It is one of the frequent manifestations of brucellosis infection. Symptoms Usually there is swelling of the joints due to exudative processes, an increase in local temperature. When the joint is infected with brucella, the process progresses rapidly, gross destruction of bone tissue occurs with the development of joint ankylosis. The synovial fluid has a serous-purulent appearance and contains brucella. With the toxic-allergic form of brucellosis arthritis, clinical symptoms are less pronounced, usually several joints are affected. After specific treatment, as a rule, a complete restoration of joint function occurs. Radiologically, in toxic-allergic forms of brucellosis arthritis, no changes are detected. Joint infection leads to the development of destructive changes, but bone destruction is rare. Radiological changes are more often detected in the elbow and knee joints: focal osteoporosis, narrowing of the joint gap, sclerotic changes. The surfaces of the sacroiliac joints are usually uneven, corroded, rounded foci of destruction, narrowing of the joint spaces and their ankylosis are found. In laboratory studies in the blood, an increase in ESR is observed within 25–35 mm / h, leukopenia with relative lymphocytosis. Immunological studies are carried out: Wright and Hadelson reactions, complement coagulation reaction, passive hemagglutination reaction, determination of opsonin activity. A bacteriological examination of blood, bone marrow, urine, and lymph nodes has been shown. The answer when sowing can be obtained after 25-30 days, since brucella grows slowly. Burnet skin test results are taken into account after 24–48 hours, since earlier it may be non-specific. To establish a diagnosis , the medical history of the disease (place of residence, eating raw milk, etc.) is important. The main diagnostic signs are mono-oligoarthritis, accompanied by damage to the periarticular soft tissues, the appearance of chills, excessive sweating, inflammatory changes in the joint in the absence of changes in the radiograph, the detection of brucella in the synovial fluid, blood, sputum, bone marrow, urine, lymph nodes, and Wright’s positive reactions , Hadelson, complement binding, opsoninin activity.
TREATMENT
- For the treatment of brucellosis arthritis, antibiotics are recommended : chloramphenicol, tetracycline, streptomycin 1-2 mg, after 2 days 5 mg and then increase the dose to 125 mg at the same interval.
- It should be remembered that the vaccine can cause a deterioration in general condition up to collapse and shock! Vaccine treatment is contraindicated in endocrine, nervous and mental disorders.
- At the same time, anti-inflammatory and diuretic drugs can be prescribed .
- Physiotherapy is recommended : electrophoresis, inductoterinia, diadynamic currents.
- After eliminating the inflammatory process, sanatorium treatment is carried out using mud applications and hydrogen sulfide baths.
BACTERIEMIC FORM. TOXIC-ALLERGIC ARTHRITIS. 2
Causes and Symptoms.
The onset may be less acute, and often gradual. Several joints are involved in the pathological process, the places of attachment of muscles and tendons are affected. More often the joints of the lower extremities are affected – knee and ankle.
When radiography of the affected joints (when there is septic arthritis ), pronounced destructive changes in the bone-cartilage tissue are detected. With the toxic-allergic form of gonococcal arthritis , changes are observed in the later stage of the disease. An increase in ESR and leukocytosis are detected in the blood. A more pronounced leukocytosis is observed in patients with gonococcemia, and a less pronounced – with the detection of gonococcus in the genitourinary organs. Cytosis increases in the synovial fluid (up to 82,000 in 1 mm). To detect gonococcal infection, the complement binding reaction with the standard antigen is used. The development of acute or subacute arthritis in patients with purulent urethritis and the detection of gonococcus in the urethral material or in the synovial fluid allow a reliable diagnosis. Difficulties in diagnosis arise with an atypical or toxic-allergic form. Diagnostics. The main diagnostic signs of gonococcal arthritis: acute monoarthritis of the lower extremities in patients with purulent urethritis, a positive Borde-Tangu reaction, detection of gonococcus in the genitourinary organs. In the synovial fluid or in the blood, leukocytosis is noted, synovial fluid – cytosis.
TREATMENT.
- In the treatment of gonococcal arthritis, antibiotic therapy is used: penicillin at 1.000.000-1.500.000 units or tetracycline at 1-1.5 g per day for at least 8-10 days,
- Anti-inflammatory drugs: salicylates, indole drugs. After aspiration of the synovial fluid, intra-articular administration of antibiotics is performed.