Book contents
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Clinical Syndromes – General
- Part II Clinical Syndromes – Head and Neck
- Part III Clinical Syndromes – Eye
- Part IV Clinical Syndromes – Skin and Lymph Nodes
- Part V Clinical Syndromes – Respiratory Tract
- Part VI Clinical Syndromes – Heart and Blood Vessels
- Part VII Clinical Syndromes – Gastrointestinal Tract, Liver, and Abdomen
- Part VIII Clinical Syndromes – Genitourinary Tract
- Part IX Clinical Syndromes – Musculoskeletal System
- 67 Infection of Native and Prosthetic Joints
- 68 Bursitis
- 69 Acute and Chronic Osteomyelitis
- 70 Polyarthritis and Fever
- 71 Infectious Polymyositis
- 72 Psoas Abscess
- Part X Clinical Syndromes – Neurologic System
- Part XI The Susceptible Host
- Part XII HIV
- Part XIII Nosocomial Infection
- Part XIV Infections Related to Surgery and Trauma
- Part XV Prevention of Infection
- Part XVI Travel and Recreation
- Part XVII Bioterrorism
- Part XVIII Specific Organisms – Bacteria
- Part XIX Specific Organisms – Spirochetes
- Part XX Specific Organisms – Mycoplasma and Chlamydia
- Part XXI Specific Organisms – Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific Organisms – Fungi
- Part XXIII Specific Organisms – Viruses
- Part XXIV Specific Organisms – Parasites
- Part XXV Antimicrobial Therapy – General Considerations
- Index
67 - Infection of Native and Prosthetic Joints
from Part IX - Clinical Syndromes – Musculoskeletal System
Published online by Cambridge University Press: 05 March 2013
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Clinical Syndromes – General
- Part II Clinical Syndromes – Head and Neck
- Part III Clinical Syndromes – Eye
- Part IV Clinical Syndromes – Skin and Lymph Nodes
- Part V Clinical Syndromes – Respiratory Tract
- Part VI Clinical Syndromes – Heart and Blood Vessels
- Part VII Clinical Syndromes – Gastrointestinal Tract, Liver, and Abdomen
- Part VIII Clinical Syndromes – Genitourinary Tract
- Part IX Clinical Syndromes – Musculoskeletal System
- 67 Infection of Native and Prosthetic Joints
- 68 Bursitis
- 69 Acute and Chronic Osteomyelitis
- 70 Polyarthritis and Fever
- 71 Infectious Polymyositis
- 72 Psoas Abscess
- Part X Clinical Syndromes – Neurologic System
- Part XI The Susceptible Host
- Part XII HIV
- Part XIII Nosocomial Infection
- Part XIV Infections Related to Surgery and Trauma
- Part XV Prevention of Infection
- Part XVI Travel and Recreation
- Part XVII Bioterrorism
- Part XVIII Specific Organisms – Bacteria
- Part XIX Specific Organisms – Spirochetes
- Part XX Specific Organisms – Mycoplasma and Chlamydia
- Part XXI Specific Organisms – Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific Organisms – Fungi
- Part XXIII Specific Organisms – Viruses
- Part XXIV Specific Organisms – Parasites
- Part XXV Antimicrobial Therapy – General Considerations
- Index
Summary
NATIVE JOINT INFECTIONS
Infections of native joints generally occur in patients with predisposing factors such as trauma, underlying arthritis, immunosuppressive therapy, diabetes mellitus, malignancies, intravenous drug abuse, and other infections (eg, endocarditis, skin infections, and urinary tract infections). Hematogenous spread of the organism through the highly vascular synovial space leads to an influx of polymorphonuclear leukocytes (PMLs) into the synovium and then to a release of enzymes that destroy the articular surface.
Diagnosis
Patients present with pain and limited motion of the joint. Fever may be mild, with only a few patients having a temperature higher than 39°C (102.2°F). Joint tenderness can be minimal to severe, but most patients have swelling as a result of joint effusions in response to the infection. Involvement of multiple joints is seen in 10% to 20% of cases, especially in viral arthritis and rheumatoid arthritis. Laboratory findings suggestive of septic arthritis include an elevated erythrocyte sedimentation rate and synovial fluid cell counts exceeding 50 000/mL, with more than 75% PMLs. In no individual case do any of these findings distinguish infected from inflammatory arthritis, such as rheumatoid or crystalline arthropathy, so the diagnosis is based on cultures of synovial fluid. On occasion, blood cultures may be positive. In patients with a chronic monarticular process caused by mycobacterial or fungal organisms, synovial tissue cultures provide a better yield than synovial fluid cultures.
- Type
- Chapter
- Information
- Clinical Infectious Disease , pp. 469 - 474Publisher: Cambridge University PressPrint publication year: 2008