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Joint Infection, Joint Ill, and Septic Arthritis
Infectious (Septic) Arthritis, Joint Ill, and Synovitis in Horses
Introduction
Infection of the joint and the surrounding structures is called septic arthritis. Similar in nature are infections of other synovial structures like tendon sheaths (septic synovitis or tenosynovitis)and bursa (septic bursitis). Also prone to infection is the growth plate of foals, this is called septic physitis.
Any acute onset of heat, swelling, and lameness in or around a joint or tendon sheath should always be suspected to be a possible infection. The consequence of not treating joint and synovial infection early and aggressively can be permanent lameness. More aggressive techniques of treatment have been shown to greatly increase the prognosis of infected joints and synovial structure. This article discusses the diagnosis, treatment, and prognosis of septic arthritis infection of joints and physis of adults and foals. Any specific consideration for infection of a particular joint or synovial space is handled in the lameness article on that joint or space.
How Joints or Tendon Sheaths Become Infected
There are several common predisposing factors for joint infections in horses:
- intra-articular injections, particularly the intra-articular injection of Adequan or other polysulfated glycoaminoglycan. This is not to be confused with the injection of hyaluronate which appears to be relatively safe. Oddly, the use of corticosteroid injections did not increase the risk of infection, though it delayed the onset of signs when infection occurred.
- lack of checking for low passive transfer in neonates
- delayed wound care
- septicemia
Adults
Most commonly joints in adults become infected because of a penetrating injury however that is not the only way with intrasynovial injection, surgical intervention, and even infected wounds close to a joint have resulted in septic arthritis. The mechanism by which infection was introduced influence the distribution of bacterial species isolated. Staphylococcus sp. account for more than 50% of the isolates from synovial structures infected by injection or surgery, whereas Gram-negative enteric bacteria and anaerobes predominate in synovial structures infected via a wound.&3 Pseudomonas sp., b-hemolytic Streptococcus sp., non-hemolytic Streptococcus sp., and Actinobacillus sp. are also commonly isolated from infected synovial structures. Polymicrobic infection is common in joints that become infected via a wound.
Foals
Septic arthritis, physitis, and polysynovitis in neonatal foals most often occur in association with or as a sequel to septicemia. Infection to the joint comes through the blood supply and it would seem the capillaries of the joint and growth plate are smaller than average and can act as a filter having bacteria lodge in them. Joint infection can occur as a primary event but more commonly as a complication of blood infection or septicemia. It should be realized that not only is the joint itself prone to infection but also the growth plate in young horses is susceptible to infection through the blood. In these cases the joint capsule may not be swollen but the areas just proximal or distal to the joint be swollen and painful.
The bacterial species involved and recommended antimicrobials are the same as those listed in the article on neonatal septicemia. Streptococcus zooepidemicus is more commonly isolated from older foals than from foals less than three weeks of age and may be the sole etiologic agent in these cases. Rhodococcus equi should be considered in cases of septic arthritis, synovitis, or osteomyelitis in foals aged & to eight months on farms with endemic R. equi infection, particularly when the individual foal has also shown signs of R. equi pneumonia.
Diagnosis
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