Septic arthritis causes

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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. The most common etiological agent of all nongonococcal causes of septic arthritis in the United States is Staphylococcus aureus. 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. ~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. ~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. 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:

• Staphylococcus aureus
• Streptococcal pyogenous
• Streptococcal agalectae
• Streptococcal pneumonia
• Neisseria gonorrhoeae
• Escherichia coli
• Staphylococcus epidermidis
• Haemophilus influenzae
• Pseudomonas aeruginosa
• Salmonella

Less Common Causes

• Peptostreptococcus
• Bacteroides fragilis
• Fusobacterium species 
• Borrelia burgdorferi
• Brucella
• Mycobacterium tuberculosis
• Mycoplasma hominis
• Fungal infection such as
  • Blastomycosis
  • Cryptococcus
  • Coccidioidomycosis
  • Sporotrichosis
  • Candida

Microorganism or other infectious disease	Associated risk factors	Key clinical clues
Staphylococcus aureus	Rheumatoid arthritis Diabetes mellitus HIV patients	Healthy adult with skin lesions and previously history of damaged joint (e.g, rheumatoid arthritis) or prosthetic joint
Streptococcus pyogenes Streptococcal pneumonia	Autoimmune diseases Chronic skin infections Trauma	Healthy adults with spleenic dysfunction
Groups B Streptococcal infection	Immunocompromised patients 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 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
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
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
Viral arthritis	Immunocompromised patient	Polyarthritis Fever Rash
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 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 murmur Septic and sterile synovitis Septic joint more common in IVDA

References

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