gonorrhea arthritis
Introduction
Introduction to gonorrhea Gonococcalarthritis is a special type of acute arthritis that is caused by sexual transmission of Neisseria gonorrhoeae. In foreign countries, gonococcal arthritis is the most common joint infection. Boston University Medical Center reported that patients with gonococcal arthritis are twice as likely as other patients with septic arthritis. Gonorrhea through sexually transmitted infections In the acute or subacute onset 2 to 3 weeks, Neisseria gonorrhoeae can be infected by blood to the joints, causing joint disease. The knee has the highest prevalence, followed by the foot, hand joints and elbow joints, mostly single joint disease. basic knowledge Proportion of the disease: the incidence rate of multi-sex partners is about 0.1%-0.2% Susceptible people: no special people Mode of infection: blood infection Complications: synovitis
Cause
Cause of gonorrhea
(1) Causes of the disease
Gonorrhea arthritis is an infection of gonococcal bacteria in humans that causes disseminated gonococcal infections leading to arthritis.
(two) pathogenesis
Surface pili will certainly contribute to the adhesion of gonococcus to the mucosa. Moderate inflammation caused by typical urinary tract infection may be related to the release of toxic lipopolysaccharide by gonococcus and the production of chemokines that are attractive to neutrophils, but some strains can cause Asymptomatic urinary tract infections, the original committee has not yet learned that these strains are generally sensitive to penicillin, can resist the bactericidal effect of normal human serum, and cause bacteremia and septic arthritis.
About 1% of adult gonorrhea patients develop gonococcal bacteremia, dermatitis and arthritis syndrome, that is, disseminated gonococcal infection (DGI). In most cases, DGI is mostly women, and the incidence of DGI varies from place to place. Due to the pathogen causing this syndrome, there are regional differences in the distribution of gonococcal strains that are sensitive to antibiotics and resistant to bactericidal action. The clinical syndromes vary in severity, from slow development, few heats, and mild joint pain. Light lesions with less skin damage, ranging from high fever to collapsed cases of collapse, but DGI episodes are mostly relatively modest compared with meningococcalemia.
Many DGI patients do not have local symptoms of gonococcal infection. The initial syndrome is often migratory asymmetrical polyarticular pain and skin damage, often accompanied by fever. Tenosynovitis occurs in many patients, generally involving the wrist flexor tendon sheath and Achilles tendon (commonly known as " There is a small amount of skin damage (generally <30). It is located at the extremities (finger, toe, limbs). It can be painful before it is found. Individual lesions are papules, pustules or bullae on the basis of erythema; Followed by sputum and necrotizing damage, although the rash is non-specific, it is also very typical. If a young patient with multiple joint pain finds such a rash, it is highly suggestive of DGI. At this time, the blood culture is often positive, and there may be an immune complex in the circulation. The positive rate of Gram staining in skin and skin lesions was only found in 5% of cases, but about 2/3 cases were able to detect gonococcal antigens by immunofluorescence-labeled anti-gonococcal antibodies.
The early stage of gonococcal may disappear on its own, and it may also enter the second stage of septic arthritis after 1 week. At this time, the skin damage has generally disappeared, the blood culture is negative, and the septic arthritis can also be non-proactive. In the case of skin damage and multiple joint pain, it occurs straight and generally involves a large joint (elbow, wrist, hip, knee, ankle), but in some cases, there are also a considerable number (of course, a few) involving two joints. There are also a small number of cases involving joint symmetry involvement, such as acute rheumatoid arthritis, examination of joint swelling, fever, intra-articular effusion, joint puncture can often find a large number of polymorphonuclear leukocytes (50,000) 100,000/mm3), but in the early stage of septic arthritis, the number of white blood cells in synovial fluid may be much less than this. When the number of white blood cells is above 80,000/mm3, the joint fluid culture is often positive, but less than 20,000. /mm3 is often negative.
Prevention
Gonorrhea prevention
Although the vaccine is actively researched, the truly effective gonococcal vaccine is still only in the hope. The condom can prevent most infections. Some contraceptive foams also have anti-gonococcal effects, but they have not been clinically confirmed.
Complication
Gonorrhea arthritis complications Complications Synovitis
It can be complicated by muscle atrophy, high joint contracture, and limited activity. At this time, the affected joint capsule is eroded by inflammation, the soft tissue around the joint and the joint is contracted, the fibrous deposition covering the joint surface is mechanized, the joint is rapidly and straight, and the fiber is beginning to be fibrous. Tonic, eventually the articular cartilage is destroyed, causing partial or total joint bony rigidity, and the joint stiffness posture is various. If the traction and fixation methods are not used during the inflammatory period, the joint is more strong than the non-functional position, and the inflammation is lighter. Inflammation, generally does not cause rigidity, but due to the contracture of the joint capsule, it will cause joint movement limitation.
Symptom
Symptoms of gonorrhea arthritis common symptoms high fever severe pain joint pain chills muscle soreness edema
Most of the gonococcal arthritis is acute, which is characterized by sudden chills and high fever. The body temperature is often around 39 °C and the swelling and pain of the local joints. A few patients may only have prodromal symptoms like a cold, migratory joints and muscle soreness. Then there is joint pain and swelling. Most of the patients begin to show multiple joints. Most of the joint symptoms disappeared over time, but only one joint or two or three joints in individual patients still have symptoms, and the affected joints are severely painful. Even if it is moved a little, it will cause severe pain. If the disease is mild, there is no fever, only joint pain, or joint edema, pain is mild, and chronic disease is rare.
Examine
Examination of gonorrhea
1. Neisseria gonorrhoeae can be found in the joint cavity puncture puncture.
2. Neisseria gonorrhoeae complement test serum and joint fluid were positive.
Different from septic arthritis, in the acute onset period, bone atrophy can be seen on the X-ray. In the stage of progressive tonicity of the joint, irregular cotton-like shadows on the X-ray can be seen on the X-ray, and the shadow changes as the disease progresses. Thin, increased amount, and finally the two joints of the bone connection, when the bone proliferation stops, the boundary of the new bone is still clearly identifiable, patients without osteogenic rigidity, in the early stage of the lesion, the joint boundary is clear, no cotton-like bone Proliferation, the different manifestations of radiology can help determine the prognosis of joints, and is also an indicator for the selection of indications for treatment of osteotopathetic treatment.
Diagnosis
Diagnosis and diagnosis of gonorrhea
Diagnostic criteria
The diagnosis of gonococcal arthritis should be based on a combination of typical clinical manifestations, positive results of bacterial culture in the genitourinary system or other sites, and gonococcal arthritis should be considered if the following conditions occur.
1. The joint is highly swollen, with severe pain and fever, but the body temperature is lower than that of general septic arthritis, about 39 °C.
2. Acute onset, chronic process.
3. Suffering from urethra or cervical gonorrhea.
4. The joint puncture fluid can detect Neisseria gonorrhoeae.
5. The affected joints have a strong tendency.
6. Neisseria gonorrhoeae complement test, serum and joint exudate almost 100% positive.
Differential diagnosis
Differential diagnosis of gonococcal arthritis includes Reiter's syndrome, rheumatic fever, rheumatoid arthritis, systemic lupus erythematosus, other infectious or post-infection arthritis.
