fluid analysis: Normal
Color WBC PMN |
clear-yellow <200-2000 <25% |
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Synovial fluid analysis: Inflammatory
Color WBC PMN |
variable cloudy/ yellow >2000-100K >50% |
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Synovial fluid analysis: Septic
Color WBC PMN |
opaque yellow- green >20K-100K >75%
difficult to differentiate septic from inflammatory
septic bursitis may have lowe cell counts and should still be considered even with count of 1000
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Synovial fluid analysis: hemorrhagic
Color WBC PMN |
bloody <200-2000 Varies 25-50% |
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What are components of synovial fluid analysis? |
gram stain: positive in 70% culture: positive in 90%
crystals do no rule out infection |
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Complications of septic arthritis (3)? |
osteomyelitis joint destruction ankylosis (can occur in matter of days) |
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Treatment for septic arthritis? |
-antibiotics for 2-6 weeks -daily needle aspiration to show improving WBCs and PMNs -arthroscopic drainage or arthrotomy |
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When should prophylactic antibiotics be considered in dental procedures? |
<2 years s/p joint replacement or immunocompromised
data is iffy |
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_______ should be considered in all sexually active individuals. |
disseminated gonococcal infection |
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Clinical features of DGI? |
-migratory tenosynovitis with asymmetric arthritis of wrist, knee, ankles, toes -pustular rash on erythematous base -fevers, malaise |
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How can one confirm the diagnosis of DGI? |
must culture GU tract, rectum, throat. more likely to yield diagnosis than synovial fluid |
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DGI is _____ mediated _____ dermatitis/arthritis. |
immune, complement fixing |
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Treatment for DGI? |
IV ceftriaxone with prompt response in 24-72 hours
may require drainage if purulent |
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Viral arthritis effects ______ with ______ presentations. |
multiple joints, bilateral
via direct infection, immune complexes. or molecular mimicry |
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Features of Parvovirus B19? |
presents like RA- MCP, PIP
rash most likely in children
based off of clinical features, IgM
resolves spontaneously 95% of the time, NSAIDs can be used
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Features of Hep C? |
does not always correlate with joint symptoms, but arthralgias are most common
can present with RF titers |
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Features of Hep B? |
-occurs just before the onset of jaundice -abrupt onset of polyarthritis -fever and urticaria -usually resolves at onset of jaundice
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Presentation of Rubella arthritis? |
Can occur before rash, occurs in 30% of patients
symptomatic treatment |
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________ presents as an insidious monoarthritis and requires synovial tissue stain to rule out diagnosis. |
Tuburculosis arthritis |
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_______ is the most acute of the fungal arthritis infections, and occurs with the most musculoskeletal symptoms. |
blastomycoses.
consider immune statues and geographic area. |
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Criteria for ARF? |
J-oints polyarthritis <3- carditis N- subcutaneous nodules E- erythema marginatum S- syndham's chorea |
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Large, multinucleated cells on histological examination of myocardial biopsy? |
aschoff bodies. |
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T/F erythema marginatum is extremely common in ARF. |
False, occurs in ~2% of patients with ARF. |
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Treatment in ARF? |
penicillin for 10 days
steroids if severe carditis |
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Lyme disease:
organism vector |
Borrelia bergdorferi Ixodes scapularis |
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Peak incidence of lyme disease? |
late spring, summer |
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clinical features of early lyme disease? |
<1 month
erythema migrans, migratory polyarthritis |
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disseminated lyme disease? |
<3 months
neurologic: meningitis, bell's palsy like symptoms bilaterally, radiculopathy
cardiac: heart block, myopericarditis
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persistent lyme disease? |
>2 months
Neurologic: encephalitis, peripheral neuropathy
rheumatologic: inflammatroy monoarthritis of the knee
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steps in testing for lyme disease? |
screen with ELISA
confirm with western blot |
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Diagnosis of lyme disease is made when? |
based on Hx of tick bite and travel to an endemic region in combination with early symptoms |
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Lyme disease treatment? |
doxycycline for 1 month (or amox)
IV ceftriaxone in CNS disease
treat empirically rather than wait for serologies |
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Differentiating different types of infectious arthritis |
see 11-7 in syllabus |
