Septic arthritis history and symptoms: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Septic arthritis}} | {{Septic arthritis}} | ||
{{CMG}} | {{CMG}}; {{AE}}{{VSKP}} | ||
==Overview== | ==Overview== | ||
Septic arthritis | Septic arthritis commonly present with joint pain (knee> hip>shoulder>ankle) associate with [[fever]], [[malaise]] and local joint symptoms such as [[swelling]], [[erythema]] and decreased range of motion at the level of joint. In children, hip is commonly affected. | ||
==Symptoms== | |||
== | ===Common Symptoms=== | ||
==Common Symptoms== | Abrupt onset of a single hot, swollen, and painful joint indicate non gonococcal arthritis.<ref name="pmid3883171">Goldenberg DL, Reed JI (1985) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3883171 Bacterial arthritis.] ''N Engl J Med'' 312 (12):764-71. [http://dx.doi.org/10.1056/NEJM198503213121206 DOI:10.1056/NEJM198503213121206] PMID: [https://pubmed.gov/3883171 3883171]</ref> It can involve any joint, but most commonly knee is the site of infection in 50% of cases of adults and elderly patients. Hip infection is the most common site in children.<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> [[Disseminated gonococcal infection]](DGI) often present initially with migratory polyarthralgias, [[tenosynovitis]], [[dermatitis]], and [[fever]] and less commonly, <50% of patients with [[Disseminated gonococcal infection|DGI]] will present with purulent joint effusion, most often of the knee or wrist.<ref name="pmid6415361">O'Brien JP, Goldenberg DL, Rice PA (1983) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6415361 Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms.] ''Medicine (Baltimore)'' 62 (6):395-406. PMID: [https://pubmed.gov/6415361 6415361]</ref> Often present with inflamed and tender tendons of the wrist, ankles, and small joints. | ||
Symptoms in newborns or infants: | '''Symptoms in newborns or infants:''' | ||
* Cries when infected joint is moved ( | * Cries when infected joint is moved (e.g. diaper change causes crying if hip joint is infected) | ||
* Fever | * [[Fever]] | ||
* Inability to move the limb with the infected joint (pseudoparalysis) | * Inability to move the limb with the infected joint (pseudoparalysis) | ||
* Irritability | * [[Irritability]] | ||
Symptoms in children and adults: | '''Symptoms in children and adults:''' | ||
* Inability to move the limb with the infected joint (pseudoparalysis) | * Inability to move the limb with the infected joint (pseudoparalysis) | ||
* Intense joint pain | * Intense [[joint pain]] | ||
* Joint swelling | * Joint [[swelling]] | ||
* Joint redness | * Joint redness | ||
* Low fever | * Low [[fever]] | ||
==Less Common Symptoms== | * The [[tenosynovitis]] is characterized by pain, [[swelling]], and [[erythema]] around the tendon. | ||
Chills may occur, but are uncommon. | |||
===Less Common Symptoms=== | |||
[[Chills]] may occur especially in gonococcal arthritis, but are uncommon. | |||
=== Microorganism Involved Based on The Clinical History and Symptoms === | |||
{| border="3" | |||
!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Clinical history}} | |||
!!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Joints involved}} | |||
!!colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Most likely microorganism}} | |||
|- | |||
|align=center| Intravenous drug use<ref name="pmid17405973">Margaretten ME, Kohlwes J, Moore D, Bent S (2007) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17405973 Does this adult patient have septic arthritis?] ''JAMA'' 297 (13):1478-88. [http://dx.doi.org/10.1001/jama.297.13.1478 DOI:10.1001/jama.297.13.1478] PMID: [https://pubmed.gov/17405973 17405973]</ref><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> | |||
|align=center| Involvement of axial joints | |||
(e.g. [[Sternoclavicular joint|sternoclavicular]] or [[sacroiliac joint]]) | |||
|align=center| [[Pseudomonas aeruginosa]] | |||
[[Staphylococcus aureus]] | |||
|- | |||
|align=center| Sexual activity | |||
|align=center|[[Tenosynovitis|Tenosynovial]] involvement in hands, wrists, or ankles | |||
|align=center|[[Neisseria gonorrhoeae]] | |||
|- | |||
|align=center|Terminal complement deficiency<ref name="pmid17405973">Margaretten ME, Kohlwes J, Moore D, Bent S (2007) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17405973 Does this adult patient have septic arthritis?] ''JAMA'' 297 (13):1478-88. [http://dx.doi.org/10.1001/jama.297.13.1478 DOI:10.1001/jama.297.13.1478] PMID: [https://pubmed.gov/17405973 17405973]</ref> | |||
|align=center|[[Tenosynovitis|Tenosynovial]] involvement in hands, wrists, or ankles | |||
|align=center|[[Neisseria gonorrhoeae]] | |||
|- | |||
|align=center|Dog or cat bite | |||
|align=center|Small joints involvement | |||
|align=center|[[Capnocytophaga]] species | |||
[[Pasteurella multocida]] | |||
|- | |||
|align=center|Ingestion of unpasteurized dairy products<ref name="pmid17405973">Margaretten ME, Kohlwes J, Moore D, Bent S (2007) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17405973 Does this adult patient have septic arthritis?] ''JAMA'' 297 (13):1478-88. [http://dx.doi.org/10.1001/jama.297.13.1478 DOI:10.1001/jama.297.13.1478] PMID: [https://pubmed.gov/17405973 17405973]</ref> | |||
|align=center|Monoarticular involvement, in specific [[sacroiliac joint]] | |||
|align=center|[[Brucella|Brucella sps]] | |||
|- | |||
|align=center|Nail through shoe | |||
|align=center|Foot | |||
|align=center|[[Pseudomonas aeruginosa]] | |||
|- | |||
|align=center|Soil exposure/gardening | |||
|align=center|Monoarticular involvement: knee, hand, or wrist | |||
|align=center|[[Nocardia|Nocardia sps]] | |||
[[Sporothrix schenckii]] | |||
|- | |||
|align=center|Soil or dust exposure containing decomposed wood | |||
(north-central and southern United States)<ref name="pmid21916390">{{cite journal| author=Horowitz DL, Katzap E, Horowitz S, Barilla-LaBarca ML| title=Approach to septic arthritis. | journal=Am Fam Physician | year= 2011 | volume= 84 | issue= 6 | pages= 653-60 | pmid=21916390 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21916390 }} </ref> | |||
|align=center|Monoarticular: knee, ankle, or elbow | |||
|align=center|[[Blastomyces dermatitidis]] | |||
|- | |||
|align=center|Southwestern United States, Central and South America | |||
(primary respiratory illness) | |||
|align=center|Knee | |||
|align=center|[[Coccidioides immitis]] | |||
|- | |||
|align=center|Cleaning fish tank<ref name="pmid17405973">Margaretten ME, Kohlwes J, Moore D, Bent S (2007) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17405973 Does this adult patient have septic arthritis?] ''JAMA'' 297 (13):1478-88. [http://dx.doi.org/10.1001/jama.297.13.1478 DOI:10.1001/jama.297.13.1478] PMID: [https://pubmed.gov/17405973 17405973]</ref><ref name="pmid16297734">{{cite journal| author=Gardam M, Lim S| title=Mycobacterial osteomyelitis and arthritis. | journal=Infect Dis Clin North Am | year= 2005 | volume= 19 | issue= 4 | pages= 819-30 | pmid=16297734 | doi=10.1016/j.idc.2005.07.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16297734 }} </ref> | |||
|align=center|Small joints involvement (e.g. fingers, wrists) | |||
|align=center|[[Mycobacterium marinum]] | |||
|} | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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[[Category:Arthritis]] | [[Category:Arthritis]] | ||
[[Category:Medical emergencies]] | [[Category:Medical emergencies]] | ||
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[[Category:Rheumatology]] | [[Category:Rheumatology]] | ||
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[[Category: | [[Category:Orthopedics]] | ||
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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 commonly present with joint pain (knee> hip>shoulder>ankle) associate with fever, malaise and local joint symptoms such as swelling, erythema and decreased range of motion at the level of joint. In children, hip is commonly affected.
Symptoms
Common Symptoms
Abrupt onset of a single hot, swollen, and painful joint indicate non gonococcal arthritis.[1] It can involve any joint, but most commonly knee is the site of infection in 50% of cases of adults and elderly patients. Hip infection is the most common site in children.[2] Disseminated gonococcal infection(DGI) often present initially with migratory polyarthralgias, tenosynovitis, dermatitis, and fever and less commonly, <50% of patients with DGI will present with purulent joint effusion, most often of the knee or wrist.[3] Often present with inflamed and tender tendons of the wrist, ankles, and small joints.
Symptoms in newborns or infants:
- Cries when infected joint is moved (e.g. diaper change causes crying if hip joint is infected)
- Fever
- Inability to move the limb with the infected joint (pseudoparalysis)
- Irritability
Symptoms in children and adults:
- Inability to move the limb with the infected joint (pseudoparalysis)
- Intense joint pain
- Joint swelling
- Joint redness
- Low fever
- The tenosynovitis is characterized by pain, swelling, and erythema around the tendon.
Less Common Symptoms
Chills may occur especially in gonococcal arthritis, but are uncommon.
Microorganism Involved Based on The Clinical History and Symptoms
| Clinical history | Joints involved | Most likely microorganism |
|---|---|---|
| Intravenous drug use[4][5] | Involvement of axial joints
(e.g. sternoclavicular or sacroiliac joint) |
Pseudomonas aeruginosa |
| Sexual activity | Tenosynovial involvement in hands, wrists, or ankles | Neisseria gonorrhoeae |
| Terminal complement deficiency[4] | Tenosynovial involvement in hands, wrists, or ankles | Neisseria gonorrhoeae |
| Dog or cat bite | Small joints involvement | Capnocytophaga species |
| Ingestion of unpasteurized dairy products[4] | Monoarticular involvement, in specific sacroiliac joint | Brucella sps |
| Nail through shoe | Foot | Pseudomonas aeruginosa |
| Soil exposure/gardening | Monoarticular involvement: knee, hand, or wrist | Nocardia sps |
| Soil or dust exposure containing decomposed wood
(north-central and southern United States)[6] |
Monoarticular: knee, ankle, or elbow | Blastomyces dermatitidis |
| Southwestern United States, Central and South America
(primary respiratory illness) |
Knee | Coccidioides immitis |
| Cleaning fish tank[4][7] | Small joints involvement (e.g. fingers, wrists) | Mycobacterium marinum |
References
- ↑ Goldenberg DL, Reed JI (1985) Bacterial arthritis. N Engl J Med 312 (12):764-71. DOI:10.1056/NEJM198503213121206 PMID: 3883171
- ↑ 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
- ↑ O'Brien JP, Goldenberg DL, Rice PA (1983) Disseminated gonococcal infection: a prospective analysis of 49 patients and a review of pathophysiology and immune mechanisms. Medicine (Baltimore) 62 (6):395-406. PMID: 6415361
- ↑ 4.0 4.1 4.2 4.3 Margaretten ME, Kohlwes J, Moore D, Bent S (2007) Does this adult patient have septic arthritis? JAMA 297 (13):1478-88. DOI:10.1001/jama.297.13.1478 PMID: 17405973
- ↑ 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
- ↑ Horowitz DL, Katzap E, Horowitz S, Barilla-LaBarca ML (2011). "Approach to septic arthritis". Am Fam Physician. 84 (6): 653–60. PMID 21916390.
- ↑ Gardam M, Lim S (2005). "Mycobacterial osteomyelitis and arthritis". Infect Dis Clin North Am. 19 (4): 819–30. doi:10.1016/j.idc.2005.07.008. PMID 16297734.