PATHOGENESIS

Bacteria enter the joint from the bloodstream; from a contiguous site of infection in bone or soft tissue; or by direct inoculation during surgery, injection, animal or human bite, or trauma. In hematogenous infection, bacteria escape from synovial capillaries, which have no limiting basement membrane, and within hours provoke neutrophilic infiltration of the synovium. Neutrophils and bacteria enter the joint space; later, bacteria adhere to articular cartilage. Degradation of cartilage begins within 48 h as a result of increased intraarticular pressure, release of proteases and cytokines from chondrocytes and synovial macrophages, and invasion of the cartilage by bacteria and inflammatory cells. Histologic studies reveal bacteria lining the synovium and cartilage as well as abscesses extending into the synovium, cartilage, and—in severe cases—subchondral bone. Synovial proliferation results in the formation of a pannus over the cartilage, and thrombosis of inflamed synovial vessels develops. Bacterial factors that appear important in the pathogenesis of infective arthritis include various surface-associated adhesins in S. aureus that permit adherence to cartilage and endotoxins that promote chondrocyte-mediated breakdown of cartilage.

MICROBIOLOGY

The hematogenous route of infection is the most common route in all age groups, and nearly every bacterial pathogen is capable of causing septic arthritis. In infants, group B streptococci, gram-negative enteric bacilli, and S. aureus are the most common pathogens. Since the advent of the Haemophilus influenzae vaccine, the predominant causes among children <5 years of age have been S. aureus, Streptococcus pyogenes (group A Streptococcus), and (in some centers) Kingella kingae. Among young adults and adolescents, N. gonorrhoeae is the most commonly implicated organism. S. aureus (including methicillin-resistant S. aureus [MRSA]) accounts for most nongonococcal isolates in adults of all ages; gram-negative bacilli, pneumococci, and β-hemolytic streptococci— particularly groups A and B but also groups C, G, and F—are involved in up to one-third of cases in older adults, especially those with under lying comorbid illnesses. Gram-negative bacilli such as Pseudomonas may occur in immunocompromised patients or intravenous drug users.

Infections after surgical procedures or penetrating injuries are due most often to S. aureus and occasionally to other gram-positive bacteria or gram-negative bacilli. Infections with coagulase-negative staphylococci are unusual except after the implantation of prosthetic joints or arthroscopy. Anaerobic organisms, often in association with aerobic or facultative bacteria, are found after human bites and when decubitus ulcers or intraabdominal abscesses spread into adjacent joints. Polymicrobial infections complicate traumatic injuries with extensive contamination. Bites and scratches from cats and other animals may introduce Pasteurella multocida or Bartonella henselae into joints either directly or hematogenously, and bites from humans may introduce Eikenella corrodens or other components of the oral flora. Penetration of a sharp object through a shoe is associated with Pseudomonas aeruginosa arthritis in the foot.

اخر الاخبار

اخبار العتبة العباسية المقدسة

المجمع العلمي يواصل تنظيم أنشطته القرآنية في محافظتي كربلاء وصلاح الدين

شعبة التوجيه الديني تنظم مجلس عزاء بذكرى شهادة الرسول الأعظم (صلى الله عليه وآله)

أكثر من قرن على صناعتها.. متحف الكفيل يرمم قطعة أثرية هندية

قسم الشؤون الفكرية ينظّم ندوة عن البعد الحضاري لزيارة الأربعين ويصدر عددًا جديدًا من مجلة الرياحين

المزيد

الآخبار الصحية

العنب.. فاكهة صغيرة بمفعول "خارق" للقلب والدماغ

دراسة تحدد "الحلقة المفقودة".. تسبب ارتفاع ضغط الدم

هذه الأطعمة تحمي دماغك من الشيخوخة وتزيد حدة الذكاء

خبراء يحذرون من مخاطر "الدهون المخفية" على القلب

المزيد

الآخبار التكنلوجية

الأرصاد الجوية تلجأ إلى الذكاء الاصطناعي.. لأي غرض؟

في منزلك.. "تعديل بسيط" يخفض ضغط الدم بشكل طبيعي

"ميزة جديدة" من إنستغرام تنافس تيك توك.. طال انتظارها

غوغل في مأزق.. بيانات 2.5 مليار مستخدم بقبضة القراصنة

المزيد

مواضيع ذات صلة

Gonococcal Arthritis

Nongonococcal Bacterial Arthritis

Streptococcus pyogenes

Treatment of Staphylococci

Enzymes and Toxins of Staphylococci

Rocky Mountain Spotted Fever

Human Ehrlichiosis

Antimicrobial Susceptibility Testing and Therapy of Neisseria and Moraxella catarrhalis

Laboratory Diagnosis of Neisseria and Moraxella catarrhalis

Spirillum Minus

Streptobacillus moniliformis

Myositis and Myonecrosis