Septic arthritis differential diagnosis: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
Line 58: | Line 58: | ||
|} | |} | ||
=== Infectious Differential for Bacterial arthritis === | === Infectious Differential for Bacterial arthritis === | ||
Line 293: | Line 197: | ||
* Septic and sterile synovitis | * Septic and sterile synovitis | ||
** Septic joint more common in IVDA | ** Septic joint more common in IVDA | ||
|} | |||
=== Differentiatial Diagnsosis for Acute Arthritis === | |||
Septic arthritis should be differentiated from other causes of acute arthritis:<ref name="pmid7547108">Goldenberg DL (1995) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7547108 Bacterial arthritis.] ''Curr Opin Rheumatol'' 7 (4):310-4. PMID: [https://pubmed.gov/7547108 7547108]</ref><ref name="pmid2198352">Shmerling RH, Delbanco TL, Tosteson AN, Trentham DE (1990) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2198352 Synovial fluid tests. What should be ordered?] ''JAMA'' 264 (8):1009-14. PMID: [https://pubmed.gov/2198352 2198352]</ref><ref name="pmid18508984">Mathews CJ, Kingsley G, Field M, Jones A, Weston VC, Phillips M et al. (2008) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18508984 Management of septic arthritis: a systematic review.] ''Postgrad Med J'' 84 (991):265-70. [http://dx.doi.org/10.1136/ard.2006.058909 DOI:10.1136/ard.2006.058909] PMID: [https://pubmed.gov/18508984 18508984]</ref><ref name="pmid11171695">Jalava J, Skurnik M, Toivanen A, Toivanen P, Eerola E (2001) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=11171695 Bacterial PCR in the diagnosis of joint infection.] ''Ann Rheum Dis'' 60 (3):287-9. PMID: [https://pubmed.gov/11171695 11171695]</ref><ref name="pmid8185697">Liebling MR, Arkfeld DG, Michelini GA, Nishio MJ, Eng BJ, Jin T et al. (1994) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8185697 Identification of Neisseria gonorrhoeae in synovial fluid using the polymerase chain reaction.] ''Arthritis Rheum'' 37 (5):702-9. PMID: [https://pubmed.gov/8185697 8185697]</ref> | |||
{| border="1" | |||
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Type of | |||
Arthritis}} | |||
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Color}} | |||
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Transparency}} | |||
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Viscosity}} | |||
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|WBC count | |||
(per mm3)}} | |||
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|PMN | |||
cellcount (%)}} | |||
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Gram stain}} | |||
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Gram Culture}} | |||
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|polymerase chain reaction | |||
(PCR) test}} | |||
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Crystals}} | |||
|- | |||
! Normal !! Clear !! Transparent !! High/thick !! < 200 !! < 25 !! Negative !! Negative !! Negative !! Negative | |||
|- | |||
!Gonococcal arthritis | |||
!Yellow | |||
!Cloudy-opaque | |||
!Low | |||
!34,000 to 68,000 | |||
!> 75 | |||
!Variable (< 50 percent) | |||
!Positive (25 to 70 percent) | |||
!Positive (> 75 percent) | |||
!Negative | |||
|- | |||
!Non-gonococcal arthritis | |||
!Yellowish-green | |||
!Opaque | |||
!Very low | |||
!> 50,000 (> 100,000 is | |||
more specific) | |||
!> 75 | |||
!Positive (60 to | |||
80 percent) | |||
!Positive (> 90 percent) | |||
!-- | |||
!Negative | |||
|- | |||
!Inflammatory: | |||
crystalline arthritis | |||
(e.g.Gout, Pseudo gout) | |||
!Yellow | |||
!Cloudy | |||
!Low/thin | |||
!2,000 to 100,000 | |||
!> 50 | |||
!Negative | |||
!Negative | |||
!Negative | |||
!Positive | |||
|- | |||
!Inflammatory: | |||
non-crystalline arthritis | |||
(e.g. Rheumatoid arthritis) | |||
!Yellow | |||
!Cloudy | |||
!Low/thin | |||
!2,000 to 100,000 | |||
!> 50 | |||
!Negative | |||
!Negative | |||
!Negative | |||
!Negative | |||
|- | |||
!Noninflammatory arthritis | |||
(e.g. Osteoarthritis) | |||
!Straw | |||
!Translucent | |||
!High/thick | |||
!200 to 2,000 | |||
!< 25 | |||
!Negative | |||
!Negative | |||
!Negative | |||
!Negative | |||
|- | |||
!Lyme arthritis | |||
!Yellow | |||
!Cloudy | |||
!Low | |||
!3,000 to 100,000 | |||
(mean: 25,000) | |||
!> 50 | |||
!Negative | |||
!Negative | |||
!Positive (85 percent) | |||
!Negative | |||
|} | |} | ||
Revision as of 14:39, 17 January 2017
Septic arthritis Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Septic arthritis differential diagnosis On the Web |
American Roentgen Ray Society Images of Septic arthritis differential diagnosis |
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
Characterestic | Gonococcal arthritis | Non gonococcal arthritis |
---|---|---|
Patient profile |
|
|
Initial presentation |
|
|
Polyarticular involvement |
|
|
Recovery of bacteria |
|
|
Response to antibiotics |
|
|
Infectious Differential for Bacterial arthritis
Microorganism or other infectious disease | Associated risk factors | Key clinical clues |
---|---|---|
Staphylococcus aureus |
| |
Streptococcus pyogenes
Streptococcal pneumonia |
| |
Groups B Streptococcal infection |
|
|
Neisseria gonorrhoeae |
|
|
Gram-negative bacilli
|
|
|
Haemophilus influenzae |
|
|
Anaerobes |
|
|
Mycobacterium spp. |
|
|
Fungal infection such as
|
|
|
Mycoplasma hominis |
|
|
Viral arthritis |
|
|
HIV infection |
|
|
Lyme disease |
|
|
Reactive arthritis |
|
|
Endocarditis |
|
|
Differentiatial Diagnsosis for Acute Arthritis
Septic arthritis should be differentiated from other causes of acute arthritis:[9][10][11][12][13]
Type of
Arthritis |
Color | Transparency | Viscosity | WBC count
(per mm3) |
PMN
cellcount (%) |
Gram stain | Gram Culture | polymerase chain reaction
(PCR) test |
Crystals |
---|---|---|---|---|---|---|---|---|---|
Normal | Clear | Transparent | High/thick | < 200 | < 25 | Negative | Negative | Negative | Negative |
Gonococcal arthritis | Yellow | Cloudy-opaque | Low | 34,000 to 68,000 | > 75 | Variable (< 50 percent) | Positive (25 to 70 percent) | Positive (> 75 percent) | Negative |
Non-gonococcal arthritis | Yellowish-green | Opaque | Very low | > 50,000 (> 100,000 is
more specific) |
> 75 | Positive (60 to
80 percent) |
Positive (> 90 percent) | -- | Negative |
Inflammatory:
crystalline arthritis (e.g.Gout, Pseudo gout) |
Yellow | Cloudy | Low/thin | 2,000 to 100,000 | > 50 | Negative | Negative | Negative | Positive |
Inflammatory:
non-crystalline arthritis (e.g. Rheumatoid arthritis) |
Yellow | Cloudy | Low/thin | 2,000 to 100,000 | > 50 | Negative | Negative | Negative | Negative |
Noninflammatory arthritis
(e.g. Osteoarthritis) |
Straw | Translucent | High/thick | 200 to 2,000 | < 25 | Negative | Negative | Negative | Negative |
Lyme arthritis | Yellow | Cloudy | Low | 3,000 to 100,000
(mean: 25,000) |
> 50 | Negative | Negative | Positive (85 percent) | Negative |
References
- ↑ 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
- ↑ 2.0 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
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ Goldenberg DL (1995) Bacterial arthritis. Curr Opin Rheumatol 7 (4):310-4. PMID: 7547108
- ↑ Shmerling RH, Delbanco TL, Tosteson AN, Trentham DE (1990) Synovial fluid tests. What should be ordered? JAMA 264 (8):1009-14. PMID: 2198352
- ↑ Mathews CJ, Kingsley G, Field M, Jones A, Weston VC, Phillips M et al. (2008) Management of septic arthritis: a systematic review. Postgrad Med J 84 (991):265-70. DOI:10.1136/ard.2006.058909 PMID: 18508984
- ↑ Jalava J, Skurnik M, Toivanen A, Toivanen P, Eerola E (2001) Bacterial PCR in the diagnosis of joint infection. Ann Rheum Dis 60 (3):287-9. PMID: 11171695
- ↑ Liebling MR, Arkfeld DG, Michelini GA, Nishio MJ, Eng BJ, Jin T et al. (1994) Identification of Neisseria gonorrhoeae in synovial fluid using the polymerase chain reaction. Arthritis Rheum 37 (5):702-9. PMID: 8185697