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__NOTOC__
{{Septic arthritis}}
{{Septic arthritis}}
 
{{CMG}}; {{AE}}{{VSKP}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' Jumana Nagarwala, M.D., ''Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital''; {{CZ}}
 
==Overview==
==Overview==
Septic arthritis should be considered whenever one is assessing a patient with joint pain.  Usually only one joint is affected ([[monoarthritis]]) however in ''seeding'' arthritis, several joints can be affected simultaneously; this is especially the case when the infection is caused by [[staphylococcus]] or [[gonococcus]] bacteria.
Septic arthritis commonly present with joint pain (knee> hip>shoulder>ankle) associate with [[fever]], [[malaise]] and local joint symptoms such as [[swelling]], [[erythema]] and decreased range of motion at the level of joint. In children, hip is commonly affected.  
 
==Symptoms==
==History & Symptoms==
===Common Symptoms===
Symptoms usually come on quickly. There is a fever, and joint swelling that is usually in just one joint. There is also intense joint pain, which gets worse with movement.
Abrupt onset of a single hot, swollen, and painful joint indicate non gonococcal arthritis.<ref name="pmid3883171">Goldenberg DL, Reed JI (1985) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3883171 Bacterial arthritis.] ''N Engl J Med'' 312 (12):764-71. [http://dx.doi.org/10.1056/NEJM198503213121206 DOI:10.1056/NEJM198503213121206] PMID: [https://pubmed.gov/3883171 3883171]</ref> It can involve any joint, but most commonly knee is the site of infection in 50% of cases of adults and elderly patients. Hip infection is the most common site in children.<ref name="pmid8972665">Morgan DS, Fisher D, Merianos A, Currie BJ (1996) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8972665 An 18 year clinical review of septic arthritis from tropical Australia.] ''Epidemiol Infect'' 117 (3):423-8. PMID: [https://pubmed.gov/8972665 8972665]</ref> [[Disseminated gonococcal infection]](DGI) often present initially with migratory polyarthralgias, [[tenosynovitis]], [[dermatitis]], and [[fever]] and less commonly, <50% of patients with [[Disseminated gonococcal infection|DGI]] will present with purulent joint effusion, most often of the knee or wrist.<ref name="pmid6415361">O'Brien JP, Goldenberg DL, Rice PA (1983) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6415361 Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms.] ''Medicine (Baltimore)'' 62 (6):395-406. PMID: [https://pubmed.gov/6415361 6415361]</ref> Often present with inflamed and tender tendons of the wrist, ankles, and small joints.


Symptoms in newborns or infants:
'''Symptoms in newborns or infants:'''
* Cries when infected joint is moved (example: diaper change causes crying if hip joint is infected)
* Cries when infected joint is moved (e.g. diaper change causes crying if hip joint is infected)
* Fever
* [[Fever]]
* Inability to move the limb with the infected joint (pseudoparalysis)
* Inability to move the limb with the infected joint (pseudoparalysis)
* Irritability
* [[Irritability]]


Symptoms in children and adults:
'''Symptoms in children and adults:'''
* Inability to move the limb with the infected joint (pseudoparalysis)
* Inability to move the limb with the infected joint (pseudoparalysis)
* Intense joint pain
* Intense [[joint pain]]
* Joint swelling
* Joint [[swelling]]
* Joint redness
* Joint redness
* Low fever
* Low [[fever]]
* The [[tenosynovitis]] is characterized by pain, [[swelling]], and [[erythema]] around the tendon.
 
===Less Common Symptoms===
[[Chills]] may occur especially in gonococcal arthritis, but are uncommon.


Chills may occur, but are uncommon.
=== Microorganism Involved Based on The Clinical History and Symptoms ===
{| border="3"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Clinical history}}
!!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Joints involved}}
!!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Most likely microorganism}}
|-
|align=center| Intravenous drug use<ref name="pmid17405973">Margaretten ME, Kohlwes J, Moore D, Bent S (2007) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17405973 Does this adult patient have septic arthritis?] ''JAMA'' 297 (13):1478-88. [http://dx.doi.org/10.1001/jama.297.13.1478 DOI:10.1001/jama.297.13.1478] PMID: [https://pubmed.gov/17405973 17405973]</ref><ref name="pmid2283490">Deesomchok U, Tumrasvin T (1990) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2283490 Clinical study of culture-proven cases of non-gonococcal arthritis.] ''J Med Assoc Thai'' 73 (11):615-23. PMID: [https://pubmed.gov/2283490 2283490]</ref>
|align=center| Involvement of axial joints
(e.g. [[Sternoclavicular joint|sternoclavicular]] or [[sacroiliac joint]])
|align=center| [[Pseudomonas aeruginosa]]
[[Staphylococcus aureus]]
|-
|align=center| Sexual activity
|align=center|[[Tenosynovitis|Tenosynovial]] involvement in hands, wrists, or ankles
|align=center|[[Neisseria gonorrhoeae]]
|-
|align=center|Terminal complement deficiency<ref name="pmid17405973">Margaretten ME, Kohlwes J, Moore D, Bent S (2007) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17405973 Does this adult patient have septic arthritis?] ''JAMA'' 297 (13):1478-88. [http://dx.doi.org/10.1001/jama.297.13.1478 DOI:10.1001/jama.297.13.1478] PMID: [https://pubmed.gov/17405973 17405973]</ref>
|align=center|[[Tenosynovitis|Tenosynovial]] involvement in hands, wrists, or ankles
|align=center|[[Neisseria gonorrhoeae]]
|-
|align=center|Dog or cat bite
|align=center|Small joints involvement
|align=center|[[Capnocytophaga]] species 
[[Pasteurella multocida]]
|-
|align=center|Ingestion of unpasteurized dairy products<ref name="pmid17405973">Margaretten ME, Kohlwes J, Moore D, Bent S (2007) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17405973 Does this adult patient have septic arthritis?] ''JAMA'' 297 (13):1478-88. [http://dx.doi.org/10.1001/jama.297.13.1478 DOI:10.1001/jama.297.13.1478] PMID: [https://pubmed.gov/17405973 17405973]</ref>
|align=center|Monoarticular involvement, in specific [[sacroiliac joint]]
|align=center|[[Brucella|Brucella sps]]
|-
|align=center|Nail through shoe
|align=center|Foot
|align=center|[[Pseudomonas aeruginosa]]
|-
|align=center|Soil exposure/gardening
|align=center|Monoarticular involvement: knee, hand, or wrist
|align=center|[[Nocardia|Nocardia sps]]
[[Sporothrix schenckii]]
|-
|align=center|Soil or dust exposure containing decomposed wood
(north-central and southern United States)<ref name="pmid21916390">{{cite journal| author=Horowitz DL, Katzap E, Horowitz S, Barilla-LaBarca ML| title=Approach to septic arthritis. | journal=Am Fam Physician | year= 2011 | volume= 84 | issue= 6 | pages= 653-60 | pmid=21916390 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21916390  }} </ref>
|align=center|Monoarticular: knee, ankle, or elbow
|align=center|[[Blastomyces dermatitidis]]
|-
|align=center|Southwestern United States, Central and South America
(primary respiratory illness)
|align=center|Knee
|align=center|[[Coccidioides immitis]]
|-
|align=center|Cleaning fish tank<ref name="pmid17405973">Margaretten ME, Kohlwes J, Moore D, Bent S (2007) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17405973 Does this adult patient have septic arthritis?] ''JAMA'' 297 (13):1478-88. [http://dx.doi.org/10.1001/jama.297.13.1478 DOI:10.1001/jama.297.13.1478] PMID: [https://pubmed.gov/17405973 17405973]</ref><ref name="pmid16297734">{{cite journal| author=Gardam M, Lim S| title=Mycobacterial osteomyelitis and arthritis. | journal=Infect Dis Clin North Am | year= 2005 | volume= 19 | issue= 4 | pages= 819-30 | pmid=16297734 | doi=10.1016/j.idc.2005.07.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16297734  }} </ref>
|align=center|Small joints involvement (e.g. fingers, wrists)
|align=center|[[Mycobacterium marinum]]
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}


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Latest revision as of 00:08, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Overview

Septic arthritis commonly present with joint pain (knee> hip>shoulder>ankle) associate with fever, malaise and local joint symptoms such as swelling, erythema and decreased range of motion at the level of joint. In children, hip is commonly affected.

Symptoms

Common Symptoms

Abrupt onset of a single hot, swollen, and painful joint indicate non gonococcal arthritis.[1] It can involve any joint, but most commonly knee is the site of infection in 50% of cases of adults and elderly patients. Hip infection is the most common site in children.[2] Disseminated gonococcal infection(DGI) often present initially with migratory polyarthralgias, tenosynovitis, dermatitis, and fever and less commonly, <50% of patients with DGI will present with purulent joint effusion, most often of the knee or wrist.[3] Often present with inflamed and tender tendons of the wrist, ankles, and small joints.

Symptoms in newborns or infants:

  • Cries when infected joint is moved (e.g. diaper change causes crying if hip joint is infected)
  • Fever
  • Inability to move the limb with the infected joint (pseudoparalysis)
  • Irritability

Symptoms in children and adults:

Less Common Symptoms

Chills may occur especially in gonococcal arthritis, but are uncommon.

Microorganism Involved Based on The Clinical History and Symptoms

Clinical history Joints involved Most likely microorganism
Intravenous drug use[4][5] Involvement of axial joints

(e.g. sternoclavicular or sacroiliac joint)

Pseudomonas aeruginosa

Staphylococcus aureus

Sexual activity Tenosynovial involvement in hands, wrists, or ankles Neisseria gonorrhoeae
Terminal complement deficiency[4] Tenosynovial involvement in hands, wrists, or ankles Neisseria gonorrhoeae
Dog or cat bite Small joints involvement Capnocytophaga species

Pasteurella multocida

Ingestion of unpasteurized dairy products[4] Monoarticular involvement, in specific sacroiliac joint Brucella sps
Nail through shoe Foot Pseudomonas aeruginosa
Soil exposure/gardening Monoarticular involvement: knee, hand, or wrist Nocardia sps

Sporothrix schenckii

Soil or dust exposure containing decomposed wood

(north-central and southern United States)[6]

Monoarticular: knee, ankle, or elbow Blastomyces dermatitidis
Southwestern United States, Central and South America

(primary respiratory illness)

Knee Coccidioides immitis
Cleaning fish tank[4][7] Small joints involvement (e.g. fingers, wrists) Mycobacterium marinum

References

  1. Goldenberg DL, Reed JI (1985) Bacterial arthritis. N Engl J Med 312 (12):764-71. DOI:10.1056/NEJM198503213121206 PMID: 3883171
  2. Morgan DS, Fisher D, Merianos A, Currie BJ (1996) An 18 year clinical review of septic arthritis from tropical Australia. Epidemiol Infect 117 (3):423-8. PMID: 8972665
  3. O'Brien JP, Goldenberg DL, Rice PA (1983) Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms. Medicine (Baltimore) 62 (6):395-406. PMID: 6415361
  4. 4.0 4.1 4.2 4.3 Margaretten ME, Kohlwes J, Moore D, Bent S (2007) Does this adult patient have septic arthritis? JAMA 297 (13):1478-88. DOI:10.1001/jama.297.13.1478 PMID: 17405973
  5. Deesomchok U, Tumrasvin T (1990) Clinical study of culture-proven cases of non-gonococcal arthritis. J Med Assoc Thai 73 (11):615-23. PMID: 2283490
  6. Horowitz DL, Katzap E, Horowitz S, Barilla-LaBarca ML (2011). "Approach to septic arthritis". Am Fam Physician. 84 (6): 653–60. PMID 21916390.
  7. Gardam M, Lim S (2005). "Mycobacterial osteomyelitis and arthritis". Infect Dis Clin North Am. 19 (4): 819–30. doi:10.1016/j.idc.2005.07.008. PMID 16297734.


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