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=== Differential Diagnosis for Bacterial arthritis ===
=== Differential Diagnosis for Bacterial arthritis ===
{| border="2" cellpadding="4" cellspacing="0" style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse;" width="75%"
! '''Microorganism''' !! '''Associated risk factors'''
!Key clinical clues
!Most definitive tests
|-
! '''Staphylococcus aureus'''
|
* Rheumatioid 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>
* 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 hisoty of damaged joint (eg, rheumatoid arthritis) or prosthetic joint
|
|-
! '''Streptococcus pyogenes'''
'''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
|
|-
! '''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 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<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 patients
|
* 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 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
| rowspan="2" |
* Synovial fluid analysis
* Histology
* Tissue culture
|-
|'''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<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 patient
!
* Polyarthritis
* Fever
* Rash
!
* Serology
|}


==References==
==References==

Revision as of 18:53, 12 January 2017

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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

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 Most definitive tests
Staphylococcus aureus
  • Rheumatioid arthritis[1]
  • Diabetes mellitus[2]
  • HIV patients[3]
  • Healthy adult with skin lesions and previously hisoty of damaged joint (eg, 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
  • Synovial fluid analysis
  • Histology
  • Tissue culture
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
  • Serology

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


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