Septic arthritis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Jumana Nagarwala, M.D., Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital; Cafer Zorkun, M.D., Ph.D. [2]

Overview

Septic arthritis should be considered whenever one is assessing a patient with joint pain. Usually only one joint is affected (monoarthritis) however in seeding arthritis, several joints can be affected simultaneously; this is especially the case when the infection is caused by staphylococcus or gonococcus bacteria.

Symptoms

Common Symptoms

Symptoms usually come on quickly. There is a fever, and joint swelling that is usually in just one joint. There is also intense joint pain, which gets worse with movement.

Symptoms in newborns or infants:

• Cries when infected joint is moved (example: 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

Less Common Symptoms

Chills may occur, but are uncommon.

Microorganism Involved Based on The Clinical History and Symptoms

Clinical history	Joints involved	Most likely microorganism
Intravenous drug use	Involvement of axial joints (e.g. sternoclavicular or sacroiliac joint)	Pseudomonas aeruginosa Staphylococcus aureus
Sexual activity	Tenosynovial involvement in hands, wrists, or ankles	Neisseria gonorrhoeae
Terminal complement deficiency	Tenosynovial involvement in hands, wrists, or ankles	Neisseria gonorrhoeae
Dog or cat bite	Small joints involvement	Capnocytophaga species Pasteurella multocida
Ingestion of unpasteurized dairy products	Monoarticular involvement, in specific sacroiliac joint	Brucella species
Nail through shoe	Foot	Pseudomonas aeruginosa
Soil exposure/gardening	Monoarticular involvement: knee, hand, or wrist	Nocardia species Sporothrix schenckii
Soil or dust exposure containing decomposed wood (north-central and southern United States)	Monoarticular: knee, ankle, or elbow	Blastomyces dermatitidis
Southwestern United States, Central and South America (primary respiratory illness)	Knee	Coccidioides immitis
Cleaning fish tank	Small joints involvement (e.g. fingers, wrists)	Mycobacterium marinum

References

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