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Health Variations 3 - Acute Exacerbations of Chronic Conditions

The case study related to Mr John D’ Souza and he is 83 years old indicate that he is suffering from septic arthritis on his right knee. Different assessments were conducted for the patient that helps to detect septic arthritis in the patient. Different factor indicated toward the presence of septic arthritis includes the medical history of rheumatoid arthritis, swollen knee, pain and malaise. These factors directly related to the risk factor and symptoms of septic arthritis that are diagnosed in the patient.

One of the major joint issues that are faced by the population is septic arthritis that is the inflammation of the synovial membrane that lead to purulent effusion in the joint capsule. The prevalence of the septic arthritis is approximately 8-27% that affects all the age groups majorly old age group. Septic arthritis leads to the destruction of the joint that increases pain and reduces the mobility of the individual. There are two modes of causes for septic arthritis that includes bacterial and others that invade the joints and initiate the inflammation (Balato et al., 2017). Different risk factors directly lead to septic arthritis in the patient includes increased age, diabetes mellitus, osteoarthritis, joint surgery, sepsis, rheumatoid arthritis and immunosuppressive medications. These factors directly increase the chances for the progression of septic arthritis and patient should continuously observe the changes to detect the issue before the late stage of the disease (Abram et al., 2018).

The septic arthritis is considered to be the life-threatening joint disorders that lead to the increase complication for the patient. The pathophysiology associated with septic arthritis starts with the route of infection that leads to deposition of the bacteria in the synovium lead to inflammation. The bacteria start multiplication in the synovial fluid and start the destruction process that leads to sign and symptoms. Different inflammatory products are generated like cytokines and protease that ultimately lead to the destruction of the different component of the joints (Johns et al., 2017). The inflammation in septic arthritis leads to an increase in the concentration of the local cytokines that directly increase the secretion of the matrix metalloprotein with other collagen degrading enzyme that lead to destruction. The secretion of the bacterial toxins and lysosomal enzymes leads to the damage of the articular surface. Different bacteria are involved in the pathogenesis of septic arthritis includes Staphylococcus aureus, Kingella kingae and Streptococcus pneumonia. The infection of the bacterial strain also differs based on the age group of the patient and thus detection should be as per the strains. Patients younger than 3 months get infected mostly from Staphylococcus aureus and Neisseria gonorrhoeae. Patients are older than 3 months to 3 years infected by Kingella kingae and Haemophilus influenza. Patient older than 3 years are the target of the Group A streptococcus, S. pneumonia and N. gonorrhoea. The prognosis and symptoms of septic arthritis depend upon the type of organism and phase of the disease. Three routes of infection directly lead to the prognosis of septic arthritis that includes hematogenous spread, direct inoculation and spread from the adjacent bone. (Montgomery & Epps, 2017).

The clinical manifestation of septic arthritis differs with the age group and different signs indicate the presence of septic arthritis in the individual. The newborn infants are facing more of septicaemia than joint issue and they are more irritable or reluctant to feeding. Some other symptoms that are prominent in the newborn child include tachycardia, fever, warmth joint, resistance toward movement and tenderness. The source of infection in the newborn child can be umbilical cord or inflamed IV site. The children mostly face the issue with acute pain in the single large joint with pseudocyesis. The symptoms that indicate the presence of septic arthritis in the children include continuous illness, rapid pulse, swinging fever and skin red with swelling in the joints. The movements are restricted due to pain and spasm that can be due to the septic toe or discharge ear. The adults face the issue with superficial joints that is due to the swelling, inflammation and pain. Some of the symptoms are warmth, tenderness and decrease movement that increases complication for the patient (Agarwa & Aggarwal, 2015).

This is some glance over the pathophysiology and clinical manifestation of septic arthritis that is diagnosed in the patient after the assessment.

References for Mr John D’ Souza Case Study

Abram, S. G. F., Alvand, A., Judge, A., Beard, D. J., & Price, A. J. (2019). Mortality and adverse joint outcomes following septic arthritis of the native knee: a longitudinal cohort study of patients receiving arthroscopic washout. The Lancet Infectious Diseases, 20(3), 341-349. DOI:10.1016/s1473-3099(19)30419-0 

Agarwal, A., & Aggarwal, A. N. (2015). Bone and joint infections in children: septic arthritis. The Indian Journal of Pediatrics, 83(8), 825–833. DOI: 10.1007/s12098-015-

Balato, G., Di Donato, S. L., Ascione, T., D'Addona, A., Smeraglia, F., Di Vico, G., & Rosa, D. (2017). Knee septic arthritis after arthroscopy: incidence, risk factors, functional outcome, and infection eradication rate. Joints, 5(2), 107–113.

Johns, B. P., Loewenthal, M. R., & Dewar, D. C. (2017). Open compared with the arthroscopic treatment of acute septic arthritis of the native knee. The Journal of Bone and Joint Surgery, 99(6), 499–505.

Montgomery, N. I., & Epps, H. R. (2017). Pediatric septic arthritis. Orthopedic Clinics of North America, 48(2), 209–216. DOI:10.1016/j.ocl.2016.12.008

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