Septic Arthritis Differential Diagnoses

  • Author: John L Brusch, MD, FACP; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jul 18, 2011
 
 

Diagnostic Considerations

When evaluating a patient with suspected septic arthritis, also consider conditions such as primary rheumatologic disorders (eg, vasculitis, crystalline arthritides), drug-induced arthritis, and reactive arthritis (eg, postinfectious diarrhea syndrome, postmeningococcal and postgonococcal arthritis, arthritis of intrinsic bowel disease[14] ).

In early disseminated gonococcal infection, an early tenosynovitis predominates without actual joint invasion such as occurs in the later variety of disseminated gonococcal infection. A viral syndrome usually produces polyarticular arthritis. Pustular lesions are consistent (as is almost any type of skin lesion) with staphylococcal bacteremia. Whenever vesicles are present, always consider staphylococcal infection.

Unlike salmonella osteomyelitis, the frequency of salmonella septic arthritis is not greatly increased in patients with sickle cell anemia. However, when septic arthritis does occur, Salmonella is more commonly identified.

Staphylococcus aureus remains the most common infectious agent in people who abuse intravenous drugs. However, a high rate of infections with gram-negative organisms, especially Pseudomonas aeruginosa and Serratia species, occurs in cases of septic arthritis. In addition, a higher rate of fungal and anaerobic infections occurs. Unusual locations, such as the sternoclavicular joint, are involved.

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

John L Brusch, MD, FACP  Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Maria D Mileno, MD  Associate Professor of Medicine, Division of Infectious Diseases, The Warren Alpert Medical School of Brown University

Maria D Mileno, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Aaron Glatt, MD  Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, St Joseph Hospital (formerly New Island Hospital)

Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

  1. Goldenberg DL, Cohen AS. Acute infectious arthritis. A review of patients with nongonococcal joint infections (with emphasis on therapy and prognosis). Am J Med. Mar 1976;60(3):369-77. [Medline].

  2. Ross JJ, Shamsuddin H. Sternoclavicular septic arthritis: review of 180 cases. Medicine (Baltimore). May 2004;83(3):139-48. [Medline].

  3. Del Pozo JL, Patel R. Clinical practice. Infection associated with prosthetic joints. N Engl J Med. Aug 20 2009;361(8):787-94. [Medline].

  4. Berbari EF, Marculescu C, Sia I, Lahr BD, Hanssen AD, Steckelberg JM, et al. Culture-negative prosthetic joint infection. Clin Infect Dis. Nov 1 2007;45(9):1113-9. [Medline].

  5. Cucurull E, Espinoza LR. Gonococcal arthritis. Rheum Dis Clin North Am. May 1998;24(2):305-22. [Medline].

  6. Broy SB, Schmid FR. A comparison of medical drainage (needle aspiration) and surgical drainage (arthrotomy or arthroscopy) in the initial treatment of infected joints. Clin Rheum Dis. Aug 1986;12(2):501-22. [Medline].

  7. McGuire NM, Kauffman CA. Septic arthritis in the elderly. J Am Geriatr Soc. Mar 1985;33(3):170-4. [Medline].

  8. Smith JW, Piercy EA. Infectious arthritis. Clin Infect Dis. Feb 1995;20(2):225-30; quiz 231. [Medline].

  9. Baraboutis I, Skoutelis A. Streptococcus pneumoniae septic arthritis in adults. Clin Microbiol Infect. Dec 2004;10(12):1037-9. [Medline].

  10. Raad J, Peacock JE Jr. Septic arthritis in the adult caused by Streptococcus pneumoniae: a report of 4 cases and review of the literature. Semin Arthritis Rheum. Oct 2004;34(2):559-69. [Medline].

  11. Corvec S, Illiaquer M, Touchais S, et al. Clinical features of group B Streptococcus prosthetic joint infections and molecular characterization of isolates. J Clin Microbiol. Jan 2011;49(1):380-2. [Medline]. [Full Text].

  12. [Best Evidence] Margaretten ME, Kohlwes J, Moore D, Bent S. Does this adult patient have septic arthritis?. JAMA. Apr 4 2007;297(13):1478-88. [Medline].

  13. Rice PA. Gonococcal arthritis (disseminated gonococcal infection). Infect Dis Clin North Am. Dec 2005;19(4):853-61. [Medline].

  14. Manadan AM, Block JA. Daily needle aspiration versus surgical lavage for the treatment of bacterial septic arthritis in adults. Am J Ther. Sep-Oct 2004;11(5):412-5. [Medline].

  15. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. Oct 14 2004;351(16):1645-54. [Medline].

  16. Hsieh PH, Lee MS, Hsu KY, Chang YH, Shih HN, Ueng SW. Gram-negative prosthetic joint infections: risk factors and outcome of treatment. Clin Infect Dis. Oct 1 2009;49(7):1036-43. [Medline].

  17. Kaandorp CJ, Krijnen P, Moens HJ, et al. The outcome of bacterial arthritis: a prospective community-based study. Arthritis Rheum. May 1997;40(5):884-92. [Medline].

  18. Zimmermann B 3rd, Mikolich DJ, Ho G Jr. Septic bursitis. Semin Arthritis Rheum. Jun 1995;24(6):391-410. [Medline].

  19. Garcia-De La Torre I. Advances in the management of septic arthritis. Rheum Dis Clin North Am. Feb 2003;29(1):61-75. [Medline].

  20. Wilson ML, Winn W. Laboratory diagnosis of bone, joint, soft-tissue, and skin infections. Clin Infect Dis. Feb 1 2008;46(3):453-7. [Medline].

  21. Schäfer P, Fink B, Sandow D, Margull A, Berger I, Frommelt L. Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis. Dec 1 2008;47(11):1403-9. [Medline].

  22. Goldenberg DL. Septic arthritis and other infections of rheumatological significance. Rheum Clin NA. 1991;17:149. [Medline].

  23. Wise CM, Morris CR, Wasilauskas BL, et al. Gonococcal arthritis in an era of increasing penicillin resistance. Presentations and outcomes in 41 recent cases (1985-1991). Arch Intern Med. Dec 12-26 1994;154(23):2690-5. [Medline].

  24. Kaandorp CJ, Dinant HJ, van de Laar MA, et al. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis. Aug 1997;56(8):470-5. [Medline].

  25. Koeppe J, Johnson S, Morroni J, Siracusa-Rick C, Armon C. Suppressive antibiotic therapy for retained infected prosthetic joints: case series and review of the literature. Infect Dis Clin Pract. 2008;16(4):224-9. [Full Text].

  26. Martínez-Pastor JC, Muñoz-Mahamud E, Vilchez F, García-Ramiro S, Bori G, Sierra J, et al. Outcome of acute prosthetic joint infections due to gram-negative bacilli treated with open debridement and retention of the prosthesis. Antimicrob Agents Chemother. Nov 2009;53(11):4772-7. [Medline].

  27. Berbari EF, Osmon DR, Carr A, et al. Dental procedures as risk factors for prosthetic hip or knee infection: a hospital-based prospective case-control study. Clin Infect Dis. Jan 1 2010;50(1):8-16. [Medline].

  28. Suprax [package insert]. Lupin Pharmaceuticals, Inc: Baltimore, Md; 2008. [Full Text].

  29. Centers for Disease Control and Prevention. Availability of cefixime 400 mg tablets--United States, April 2008. MMWR Morb Mortal Wkly Rep. Apr 25 2008;57(16):435. [Medline].

 
Previous
Next
 
Table 1. Clinical Features of Viral Septic Arthritis
VirusClinical Features of Viral Septic Arthritis
Parvovirus B19Occurs in adult women with erythema infectiosum, often an itchy rash
Hepatitis AMuscle aches and rash in 10% of cases
Hepatitis BOnset in the preicteric phase; usually resolves as jaundice develops; chronic arthritis possible in patients with chronic hepatitis B infection
Hepatitis CHistory similar to hepatitis B joint infection
Rubella (natural infection and vaccine related)Onset is possible before, during, or after the appearance of the rash; usually resolves in a few weeks; may recur and, more commonly, may persist
Human immunodeficiency virus [HIV] (2 types occur, both with noninflammatory, sterile joint fluid)Develops over several days, and severe knee or ankle pain is characteristic; excellent response to nonsteroidal anti-inflammatory agents (NSAIDS)
Sudden onset of severe pain in the shoulders and elbows, closely resembling an acute gouty attack; Opiates often necessary to control pain
MumpsOccurs in adult men 2 weeks after the presentation of parotitis
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.