Gonococcal and nongonococcal arthritis
García-De La Torre I et al. - Article reviews the risk factors, pathogenesis, clinical manifestations, diagnosis, and treatment of nongonococcal and gonococcal arthritis. - Risk factors: RA, diabetes, liver disease, alcoholism, chronic renal failure, malignancies, intravenous drug use, hemodialysis, AIDS, hemophilia, organ transplantation, hypogammaglobulinemia, immunosuppressive drugs and glucocorticosteroids, biologic agents etc.
- Pathogenesis: Bacterial invasion, host inflammation, and tissue ischemia. Bacterial enzymes and toxins are directly injurious to cartilage.
- Clinical features: Gonococcal vs nongonococcal arthritis –
- Patient profile: Sexually active young adults, mainly women vs Newborns or adults with chronic disease (diabetes, RA, OA)
- Presentation: Migratory polyarthritis dermatitis, tenosynovitis vs Single joint involvement
- Pattern of joint involvement: Polyarticular ~50% vs Oligoarticular ~90%
- Culture positivity: Less than 50% vs Nearly 90%
- Prognosis: Good with adequate antibiotic therapy vs Usually bad prognosis, requiring joint drainage in most cases
- Diagnosis: Recent onset of fever, general malaise, arthralgia and synovitis (mono/polyarticular)
- Prognosis:
- Gram-positive cocci: Cefazolin 2 g IV q 8 h Cefotaxime 1 g IV q 8 h
- Gram-negative cocci: Ceftriaxone 1 g IV q 24 h
- Gram-negative rods:Cefepime 2 g IV q 8 h Piperacillin-tazobactam 4.5 g IV q 6 h
- MRSA suspicion or risk factorsVancomycin 1 g IV q 12 h
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