Hello again, Cyn.

Usually, it's a pleasure to assist a fellow researcher, but not in a case like this.

David and Byrd have provided you with some helpful resources. In addition to the information I found for you previously, I have researched the newest development in your son's case.

My previous information:

It seems your son's doctors are taking the standard steps. Immediate
surgery to remove fluid is crucial, as is antibiotic therapy.

Naturally, the prognosis improves depending on how early the problem was caught and treated.

Here's a few additional links. I hope these are of some help.

"Septic Arthritis" from the Mayo Clinic:
http://www.mayoclinic.com/health/bone-and-joint-infections/DS00545

"Septic arthritis is an infection in a joint. Bacteria, or less commonly fungi, can spread from other infected areas in your body to the joint. . . germs infiltrate the joint and damage it, causing severe pain. Bacteria most commonly target your knee, though other joints can be affected by septic arthritis."

"Treatment":
http://www.mayoclinic.com/health/bone-and-joint-infections/DS00545/DSECTION=8

HealthCares:
http://bone-muscle.health-cares.net/septic-arthritis-treatment.php

"Rest, immobilization, elevation, and warm compresses may be used at the onset of treatment for pain relief measures. Performing exercises for the affected joint aids the recovery process. Septic arthritis often causes intense pain. Patients are given medications to relieve pain, together with hot compresses or ice packs on the affected joint. In some cases the patient's arm or leg is put in a splint to protect the sore joint from accidental movement. Recovery can be speeded up, however, if the patient practices range-of-motion exercises to the extent that the pain allows."

It may take up to 48 hours for your son to feel the effects of
antibiotics, and he may need anti-fungal meds. After the immediate crisis has passed, he may also require physical therapy.

See Abstract: "Arthroscopic treatment of septic joints: prognostic
factors." By Vispo Seara JL, Barthel T, Schmitz H, Eulert J. at Entrez
PubMed:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12029509&dopt=Abstract

"From 1987 to 1993, 88 patients (average age 48 years, range 3 months to 83 years) with septic arthritis were treated at the orthopaedic clinic Konig Ludwig Haus of the University of Wurzburg by arthroscopic means consisting of joint debridement and application of suction drains, combined with appropriate antibiotics and early functional treatment.. . . At the average follow-up evaluation after 2.5 years (range 6 months to 5 years), the functional results were excellent or good in 61% of the patients,satisfactory in 20% and poor in 19% from our series . . . ."

Factors in patient recovery included age (and your son has youth on his side) and quick medical intervention after the onset of infection and symptoms.

From "Guideline for the management of the hot swollen joint in adults with a particular focus on septic arthritis," by Vivienne Weston and Gerald Coakley, "JAC Advance Access originally published online on July 19, 2006, Journal of Antimicrobial Chemotherapy 2006 58(3):492-493;doi:10.1093/jac/dkl295": 

"The hot swollen joint is a common clinical condition, which has a wide differential diagnosis, the most serious of which that must not be missed being septic arthritis. This has a mortality of up to 11% and results in permanent joint damage in up to a third of patients."

Family Practice Notebook:
http://www.fpnotebook.com/RHE39.htm

"Prognosis
Early joint drainage and antibiotics
Good prognosis

"Delayed management >24 hours
Risk of joint arthrosis, fibrosis and osteonecrosis."

*******************************************************************

As to the new development, the possible spread of the infection to the heart:

From UpToDate Patient,"Patient information: Joint infection," by Don L Goldenberg, MD:
http://patients.uptodate.com/topic.asp?title=heart&file=bone_joi%2F9211&mark=1&submit=find

"BACTERIAL (NONGONOCOCCAL) ARTHRITIS . . .Nongonococcal bacterial arthritis is a potentially destructive form of acute arthritis. Prompt diagnosis and treatment is critical to minimize joint damage. Several factors increase the risk of developing this type of septic arthritis."

" . . .Intravenous drug use: A large number of bacteria can enter the bloodstream when street drugs (eg, heroin) are injected. Endocarditis, an infection within the heart, can occur in this setting, and is often associated with septic arthritis."

For an overview of Endocarditis, see U.S. News & World Report, "Endocarditis," August 31, 2006. This article concerns congenital Endocarditis, but some information here is still relevant to your son's case:

http://www.usnews.com/usnews/health/heart/congenital/congenital.manage.endocarditis.htm

"Endocarditis is a dangerous infection of the endocardium, the lining of the inside of the heart's four chambers. Certain bacteria and other microorganisms that occasionally circulate in the blood may settle and multiply on the heart valves . . . ."

"Treatment of endocarditis may require four to six weeks or more of intravenous antibiotics and may include surgery. Penicillin (amoxicillin/ampicillin) and gentamicin are the most commonly used antibiotics. Other antibiotics can be used as well: vancomycin, cephalosporin, clindamycin, or azithromycin. Although powerful antibiotics are available, treatment can be difficult and complications of endocarditis may occur."

Your son should discuss the antibiotics with his doctors. I do know vancomycin can cause kidney problems in some patients, and sepsis can also cause kidney problems. You may want to ask your son if he has discussed the benefits and possible risks of his specific meds with his doctors.

Tests

According to the paper David referenced, "Septic Arthritis," by Gabriel Munoz, MD and Edmund W Raycraft, MD:
http://www.emedicine.com/orthoped/topic437.htm

"Ultrasound can be used to define the extent of septic arthritis and help guide treatment.

Ultrasound helps to differentiate septic arthritis from other conditions (eg, soft tissue abscesses, tenosynovitis) in which treatment may differ."

Microscope down the Throat

Microorganisms associated with Endocarditis often colonize in the throat. This test is a further attempt to assess any damage to the heart valves and to get a closer look at the infection.

From the CardiologyChannel:
http://www.cardiologychannel.com/endocarditis/diagnosis.shtml

"In some cases of suspected endocarditis, a special type of echocardiogram called a transesophageal echo (TEE) may be performed. A transesophageal echo uses a long tube with a special microphone-like device mounted on one end. The tube is passed through the mouth and throat and then down the esophagus (organ that connects the throat to the stomach, located directly behind the heart). This allows the imaging part of the transesophageal echo to be placed in close proximity to the heart and enables the doctor to obtain high-quality images of the heart and the heart valves.

"This procedure is able to detect more than 90% of heart valve infections . . . ."

You will also see other commonly performed tests for Endocarditis at that page.

Treatment:

From the Mayo Clinic:
http://www.mayoclinic.com/health/endocarditis/DS00409/DSECTION=8

"You may need to take antibiotics for up to six weeks to clear up the infection. Once your fever and the worst of your signs and symptoms have passed, you may be able to leave the hospital and continue antibiotic therapy in an outpatient setting."

From the CardiologyChannel:
http://www.cardiologychannel.com/endocarditis/diagnosis.shtml

"Treatment

Primary treatment for endocarditis involves an intensive course of antibiotics . . . . usually for at least 4 to 6 weeks. For much, if not all of this time, the antibiotics are administered intravenously (i.e., through a vein). To increase the chances of successfully treating the infection, a combination of antibiotics is often used. . .

"Sometimes, the infection is not controlled with antibiotics, and the bacteria continue to grow on the infected heart valve, and possibly in the blood. If this occurs, open heart surgery may be necessary to remove and replace the infected heart valve."

Also see

"Neurological Complications of Endocarditis in Persons Taking Drugs Intravenously,"by Harry Openshaw, MD.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1130040

From the Abstract:

"The clinical and neuropathological features encountered are compared with those reported in persons with endocarditis who were not addicts. The review indicates that neurological complications in nonaddicts and in addicts are similar in type but are more common and severe in addicts."

Read the full paper by following the links under "Full Text."

By "tapping" his foot, I assume you mean they're going to drain the foot to relieve the swelling (and to test the fluid)?

I'm afraid sepsis and Endocarditis require a long recovery period, but it sounds like your son's doctors are being very thorough in their treatment, and in trying to determine just what they're dealing with and the extent of the infection.

The key thing is your son got to a hospital and got help. I'm not sure how quickly he got there following the onset of his symptoms, but he appears to be receiving excellent care, and he certainly is getting loving support from his family.

I hope my Answer is of help, and that your son's condition improves very soon.

Take care,
nancy
uclue Researcher