Difference between revisions of "Septic Arthritis"

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*'''Bacterial arthritis'''
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Also known as: '''''Infectious Arthritis'''''
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**Most common in food animals, especially young
 +
**Portals of entry include:
 +
***Navel and GI tract -> bacteraemia
 +
***Haematogenously -> polyarthritis
 +
***Traumatic inoculation
 +
***Extension from bone or periarticular soft tissue
  
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==Introduction==
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*'''Viral arthritis'''
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Infectious arthritis describes the presence in joints of a bacterial, viral or fungal infection. This leads to '''cartilage damage''' due to the release of enzymes, the accumulation of fibrin, white blood cells and organisms. There may be the formation of pannus, which is a granulation tissue overgrowth of the cartilage surface, and a loss of glycosaminoglycans which protect the cartilage.
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**Progressive inflammatory and degenerative joint disease
 +
**Synovitis with cartilage destruction
 +
**Chronic mononuclear inflammatory reactions
  
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'''Bacterial arthritis''' occurs most commonly in food animals, especially young animals, in horses, and more rarely in small animals.
 
  
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Ports of entry into the joint include:
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===In Sheep===
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:'''Trauma''': from a penetrating wound, a bite
 
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:'''Extension''': from adjacent tissue or bone
 
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:'''Haematogenous''': from an umbilical infection, pneumonia, urinary tract infection, [[endocarditis]], dermatitis, [[Periodontal Disease|periodontal disease]], discospondylitis
 
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:'''Iatrogenic''': joint injection or surgery
 
  
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==Species Differences==
 
−
 
−
'''Sheep'''
 
 
*[[Retroviridae|'''Maedi visna virus''']]
 
*[[Retroviridae|'''Maedi visna virus''']]
−
*Bacterial infections mostly affects lambs except for Mycoplasmal arthritis
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*Bacterial infections mostly affects lambs except for Mycoplasmal artheritis
 
*[[Erysipelothrix rhusiopathiae|'''''Erysipelothrix rhusiopathiae''''']]
 
*[[Erysipelothrix rhusiopathiae|'''''Erysipelothrix rhusiopathiae''''']]
 +
 
*'''''[[Corynebacterium pyogenes]]'''''
 
*'''''[[Corynebacterium pyogenes]]'''''
 +
 
*[[:Category:Streptococcus species|'''''Streptococcus'' spp.''']]
 
*[[:Category:Streptococcus species|'''''Streptococcus'' spp.''']]
 +
 
*[[:Category:Staphylococcus species|'''''Staphylococci''''']]
 
*[[:Category:Staphylococcus species|'''''Staphylococci''''']]
 +
 
*[[:Category:Chlamydophila species|'''''Chlamydia sp.''''']]
 
*[[:Category:Chlamydophila species|'''''Chlamydia sp.''''']]
  
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'''Pigs'''
+
===In Pigs===
 +
 
 
*[[Erysipelas - Pig|'''''Erysipelothrix rhusiopathiae''''']]
 
*[[Erysipelas - Pig|'''''Erysipelothrix rhusiopathiae''''']]
 +
 
*'''''[[Corynebacterium pyogenes]]''''' and [[:Category:Staphylococcus species|'''''Staphylococci''''']]
 
*'''''[[Corynebacterium pyogenes]]''''' and [[:Category:Staphylococcus species|'''''Staphylococci''''']]
 +
 
*'''''[[Haemophilus suis]]'' and ''[[Haemophilus parasuis]]'''''
 
*'''''[[Haemophilus suis]]'' and ''[[Haemophilus parasuis]]'''''
 +
 
*'''''[[Mycoplasma hyosynoviae]]'' and ''M. hyorhinis'''''
 
*'''''[[Mycoplasma hyosynoviae]]'' and ''M. hyorhinis'''''
  
−
'''Cattle'''
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===In Cattle===
 +
 
 
*Neonatal polyarthritis by:
 
*Neonatal polyarthritis by:
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:[[:Category:Streptococcus species|'''''Streptococcus'' spp.''']]: via the umbilicus and also involves eyes and meninges
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**[[:Category:Streptococcus species|'''''Streptococcus'' spp.''']]  
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:[[Escherichia coli|'''''Coliforms''''']]: Localise in joints and meninges in severe non-fatal neonatal colibacillosis. The infection may remain as chronic arthritis in larger joints.
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***Via umbilicus
 +
***Also involves eyes and meninges
 +
**[[Escherichia coli|'''''Coliforms''''']]
 +
***Localises in joints and meninges in severe non-fatal neonatal colibacillosis
 +
***May remain as chronic arthritis in larger joints
 
*Infections at any age:
 
*Infections at any age:
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:'''''[[Corynebacterium pyogenes]]''''': suppurative arthrtis, often due to a penetrating wound into or close to joints
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**'''''[[Corynebacterium pyogenes]]'''''  
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:[[:Category:Mycoplasmas|'''''Mycoplasma spp.''''']]: may be responsible for some chronic cases but difficult to prove as hard to isolate, leads to a fibrinous polyarthritis
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***Suppurative arthrtis
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:[[:Category:Chlamydophila species|'''''Chlamydia sp.''''']]: severe disease in young calves with a high mortality. The organism can be seen in smears of synovial fluid from swollen joints. The surrounding tissue is oedematous and hyperaemic. It is possibly due to intrauterine infection.
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***Often due to pebetrating wound into or close to joints
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:'''''[[Brucella abortus]]''''': uncommonly localises in joints but can occur in '''carpal bursitis ([[hygroma]]) in cattle and bursitis in horses'''.
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**[[:Category:Mycoplasmas|'''''Mycoplasma spp.''''']]
 +
***May be respinsible for some chronic cases but difficult to prove as hard to isolate
 +
***Fibrinous polyarthritis
 +
**[[:Category:Chlamydophila species|'''''Chlamydia sp.''''']]
 +
***Severe disease in young calves
 +
***High mortality
 +
***Can be seen in smears of synovial fluid from swollen joints
 +
***Oedematous and hyperaemic surrounding tissue
 +
***Possibly due to intrauterine infection
 +
**'''''[[Brucella abortus]]'''''
 +
***Uncommonly localises in joints
 +
***Usually in '''carpal bursitis ([[hygroma]]) in cattle and bursitis in horses'''
 +
 
 +
===In Horses===
  
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'''Horses'''
 
 
*Arthritis can occur following neonatal infections by:
 
*Arthritis can occur following neonatal infections by:
−
:'''''[[Actinobacillus equuli]]'''''
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**'''''[[Actinobacillus equuli]]'''''
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:[[:Category:Streptococcus species|'''''Streptococcus'' spp.''']]  
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**[[:Category:Streptococcus species|'''''Streptococcus'' spp.''']]  
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:[[Escherichia coli|'''''Coliforms''''']]
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**[[Escherichia coli|'''''Coliforms''''']]
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:[[Salmonella|'''''Salmonella''''']]
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**[[Salmonella|'''''Salmonella''''']]
−
 
 
−
'''Goats'''
 
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*[[Caprine Arthritis Encephalitis Virus]]
 
  
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'''Dogs'''
 
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*[[:Category:Staphylococcus species|'''''Staphylococci''''']]
 
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*[[:Category:Streptococcus species|'''''Streptococci''''']]
 
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*[[:Category:Corynebacterium species|'''''Corynebacterium''''']]
 
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*'''''[[Escherichia coli]]'''''
 
  
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==Clinical Signs==
 
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Infectious arthritis usually presents as a '''shifting lameness''' in one or more joints.
 
  
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There will be '''joint effusion, heat, periarticular swelling''', and there may be '''systemic signs''' such as fever, depression, anorexia and lymphadenopathy.
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===In Goats===
  
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The condition usually progresses rapidly.
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*[[Caprine Arthritis Encephalitis Virus]]
  
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If a wound is involved with the joint there may be '''open drainage''' with leakage of synovial fluid. These animals are usually less painful as it is the pressure of joint capsule distension by fluid that causes the pain.
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===In Dogs===
  
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==Diagnosis==
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*[[:Category:Staphylococcus species|'''''Staphylococci''''']]
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The diagnosis is made on the basis of the clinical signs and the results of synovial fluid examination. The '''synovial fluid''' should be collected before administering antibiotics.
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**May cause '''discospondylitis'''
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**Destructive inflammatory lesion
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'''Culture and sensitivity''' in aerobic and anaerobic media should be performed though up to 50% of cultures will yield false-negative results. Inoculating the fluid into '''blood culture medium''' and then blood agar increases the chances of obtaining a positive result.
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**Bacterial localise in ''[[Joints - Anatomy & Physiology#Fibrocartilagenous joints|''annulus fibrosis'']] -> may spread to local bone
−
 
 
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'''Gram stain and smear examination''' of the fluid will reveal a very high number of white blood cells, over 90% neutrophils. Neutrophils may be degenerate with intra and extra-cellular bacteria.
 
−
 
 
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Total protein is usually >4g/dl. The fluid is of low viscosity, high volume and turbid.
 
−
 
 
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'''Radiography''' can help in the diagnosis and is essential in providing a baseline of joint anatomy to evaluate any changes that might occur down the line.
 
−
 
 
−
[[Contrast Radiography#Contrast Studies in Horses|'''Contrast radiography''']] may help in horses to determine if a joint has been entered by a penetrating foreign body.
 
−
 
 
−
==Treatment==
 
−
'''[[Antibiotics]]''' should be administered for a minimum of 4-6 weeks, initially broad spectrum and then depending on culture and sensitivity results.
 
−
 
 
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'''Drainage and flushing''' is mandatory. Usually open drainage is performed via an arthrotomy. This allows debridement and lavage with high volumes of isotonic fluid.
 
−
 
 
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Needle distension and irrigation is less effective as fibrin can occlude the needles.
 
−
 
 
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The joint should be '''rested''', but its range of motion should be preserved through passive range of motion exercises or swimming.
 
−
 
 
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Exercise should be restricted for 3-4 months.
 
−
 
 
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'''[[NSAIDs]]''' can be administered for pain, corticosteroids are contraindicated in cases of infection.
 
−
 
 
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Chronic cases with irreversible bony damage may require '''salvage surgery''' such as arthrodesis, excision arthroplasty or amputation, especially if the pain is uncontrollable.
 
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{{Learning
 
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|flashcards = [[Small Animal Orthopaedics Q&A 15]]
 
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}}
 
−
 
 
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==References==
 
−
Pasquini, C. (1999) '''Tschauner's Guide to Small Animal Clinics''' ''Sudz Publishing''
 
−
 
 
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Merck and Co (2008) '''Merck Veterinary Manual''' ''Merial''
 
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{{review}}
 
  
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{{OpenPages}}
 
  
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[[Category:Musculoskeletal Diseases - Dog]]
 
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[[Category:Musculoskeletal Diseases - Cat]]
 
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[[Category:Musculoskeletal Diseases - Horse]]
 
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[[Category:Musculoskeletal Diseases - Cattle]]
 
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[[Category:Musculoskeletal Diseases - Pig]]
 
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[[Category:Musculoskeletal Diseases - Sheep]]
 
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[[Category:Musculoskeletal Diseases - Goat]]
 
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[[Category:Expert Review]]
 
 
[[Category:Arthritis]]
 
[[Category:Arthritis]]

Revision as of 13:12, 4 August 2011

  • Bacterial arthritis
    • Most common in food animals, especially young
    • Portals of entry include:
      • Navel and GI tract -> bacteraemia
      • Haematogenously -> polyarthritis
      • Traumatic inoculation
      • Extension from bone or periarticular soft tissue
  • Viral arthritis
    • Progressive inflammatory and degenerative joint disease
    • Synovitis with cartilage destruction
    • Chronic mononuclear inflammatory reactions


In Sheep

In Pigs

In Cattle

  • Neonatal polyarthritis by:
    • Streptococcus spp.
      • Via umbilicus
      • Also involves eyes and meninges
    • Coliforms
      • Localises in joints and meninges in severe non-fatal neonatal colibacillosis
      • May remain as chronic arthritis in larger joints
  • Infections at any age:
    • Corynebacterium pyogenes
      • Suppurative arthrtis
      • Often due to pebetrating wound into or close to joints
    • Mycoplasma spp.
      • May be respinsible for some chronic cases but difficult to prove as hard to isolate
      • Fibrinous polyarthritis
    • Chlamydia sp.
      • Severe disease in young calves
      • High mortality
      • Can be seen in smears of synovial fluid from swollen joints
      • Oedematous and hyperaemic surrounding tissue
      • Possibly due to intrauterine infection
    • Brucella abortus
      • Uncommonly localises in joints
      • Usually in carpal bursitis (hygroma) in cattle and bursitis in horses

In Horses


In Goats

In Dogs

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