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 [1]. 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 [2] [3]. The clinical presentation is centered around three main complaints - joint pain, swelling, and fever (about 40% of patients have a fever of >39C) [3] [4]. Either one (monoarticular) or more than one (polyarticular) joint can be affected. Gonococcal arthritis is typically polyarticular [5]. The pain is often severe and is exacerbated with minimal movement, thus a decreased range of motion is also an important finding [4] [6]. Additional less common features of bacterial arthritis include erythema of the skin over the infected joint, rigors, excessive sweating, and constitutional symptoms [1] [3] [4] [6].

• 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]

  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]

• Chills

  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]

• Reiter's Syndrome

  “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]

• Rigor

  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]

• High Fever

  —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]

• Tachycardia

  […] 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]

• Arthritis

  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]

• Joint Effusion

  […] 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]

• Joint 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]

  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

  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]

• Joint Deformity

  A chronic and progressive course is common with joint deformities and disability. [kmle.co.kr]

  During the acute phase of bacterial arthritis, patient rest and optimal joint position are absolutely required to prevent the occurrence of joint deformation and deleterious contractures. [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 [4]. One of the key steps in solidifying the diagnosis is the analysis of synovial fluid [7]. 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 [2] [3] [4]. 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 [7]. Gram staining is also described as an important microbiological method in the case of arthritis, but its variable sensitivity is an important limitation [1] [7].

• 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]

• Elevated Sedimentation Rate

  L ABORATORY DIAGNOSIS The laboratory abnormalities suggestive septic arthritis includes peripheral leucocytosis, elevated sedimentation rate and C-reactive protein. [antimicrobe.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]

• Listeria Monocytogenes

  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]

1. Ross JJ, Saltzman CL, Carling P, Shapiro DS. Pneumococcal septic arthritis: review of 190 cases. Clin Infect Dis. 2003;36(3):319-327.
2. Margaretten ME, Kohlwes J, Moore D, Bent S. Does this adult patient have septic arthritis? JAMA. 2007;297(13):1478-1488.
3. Carpenter CR, Schuur JD, Everett WW, Pines JM. Evidence-based Diagnostics: Adult Septic Arthritis. Acad Emerg Med. 2011;18(8):781-796.
4. Smith JW, Chalupa P, Shabaz Hasan M. Infectious arthritis: clinical features, laboratory findings and treatment. Clin Microbiol Infect. 2006;12(4):309-314.
5. Bardin T. Gonococcal arthritis. Best Pract Res Clin Rheumatol. 2003;17(2):201-208.
6. Al-Ahaideb A. Septic arthritis in patients with rheumatoid arthritis. J Orthop Surg. 2008;3:33.
7. Wilson ML, Winn W. Laboratory diagnosis of bone, joint, soft-tissue, and skin infections. Clin Infect Dis. 2008;46(3):453-457.