QUIZ: Patient Management

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You are working late night when a previously healthy 4-year-old girl is brought in  to the ED because of fever and refusal to walk for 1 day. She appears mildly ill. Her temperature is 38.6 C (101.5 F), pulse is 120/min, and respirations are 22/min. The right knee is erythematous and swollen. She holds her right knee in flexion and resists any attempted movement of her right leg. She cries when the right knee is moved. Which of the following is the most appropriate next step in management?

A) Acetaminophen with codeine therapy

B) Arthrocentesis

C) Bone marrow aspiration

D) Bone scan

E) Immobilization and traction

F) Lyme titer

G) MRI of the spine

H) Physical therapy

I) Reassurance

J) Serum rheumatoid factor assay

K) Systemic antibiotic therapy

Infections of the joints (known as septic arthritis, pyogenic arthritis, suppurative arthritis, purulent arthritis, or pyarthrosis) have many causes i.e, bacteria, fungi, mycobacteria, and viruses. However, the term “septic arthritis” usually refers to bacterial arthritis or fungal arthritis, but bacterial joint infections are most common.

Bacterial arthritis is a medical emergency and requires prompt recognition and management. Any delays in treatment are often associated with long-term sequelae. These sequelae can have major lifelong impact if a major weight-bearing joint is involved, particularly when the hip joint is involved in infants.

As such, the goals of treatment include sterilization and decompression of the joint space and removal of inflammatory debris to relieve pain and prevent deformity or functional sequelae. Surgical drainage and antimicrobial therapy are the cornerstones of therapy. After appropriate cultures have been obtained, empiric antimicrobial therapy should be initiated for infants and children with characteristic clinical and laboratory features of bacterial arthritis.

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