Bacterial arthritis is predominantly caused by Staphylococcus aureus, streptococci, and Neisseria gonorrhoeae. Joint pain and swelling (involving either one or more joints), as well as fever, are three cardinal symptoms seen in these patients. The diagnosis can be made after a proper physical examination, while the determination of the underlying pathogen is achieved through microbiological studies, primarily in the form of blood and synovial fluid cultures.
Bacterial arthritis or infection of the joints and the articular tissues is encountered across all age groups. Overall, Staphylococcus aureus is the most common cause (although Neisseria gonorrhoeae is the number one cause of septic arthritis in younger adults), but streptococcal species (including S. pneumoniae, S. viridans, S. pyogenes), tuberculosis, and a range of both gram-positive and gram-negative bacteria can be responsible for the infection . Several conditions have been described in the literature as potential risk factors for bacterial arthritis, including diabetes mellitus, previous skin infection, rheumatoid arthritis (RA), human immunodeficiency virus (HIV) type 1 infection, as well as increasing age, joint surgery, intravenous drug abuse, and the presence of hip or knee prostheses  . The clinical presentation is centered around three main complaints - joint pain, swelling, and fever (about 40% of patients have a fever of >39C)  . Either one (monoarticular) or more than one (polyarticular) joint can be affected. Gonococcal arthritis is typically polyarticular . The pain is often severe and is exacerbated with minimal movement, thus a decreased range of motion is also an important finding  . Additional less common features of bacterial arthritis include erythema of the skin over the infected joint, rigors, excessive sweating, and constitutional symptoms    .
Entire Body System
[ 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]
The clinical presentation is centered around three main complaints - joint pain, swelling, and fever (about 40% of patients have a fever of 39C). Either one (monoarticular) or more than one (polyarticular) joint can be affected. [symptoma.com]
[…] the infected joint (pseudoparalysis) Severe joint pain Joint swelling Joint redness Fever Chills may occur, but are uncommon. [nlm.nih.gov]
We conclude, that the absence of fever, rigors, blood leucocytosis and positive blood cultures does not rule out the possibility of bacterial arthritis. [ncbi.nlm.nih.gov]
Constitutional symptoms such as fever, chills, and rigors are poorly sensitive for septic arthritis. [ncbi.nlm.nih.gov]
[…] diaper changes) Fever Not able to move the limb with the infected joint (pseudoparalysis) Fussiness Symptoms in children and adults: Not able to move the limb with the infected joint (pseudoparalysis) Severe joint pain Joint swelling Joint redness Fever Chills [nlm.nih.gov]
With septic arthritis, patients may experience symptoms and signs that include fever, chills, as well as joint pain, swelling, redness, stiffness, and warmth. [medicinenet.com]
Septic arthritis symptoms may include: Chills Fatigue and generalized weakness Fever Inability to move the limb with the infected joint Severe pain in the affected joint, especially with movement Swelling (increased fluid within the joint) Warmth (the [webmd.com]
“Reactive” (sterile) arthritis, formerly known as Reiter’s syndrome, may occur following chlamydial genital infection or bacterial gastroenteritis caused by campylobacter, salmonella, and other agents. [clinicaladvisor.com]
syndrome Rheumatoid Arthritis Crystal Disease - gout, pseudogout Treatment 1.Depends on organism and host 2.Antibiotics a.Usually begin with oxacillin (nafcillin) or vancomycin b.Add gentamicin initially until culture results back c.Consider broader [enotes.tripod.com]
Reactive arthritis (including Reiter's syndrome, psoriatic arthritis, ankylosing spondylitis and arthritis associated with inflammatory bowel disease) often presents with inflammation in a few large joints, distributed asymmetrically. [patient.info]
Reactive arthritis (formerly Reiter syndrome) is associated with inflammation around the head of the penis (circinate balanitis). [medicinenet.com]
It can also be caused by a type of arthritis known as reactive arthritis or Reiter’s syndrome, which can also affect the joints and the eyes. [webmd.com]
We conclude, that the absence of fever, rigors, blood leucocytosis and positive blood cultures does not rule out the possibility of bacterial arthritis. [ncbi.nlm.nih.gov]
Additional less common features of bacterial arthritis include erythema of the skin over the infected joint, rigors, excessive sweating, and constitutional symptoms. [symptoma.com]
Sweats (sensitivity, 27%; 95% CI, 20%-34%) and rigors (sensitivity, 19%; 95% CI, 15%-24%) are less common findings in septic arthritis. [doi.org]
—Staphylococcal arthritis: Usually monarticular (seldom polyarticular), staphy-lococcal arthritis affects the knee, hip, shoulder, elbow, wrist, or ankle, and 90% of patients exhibit high fevers. [rheumaknowledgy.com]
Neonates and infants may not appear that unwell and may not always have a high fever. Careful examination and clinical suspicion are important. [pmmonline.org]
[…] on septicaemia large joint(esp hip) Often in the superficialRather than joint pain joint(knee, wrist or ankle ) o Pseudoparesis Baby is irritable & Joints painful, swollenrefuse to feed o Child is ill,rapid pulse & inflamed. and swingingfever Tachycardia [slideshare.net]
[…] vary from case to case, but the following are the most commonly seen signs and symptoms: Severe pain that worsens with movement Swelling of the joint Warmth and redness around the joint Fever Chills Fatigue Weakness Decreased appetite Rapid heart rate (tachycardia [belmarrahealth.com]
Sleep Disturbance in the Hospitalized Patient -- Chapter 97: Nausea and Vomiting -- Chapter 98: Numbness: A Localization-Based Approach -- Chapter 99: Pain -- Chapter 100: Suspected Intoxication and Overdose -- Chapter 101: Syncope -- Chapter 102: Tachycardia [worldcat.org]
Clinical manifestations may include vague complaints like irritability, anxiety, failure to thrive, tachycardia and anemia. [omicsonline.org]
Bacterial arthritis or infection of the joints and the articular tissues is encountered across all age groups. [symptoma.com]
Clinical findings identify patients with peripheral, monoarticular arthritis who might have septic arthritis. [ncbi.nlm.nih.gov]
Conclusions Clinical findings identify patients with peripheral, monoarticular arthritis who might have septic arthritis. [doi.org]
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]
[…] on both sides of a joint if left untreated, reactive juxta-articular sclerosis and, in severe cases, ankylosis will develop Ultrasound useful in superficial joints and in children shows joint effusion echogenic debris may be present color Doppler may [radiopaedia.org]
In a prospective diagnostic study, 102 consecutive patients with atraumatic joint effusion were included. Synovial fluid glucose concentrations were determined using both glucometer and automated analyzer respectively. [ncbi.nlm.nih.gov]
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]
Radiograph: An x-ray that can be useful in initial stages of the disease to show joint effusion. Ultrasound: Useful in children, can be used to show joint effusion. [belmarrahealth.com]
In the affected joint, there is moderate to severe pain accompanied by joint effusion, muscle spasm and decreased range of motion. There is also high-grade fever. [boneandspine.com]
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]
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]
Early disseminated - weeks after infection with neurological features (facial nerve palsy, meningitis and rarely meningoencephalitis), heart conduction defects and arthralgia. [pmmonline.org]
Tenosynovitis and migratory arthralgias are common, and characteristic pustular (often painful) lesions are found on the skin. Fever may be absent, and a minority will have genitourinary, pharyngeal, or rectal symptoms on presentation. [rheumaknowledgy.com]
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]
Tenosynovitis, dermatitis, and polyarthritis syndrome or dermatitis-arthritis syndrome; the initial manifestations include fever, malaise, and arthralgias following an infection of the cervix, urethra, or pharynx. [atsu.edu]
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]
The physician's ability to recognize signs and symptoms of bacterial arthritis through a detailed patient history and a thorough physical examination is essential for making the diagnosis. Information regarding the onset and course of symptoms should be noted, whereas the assessment of preexisting comorbidities that could predispose individuals to this infection is mandatory. Joint pain and swelling, as principal complaints, need to be evaluated during a physical exam, and as soon as valid clinical suspicion is raised, a complete laboratory workup must be conducted. Serum inflammatory markers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), are often elevated in bacterial arthritis . One of the key steps in solidifying the diagnosis is the analysis of synovial fluid . Many studies have confirmed that the white blood cell count of > 50 × 109/L (with a predominance of polymorphonuclear cells, or PMNs) in synovial fluid is highly indicative of septic arthritis   . Furthermore, cultivation of synovial fluid is a definite method for identifying the causative agent of joint infection, and both anaerobic, but more importantly aerobic cultures should be drawn . Gram staining is also described as an important microbiological method in the case of arthritis, but its variable sensitivity is an important limitation  .
Joint Space Narrowing
염증이 진행되어 연골과 연골 하부 골의 파괴가 진행되면서 관절강 협착을 유발하는데 염증이 관절강 내에서 전체적으로 균일하게 일어나므로 대칭적 관절강 협착(symmetric joint space narrowing)이 생긴다. 또한 주변 연부 조직에 염증이 동반되므로 연부 조직 부종이 생긴다. [ekjm.org]
In later stages, diffuse joint space narrowing due to cartilage destruction may be evident. [patient.info]
Later findings include joint space narrowing due to destruction of the joint.Ultrasound is effective at detecting joint effusions.CT and MRI are not required for diagnosis; but if the diagnosis is unclear or the joints are hard to examine (ie.sacroiliac [en.wikipedia.org]
In time significant cartilage damage occurs followed by joint space narrowing. Significant damage to the joint can occur as soon as 3 days in untreated infections. [atsu.edu]
As the infection progresses, radiographic detection of diffuse joint space narrowing due to cartilage destruction is possible. [doi.org]
Blood Culture Positive
cultures Positive in 50-70% of patients with nongonococcal bacterial arthritis Diagnostic if positive Limited usefulness but may be helpful when ruling out other diseases, particularly in children Lower rate of positivity in prosthetic joints Tissue [arupconsult.com]
Other important diagnostic tests include blood cultures (positive in 50–70% of acute bacterial arthritides) (27), but in only 30% or less of gonococcal arthritis cases) (38), wound cultures (although these often correlate poorly with synovial fluid culture [the-hospitalist.org]
We also look at some unusual microorganisms, eg, group C Streptococcus, Streptococcus viridans, Listeria monocytogenes, Pseudomonas cepacia, Pseudomonas maltophilia, and Neisseria sicca. [ncbi.nlm.nih.gov]
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]
Abstract The key to successful treatment of acute bacterial arthritis is early diagnosis and initiation of empirical antibacterial therapy. Treatment includes antimicrobial therapy, debridement of the infected joint and treatment of pain. [ncbi.nlm.nih.gov]
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]
Prognosis: In general, mortality rates are below 5%. Prognosis is poorest in the elderly and those with gram-negative infections, polyarticular involvement, prosthetic joints, or delayed diagnosis. [rheumaknowledgy.com]
Septic arthritis in adults is a challenging diagnosis, but prompt differentiation of a bacterial etiology is crucial to minimize morbidity and mortality. [ncbi.nlm.nih.gov]
[…] pain and inflammation (better than acetaminophen) Septic Bursitis 1.Most commonly occurs in olecranon or pre-patellar bursa a.Trauma is major risk factor b.Alcoholism c.Diabetes mellitus d.Typically occurs in middle-aged men involved in manual labor 2.Etiology [enotes.tripod.com]
Clinicians are able to deduce the etiology of acute nontraumatic joint pain/swelling within 3-days in most cases, but in an era of “ overdiagnosis ” and “overtreatment” ED providers lack the luxury of a 3-day admission for most monoarticular arthritis [epmonthly.com]
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 The epidemiology is described above. Prognosis See above. Special considerations for nursing and allied health professionals. NA What's the evidence? Gupta, MN, Sturrock, RD, Field, M. [clinicaladvisor.com]
Epidemiology Information concerning the epidemiology of septic arthritis is limited due to several factors. [omicsonline.org]
Background Epidemiology Incidence – 2-10/100,000 in the U.S. 30-40/100,000 in patients with rheumatoid arthritis 40-70/100,000 in patients with prosthetic joints Transmission Most cases are hematogenously acquired Other mechanisms for infection Surgery [arupconsult.com]
Epidemiology Common in uncircumcised newborns or uncircumcised men with poor hygiene and accumulation of smegma May be due to poor hygiene, sexual transmission or associated with dermatologic disorders Etiology Due to propensity of pathogenic bacteria [pathologyoutlines.com]
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]
Polymerase chain reaction may be an important diagnostic test in culture-negative cases and may be very helpful in understanding the pathophysiology of gonococcal arthritis. [ncbi.nlm.nih.gov]
We review the pathophysiology of bacterial arthritis, clinical and microbiologic characteristics of its common forms, and current approaches to diagnosis and treatment of this condition.PathophysiologyBacterial arthritis is usually hematogenously acquired [nejm.org]
The pathophysiology of septic arthritis – or how the disease occurs – is when organisms such as viruses, bacteria, or fungi enter the joint space directly (as in the case of an injury or injection that breaks the skin) or through the bloodstream from [joybauer.com]
Pathophysiology The pathophysiology of bacterial (or fungal) arthritis differs according to the route of entry; that is: Hematogenous (either in the course of a primary bacteremic illness, including endocarditis, or from another focus such as urinary [clinicaladvisor.com]
The trend in antibiotic prophylaxis to prevent late infections in total joint replacement is to narrow the targeted hosts to those most at risk, to define the procedures associated with the greatest risk of bacteremia, and to simplify the antibiotic regimen [ncbi.nlm.nih.gov]
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