All are true about septic arthritis except:
Ans: D (E.coli is...) Complication: Damage to the cartilaginous physts or the epiphysis in the growing child is the most serious complication. Sequelae include retarded growth, partial or complete destruction of epiphysis, deformity of the joint, epiphyseal osteonecrosis, acetabular dysplasia & psuedoarthrosis of the hip"- Apiey 9th/45"Aspirate the joint & examine the fluid. .4 WBC & gram stain should be carried out immediately. Sample of fluid are also sent for full microbiological examination & tests for antibiotic sensitivity"- Apiey 9th/44SEPTIC ARTHRITIS Maheswari 5th/175-78; 3rd/163It is more common in children & males are more susceptible. Stcrp/iy/ocoocus aureus is the commonest causative organism, other organisms are strepto- pneumo & Gonococcus.The organism reach the joint by one of the following routes-Haematogenous: This is the commonest routeSecondary to nearby osteomyelitis: This is a particularly common route in joints with intra-articular metaphysicPenetrating woundsIatrogenicUmbilical cord sepsisPATHOGENESIS Nelson 18th/2846Suppurative arthritis primarily occurs as a result of hematogenous seeding of the synovial space. Less often, organisms enter the joint space by direct inoculation or extension from a contiguous focus.The synovia] membrane has a rich vascular supply and lacks a basement membrane, providing an ideal environment for hematogenous seeding. Table (Maheswari 5th/177): Synovial joint examinationPointsNormalNon-inflammatoryInflammatorySepticGross examination Volume (ml)Often < 3.5 mlOften > 3.5 mlOften > 3.5 ml> 3.5 ml* Viscosity* Colour* ClarityHighColourlessTransparentHighStraw yellow TransparentLowYellowTranslucentVariableVariableOpaqueExamination in lab.* WBC count* PMN leucocytes* Culture* Mucin clot* Glucose level<200<25%-FirmEqual to blood glucose200-2000<25%-FirmNearly equal to blood glucose2000-7500 >>50%-Friable<25 mg%. of blood glucose>10000>75%+Friable>25 mg% of blood glucose* Crystal examination: Positive in Gout-Sodium biurate.Positive in Pseudogout-Ca pyrophosphate
Staph. Aurreus is most common causative organism
Common in children
Affect growth plate
E.coli is the commonest causative organism
Infective Arthritis