Septic Joint: Difference between revisions

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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. Some joints can be tapped in Bethel for evaluation; 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. You can always consult with other providers here or with ortho in Anchorage if you are uncertain of how to manage a patient.
'''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===
===Resources/References===
*Samraj, R S., & Fergie, J. [https://www.pagepress.org/journals/index.php/idr/article/view/6494 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
*Samraj, R S., & Fergie, J. [https://www.pagepress.org/journals/index.php/idr/article/view/6494 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. [https://watermark.silverchair.com/piw024.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAqEwggKdBgkqhkiG9w0BBwagggKOMIICigIBADCCAoMGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQM3G51NiIE2QN_8kHNAgEQgIICVOrI3lN2bq6zZKIWiRYgC-tBnRdB4Ba9XTuS79ZJhuOYnrzYoUmLeovl5vPjqfzDoFv6PvjOACT0zwbMKsg2pN5oVL87SzVakidE8_p39lkqEk9NAdNdF-ECyBYpzlkIkjxqlHAkJYVc2EtgETJxgJU8EMOJ7PKkqgCJGt5kpTGLKxC5OdoLaWE3bxcvgiLDzyl4zRWvxm3Vv_nQx678MUImW_nhouSMdHR3i4daW5Ni2Qx6X2kXgS3FPwUXsCnxfSV8GEWVYEQ_do3Ki-vUpV6Y5SUOmkQdmiFxzxHIJCcUuQuAZ92-gy10X3qBnQlf9a_sXkJy4vbNUMIze9OZibD-sHw7eNHyliEDnhMaWHtTDe7B4qkbPw0q-HLFqMUghLpTj9Kkizd2qNFvSiZGOaTpI-TLAXo9ktbNa6P0rOwzzSSBR1ixYjYAYkwU-dcv-RJkbG3x9AxNoKbC3IoUiYhoUbu9rRrfG03fp8vqGsgURaTbNGcVvjxIwS6GnJm8vzprkDQuxerPpMdbwheNirKkHEciopluFeVcLMTzz4oS6zbe-YdFLCfNlpmcXlzNiAh-y9yFXIxAGGGOTi2P-_CWTLQlvHRWvI-ogjQ3YIMlZ7l_STrHlPaxZ4RJY2wGJVfR0Iyh70-RgOopqEQlXcMauIFCWM5NSqhRHZkfY-dpkYhOVqyYpym2OUXKXMt_H_gHjiuysf2_ixrid2m40hjsgR9vjCaGKzUU3HdKJ4khLTsxXPrC-47nQQItt8qMkffcW5fShBd-OC_RoSpza-EsijaI 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
*Long, B. et al.  [https://escholarship.org/uc/item/2md2x015 Evaluation and Management of Septic Arthritis and its Mimics in the Emergency Department] 2019, 20:2. DOI: doi.org/10.5811/westjem.2018.10.40974
*Hammitt L. L., Block S., Hennessy T. W., Debyle C., Peters H., Parkinson A., Singleton R., Butler J. C.. 2005; [https://journals.lww.com/pidj/Abstract/2005/05000/Outbreak_of_Invasive_Haemophilus_influenzae.12.aspx Outbreak of invasive Haemophilus influenzae serotype a disease]. Pediatr Infect Dis J24:453–456
*Jin et al. [https://iai.asm.org/content/iai/75/6/2650.full.pdf Minireview: ''Haemophilus influenzae'' Type a Infection and Its Prevention].  Infection and Immunity, 2007: p2650-2654.  doi:10.1128/IAI.01774-06
*[https://anmc.org/files/CG_PedSepticArthOst.pdf ANMC Pediatric Acute Hematogenous Septic Arthritis/Osteomyelitis Guideline] (pdf)




[[Practicing Medicine in Bush Alaska—Some ABCs|Common/Unique Medical Diagnoses]]
[[Practicing Medicine in Bush Alaska—Some ABCs|Common/Unique Medical Diagnoses]]

Latest revision as of 21:04, 24 November 2020

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


Common/Unique Medical Diagnoses