Septic arthritis differential diagnosis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
Line 62: Line 62:
! '''Microorganism''' !! '''Associated risk factors'''
! '''Microorganism''' !! '''Associated risk factors'''
!Key clinical clues
!Key clinical clues
!Most definitive tests
|-
|-
! '''Staphylococcus aureus'''
! '''Staphylococcus aureus'''
Line 71: Line 70:
|
|
* Healthy adult with skin lesions and previously history of damaged joint (e.g, rheumatoid arthritis) or prosthetic joint
* Healthy adult with skin lesions and previously history of damaged joint (e.g, rheumatoid arthritis) or prosthetic joint
|
|-
|-
! '''Streptococcus pyogenes'''  
! '''Streptococcus pyogenes'''  
Line 81: Line 79:
|
|
* Healthy adults with spleenic dysfunction
* Healthy adults with spleenic dysfunction
|
|-
|-
! '''Groups B Streptococcal infection'''
! '''Groups B Streptococcal infection'''
Line 91: Line 88:
|
|
* Healthy adults with spleenic dysfunction
* Healthy adults with spleenic dysfunction
|
|-
|-
!'''Neisseria gonorrhoeae'''
!'''Neisseria gonorrhoeae'''
Line 105: Line 101:
** Complement deficiency (C5-9 deficiency)  
** Complement deficiency (C5-9 deficiency)  
** Culture negativity on synovial fluid analysis
** Culture negativity on synovial fluid analysis
|
|-
|-
| '''Gram-negative bacilli'''
| '''Gram-negative bacilli'''
Line 118: Line 113:
* Immunocompromised patients
* Immunocompromised patients
* Recent history gastrointestinal infections such as infectious diarrhea caused by Shigella, Salmonella, Campylobacter, or Yersinia
* Recent history gastrointestinal infections such as infectious diarrhea caused by Shigella, Salmonella, Campylobacter, or Yersinia
|
|-
|-
!'''Haemophilus influenzae'''
!'''Haemophilus influenzae'''
|
|
* Unimmunized children<ref name="pmid7497542">De Jonghe M, Glaesener G (1995) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7497542 [Type B Haemophilus influenzae infections. Experience at the Pediatric Hospital of Luxembourg].] ''Bull Soc Sci Med Grand Duche Luxemb'' 132 (2):17-20. PMID: [https://pubmed.gov/7497542 7497542]</ref>
* Unimmunized children<ref name="pmid7497542">De Jonghe M, Glaesener G (1995) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7497542 [Type B Haemophilus influenzae infections. Experience at the Pediatric Hospital of Luxembourg].] ''Bull Soc Sci Med Grand Duche Luxemb'' 132 (2):17-20. PMID: [https://pubmed.gov/7497542 7497542]</ref>
|
|
|
|-
|-
Line 133: Line 126:
* Immunocompromised hosts
* Immunocompromised hosts
* Recent history of gastrointestinal infection
* Recent history of gastrointestinal infection
|
|-
|-
!'''Mycobacterium spp.'''
!'''Mycobacterium spp.'''
Line 142: Line 134:
* Recent history of travel to endemic areas (e.g. India, South Africa, Mexico etc.)
* Recent history of travel to endemic areas (e.g. India, South Africa, Mexico etc.)
* Incidious onset of monoarthritis
* Incidious onset of monoarthritis
| rowspan="2" |
* Synovial fluid analysis
* Histology
* Tissue culture
|-
|-
|'''Fungal infection''' such as  
|'''Fungal infection''' such as  
Line 164: Line 152:
* Immunocompromised patients
* Immunocompromised patients
* Recent history of urinary tract procedure<ref name="pmid7888535">Luttrell LM, Kanj SS, Corey GR, Lins RE, Spinner RJ, Mallon WJ et al. (1994) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7888535 Mycoplasma hominis septic arthritis: two case reports and review.] ''Clin Infect Dis'' 19 (6):1067-70. PMID: [https://pubmed.gov/7888535 7888535]</ref>
* Recent history of urinary tract procedure<ref name="pmid7888535">Luttrell LM, Kanj SS, Corey GR, Lins RE, Spinner RJ, Mallon WJ et al. (1994) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7888535 Mycoplasma hominis septic arthritis: two case reports and review.] ''Clin Infect Dis'' 19 (6):1067-70. PMID: [https://pubmed.gov/7888535 7888535]</ref>
|
|-
|-
!Viral arthritis
!Viral arthritis
Line 173: Line 160:
* Fever
* Fever
* Rash
* Rash
|
* Serology
|-
|-
!HIV infection
!HIV infection
Line 182: Line 167:
|
|
* Sterile, acute synovitis or reactive arthritis
* Sterile, acute synovitis or reactive arthritis
|
* Serology
|-
|-
!Lyme disease
!Lyme disease
Line 191: Line 174:
* History of erythema Serology migrans
* History of erythema Serology migrans
* History of recent visit to endemic Lyme area
* History of recent visit to endemic Lyme area
|
* Serology
|-
|-
!Reactive arthritis
!Reactive arthritis
Line 203: Line 184:
* Uveitis
* Uveitis
* Conjunctivitis
* Conjunctivitis
|
* Radiological sacroiliitis
* HLA-B27
|-
|-
!Endocarditis
!Endocarditis
Line 217: Line 195:
* Septic and sterile synovitis
* Septic and sterile synovitis
** Septic joint more common in IVDA
** Septic joint more common in IVDA
|Blood culture
|}
|}


Revision as of 19:13, 12 January 2017

Septic arthritis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Septic Arthritis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Other Diagnostic Studies

Treatment

Medical Therapy

Surgical Therapy

Primary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Septic arthritis differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Septic arthritis differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Septic arthritis differential diagnosis

CDC on Septic arthritis differential diagnosis

Septic arthritis differential diagnosis in the news

Blogs on Septic arthritis differential diagnosis

Directions to Hospitals Treating Septic arthritis

Risk calculators and risk factors for Septic arthritis differential diagnosis

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

Differential Diagnosis

Differentiating gonococcal arthritis from non-gonococcal arthritis
Characterestic Gonococcal arthritis Non gonococcal arthritis
Patient profile
  • Mostly sexually active young adult
  • Female > male
  • Patient with history of rheumatoid arthritis or other systemic arthritis
  • Immunocompromised patient
  • Common in extremes of age such as in newborn or elderly
Initial presentation
  • Migratory polyarthralgia is common
  • Tenosynovitis in majority of patients
  • Dermatitis in majority of patients
  • Single hot, swollen and painful joint
  • Polyarthralgia is very rare
  • Tenosynovitis and dermatitis are very rare.
Polyarticular involvement
  • Common (~40–70% of patients)
  • Usually involves 2-3 joints
  • Rare (~10–20% of patients).
  • Mostly monoarticular involvement (>85%)
Recovery of bacteria
  • Positive blood culture <10%
  • Positive synovial fluid culture <50%
  • Positive blood culture 50%
  • Positive synovial fluid culture >90%
Response to antibiotics
  • Within a few days outcome excellent
  • Takes weeks
  • Joint drainage must be adequate
  • Outcome often poor

Differential Diagnosis for Bacterial arthritis

Microorganism Associated risk factors Key clinical clues
Staphylococcus aureus
  • Rheumatioid arthritis[1]
  • Diabetes mellitus[2]
  • HIV patients[3]
  • Healthy adult with skin lesions and previously history of damaged joint (e.g, rheumatoid arthritis) or prosthetic joint
Streptococcus pyogenes

Streptococcal pneumonia

  • Autoimmune diseases[4]
  • Chronic skin infections[2]
  • Trauma
  • Healthy adults with spleenic dysfunction
Groups B Streptococcal infection
  • Immunocompromised patients[5]
  • Diabetes mellitus
  • Malignancy
  • Severe genitourinary or gastrointestinal infections
  • Healthy adults with spleenic dysfunction
Neisseria gonorrhoeae
  • Complement deficiency
  • Systemic lupus erythematosus
  • Male homosexuality
  • low socioeconomic status
  • Healthy young and sexually active adult with
    • Tenosynovitis
    • Skin lesions such as vesicular pustules
    • Complement deficiency (C5-9 deficiency)
    • Culture negativity on synovial fluid analysis
Gram-negative bacilli
  • Pseudomonas
  • Escherichia coli
  • History of intravenous drug abuse[6]
  • Extremes of age
  • Immunocompromised patients
  • Immunocompromised patients
  • Recent history gastrointestinal infections such as infectious diarrhea caused by Shigella, Salmonella, Campylobacter, or Yersinia
Haemophilus influenzae
  • Unimmunized children[7]
Anaerobes
  • Diabetes mellitus
  • Patients with prosthetic joints
  • Immunocompromised hosts
  • Recent history of gastrointestinal infection
Mycobacterium spp.
  • Recent history of travel to endemic areas
  • Immunocompromised patients
  • Recent history of travel to endemic areas (e.g. India, South Africa, Mexico etc.)
  • Incidious onset of monoarthritis
Fungal infection such as
  • Blastomycosis
  • Cryptococcus
  • Coccidioidomycosis
  • Sporotrichosis
  • Immunocompromised patients
  • Immunocompromised patients
  • Incidious onset of monoarthritis
Mycoplasma hominis
  • Recent history of urinary tract procedure
  • Immunocompromised patients
  • Recent history of urinary tract procedure[8]
Viral arthritis
  • Immunocompromised patient
  • Polyarthritis
  • Fever
  • Rash
HIV infection
  • History of multiple sexual partners
  • History of IVDA
  • Sterile, acute synovitis or reactive arthritis
Lyme disease
  • History of recent visit to endemic Lyme area
  • History of erythema Serology migrans
  • History of recent visit to endemic Lyme area
Reactive arthritis
  • Recent gastrointestinal/ genitourinary infection
  • Recent gastrointestinal/ genitourinary infection
  • Enthesopathy
  • Skin lesions
  • Uveitis
  • Conjunctivitis
Endocarditis
  • History of endocarditis
  • Damaged heart valves
  • Congenital heart diseases
  • Fever
  • New onset of heart murmur
  • Septic and sterile synovitis
    • Septic joint more common in IVDA

References

  1. ↑ Goldenberg DL, Cohen AS (1976) Acute infectious arthritis. A review of patients with nongonococcal joint infections (with emphasis on therapy and prognosis). Am J Med 60 (3):369-77. PMID: 769545
  2. ↑ 2.0 2.1 Le Dantec L, Maury F, Flipo RM, Laskri S, Cortet B, Duquesnoy B et al. (1996) Peripheral pyogenic arthritis. A study of one hundred seventy-nine cases. Rev Rhum Engl Ed 63 (2):103-10. PMID: 8689280
  3. ↑ Vassilopoulos D, Chalasani P, Jurado RL, Workowski K, Agudelo CA (1997) Musculoskeletal infections in patients with human immunodeficiency virus infection. Medicine (Baltimore) 76 (4):284-94. PMID: 9279334
  4. ↑ 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
  5. ↑ Schattner A, Vosti KL (1998) Bacterial arthritis due to beta-hemolytic streptococci of serogroups A, B, C, F, and G. Analysis of 23 cases and a review of the literature. Medicine (Baltimore) 77 (2):122-39. PMID: 9556703
  6. ↑ 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
  7. ↑ De Jonghe M, Glaesener G (1995) [Type B Haemophilus influenzae infections. Experience at the Pediatric Hospital of Luxembourg.] Bull Soc Sci Med Grand Duche Luxemb 132 (2):17-20. PMID: 7497542
  8. ↑ Luttrell LM, Kanj SS, Corey GR, Lins RE, Spinner RJ, Mallon WJ et al. (1994) Mycoplasma hominis septic arthritis: two case reports and review. Clin Infect Dis 19 (6):1067-70. PMID: 7888535


Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Septic_arthritis_differential_diagnosis&oldid=1282592"