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IFSI S3 UE 2.5 Arthrite infectieuse
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Arthrite infectieuse
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2.5 Processus inflammatoire et infectieuxArthrite infectieuse
date 30/09/2024
Germe responsable dans l’articulation atteinte
Arthrite d’origine bactérienne
Évolution grave (locale et générale) si retard traitement
1°ARTHRITE PURULENTE
La plus fréquente, arthrite staphylococcique
A) ETIOLOGIE
mécanismes
- Hématogène : origine « métastatique »,(panaris, abcès,...)
- Inoculation directe : injection cortisonique intra-articulaire (défaut d’asepsie)
- Ostéite (ostéo-arthrite): infection sur prothèse articulaire (hanche)
germe staphylocoque doré
siège : genou ++, hanche, épaule
terrain fragile, immuno-déprimé
B) SIGNES CLINIQUES
Tableau aigu, inflammation articulaire vive
Signes inflammatoires locaux : Rougeur, chaleur douleur.
Signes généraux : Fièvre, frissons…
C) SIGNES BIOLOGIQUES
Vitesse de sédimentation, CRP (protéine C-réactive), fibrinogène augmentés
Hyperleucocytose à polynucléaires neutrophiles
D) SIGNES RADIOLOGIQUES
Au début, NORMALES
Au bout de 1 à 2 semaines, DESTRUCTIONS CARTILAGE ET OS
E) DIAGNOSTIC = MISE EN EVIDENCE DU GERME
--> PONCTION ARTICULAIRE
Le liquide articulaire est trouble, riche en cellules (> 2 000/mm3 voire >10 000)
--> Isolement du germe = certitude diagnostique
HEMOCULTURES
F) TRAITEMENT
RAPIDE
Hospitalisation, antibiothérapie intra-veineuse, ponctions évacuatrices répétées possibles,
immobilisation +/-
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