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{{Septic arthritis}}
{{Septic arthritis}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' Jumana Nagarwala, M.D., ''Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital''; {{CZ}}
{{CMG}}; {{AE}}{{VSKP}}


==Overview==
==Overview==
Septic arthritis develops when bacteria or other tiny disease-causing organisms (microorganisms) spread through the bloodstream to a joint. It may also occur when the joint is directly infected with a microorganism from an injury or during surgery. The most common sites for this type of infection are the knee and hip. Most cases of acute septic arthritis are caused by bacteria such as staphylococcus or streptococcus. Chronic septic arthritis (which is less common) is caused by organisms such as Mycobacterium tuberculosis and Candida albicans.
Septic arthritis develops when [[bacteria]] or tiny disease-causing [[microorganisms]] that spread through the bloodstream to a [[synovium]]. It may also occur when the joint is directly infected with a microorganism from an injury or during [[surgery]].<ref name="pmid8412643">Dubost JJ, Fis I, Denis P, Lopitaux R, Soubrier M, Ristori JM et al. (1993) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8412643 Polyarticular septic arthritis.] ''Medicine (Baltimore)'' 72 (5):296-310. PMID: [https://pubmed.gov/8412643 8412643]</ref> The most common etiological agent of all [[Nongonococcal urethritis|nongonococcal]] causes of septic arthritis in the United States is [[Staphylococcus aureus]].<ref name="pmid2283490">Deesomchok U, Tumrasvin T (1990) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2283490 Clinical study of culture-proven cases of non-gonococcal arthritis.] ''J Med Assoc Thai'' 73 (11):615-23. PMID: [https://pubmed.gov/2283490 2283490]</ref> The most common sites for this type of infection are the knee and hip. Most cases of acute septic arthritis are caused by bacteria such as [[staphylococcus]] or [[streptococcus]]. Chronic septic arthritis (which is less common) is caused by organisms such as [[Mycobacterium tuberculosis]] and [[Candida albicans]].[[Gram-negative bacilli]] account for 10 to 20% of septic arthritis causes.<ref name="pmid2283490">Deesomchok U, Tumrasvin T (1990) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2283490 Clinical study of culture-proven cases of non-gonococcal arthritis.] ''J Med Assoc Thai'' 73 (11):615-23. PMID: [https://pubmed.gov/2283490 2283490]</ref> ~10% of patients with nongonococcal septic arthritis are due to polymicrobial cause of infections. Anaerobes are also can cause septic arthritis in few cases.


==Causes==
==Causes==
Bacteria are carried by the bloodstream from an infectious focus elsewhere, introduced by a [[skin]] [[lesion]] that penetrates the joint, or by extension from adjacent tissue (e.g. bone or bursae).
[[Gram-negative bacilli]] account for 10 to 20% of septic arthritis causes.<ref name="pmid2283490">Deesomchok U, Tumrasvin T (1990) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2283490 Clinical study of culture-proven cases of non-gonococcal arthritis.] ''J Med Assoc Thai'' 73 (11):615-23. PMID: [https://pubmed.gov/2283490 2283490]</ref> ~10% of patients with [[Nongonococcal urethritis|nongonococcal]] septic arthritis are due to polymicrobial cause of infections. Anaerobes are also can cause septic arthritis in few cases. Most common cause of septic arthritis in children age < 2 years are [[Haemophilus influenzae]] (in immunized children), [[Staphylococcus aureus|Staph. aureus]], [[Group A streptococcal infection|group A Streptococcal infections]] and [[Kingella|Kingella kingae]].<ref name="pmid7735407">Yagupsky P, Bar-Ziv Y, Howard CB, Dagan R (1995) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7735407 Epidemiology, etiology, and clinical features of septic arthritis in children younger than 24 months.] ''Arch Pediatr Adolesc Med'' 149 (5):537-40. PMID: [https://pubmed.gov/7735407 7735407]</ref> The source of infection in most of the cases (~50%) often from the [[skin]], [[lungs]] or [[Urinary bladder|bladder]].
===Common Causes===
Common microorganisms causing septic arthritis includes:<ref name=Axford>{{cite book |author=O'Callaghan C, Axford JS |title=Medicine |publisher=Blackwell Science |location=Oxford |year=2004 |pages= |isbn=0-632-05162-0 |edition=2nd ed.}}</ref><ref name="pmid9269165">Bowerman SG, Green NE, Mencio GA (1997) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9269165 Decline of bone and joint infections attributable to haemophilus influenzae type b.] ''Clin Orthop Relat Res''  (341):128-33. PMID: [https://pubmed.gov/9269165 9269165]</ref><ref name="pmid9619939">Peltola H, Kallio MJ, Unkila-Kallio L (1998) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9619939 Reduced incidence of septic arthritis in children by Haemophilus influenzae type-b vaccination. Implications for treatment.] ''J Bone Joint Surg Br'' 80 (3):471-3. PMID: [https://pubmed.gov/9619939 9619939]</ref><ref name=Axford>{{cite book |author=O'Callaghan C, Axford JS |title=Medicine |publisher=Blackwell Science |location=Oxford |year=2004 |pages= |isbn=0-632-05162-0 |edition=2nd ed.}}</ref><ref>[http://wordnet.com.au/Products/topics_in_infectious_diseases_Aug01.htm Topics in Infectious Diseases Newsletter, August 2001, Pseudomonas aeruginosa.]</ref><ref name=Axford>{{cite book |author=O'Callaghan C, Axford JS |title=Medicine |publisher=Blackwell Science |location=Oxford |year=2004 |pages= |isbn=0-632-05162-0 |edition=2nd ed.}}</ref><ref name="pmid9306869">Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA (1997) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9306869 Incidence and sources of native and prosthetic joint infection: a community based prospective survey.] ''Ann Rheum Dis'' 56 (8):470-5. PMID: [https://pubmed.gov/9306869 9306869]</ref>
* [[Staphylococcus aureus]]
* [[Streptococcal Infection|Streptococcal pyogenous]]
* [[Streptococcal Infection|Streptococcal agalectae]]
* [[Streptococcal Infection|Streptococcal pneumonia]]
* [[Neisseria gonorrhoeae]]
* [[Escherichia coli]]
* [[Staphylococcus epidermidis]]
* [[Haemophilus influenzae]]
* [[Pseudomonas aeruginosa]]
* [[Salmonella]]


Microorganisms must reach the [[synovial membrane]] of a joint.  This can happen in any of the following ways:
=== Less Common Causes ===
* Dissemination of [[pathogen]]s via the blood, from [[abscess]]es or wound infections,
* [[Peptostreptococcus]]
* Dissemination from an [[osteomyelitis|acute osteomyelitic focus]],
* [[Bacteroides fragilis]]
* Dissemination from adjacent [[soft tissue]] infection,
* [[Fusobacterium species]] 
* Entry via [[penetrating trauma]]
* [[Borrelia burgdorferi]]
* Entry via [[iatrogenic]] means.<ref name=Axford/>
* [[Brucella]]
* [[Mycobacterium tuberculosis]]
* [[Mycoplasma hominis]]
* Fungal infection such as
** [[Blastomycosis]]
** [[Cryptococcus]]
** [[Coccidioidomycosis]]
** [[Sporotrichosis]]
** [[Candida]]


Bacteria that are commonly found to cause septic arthritis are:
* [[Staphylococcus aureus]] - the most common cause in adults
* ''Streptococci'' - the second most common cause <ref name=Kaandorp>{{cite journal |author=Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA |title=Incidence and sources of native and prosthetic joint infection: a community based prospective survey |journal=Ann Rheum Dis.  |volume=56 |issue=8 |pages=470–5 |year=1997 |month=August |pmid=9306869 |pmc=1752430 |doi= |url=}}<br/>{{cite journal |author=Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M |title=Clinical features and outcome of septic arthritis in a single UK Health District 1982-1991 |journal=Ann Rheum Dis. |volume=58 |issue=4 |pages=214–9 |year=1999 |month=April |pmid=10364899 |pmc=1752863 |doi= |url=}}</ref>
* [[Haemophilus influenzae]] - was the most common cause in children but is now uncommon in areas where Haemophilus vaccination is practiced<ref>{{cite journal |author=Bowerman SG, Green NE, Mencio GA |title=Decline of bone and joint infections attributable to haemophilus influenzae type b |journal=Clin Orthop Relat Res. |volume= |issue=341 |pages=128–33 |year=1997 |month=August |pmid=9269165 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0009-921X&volume=341&spage=128}}<br/>{{cite journal |author=Peltola H, Kallio MJ, Unkila-Kallio L |title=Reduced incidence of septic arthritis in children by Haemophilus influenzae type-b vaccination. Implications for treatment |journal=J Bone Joint Surg Br. |volume=80 |issue=3 |pages=471–3 |year=1998 |month=May |pmid=9619939 |doi= |url=http://www.jbjs.org.uk/cgi/pmidlookup?view=long&pmid=9619939}}
</ref>
* [[gonorrhea|Neisseria gonorrhoea]] - in young adults (although this is now thought rare in western europe <ref name=Kaandorp/>
* [[Escherichia coli]] - in the elderly, IV drug users and the seriously ill
* [[M. tuberculosis]], [[Salmonella]] spp. and [[Brucella]] spp. - cause septic spinal arthritis <ref name=Axford>{{cite book |author=O'Callaghan C, Axford JS |title=Medicine |publisher=Blackwell Science |location=Oxford |year=2004 |pages= |isbn=0-632-05162-0 |edition=2nd ed.}}</ref>


In bacterial infection, [[Pseudomonas aeruginosa]] has been found to infect joints, especially in children who have sustained a puncture wound. This bacteria also causes [[endocarditis]].<ref>[http://wordnet.com.au/Products/topics_in_infectious_diseases_Aug01.htm Topics in Infectious Diseases Newsletter, August 2001, Pseudomonas aeruginosa.]</ref>
{| border="2" cellpadding="4" cellspacing="0" style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;" width="75%"
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Microorganism or other infectious disease'''}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF| '''Associated risk factors'''}}
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Key clinical clues}}
|-
! '''[[Staphylococcus aureus]]'''
|
* [[Rheumatoid arthritis]]<ref name="pmid769545">Goldenberg DL, Cohen AS (1976) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=769545 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: [https://pubmed.gov/769545 769545]</ref>
* [[Diabetes mellitus]]<ref name="pmid8689280">Le Dantec L, Maury F, Flipo RM, Laskri S, Cortet B, Duquesnoy B et al. (1996) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8689280 Peripheral pyogenic arthritis. A study of one hundred seventy-nine cases.] ''Rev Rhum Engl Ed'' 63 (2):103-10. PMID: [https://pubmed.gov/8689280 8689280]</ref>
* [[Human Immunodeficiency Virus (HIV)|HIV]] patients<ref name="pmid9279334">Vassilopoulos D, Chalasani P, Jurado RL, Workowski K, Agudelo CA (1997) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9279334 Musculoskeletal infections in patients with human immunodeficiency virus infection.] ''Medicine (Baltimore)'' 76 (4):284-94. PMID: [https://pubmed.gov/9279334 9279334]</ref>
|
* Healthy adult with skin lesions and previously history of damaged joint (e.g, [[rheumatoid arthritis]]) or [[Prosthetic|prosthetic joint]]
|-
! '''[[Streptococcus pyogenes]]'''
'''[[Streptococcal Infection|Streptococcal pneumonia]]'''
|
* [[Autoimmune diseases]]<ref name="pmid8972665">Morgan DS, Fisher D, Merianos A, Currie BJ (1996) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8972665 An 18 year clinical review of septic arthritis from tropical Australia.] ''Epidemiol Infect'' 117 (3):423-8. PMID: [https://pubmed.gov/8972665 8972665]</ref>
* Chronic skin infections<ref name="pmid8689280">Le Dantec L, Maury F, Flipo RM, Laskri S, Cortet B, Duquesnoy B et al. (1996) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8689280 Peripheral pyogenic arthritis. A study of one hundred seventy-nine cases.] ''Rev Rhum Engl Ed'' 63 (2):103-10. PMID: [https://pubmed.gov/8689280 8689280]</ref>
* Trauma
|
* Healthy adults with spleenic dysfunction
|-
! '''[[Group B streptococcal infection|Groups B Streptococcal infection]]'''
|
* [[Immunocompromised]] patients<ref name="pmid9556703">Schattner A, Vosti KL (1998) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9556703 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: [https://pubmed.gov/9556703 9556703]</ref>
* [[Diabetes mellitus]]
* [[Malignancy]]
* Severe [[Genitourinary pathology|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 [[Pustules|vesicular pustules]]
** [[Complement deficiency]] (C5-9 deficiency)
** Culture negativity on synovial fluid analysis
|-
| '''[[Gram-negative bacilli]]'''
* [[Pseudomonas]]
 
* [[Escherichia coli]]
|
* History of intravenous drug abuse<ref name="pmid2283490">Deesomchok U, Tumrasvin T (1990) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2283490 Clinical study of culture-proven cases of non-gonococcal arthritis.] ''J Med Assoc Thai'' 73 (11):615-23. PMID: [https://pubmed.gov/2283490 2283490]</ref>
* Extremes of age
* [[Immunocompromised host|Immunocompromised patients]]
|
* [[Immunocompromised host|Immunocompromised patients]]
* Recent history gastrointestinal infections such as [[infectious diarrhea]] caused by [[Shigella]], [[Salmonella]], [[Campylobacter]], or [[Yersinia]]
|-
!'''[[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>
|
|-
!'''[[Anaerobes]]'''
|
* [[Diabetes mellitus]] 
* Patients with [[Prosthetic|prosthetic joints]]
|
* [[Immunocompromised host|Immunocompromised hosts]]
* Recent history of gastrointestinal infection
|-
!'''[[Mycobacterium|Mycobacterium spp.]]'''
|
* Recent history of travel to endemic areas
|
* [[Immunocompromised host|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 host|Immunocompromised patients]]
|
* [[Immunocompromised host|Immunocompromised patients]]
* Incidious onset of monoarthritis
|-
!'''[[Mycoplasma hominis]]'''
|
* Recent history of urinary tract procedure
|
* [[Immunocompromised host|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>
|-
!Viral arthritis
|
* [[Immunocompromised host|Immunocompromised patient]]
|
* Polyarthritis
* [[Fever]]
* [[Rash]]
|-
![[Human Immunodeficiency Virus (HIV)|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 chronicum migrans|erythema 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 [[Heart murmur|murmur]]
* Septic and sterile [[synovitis]]
** Septic joint more common in IVDA
|}


==References==
==References==
{{reflist|2}}
{{Reflist|2}}


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Latest revision as of 00:08, 30 July 2020

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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

Septic arthritis develops when bacteria or tiny disease-causing microorganisms that spread through the bloodstream to a synovium. It may also occur when the joint is directly infected with a microorganism from an injury or during surgery.[1] The most common etiological agent of all nongonococcal causes of septic arthritis in the United States is Staphylococcus aureus.[2] The most common sites for this type of infection are the knee and hip. Most cases of acute septic arthritis are caused by bacteria such as staphylococcus or streptococcus. Chronic septic arthritis (which is less common) is caused by organisms such as Mycobacterium tuberculosis and Candida albicans.Gram-negative bacilli account for 10 to 20% of septic arthritis causes.[2] ~10% of patients with nongonococcal septic arthritis are due to polymicrobial cause of infections. Anaerobes are also can cause septic arthritis in few cases.

Causes

Gram-negative bacilli account for 10 to 20% of septic arthritis causes.[2] ~10% of patients with nongonococcal septic arthritis are due to polymicrobial cause of infections. Anaerobes are also can cause septic arthritis in few cases. Most common cause of septic arthritis in children age < 2 years are Haemophilus influenzae (in immunized children), Staph. aureus, group A Streptococcal infections and Kingella kingae.[3] The source of infection in most of the cases (~50%) often from the skin, lungs or bladder.

Common Causes

Common microorganisms causing septic arthritis includes:[4][5][6][4][7][4][8]

Less Common Causes


Microorganism or other infectious disease Associated risk factors Key clinical clues
Staphylococcus aureus
Streptococcus pyogenes

Streptococcal pneumonia

  • Healthy adults with spleenic dysfunction
Groups B Streptococcal infection
  • Healthy adults with spleenic dysfunction
Neisseria gonorrhoeae
Gram-negative bacilli
Haemophilus influenzae
  • Unimmunized children[14]
Anaerobes
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
Mycoplasma hominis
  • Recent history of urinary tract procedure
Viral arthritis
HIV infection
  • History of multiple sexual partners
  • History of IVDA
Lyme disease
  • History of recent visit to endemic Lyme area
Reactive arthritis
  • Recent gastrointestinal/ genitourinary infection
Endocarditis

References

  1. ↑ Dubost JJ, Fis I, Denis P, Lopitaux R, Soubrier M, Ristori JM et al. (1993) Polyarticular septic arthritis. Medicine (Baltimore) 72 (5):296-310. PMID: 8412643
  2. ↑ 2.0 2.1 2.2 2.3 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
  3. ↑ Yagupsky P, Bar-Ziv Y, Howard CB, Dagan R (1995) Epidemiology, etiology, and clinical features of septic arthritis in children younger than 24 months. Arch Pediatr Adolesc Med 149 (5):537-40. PMID: 7735407
  4. ↑ 4.0 4.1 4.2 O'Callaghan C, Axford JS (2004). Medicine (2nd ed. ed.). Oxford: Blackwell Science. ISBN 0-632-05162-0.
  5. ↑ Bowerman SG, Green NE, Mencio GA (1997) Decline of bone and joint infections attributable to haemophilus influenzae type b. Clin Orthop Relat Res (341):128-33. PMID: 9269165
  6. ↑ Peltola H, Kallio MJ, Unkila-Kallio L (1998) Reduced incidence of septic arthritis in children by Haemophilus influenzae type-b vaccination. Implications for treatment. J Bone Joint Surg Br 80 (3):471-3. PMID: 9619939
  7. ↑ Topics in Infectious Diseases Newsletter, August 2001, Pseudomonas aeruginosa.
  8. ↑ Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA (1997) Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis 56 (8):470-5. PMID: 9306869
  9. ↑ 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
  10. ↑ 10.0 10.1 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
  11. ↑ 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
  12. ↑ 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
  13. ↑ 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
  14. ↑ 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
  15. ↑ 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


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