Septic arthritis is infection of one or
more joints by microorganisms. It can be caused by bacterial, viral, and fungal
infections. The risks for the development of septic arthritis include a patient
taking immune-suppression medicines, intravenous drug abuse, past joint
disease, injury or surgery, and underlying medical illnesses which include
diabetes, alcoholism, sickle cell disease, rheumatic diseases, and immune
deficiency disorders. This retrospective analysis documented the
features and factors that potentially affected the outcomes in septic arthritis
in the Cross River Basin area of south-south Nigeria.
In this study, a
sample of 43 patients who presented with septic arthritis in 45 joints was
collected between September 2007 and August 2010. There were 24 males and 19
females (M:F = 1.3:1). Forty patients were children while three were adults.
Thirty-three patients were urban dwellers, 8 were semi-urban dwellers and 2
were rural dwellers. Twenty-five children were first seen by a Paediatrician.
Only 5 patients were first seen by an Orthopaedic surgeon. Definitive treatment
was conservative in 28 children and arthrotomy/washout in 12 children and 3
adults. And the findings showed that 1) trauma, sickle cell anaemia and
sepsis were significant co-morbid factors accounting for 15% each for trauma
and sickle cell anaemia, and 12.5% for sepsis in children; 2) Fever, joint
swelling, pain and non-weight bearing on the affected limb were the presenting
clinical features with a median duration of 7 days in both age groups; 3) The knee was the most commonly affected joint in children (60%) and
adults (66.7%) with the left knee predominating in both age groups (37.5%,
children and 66.7%, adults). Nineteen (19)
patients (44.2%) did not have a microbiological and sensitivity assay done
owing to a variety of factors including poverty and faulty equipment and among
those who had a microbiological and sensitivity assay performed, Staphylococcus aureus was the most
common pathogen (25%), followed by Enterobacteriacae
and Pseudomonas auroginosa (5% each).
In conclusion, injudicious
interventions in musculoskeletal conditions consisted not only of traditional
bone setting and other unorthodox practices, but also sub-optimal orthodox
medical practices. Healthcare outcomes in Africa were a function of the skewed
distribution of the healthcare workforce and a weak referral chain. The near
absence of follow-up culture underscored the need for education on injudicious
antibiotic therapy to be directed at patients and physicians. So continuing
medical education must seek to draw attention to the issues of
intra-professional communication and practices that promote poor outcomes in
the developing world.
Article by Ikpeme
A. Ikpeme, et al, from University of Calabar Teaching Hospital, Calabar,
Nigeria.
Full access: http://mrw.so/3Oa9j3
Image by Health Same, from Flickr-cc.
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