Septic Joint

A.K.A Septic Arthritis

Any children with a red, swollen joint with or without fever and refusal to use the limb should be evaluated in Bethel. Suspected toxic synovitis should also be evaluated here and not managed in the village.

Source of Infection:

• Most commonly hematogenous seeding due to bacteremia
• Common Organisms: MSSA, MRSA, Beta-hemolytic Streptococci, Haemophilus influenzae a (Hia)

Diagnosis:

• Usually confirmed by culture of synovial fluid
• Some joints can be tapped in Bethel for initial fluid collection prior to starting antibiotics; several of the family practitioners and ER providers are trained in aspiration of some joints, although hip joints and other complicated joint aspirations are usually done by ortho in Anchorage.

Management:

• Usually requires orthopedic surgical involvement.
• IV antibiotics (Peds): Vancomycin for staph coverage and Ceftriaxone (per ANMC guideline, 100mg/kg/day iv q24h (max 2g/dose)) for Hia and strep coverage.
• Consult with other providers here as needed.
• For Pediatric septic arthritis: Contact ortho immediately (ANMC for beneficiaries and Providence for non-beneficiaries) to arrange transport (most likely medevac).

Resources/References

• Samraj, R S., & Fergie, J. Septic arthritis and hemarthroses caused by Haemophilus influenzae serotype A in children. Infectious Disease Reports, 8(3). (2016). DOI: doi.org/10.4081/idr.2016.6494
• Pavlik, et al. Non–Type b Haemophilus influenzae Septic Arthritis in Children. Journal of the Pediatric Infectious Diseases Society. 2017;6(3):e134–e9.

DOI: 10.1093/jpids/piw024

• ANMC Pediatric Acute Hematogenous Septic Arthritis/Osteomyelitis Guideline (pdf)

Common/Unique Medical Diagnoses