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Septic Bursitis

Septic bursitis is defined as an infection with the accumulation of pus within the sac-like structures which lie between the skin and bone or between the tendons, ligaments, and bone. It may be primary due to direct bacterial inoculation through a cutaneous wound or spread of local cellulitis or secondary to hematogenous spread of infection.


Presentation

Bursae are sac-like structures which either lie superficially between the skin and bone or are located deeply between the tendons, ligaments, and bone. Inflammation of bursae could be septic (with the formation of pus) or non-septic. Septic bursitis (SB) is commonly encountered in the superficial bursae e.g. olecranon and prepatellar bursae. In a majority of the cases, SB follows direct inoculation of traumatic superficial cutaneous wounds or contiguous spread of infection from local cellulitis [1] [2]. Rarely, deep bursae e.g. subacromial and iliopsoas bursae may get infected secondary to hematogenous spread of micro-organisms e.g. in septic arthritis, bacteremia, bacterial endocarditis. Micro-organisms implicated in SB are Staphylococcus aureus in a majority of the cases followed by streptococci, mycobacteria (both tuberculous and nontuberculous strains), fungi (Candida), and algae (Prototheca wickerhamii) [3]. The incidence of SB is reported to be higher in men [4]. Risk factors for SB include loss of skin integrity, impaired response to infection (eg, diabetes mellitus, alcohol abuse), and autoimmune conditions that lead to an increased amount of bursal fluid or tissue (such as rheumatoid arthritis or tophaceous gout) [1] [5] [6].

Clinical presentation may help to differentiate between septic from nonseptic bursitis. SB is almost always associated with symptoms of pain, swelling, and fever [5] while non-septic bursitis is associated with only swelling [6]. Erythema is present in both SB and non-SB [5]. Other symptoms include local tenderness and a history of repeated trauma or movement. Concomitant symptoms of systemic comorbid conditions like syphilis or pulmonary tuberculosis, bacterial endocarditis may also be present.

Fever
  • Fever (body temperature of or 37.8 degrees C) occurred in 20%. Staphylococcus aureus was identified in 88% of culture-proven cases of OBS.[ncbi.nlm.nih.gov]
  • SB is almost always associated with symptoms of pain, swelling, and fever while non-septic bursitis is associated with only swelling. Erythema is present in both SB and non-SB.[symptoma.com]
Chills
  • The most common symptoms were pain (87%), redness (77%) and fever or chills (45%). Common signs included erythema (92%), swelling (85%), edema (75%), tenderness (59%), fluctuance (50%), heat (36%) and reduced range of motion (27%).[ncbi.nlm.nih.gov]
  • Low grade fever and chills may also be present. The prepatellar bursa lies in front of the knee between the patella (kneecap) and the skin.[articlesurfing.com]
  • However, a few symptoms are specific to septic bursitis: Extreme warmth or redness to the area above the joint Extreme tenderness to the area above the joint Fever or chills General feelings of sickness It can be difficult to tell the difference between[arthritis-health.com]
Italian
  • Images: Related links to external sites (from Bing) Ontology: Infected bursa (C1290161) Concepts Disease or Syndrome ( T047 ) SnomedCT 122482001 Italian Borsite infettiva, Borsite infettiva NAS, Borsite settica Dutch bursitis infectieus NAO, septische[fpnotebook.com]
Rigor
  • Using a T•Shellz Wrap will not expose you to the risk of causing further harm to soft tissue like you can when using rigorous exercise.[aidmybursa.com]
Fishing
  • A 48-yearold male fish-merchant with a history of HIV infection with a CD4 cell count of 79 cells/ml presented with pain of the left ankle for 2 weeks and fever for 1 day.[ncbi.nlm.nih.gov]
  • […] myocardiopathy (紅) 【紅色肥厚症】*erythroplasia 【紅斑】*erythema 【紅斑角皮症】*erythrokeratodermia 【紅斑性湿疹】*eczema erythematosum[L] 【紅斑性天疱瘡】*pemphigus erythematosus[L] 【紅斑性狼瘡】*lupus erythematosus[L] 【紅板症】*erythroplakia 【紅皮症】*erythroderma 【紅変歯】 *erythrodontia 赤色歯 (鈎) 【鈎状胃】*fish-hook[medo.jp]
Dyspnea
  • At admission she denied any dyspnea, chest pain, rash, dysuria, diarrhea, or intravenous drug abuse.[jrheum.org]
  • He denied any systemic symptoms such as fever, anorexia, weight loss, sweating, cough or dyspnea. The patient had undergone amputation of the right hallux and long toe as complication of diabetes mellitus several years ago.[ijcasereportsandimages.com]
  • 空胞細胞症) 【コクシジウム症】*coccidiosis 【コラーゲン炎】*collagenitis 【コルサコフ症候群】*Korsakoff syndrome 【コレラ】*cholera 【コレステロール塞栓症】*cholesterol embolism *atheroma embolism 【コレラ性下痢】*cholera diarrhea/*choleraic diarrhea 【コンジローマ】*condyloma (呼) 【呼吸緩徐】【呼吸緩慢】*bradypnea ( 徐呼吸) 【呼吸困難】*dyspnea[medo.jp]
Cough
  • He denied any systemic symptoms such as fever, anorexia, weight loss, sweating, cough or dyspnea. The patient had undergone amputation of the right hallux and long toe as complication of diabetes mellitus several years ago.[ijcasereportsandimages.com]
  • せき/ 【咳喘息】*cough variant asthma (略 CVA) (顎) 【顎関節機能障害】【顎関節機能異常】*temporomandibular dysfunction 【顎口蓋裂】*gnathopalatoschisis 【顎口虫症】*gnathostomiasis (含) 【含気性腹膜炎】*pneumoperitonitis 【含歯性嚢胞】 *dentigerous cyst (癌) 【癌】【癌腫】*carcinoma *cancer 【癌腫症】【癌多発症】*carcinomatosis[medo.jp]
Loss of Appetite
  • […] of appetite *dysorexia *anorexia [無食欲] (心) 【心因性冷感症】*psychologic dyspareunia 【心筋炎】*myocarditis 【心室機能不全】*ventricular dysfunction 【心筋梗塞】*myocardial infarction 【心筋障害】【心筋症】*cardiomyopathy *myocardiopathy 【心筋線維症】*myocardial fibrosis (略 MF) 【心筋軟化症】*myomalacia[medo.jp]
Dyschezia
  • 肺胞内肺炎】*intra-alveolar pneumonia 【肺癆】*phthisis pulmonum[L]〈肺結核のこと〉 (敗) 【敗血症】*sepsis *septicemia 【敗血性子宮炎】*septimetritis 【敗血症性ショック】*septic shock (胚) 【胚細胞腫】*germ cell tumor *germinoma (排) 【排尿緩慢】*bradyuria 【排尿困難】*dysuria 【排尿痛】*urodynia *uralgia 【排便困難】【排便障害】*dyschezia[medo.jp]
Oral Ulcers
  • Six months before, she was diagnosed with systemic lupus erythematosus (SLE) on the basis of nonerosive polyarthritis, painless oral ulcers, positive antinuclear antibody (IFI-Hep2) titer of 1:10,240 with homogeneous pattern, and anti-dsDNA (Farr assay[jrheum.org]
Heart Murmur
Skin Lesion
  • No redness, hotness, or skin lesion of the right arm was observed. Yet, there was tenderness over deltoid muscle and stiffness in the range of motion (ROM) of the right shoulder.[ijcasereportsandimages.com]
Joint Deformity
  • Ultrasonography can also differentiate between solid and cystic masses and detect popliteal bursitis in presence of extensive joint deformities.[symptoma.com]
Dysuria
  • At admission she denied any dyspnea, chest pain, rash, dysuria, diarrhea, or intravenous drug abuse.[jrheum.org]
  • *pulmonary alveolar proteinosis (略 PAP) 【肺胞内肺炎】*intra-alveolar pneumonia 【肺癆】*phthisis pulmonum[L]〈肺結核のこと〉 (敗) 【敗血症】*sepsis *septicemia 【敗血性子宮炎】*septimetritis 【敗血症性ショック】*septic shock (胚) 【胚細胞腫】*germ cell tumor *germinoma (排) 【排尿緩慢】*bradyuria 【排尿困難】*dysuria[medo.jp]
Neglect
  • They are the immunocompromised host, patients with underlying bursal disease and the neglected patient with significant cellulitis. Case reports of these types are presented.[arizona.pure.elsevier.com]

Workup

Although the diagnosis of SB is not based on the clinical presentation, it may be suspected in presence of fever, and bursal inflammation as these symptoms are less severe in non-SB. Also, joint mobility is usually preserved in SB while it is limited in other types of bursitis. A detailed history to exclude trauma, occupation injury, comorbid medical conditions (rheumatoid arthritis, gout, diabetes mellitus, syphilis, HIV) should be obtained. A thorough physical examination needs to be performed to look for signs of inflammation locally as well as to exclude bacteremia. Routine laboratory blood work may reveal leukocytosis, elevated inflammatory markers (erythrocyte sedimentation rate, C-reactive protein) while blood culture is indicated if SB in the deep bursae is suspected. Rheumatoid factor (RF), and anti–citric citrullinated peptide (anti-CCP) tests should also be ordered to exclude autoimmune diseases. Aspiration and analysis of the bursal fluid form the mainstay of diagnosing SB as it is likely to show cell counts exceeding 70,000/µL, with a predominance of polymorphonuclear leukocytes (PMNs). Microbiological analysis of the aspirated fluid demonstrates Staphylococcus aureus and other gram-positive organisms in a majority of the cases [2].

Plain radiography will only reveal joint effusion or soft tissue swelling but does not help to detect SB. Although computed tomography (CT) is not required magnetic resonance imaging (MRI) can help to identify local joint anatomy, soft tissue abscesses as well as the bursal fluid [7]. Ultrasonography is useful when the diagnosis is uncertain and to perform ultrasound guided aspiration of the bursa. Ultrasonography can also differentiate between solid and cystic masses and detect popliteal bursitis in presence of extensive joint deformities [8] [9].

Brucella Abortus
  • Although the most common pathogen is S. aureus, other pathogens such as Brucella abortus play an important role in this infection in our area.[ncbi.nlm.nih.gov]
Neisseria Gonorrhoeae
  • Patient characteristics and epidemiologic exposures may provide clues to unusual causative organisms that are occasionally encountered, such as Neisseria gonorrhoeae, Pasteurella multocida, atypical mycobacteria, fungi, and protothecosis.[ncbi.nlm.nih.gov]

Treatment

  • In septic bursitis, the effects of delay in treatment are deleterious by prolonging culture-positivity despite adequate antibiotic therapy.[ncbi.nlm.nih.gov]
  • In this article, surgeons from The Philadelphia Hand Center explore the best treatment for septic olecranon bursitis . Since studies of this problem are limited, evidence-based treatment has not been established.[eorthopod.com]
  • Most of their cases underwent this method of treatment as a salvage procedure due to previous treatment failures. In spite of this, 82% of them had "fair" to "good" short term results.[healio.com]

Prognosis

  • Keywords : Septic bursitis, Cloxacillin, Rifampicin, Gentamicin, Prognosis[em-consulte.com]
  • Prognosis: Most patients recover completely without sequelae. BIBLIOGRAPHY Ho G, Su EY. Antibiotic therapy of septic bursitis: its implication in the treatment of septic arthritis.[rheumaknowledgy.com]
  • When septic bursitis is diagnosed early and treated accordingly, the prognosis is excellent.[cid.oxfordjournals.org]
  • Prognosis Prepatellar bursitis can lead to pain and reduced function of the knee joint. This may be worse if septic bursitis is not recognised promptly. Generally the prognosis is very good with appropriate treatment.[patient.info]

Etiology

  • Although skin necrosis is frequently cited as a complication of open bursectomy, there is limited information in the medical literature on the etiology and management of this rare but serious complication.[ncbi.nlm.nih.gov]
  • Etiology and Pathogenesis 150 bursae in the human body Bacterial inoculation, spread from soft tissue, or hematogenous Superficial bursae – direct inoculation or contiguous spread Separate skin from deeper tissues Prepatellar or infrapatellar – athletes[slideshare.net]

Epidemiology

  • Patient characteristics and epidemiologic exposures may provide clues to unusual causative organisms that are occasionally encountered, such as Neisseria gonorrhoeae, Pasteurella multocida, atypical mycobacteria, fungi, and protothecosis.[ncbi.nlm.nih.gov]
  • Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty[amjorthopedics.com]
  • Introduction Swelling and inflammation of the anterior knee Epidemiology incidence most common bursitis of the knee location bursa anterior to patella risk factors excessive kneeling common in wrestlers concern for septic bursitis in wrestlers Pathophysiology[orthobullets.com]
  • Streptococcus pneumoniae: Epidemiology, risk factors, and strategies for prevention. Semin Respir Crit Care Med 2009;30(2):189–209. [ CrossRef ] [ Pubmed ] Costantino TG, Roemer B, Leber EH.[ijcasereportsandimages.com]
Sex distribution
Age distribution

Pathophysiology

  • Introduction Swelling and inflammation of the anterior knee Epidemiology incidence most common bursitis of the knee location bursa anterior to patella risk factors excessive kneeling common in wrestlers concern for septic bursitis in wrestlers Pathophysiology[orthobullets.com]
  • Overview of Common Superficial Bursitis Major risk factors Location Prevalence Occupation, type of athlete, and other contributors Body positions Most common pathophysiologic mechanism Other pathophysiologic mechanisms Olecranon Common Miners, students[aafp.org]
  • Pathophysiology [ edit ] The literature on the pathophysiology of bursitis describes inflammation as the primary cause of symptoms. Inflammatory bursitis is usually the result of repetitive injury to the bursa.[en.wikipedia.org]
  • Pathophysiologically, the exudation of synovia![healio.com]

Prevention

  • Early recognition, prompt therapy, and preventive measures are necessary to reduce the morbidity of septic bursitis.[ncbi.nlm.nih.gov]
  • Early recognition, prompt therapy, and preventive measures are necessary to reduce the morbidity of septic bursitis. FULL TEXT[annals.org]
  • Elbow (Olecranon) Bursitis Hip (Trochanteric) Bursitis Septic Bursitis Treatment Septic bursitis requires medical attention and antibiotic treatment to prevent the infection from spreading to other parts of the body or into the bloodstream.[arthritis-health.com]

References

Article

  1. Valeriano-Marcet J, Carter JD, Vasey FB. Soft tissue disease. Rheum Dis Clin North Am. 2003;29(1):77.
  2. Zimmermann B 3rd, Mikolich DJ, Ho G Jr. Septic bursitis.Semin Arthritis Rheum. 1995;24(6):391.
  3. Torralba KD, Quismorio FP Jr. Soft tissue infections. Rheum Dis Clin North Am. 2009 Feb; 35(1):45-62.
  4. Laupland KB, Davies HD, Calgary Home Parenteral Therapy Program Study Group. Olecranon septic bursitis managed in an ambulatory setting. The Calgary Home Parenteral Therapy Program Study Group. Clin Invest Med. 2001;24(4):171.
  5. Ho G Jr, Tice AD, Kaplan SR. Septic bursitis in the prepatellar and olecranon bursae: an analysis of 25 cases. Ann Intern Med. 1978;89(1):21.
  6. Canoso JJ, Yood RA. Reaction of superficial bursae in response to specific disease stimuli. Arthritis Rheum. 1979;22(12):1361.
  7. Guanche CA. Clinical update: MR imaging of the hip. Sports Med Arthrosc. 2009 Mar; 17(1):49-55.
  8. Blankstein A, Ganel A, Givon U, Mirovski Y, Chechick A. Ultrasonographic findings in patients with olecranon bursitis. Ultraschall Med. 2006 Dec; 27(6):568-71.
  9. Tsai YH, Huang TJ, Hsu WH, et al. Detection of subacromial bursa thickening by sonography in shoulder impingement syndrome. Chang Gung Med J. 2007 Mar-Apr; 30(2):135-41.

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Last updated: 2019-07-11 21:50