Difference between revisions of "Septic Arthritis"

From WikiVet English
Jump to navigation Jump to search
(Created page with "*'''Bacterial arthritis''' **Most common in food animals, especially young **Portals of entry include: ***Navel and GI tract -> bacteraemia ***Haematogenously -> polyarthritis **...")
 
 
(6 intermediate revisions by 2 users not shown)
Line 1: Line 1:
*'''Bacterial arthritis'''
+
{{OpenPagesTop}}
**Most common in food animals, especially young
+
Also known as: '''''Infectious Arthritis'''''
**Portals of entry include:
 
***Navel and GI tract -> bacteraemia
 
***Haematogenously -> polyarthritis
 
***Traumatic inoculation
 
***Extension from bone or periarticular soft tissue
 
  
*'''Viral arthritis'''
+
==Introduction==
**Progressive inflammatory and degenerative joint disease
+
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.
**Synovitis with cartilage destruction
 
**Chronic mononuclear inflammatory reactions
 
  
 +
'''Bacterial arthritis''' occurs most commonly in food animals, especially young animals, in horses, and more rarely in small animals.
  
===In Sheep===
+
Ports of entry into the joint include:
 +
:'''Trauma''': from a penetrating wound, a bite
 +
:'''Extension''': from adjacent tissue or bone
 +
:'''Haematogenous''': from an umbilical infection, pneumonia, urinary tract infection, [[endocarditis]], dermatitis, [[Periodontal Disease|periodontal disease]], discospondylitis
 +
:'''Iatrogenic''': joint injection or surgery
  
 +
==Species Differences==
 +
 +
'''Sheep'''
 
*[[Retroviridae|'''Maedi visna virus''']]
 
*[[Retroviridae|'''Maedi visna virus''']]
*Bacterial infections mostly affects lambs except for Mycoplasmal artheritis
+
*Bacterial infections mostly affects lambs except for Mycoplasmal arthritis
 
*[[Erysipelothrix rhusiopathiae|'''''Erysipelothrix rhusiopathiae''''']]
 
*[[Erysipelothrix rhusiopathiae|'''''Erysipelothrix rhusiopathiae''''']]
 +
*'''''[[Corynebacterium pyogenes]]'''''
 +
*[[:Category:Streptococcus species|'''''Streptococcus'' spp.''']]
 +
*[[:Category:Staphylococcus species|'''''Staphylococci''''']]
 +
*[[:Category:Chlamydophila species|'''''Chlamydia sp.''''']]
 +
 +
'''Pigs'''
 +
*[[Erysipelas - Pig|'''''Erysipelothrix rhusiopathiae''''']]
 +
*'''''[[Corynebacterium pyogenes]]''''' and [[:Category:Staphylococcus species|'''''Staphylococci''''']]
 +
*'''''[[Haemophilus suis]]'' and ''[[Haemophilus parasuis]]'''''
 +
*'''''[[Mycoplasma hyosynoviae]]'' and ''M. hyorhinis'''''
 +
 +
'''Cattle'''
 +
*Neonatal polyarthritis by:
 +
:[[:Category:Streptococcus species|'''''Streptococcus'' spp.''']]: via the umbilicus and also involves eyes and meninges
 +
:[[Escherichia coli|'''''Coliforms''''']]: Localise in joints and meninges in severe non-fatal neonatal colibacillosis. The infection may remain as chronic arthritis in larger joints.
 +
*Infections at any age:
 +
:'''''[[Corynebacterium pyogenes]]''''': suppurative arthrtis, often due to a penetrating wound into or close to joints
 +
:[[:Category:Mycoplasmas|'''''Mycoplasma spp.''''']]: may be responsible for some chronic cases but difficult to prove as hard to isolate, leads to a fibrinous polyarthritis
 +
:[[: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.
 +
:'''''[[Brucella abortus]]''''': uncommonly localises in joints but can occur in '''carpal bursitis ([[hygroma]]) in cattle and bursitis in horses'''.
  
*'''''[[Corynebacterium pyogenes]]'''''
+
'''Horses'''
 +
*Arthritis can occur following neonatal infections by:
 +
:'''''[[Actinobacillus equuli]]'''''
 +
:[[:Category:Streptococcus species|'''''Streptococcus'' spp.''']]
 +
:[[Escherichia coli|'''''Coliforms''''']]
 +
:[[Salmonella|'''''Salmonella''''']]
  
*[[:Category:Streptococcus species|'''''Streptococcus'' spp.''']]
+
'''Goats'''
 +
*[[Caprine Arthritis Encephalitis Virus]]
  
 +
'''Dogs'''
 
*[[:Category:Staphylococcus species|'''''Staphylococci''''']]
 
*[[:Category:Staphylococcus species|'''''Staphylococci''''']]
 +
*[[:Category:Streptococcus species|'''''Streptococci''''']]
 +
*[[:Category:Corynebacterium species|'''''Corynebacterium''''']]
 +
*'''''[[Escherichia coli]]'''''
  
*[[:Category:Chlamydophila species|'''''Chlamydia sp.''''']]
+
==Clinical Signs==
 +
Infectious arthritis usually presents as a '''shifting lameness''' in one or more joints.
 +
 
 +
There will be '''joint effusion, heat, periarticular swelling''', and there may be '''systemic signs''' such as fever, depression, anorexia and lymphadenopathy.
 +
 
 +
The condition usually progresses rapidly.
 +
 
 +
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.
 +
 
 +
==Diagnosis==
 +
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.
 +
 
 +
'''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.
 +
 
 +
'''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.
  
===In Pigs===
+
Total protein is usually >4g/dl. The fluid is of low viscosity, high volume and turbid.
  
*[[Erysipelas - Pig|'''''Erysipelothrix rhusiopathiae''''']]
+
'''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.
  
*'''''[[Corynebacterium pyogenes]]''''' and [[:Category:Staphylococcus species|'''''Staphylococci''''']]
+
[[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.
  
*'''''[[Haemophilus suis]]'' and ''[[Haemophilus parasuis]]'''''
+
==Treatment==
 +
'''[[Antibiotics]]''' should be administered for a minimum of 4-6 weeks, initially broad spectrum and then depending on culture and sensitivity results.
  
*'''''[[Mycoplasma hyosynoviae]]'' and ''M. hyorhinis'''''
+
'''Drainage and flushing''' is mandatory. Usually open drainage is performed via an arthrotomy. This allows debridement and lavage with high volumes of isotonic fluid.
  
===In Cattle===
+
Needle distension and irrigation is less effective as fibrin can occlude the needles.
  
*Neonatal polyarthritis by:
+
The joint should be '''rested''', but its range of motion should be preserved through passive range of motion exercises or swimming.
**[[:Category:Streptococcus species|'''''Streptococcus'' spp.''']]
 
***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:
 
**'''''[[Corynebacterium pyogenes]]'''''
 
***Suppurative arthrtis
 
***Often due to pebetrating wound into or close to joints
 
**[[: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===
+
Exercise should be restricted for 3-4 months.
  
*Arthritis can occur following neonatal infections by:
+
'''[[NSAIDs]]''' can be administered for pain, corticosteroids are contraindicated in cases of infection.
**'''''[[Actinobacillus equuli]]'''''
 
**[[:Category:Streptococcus species|'''''Streptococcus'' spp.''']]
 
**[[Escherichia coli|'''''Coliforms''''']]
 
**[[Salmonella|'''''Salmonella''''']]
 
  
 +
Chronic cases with irreversible bony damage may require '''salvage surgery''' such as arthrodesis, excision arthroplasty or amputation, especially if the pain is uncontrollable.
  
 +
{{Learning
 +
|flashcards = [[Small Animal Orthopaedics Q&A 15]]
 +
}}
  
===In Goats===
+
==References==
 +
Pasquini, C. (1999) '''Tschauner's Guide to Small Animal Clinics''' ''Sudz Publishing''
  
*[[Caprine Arthrirtis Encephalitis Virus]]
+
Merck and Co (2008) '''Merck Veterinary Manual''' ''Merial''
  
===In Dogs===
 
  
*[[:Category:Staphylococcus species|'''''Staphylococci''''']]
+
{{review}}
**May cause '''discospondylitis'''
 
**Destructive inflammatory lesion
 
**Bacterial localise in ''[[Joints - Anatomy & Physiology#Fibrocartilagenous joints|''annulus fibrosis'']] -> may spread to local bone
 
  
 +
{{OpenPages}}
  
 +
[[Category:Musculoskeletal Diseases - Dog]]
 +
[[Category:Musculoskeletal Diseases - Cat]]
 +
[[Category:Musculoskeletal Diseases - Horse]]
 +
[[Category:Musculoskeletal Diseases - Cattle]]
 +
[[Category:Musculoskeletal Diseases - Pig]]
 +
[[Category:Musculoskeletal Diseases - Sheep]]
 +
[[Category:Musculoskeletal Diseases - Goat]]
 +
[[Category:Expert Review]]
 
[[Category:Arthritis]]
 
[[Category:Arthritis]]

Latest revision as of 18:21, 18 July 2012


Also known as: Infectious Arthritis

Introduction

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.

Bacterial arthritis occurs most commonly in food animals, especially young animals, in horses, and more rarely in small animals.

Ports of entry into the joint include:

Trauma: from a penetrating wound, a bite
Extension: from adjacent tissue or bone
Haematogenous: from an umbilical infection, pneumonia, urinary tract infection, endocarditis, dermatitis, periodontal disease, discospondylitis
Iatrogenic: joint injection or surgery

Species Differences

Sheep

Pigs

Cattle

  • Neonatal polyarthritis by:
Streptococcus spp.: via the umbilicus and also involves eyes and meninges
Coliforms: Localise in joints and meninges in severe non-fatal neonatal colibacillosis. The infection may remain as chronic arthritis in larger joints.
  • Infections at any age:
Corynebacterium pyogenes: suppurative arthrtis, often due to a penetrating wound into or close to joints
Mycoplasma spp.: may be responsible for some chronic cases but difficult to prove as hard to isolate, leads to a fibrinous polyarthritis
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.
Brucella abortus: uncommonly localises in joints but can occur in carpal bursitis (hygroma) in cattle and bursitis in horses.

Horses

  • Arthritis can occur following neonatal infections by:
Actinobacillus equuli
Streptococcus spp.
Coliforms
Salmonella

Goats

Dogs

Clinical Signs

Infectious arthritis usually presents as a shifting lameness in one or more joints.

There will be joint effusion, heat, periarticular swelling, and there may be systemic signs such as fever, depression, anorexia and lymphadenopathy.

The condition usually progresses rapidly.

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.

Diagnosis

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.

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.

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.

Total protein is usually >4g/dl. The fluid is of low viscosity, high volume and turbid.

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 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.

Drainage and flushing is mandatory. Usually open drainage is performed via an arthrotomy. This allows debridement and lavage with high volumes of isotonic fluid.

Needle distension and irrigation is less effective as fibrin can occlude the needles.

The joint should be rested, but its range of motion should be preserved through passive range of motion exercises or swimming.

Exercise should be restricted for 3-4 months.

NSAIDs can be administered for pain, corticosteroids are contraindicated in cases of infection.

Chronic cases with irreversible bony damage may require salvage surgery such as arthrodesis, excision arthroplasty or amputation, especially if the pain is uncontrollable.


Septic Arthritis Learning Resources
FlashcardsFlashcards logo.png
Flashcards
Test your knowledge using flashcard type questions
Small Animal Orthopaedics Q&A 15


References

Pasquini, C. (1999) Tschauner's Guide to Small Animal Clinics Sudz Publishing

Merck and Co (2008) Merck Veterinary Manual Merial




Error in widget FBRecommend: unable to write file /var/www/wikivet.net/extensions/Widgets/compiled_templates/wrt6723e960b01952_99644586
Error in widget google+: unable to write file /var/www/wikivet.net/extensions/Widgets/compiled_templates/wrt6723e960b6d7d6_13794430
Error in widget TwitterTweet: unable to write file /var/www/wikivet.net/extensions/Widgets/compiled_templates/wrt6723e960bb4c87_03424896
WikiVet® Introduction - Help WikiVet - Report a Problem