Gonococcal arthritis

Gonococcal arthritis is caused by infection with gram-negative-diplococul Neisseria gonorrhoeae. It is the most common form of septic arthritis. Although the pathogenesis is controversial artriculate damage seems to be a consequence of gonogocice disseminated infection. Gonococcal arthritis is an infection that manifests as bacteremia, arthritis-dermatitis syndrome in 60% of cases or as localized septic arthritis, the remaining 40%. Arthritis dermatitis syndrome includes classic triad of dermatitis, and rheumatoid tenosinovitei migration.
Infection occurs in people infected with gonorrhea. It affects four times more women than men and is more common among sexually active teenagers. There is an increased incidence of menses and during pregnancy. Arthritis is the result of a single joint dissemination of gonococcal infection. Dissemination is associated with symptoms of fever, chills, arthralgia and multiple erythematous macular rash. This episode stops when a joint becomes infected. The most affected joints are the big ones such as knee, wrist and ankle.
There are two aspects of the treatment of sexually transmitted diseases. Firstly we want cure the infected person and the second is to locate, test and treat infected contacts Top to prevent the spread of disease. In the past treat gonorrhea with penicillin, today there are multiple variants potent antibiotics.Morbidity associated with this arthritis was dramatically decreased postantibiotica. Gonococcal arthritis complications including pericarditis, endocarditis, meningitis, perihepatic, piomiozita, osteomyelitis and glomerulonephritis are rare today.
The pathogenesis of gonococcal arthritisNeisseria gonorrhoeae is a highly infectious organism capable of colonizing various mucosal surfaces. The risk of infection from a single contact with the body is 60-90% to 20-50% in men and women. Common site of infection include the urethra, cervix, throat and rectum, however, infection can be asymptomatic in some patients. Spreading marrow mucosal infection occurs in 3% of cases and plays a major role in the pathogenesis of arthritis-dermatitis syndrome or localized septic arthritis. These presentations represent different stages of the disease.
Risk factors for disseminated infection include:-Female sex, pregnancy, her periodsSystemic lupus erythematosus-deficit complementSocoieconomic and low social-statusIntravenous drug-abuseHIV-infection, multiple sex partners.
Gonococcal arthritis - Signs and symptomsClinical presentation of disseminated gonococcal infection is typically split in the form of bacteremia and septic arthritis.Gonococcal arthritis is an infection that manifests as bacteremia, arthritis-dermatitis syndrome in 60% of cases or as localized septic arthritis, the remaining 40%. Arthritis dermatitis syndrome includes classic triad of dermatitis, and rheumatoid tenosinovitei migration. Arthritis is the result of a single joint dissemination of gonococcal infection. Dissemination is associated with symptoms of fever, chills, arthralgia and multiple erythematous macular rash.This episode stops when a joint becomes infected. Most affected are the big ones such as knee joints, wrists and ankles.Time elapsed from initial infection until clinical manifestations is a day to three months.Form bacteraemia - arthritis-dermatitis syndrome:Symptoms are typically present 3-5 days before diagnosis.Migratory arthralgia are the most common symptoms of a person with gonorrhea onset disseminated and are polyarticular.Arthralgia are asymmetric and tend to affects the upper extremities more than lower ones. Wrist, elbow, ankles and knees are most affected. Symptoms resolve spontaneously in 30-40% of septic arthritis cases or evolve from one or more joints.The pain is due tenosinovitei. Tenosynovitis of disseminated gonorrhea is asymmetric and appears on the dorsal wrist and hands, as in the metacarpophalangeal joints, ankles and knees.Impaired diffuse finger dactylitis cause.The rash associated with bacteremia form of gonorrhea is painless and nonpruritica and papular lesions consisted of small, pustular or vesicular. The lesions tend to disappear in a few days after treatment. Rarely erythema nodosum lesions may be similar or erythema multiforme. Nonspecific constitutional symptoms including myalgia, fever and malaise.The form of septic arthritis:Joint symptoms begins in a few days-weeks after gonococcal infection. Patients experience pain, redness and swelling in one or more joints, usually knees, wrists, ankle and elbow.
Other alterations include:-Curtis syndrome, Fitz-Hugh-gonococcal perihepaticWaterhouse-sepsis syndrome-Gonococcal endocarditis-Gonococcal meningitis.
Complications and disease progression:Gonococcal arthritis complications including pericarditis, endocarditis, meningitis, perihepatic, piomiozita, osteomyelitis and glomerulonephritis are rare today. Morbidity associated with this arthritis was dramatically decreased postantibiotica.
Gonococcal arthritis - DiagnosisLaboratory studies:Localizations-culture samples from infection is the most important diagnostic test performed-Synovial fluid cultures are positive for the organism in 50% of cases alone are insufficient for diagnosis andCulture-cervix, pharynx, urethra needed-Cultures are important for determining sensitivity to antibiotics-Full blood count, with easy hyperleukocytosisErythrocyte-sedimentation rate is highSynovial fluid, cellularity is over 50. 000 leukocytes / MicroLite, with 90% PMN-Purulent synovial fluid can occurGram-negative staining for microosranismeUrine-culture, rectal, hemocultures.Simple radiograph the affected joint is normal.Procedures performed:Arthrocentesis is mandatorie in cases of septic arthritis. Surgical drainage may be necessary in some cases.
The differential diagnosis is made with the following diseases: hepatitis B, C, Lyme disease, reactive arthritis, septic arthritis, syphilis, meningococcemia, bacterial endocarditis, parvovirus infection, gout, enteroviroze, echovirus infection, systemic lupus erythematosus, rheumatoid nodosum, vasculitis hypersensitive , purple.
Treatment of gonococcal arthritisWhen septic arthritis is suspected, empiric antibiotics is necessary until laboratory confirmation of sensitivity and bacteriology.Spectrum antibiotic to be healthy hosts include gram-negative organisms. Patients should be admitted to establish the diagnosis and prevent complications. The recommended daily synovial epansamentele purulent drainage. Surgical drainage is necessary when arthrocentesis is inefficient. Intravenous therapy may be substituted with the mouth in 24-48 hours after clinical improvement.
The point is to locate, test and treat infected contacts Top to prevent the spread of disease. In the past treat gonorrhea with penicillin, today there are multiple variants potent antibiotics. We recommend administration of ceftriaxone intramuscularly or intravenously every 24 hours. The alternatives include cefotaxime.In patients who do not tolerate cephalosporins indicate spectinomycin, fluoroquinolonele: ciprofloxacin, ofloxacin, levofloxacin.Special situations including pregnant women and pediatric patients. They should not be treated with quinolones or tetracyclines. Pregnant women should be treated with cephalosporin. Since 30% of patients are coinfected with chlamydia is recommended to treatment with azithromycin or doxycycline. Alternatives include erythromycin or amoxicillin for pregnant women.Prognosis in gonococcal arthritis:With appropriate antibiotic therapy and joint drainage is complete recovery in patients with septic arthritis. For patients with more severe forms of infection evolution depends on comorbidities.Patients with acute endocarditis require valve surgery and antibiotics 4-6 weeks.