2. Cecil Medicine, 23rd ed Harrison's Principles of Internal Medicine, 17 Edition Nelson Textbook of Pediatrics 18th Edition Campbell's Operative Orthopaedics, 11th ed Last literature review version 19.1: January 2011 |UpToDate

3. 1-Gonococcal Arthritis 2-N0N Gonococcal Arthritis 3-TB 4-FUNGAL 5-VIRAL

4. 1-ACUTE=BAC 2-CHRONIC=TB/FUNGAL

5. 1-hematogenous Why joints are affected and other vulnerable organs lack of a limiting basement membrane in the capillaries of synovium 1-hematogenous Why joints are affected and other vulnerable organs lack of a limiting basement membrane in the capillaries of synovium شایع ترین

6. مثل=1نومونی 2-کورک

7. 2-inoculation 3-adjacent site of osteomyelitis or cellulitis

8. PATHOLOGY ورود باکتری به سینویوم PMN ARRIVE PANUS FORMATION= SYNOVIALL CELL PROLIFERATION+PMN INFILTRATION PROTEASE +COLAGENASE DESTROY JOINN IN 48 Hr

9. DSC00019(1).JPG

10. infant 1=umbilical cord 2=femoral venipuncture = Septic arthritis of the hip can result from femoral venipuncture

11. 1-Age greater than 80 years 2-Diabetes mellitus 3-Rheumatoid arthritis 4- Prosthetic joint 5-Recent joint surgery 7-Skin infection, 8-cutaneous ulcers 9- IV drug abuse, 10-alcoholism 11-Previous intra-articular corticosteroid injection آدم سالم عفونت مفصلی نمیگیره!

14. گرم منفی های فرصت طلب

16. The lower extremity weight bearing joints are predominantly affected (61% to 79% زانو= شایعترین رتبه 2=hip رتبه 3=شانه+مچ+آرنج

18. Acute septic arthritis of the sternoclavicular joint

19. Among IV drug users, infections of the spine, sacroiliac joints, or sternoclavicular joints (Fig. 328-1) are more commo Polyarticular infection is most common among patients with rheumatoid arthritis

20. In the first few days of infection, radiographs usually are normal; however, they may be helpful in that they may show soft-tissue swelling, displacement of the fat pad, or joint space widening from localized edema

21. As the infection progresses, joint space narrowing from the destruction of cartilage

23. The usual presentation consists of moderate to severe pain that is uniform around the joint, effusion, muscle spasm, and decreased range of motion. Fever in the range of 38.3°–38.9°C

24. The inflamed, swollen joint A focus of extraarticular infection, such as a boil or pneumoni

27. aspiration before antibiotic therapy is initiated Gram staining, culture, cell counts, and crystal analysis synovial leukocyte counts greater than 50,000/mm3 indicate infectious arthritis polymorphonuclear neutrophils, if greater than 90%, indicates infection.

29. extremely elevated synovial WBC (>100,000/mm3) are not always due to infection. Sterile processes that can cause this degree of leukocytosis, sometimes termed "pseudoseptic arthritis", include: reactions to intraarticular injections (eg, hyaluronans), flares of rheumatoid arthritis, leukemic infiltration, and gout [8

30. لکوسینور =25تا 250 هزار متوسط 100هزار PMN=90%

31. اسمیر= 1=GRAM + CLUSTER =STAPH 2=GRAM – DIPLOCOC= N.G

32. ESR+CRP RISE

33. استاف Blood cx=50% Smear=75% Fluid cx=90%

34. گرم منفی Smear=50%

35. Glucose + LDH are not specific for infection, and measurement of these levels is not necessary to make the diagnosis.

36. The synovial fluid should be examined for crystals, because gout and pseudogout can resemble septic arthritis clinically, and infection and crystal-induced disease occasionally occur together

37. Clarity abnormally large numbers of nucleated or red blood cell

38. Viscosity Viscosity produce a long string-like extension as it falls you should do this not lab

39. در ایران اغلب کشت منفی است A positive synovial culture should be indicative of septic arthritis in 100 percent of cases if laboratory error and contamination can be excluded. Gold=1-masachoset=cx 2-hasanchset= cell cout

40. Negative cultures may occur in those who have received recent antimicrobial therapy or are infected with a fastidious organism such as some streptococci or mycoplasma.

41. درمان (1) The joint must be adequately drained, (2) antibiotics must be given to diminish the systemic effects of sepsis, and (3) the joint must be rested in a stable position

42. the joint should be splinted! in a position of function. If the response is not favorable and repeat aspiration does not show a decrease in the synovial leukocyte count within 24 to 48 hours, open surgical drainage is necessary

43. direct instillation of antibiotics into the joint is not necessary to achieve adequate levels in synovial fluid and tissue

44. The three procedures used The three procedures used are needle aspiration (single or multiple), arthroscopic drainage, or arthrotomy (open surgical drainage). daily aspiration may be necessary

45. Because the knee is a superficial joint, it can be aspirated easily

46. درمان باید حتما باید وریدی باشد کورتون سودی ندارد بیمار نباید روی مفصل ویت بیرینگ کند ولی باید حرکات باسیو را انجام دهد.

47. درمان اولیه با اسمیر 1-اسمیر منفی=گنوکوک=سفتریاکسون 2= کوکسی گرم += نافسیلین 3=مقاومت بیمارستانی = وانکو 4=معتاد=کلوگزاسیلین+جنتا

48. درمان قطعی استاف=4 هفته وانکو استرب=2هفته بنی سیلین گرم منفی=4هفته سفتریاکسون یا فلوروکینولون سودوموناس=2 هفته مزلوسیلین+جنتا یا سفتازیدم+جنتا

49. DGI Women are at greatest risk during menses and during pregnancy and overall are two to three times more likely than men to develop disseminated gonococcal infection (DGI) and arthritis syndrome of fever, chills, rash, and articular symptoms. Small numbers of papules that progress to hemorrhagic pustules develop on the trunk and the extensor surfaces of the distal extremities

50. کشت مایع و بوست منفی است. BLOOD CX=45% اغلب دست گرفتار می شود

51. Migratory arthritis consequence of an immune reaction to circulating gonococci and immune-complex deposition in tissues. Thus, cultures of synovial fluid are consistently negative, and blood cultures are positive in <45% of patients Synovial fluid may be difficult to obtain from inflamed joints and usually contains only 10,000–20,000 leukocytes/

52. True gonococcal True gonococcal septic arthritis is less common than the DGI syndrome A single joint, such as the hip, knee, ankle, or wrist, is usually involved Synovial fluid, which contains >50,000 leukocytes cultures of synovial fluid are positive in <40% of cases. Blood cultures are almost always negative.

53. BLOOD Cx=always manfi Smear=40% Tx=7D ceftriaxone1gr IV per 24Hr سفتریاکسون در گنوکوک معجزه می کنه! + doxycycline =کلامیدیا

54. Tuberculous accounts for ~1% of all cases of tuberculosis and for 10% of extrapulmonary cases chronic granulomatous monarthritis

55. systemic symptoms are seen in only half of all cases. cell count of 20,000/ L, with ~50% neutrophils !؟ Acid-fast staining of the fluid yields positive results in fewer than one-third of cases cultures are positive in 80%. Culture of synovial tissue taken at biopsy is positive in ~90% Therapy for tuberculous arthritis is the same as that for tuberculous pulmonary disease, smear=30%

56. Fungal Arthritis

57. Viral Arthritis شایع ترین=paro B19 Mump RUBELLA HBV HIV

58. complicates 1–4% of total joint replacementsThe majority of infections are acquired intraoperatively or immediately postoperatively as Treatment includes surgery and high doses of parenteral antibiotics, which are given for 4–6 weeks because bone is usually involved.

59. prosthesis must be replaced. Implantation of a new prosthesis is best delayed for several weeks or months

60. deeply situated in a joint, such as the shoulder or hip, open surgical drainage should be done.