Presentation
Fevers are usually low-grade and rigors are only present in a minority of cases. [patient.info]
Delay in presentation was defined as the interval, in days, between the onset of symptoms attributable to septic arthritis and presentation of the patient to medical services. [doi.org]
Abstract The clinical presentation of 41 adult patients with infectious arthritis has been reviewed with special emphasis on initial synovial fluid leukocytosis. [ncbi.nlm.nih.gov]
Entire Body System
- Pain
Gout and pseudogout can also present with pain, inflammation and, occasionally, spiky fevers and chills. The triad of fever, pain and impaired range of motion is typical. [patient.info]
There is also intense joint pain, which gets worse with movement. [nlm.nih.gov]
Symptoms typically include redness, heat and pain in a single joint associated with a decreased ability to move the joint. Onset is usually rapid. Other symptoms may include fever, weakness and headache. [en.wikipedia.org]
In patients who present with an acutely painful and swollen joint, prompt identification and treatment of septic arthritis can substantially reduce morbidity and mortality. [ncbi.nlm.nih.gov]
Context In patients who present with an acutely painful and swollen joint, prompt identification and treatment of septic arthritis can substantially reduce morbidity and mortality. [doi.org]
- Fever
[ 713.6 ] Staphylococcus 711.0 Streptococcus 711.0 syphilis (see also Syphilis) 094.0 [ 711.4 ] syringomyelia 336.0 [ 713.5 ] thalassemia (see also Thalassemia) 282.40 [ 713.2 ] tuberculosis (see also Tuberculosis, arthritis) 015.9 [ 711.4 ] typhoid fever [icd9data.com]
Gout and pseudogout can also present with pain, inflammation and, occasionally, spiky fevers and chills. The triad of fever, pain and impaired range of motion is typical. [patient.info]
[…] the infected joint (pseudoparalysis) Severe joint pain Joint swelling Joint redness Fever Chills may occur, but are uncommon. [nlm.nih.gov]
Other symptoms may include fever, weakness and headache. Occasionally, more than one joint may be involved.Causes include bacteria, viruses, fungi and parasites. [en.wikipedia.org]
Your joint gets: Very painful Red and warm Swollen and stiff Sometimes, you get fever and chills. [msdmanuals.com]
- Swelling
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. [nlm.nih.gov]
There is often no significant swelling or fever, although high-grade fever, focal swelling and redness occasionally occur. Cellulitis and sinus development are common presenting features. [patient.info]
Three days before referral, the patient developed fever and slight swelling of the left ankle during the night. [doi.org]
Joint pain (sensitivity, 85%; 95% confidence interval [CI], 78%-90%), a history of joint swelling (sensitivity, 78%; 95% CI, 71%-85%), and fever (sensitivity, 57%; 95% CI, 52%-62%) are the only findings that occur in more than 50% of patients. [ncbi.nlm.nih.gov]
- Sepsis
The acute onset of monoarticular joint pain, erythema, heat, and immobility should raise suspicion of sepsis. Constitutional symptoms such as fever, chills, and rigors are poorly sensitive for septic arthritis. [ncbi.nlm.nih.gov]
Sepsis was considered to have contributed to death when no other specific cause, for example, terminal malignancy was apparent from the notes. [doi.org]
- Inflammation
Viral infections frequently involve multiple joints and produce inflammation without suppuration. [ncbi.nlm.nih.gov]
The symptoms usually include fever (which may be quite high), chills, general weakness and headaches, followed by inflammation of one or more joints. [rarediseases.org]
Septic arthritis is an infection producing inflammation in a native or prosthetic joint or more than one joint. It can be acute or chronic. [patient.info]
Urological inflammation occurred in 9 cases, ophthalmological inflammation in 3 cases and pleuritis, pericarditis was observed in 1 patient. [hungary.pure.elsevier.com]
Respiratoric
- Pneumonia
In children, septic arthritis is usually associated with systemic infections such as pneumonia or meningitis; in young adults, gonococcal arthritis is the most common cause; and in the aged, septic arthritis is usually superimposed on chronic joint disease [ncbi.nlm.nih.gov]
[…] species [human bites]), Aeromonas hydrophila (myelogenous leukemia), P aeruginosa, Serratia species, Candida species (particularly common in persons who abuse intravenous drugs), Mycobacterium marinum (water exposure), S schenckii (gardening), and S pneumoniae [emedicine.medscape.com]
Chapter 187: Health Care and Hospital-Acquired Pneumonia -- Chapter 188: Intravascular Catheter-Related Infections: Management and Prevention -- Chapter 189: Infective Endocarditis -- Chapter 190: Clostridium difficile-Associated Disease (CDAD) -- Chapter [worldcat.org]
[…] as sex with multiple partners and without use of condoms) An infection that reaches the bloodstream (bacteremia) People being treated with dialysis Skin infections For example, bacteria may become deposited in one or more joints in a person who has pneumonia [msdmanuals.com]
Gastrointestinal
- Diarrhea
THE BEDSIDE -- Chapter 75: Acute Abdominal Pain -- Chapter 76: Acute Back Pain -- Chapter 77: Evaluation of Anemia -- Chapter 78: Bleeding and Coagulopathy -- Chapter 79: Chest Pain -- Chapter 80: Constipation -- Chapter 81: Delirium -- Chapter 82: Diarrhea [worldcat.org]
Septic arthritis following cases of infectious diarrhea may be caused by Shigella spp., Salmonella spp., Campylobacter spp., or Yersinia spp. ( 50, 82 ). However, these cases may reflect a form of reactive arthritis. [doi.org]
- Vomiting
Bacteraemia is a common finding and, when present, may cause prostration, vomiting or hypotension. Patients with septic arthritis of the sternoclavicular, acromioclavicular, sternocostal or manubrosternal joints may present with chest wall pain. [patient.info]
Chapter 91: Hypertensive Urgencies and Emergencies -- Chapter 92: Hyperthermia and Fever -- Chapter 93: Hypotension -- Chapter 94: Hypothermia -- Chapter 95: Hypoxia -- Chapter 96: Sleep Disturbance in the Hospitalized Patient -- Chapter 97: Nausea and Vomiting [worldcat.org]
- Abdominal Pain
Imaging -- Chapter 117: Advanced Abdominal Imaging. [worldcat.org]
- Nausea
Hemoptysis -- Chapter 91: Hypertensive Urgencies and Emergencies -- Chapter 92: Hyperthermia and Fever -- Chapter 93: Hypotension -- Chapter 94: Hypothermia -- Chapter 95: Hypoxia -- Chapter 96: Sleep Disturbance in the Hospitalized Patient -- Chapter 97: Nausea [worldcat.org]
Skin
- Dermatitis
Gonococcal disease usually presents with fever, arthralgia, multiple skin lesions (dermatitis-arthritis syndrome) and tenosynovitis of the hand joints, knees, wrists, ankles and elbows. [patient.info]
Other symptoms of disseminated gonococcal infection can include migration of joint pain, tenosynovitis and dermatitis. Synovial fluid cultures are positive in 25 to 70% of the cases while blood cultures are seldom positive. [en.wikipedia.org]
Some patients develop septic gonococcal arthritis without prior polyarthralgia, tenosynovitis, or dermatitis. [doi.org]
Musculoskeletal
- Arthritis
Septic arthritis is inflammation of a joint due to a bacterial or fungal infection. Septic arthritis that is due to the bacteria that cause gonorrhea has different symptoms and is also called gonococcal arthritis. [nlm.nih.gov]
Reactive arthritis, post-infectious diarrhoeal syndrome, post-meningococcal and post-gonococcal arthritis, arthritis associated with intrinsic bowel disease. Lyme disease. Viral arthritis. Infective endocarditis. [patient.info]
A normal WBC count does not rule out septic arthritis. The erythrocyte sedimentation rate (ESR) is elevated in septic arthritis; it returns to normal levels with resolution of the infection. [emedicine.com]
Clinical findings identify patients with peripheral, monoarticular arthritis who might have septic arthritis. [ncbi.nlm.nih.gov]
- Joint Effusion
Ultrasonography is useful in confirming a joint effusion in a deeply placed joint such as the hip. It can also be used to guide joint aspiration. Magnetic resonance imaging (MRI) has no role in the initial workup. [emedicine.com]
These are the most sensitive methods for diagnosing periarticular abscesses, joint effusions and osteomyelitis. [patient.info]
Ultrasonography of hip joint effusions. Skeletal Radiol. 16 : 607 -611. View Abstract [doi.org]
Ultrasonography of hip joint effusions. Skeletal Radiol. 16 : 607-611. [ PubMed ] [ Google Scholar ] [ncbi.nlm.nih.gov]
- Joint Swelling
[…] the infected joint (pseudoparalysis) Severe joint pain Joint swelling Joint redness Fever Chills may occur, but are uncommon. [nlm.nih.gov]
Joint pain (sensitivity, 85%; 95% confidence interval [CI], 78%-90%), a history of joint swelling (sensitivity, 78%; 95% CI, 71%-85%), and fever (sensitivity, 57%; 95% CI, 52%-62%) are the only findings that occur in more than 50% of patients. [ncbi.nlm.nih.gov]
- Arthralgia
Severe forms of the disease result in chronic incapacitating arthralgia and arthritis. The mechanisms of how these viruses cause musculoskeletal disease are ill defined. [ncbi.nlm.nih.gov]
Gonococcal disease usually presents with fever, arthralgia, multiple skin lesions (dermatitis-arthritis syndrome) and tenosynovitis of the hand joints, knees, wrists, ankles and elbows. [patient.info]
The presenting symptoms in DGI may include migratory arthralgias, moderate fever, chills, dermatitis, and tenosynovitis. The large majority of these patients have asymptomatic genital, anal, or pharyngeal gonococcal infections ( 122 ). [doi.org]
- Knee Pain
Derek Isenberg and Dorian Jacobs, Knee Pain and Fever, Visual Journal of Emergency Medicine, 3, (15), (2016). Jacob Daynes, Matthew F. [doi.org]
Neurologic
- Headache
The symptoms usually include fever (which may be quite high), chills, general weakness and headaches, followed by inflammation of one or more joints. [rarediseases.org]
Other symptoms may include fever, weakness and headache. Occasionally, more than one joint may be involved.Causes include bacteria, viruses, fungi and parasites. [en.wikipedia.org]
Chapter 80: Constipation -- Chapter 81: Delirium -- Chapter 82: Diarrhea -- Chapter 83: Disorders of the Eye -- Chapter 84: Dizziness and Vertigo -- Chapter 85: Dyspnea -- Chapter 86: Edema -- Chapter 87: Falls -- Chapter 88: Fever and Rash -- Chapter 89: Headache [worldcat.org]
Demonstration of the typical and slowly expanding erythema migrans skin lesion at the site of the tick bite and the development of influenza-like symptoms (including malaise, fatigue, headache, fever, regional lymphadenopathy, and migratory polyarthragia [doi.org]
Workup
Magnetic resonance imaging (MRI) has no role in the initial workup. The use of this expensive and time-consuming modality should be reserved for situations in which simpler measures, such as joint aspiration, fail to provide a diagnosis. [emedicine.com]
Microbiology
- Gram-Positive Bacteria
bacteria ; Sect. 6: Diseases caused by gram-negative bacteria ; Sect. 7: Miscellaneous bacterial infections ; Sect. 8: Mycobacterial diseases ; Sect. 9: Spirochetal diseases ; Sect. 10: Diseases caused by rickettsiae, mycoplasmas, and chlamydiae ; Sect [worldcat.org]
Treatment
Especially in infants, treatment delay or inappropriate treatment may result in cartilage destruction, avascular necrosis and physeal injury [ 5, 6 ], with an increased risk of severe deformation and functional impairment. [doi.org]
A secondary objective was to quantify test and treatment thresholds using derived estimates of sensitivity and specificity, as well as best-evidence diagnostic and treatment risks and anticipated benefits from appropriate therapy. [ncbi.nlm.nih.gov]
Surgical drainage may be required in any infected joint which does not respond to medical treatment. [patient.info]
With treatment, about 15% of people die, while without treatment 66% die. Risk of permanent impairment of the joint varies greatly. [en.wikipedia.org]
Prognosis
In contrast, gonococcal arthritis is often successfully treated with antimicrobial therapy alone and demonstrates a very low rate of complications and an excellent prognosis for full return of normal joint function. [ncbi.nlm.nih.gov]
Recent reports using a staging system based on arthroscopic findings have proven that the prognosis worsens as the stage advances [ 10, 11 ]. [doi.org]
Etiology
From the theoretical standpoint, the interactions between infectious agents and patients with impaired immunity suggest ways in which the same or similar agents could be responsible for arthritis of unknown etiology. [ncbi.nlm.nih.gov]
PubMed Google Scholar Nelson JD: The bacterial etiology and antibiotic management of septic arthritis in infants and children. Pediatrics. 1972, 50: 437-440. PubMed Google Scholar Gillespie R: Septic arthritis of childhood. [doi.org]
Epidemiology
Preventive measures directed to patients with prosthetic joints or osteosynthetic material, and a known haematogenous source would have prevented at most 8% of all cases. bacterial arthritis prosthetic joint infection epidemiology prevention Statistics [doi.org]
Prompt diagnosis and treatment of infectious arthritis can help prevent significant morbidity and mortality. [ 1 ] Epidemiology Staphylococcus aureus is the most frequent pathogen responsible for septic arthritis in any age group, mainly meticillin-sensitive [patient.info]
Clinical and epidemiological clues often lead the clinician to perform appropriate serological studies via antibody titers. Crystal-induced arthritis. Gout and pseudogout may mimic many of the symptoms associated with septic arthritis. [ncbi.nlm.nih.gov]
Pathophysiology
Knowledge of PID syndromes both enhances the diagnostic capabilities of physicians and provides understanding the pathophysiology of bone and joint abnormalities associated with immune dysfunction. [ncbi.nlm.nih.gov]
Composition of staphylococcal bi-component toxins determines pathophysiological reactions. J. Med. Microbiol. 46 : 479 -485. ↵ Kuypers, J. M., and R. A. Proctor. 1989. [doi.org]
Prevention
Preventive measures directed to patients with prosthetic joints or osteosynthetic material, and a known haematogenous source would have prevented at most 8% of all cases. bacterial arthritis prosthetic joint infection epidemiology prevention Statistics [doi.org]
Prompt diagnosis and treatment of infectious arthritis can help prevent significant morbidity and mortality. The acute onset of monoarticular joint pain, erythema, heat, and immobility should raise suspicion of sepsis. [ncbi.nlm.nih.gov]
Chapter 16: Patient-Centered Care -- Chapter 17: Harnessing Data to Make Quality Improvement Decisions: Measurement and Measures -- Chapter 18: Standardization and Reliability -- Chapter 19: Tools to Identify Problems and Reduce Risks -- Chapter 20: Preventing [worldcat.org]
Preventive (prophylactic) antibiotics may be helpful for people at high risk. Bacterial arthritis; Non-gonococcal bacterial arthritis Cook PP, Siraj DS. Bacterial arthritis. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. [nlm.nih.gov]