Purulent arthritis: symptoms, causes, diagnosis and treatment

Purulent arthritis is an inflammation of all joint structures caused by pathogenic bacteria. As a rule, "culprits of the celebration" are strepto- and staphylococci, but sometimes they are joined by anaerobic flora. The causative agent can enter the joint through a wound, a needle prick, with the flow of blood and lymph.

Definition

Purulent arthritis is a limited acute inflammatory process of the microbial etiology that develops in the joint cavity. If untimely or substandard treatment is capable of causing severe long-term effects, such as arthrosis and contractures. In addition, the spread of infection beyond the boundaries of the joint may threaten the appearance of phlegmon and abscesses. In advanced cases, sepsis and osteomyelitis are possible.

As a rule, surgeons or traumatologists deal with this pathology. Their main task is to open the joint cavity and provide an outflow of infected fluid, and also to prescribe adequate antibiotic therapy.

Etiology

Purulent arthritis can develop absolutely in any joint, but most often the shoulder, knee, ankle and hip are affected, since they are most prone to traumatization and experience great loads. Features of the structure of the capsule provide a long accumulation of pus without any manifestations. Because of this, infected fluids impregnate all joint tissues, including cartilage and bones. This in the future leads to serious complications.

Good blood supply and lymphatic drainage contribute to the spread of inflammation to neighboring areas, which in the future threatens the development of sepsis and purulent osteomyelitis. The culprits of the disease in most cases are streptococci and staphylococci, a little less common gonococcus, E. coli, salmonella, Klebsiella and protea.

Among the risk factors can be identified strong contamination of penetrating joint wounds, the presence in the history of open fractures, the reduction of local and general immunity and depletion of the body as a whole.

Kinds

Purulent arthritis can be of two kinds depending on what caused the inflammatory reaction:

1. Non-traumatic.
2. Traumatic.

In addition, arthritis is distinguished by the time of appearance:

1. Primary arthritis, when the infectious process began directly in the joint cavity. This may be the result of a fracture, dislocation, injury or injury.
2. Secondary arthritis. Possible in the event that the infection has penetrated into the joint from another place in the body.

Purulent arthritis of the shoulder joint

Omatrite occurs in the case of penetrating injuries or infection by hematogenous or lymphogenous pathways. The very first sign of the disease is pain in motion, touch and swinging at the joint.

With the passage of time purulent brachial arthritis becomes noticeable to the naked eye, as the liquid accumulates in the articular bag and deforms it. Under the fingers, the doctor feels pus. If the liquid accumulates a lot, it can melt the capsule and drain into muscle cases, under the fascia. In this case, it is necessary to treat the phlegmon of the shoulder and neck.

The characteristic posture of the victim can give out the presence of pathology. He protects the limb, practically does not use it, the shoulder is lowered, and the arm itself is diverted and bent at the elbow.

Arthritis of the joints of the lower limb

Purulent arthritis of the knee joint develops after infection of tissues with pathogenic bacteria. Eighty percent of all cases of infection occur through the fault of staphylococcus, meningococcus or Pseudomonas aeruginosa. The disease begins acutely, with a rise in temperature and severe intoxication. The knee swells, all the physiological depressions and protrusions are smoothed, sometimes purulent fistulas are formed in the places of tissue thinning.

Purulent arthritis of the ankle, as a rule, develops against a background of systemic inflammatory diseases, such as lupus, gout or Bekhterev's disease. This pathology is characterized by a rise in local and general temperature, swelling of the joint, redness of the skin. Sometimes fistulous movements can also appear. In advanced cases, edema spreads to the foot, and pus breakthroughs form fouling.

Purulent arthritis of the hip joint, or coxit, occurs in autoimmune diseases, impaired uric acid metabolism, the presence of a chronic inflammatory process in the body, and also as a result of joint overload. At the forefront is the strongest intoxication, fever, nausea and vomiting, as well as pain when moving in the joint and touching it, redness of the skin over the joint.

Symptoms

Acute purulent arthritis begins abruptly. The affected joint swells, becomes hot to the touch, the skin over it is hyperemic, taut and glitters. At the same time, the patient begins to experience pain during movement, which intensifies over time and acquire a "shooting" character. Any touch becomes painful, a person can not wear clothes on an affected limb. If nothing is done, then a few days later the swelling will spread above and below the joint.

In addition to local, there are general symptoms. Among them, intoxication, high fever, chills, nausea and vomiting prevail. Possible loss of consciousness, headaches. Palpitation is frequent, breathing is deep and heavy.

Diagnostics

To establish the diagnosis, in addition to examining and collecting an anamnesis, it is necessary to conduct laboratory and instrumental studies. In a general blood test, a typical inflammatory pattern is noted: an increase in the rate of erythrocyte sedimentation, a shift in the leukocyte formula to reticulocytes, and a huge number of neutrophils. It is also recommended to make a puncture of the joint and give the received liquid for microbiological examination. Pus is microscopized, stained with aniline dyes and sowed on a nutrient medium. After five days, the doctor receives an opinion, which indicates the causative agent and its sensitivity to antibiotic therapy.

From instrumental studies, x-rays are prescribed. The picture clearly shows the swelling of the tissues, the width of the joint gap, the presence of erosion and osteoporosis. If the arthritis has just begun, then the radiography may not be informative. In such cases, the patient is sent to an ultrasound or CT scan. In addition to all of the above, it is necessary to appoint a consultation of an infectious disease doctor to exclude a generalized infection.

Purulent arthritis: treatment

Even with a suspected purulent arthritis, the patient must necessarily go to the hospital. Immediately, without waiting for the results of laboratory studies, empirical antimicrobial therapy of a wide spectrum of action is appointed to cover all possible pathogens. This approach avoids serious complications.

At first it is suggested to try conservative treatment. If the amount of pus is negligible or not at all, gypsum is applied to the limb to fix it in one position, then antibiotics are injected intra-articularly.

If there is empyema of the capsule or with the naked eye, you can see that a lot of fluid has accumulated in the joint, in this case immediate arthrosis and drainage are indicated. When a patient arrives with penetrating wounds to the joints, the primary surgical treatment of the damaged area is first carried out, the removal of dirt and foreign bodies, the revision of all pockets and possible debris, and only then is the drainage tube put.

Prevention

As a preventive measure of purulent arthritis, it is recommended to carry out timely operations for osteomyelitis, in time to open the abscess and phlegmon appearing in the places of injuries. In addition, it is necessary to comply with the timing of the treatment of infectious diseases and in no case to abolish the medication alone. This can cause resistance of microorganisms and make further therapy more difficult.

If you are still injured, you must thoroughly wash the wound, treat the edges with iodine or zelenka and apply a clean bandage. The limb should be well fixed and already in such a form should be sent for medical care. This will facilitate the work of the doctor and help delay the onset of inflammation.

Complications

The most serious complication of purulent arthritis is the right to sepsis. This condition, which in the literal sense of the word threatens the life of a person, since it can end fatal. But, in addition to generalized infection, there are a number of other diseases associated with this pathology.

Accumulation of pus in the articular bag can lead to its melting and the formation of phlegmon, fistulas and swells of inflammatory exudate. In addition, not only soft tissues, but also bones can melt, and the result of such arthritis will be deformations and defibulations of the limbs. Contractures, which are formed due to the forced position of the joint, in the most severe cases can lead to loss of function and disability.

Therefore, it is extremely important to seek medical help in a timely manner. Do not try to endure the pain or help yourself by people's methods. This can only aggravate the situation. Whatever thrill you feel at the sight of a person with a needle or a scalpel, in case of acute inflammatory diseases it is better not to hesitate with treatment.