Bacterial arthritis or infection of the joints and the articular tissues is encountered across all age groups. Overall, Staphylococcus aureus is the most common cause (although Neisseria gonorrhoeae is the number one cause of septic arthritis in younger adults), but streptococcal species (including S. pneumoniae, S. viridans, S. pyogenes), tuberculosis, and a range of both gram-positive and gram-negative bacteria can be responsible for the infection [1]. Several conditions have been described in the literature as potential risk factors for bacterial arthritis, including diabetes mellitus, previous skin infection, rheumatoid arthritis (RA), human immunodeficiency virus (HIV) type 1 infection, as well as increasing age, joint surgery, intravenous drug abuse, and the presence of hip or knee prostheses [2] [3]. The clinical presentation is centered around three main complaints - joint pain, swelling, and fever (about 40% of patients have a fever of >39C) [3] [4]. Either one (monoarticular) or more than one (polyarticular) joint can be affected. Gonococcal arthritis is typically polyarticular [5]. The pain is often severe and is exacerbated with minimal movement, thus a decreased range of motion is also an important finding [4] [6]. Additional less common features of bacterial arthritis include erythema of the skin over the infected joint, rigors, excessive sweating, and constitutional symptoms [1] [3] [4] [6].

• Fever

  [ 713.6 ] Staphylococcus 711.0 Streptococcus 711.0 syphilis (see also Syphilis) 094.0 [ 711.4 ] syringomyelia 336.0 [ 713.5 ] thalassemia (see also Thalassemia) 282.40 [ 713.2 ] tuberculosis (see also Tuberculosis, arthritis) 015.9 [ 711.4 ] typhoid fever [icd9data.com]

  We conclude, that the absence of fever, rigors, blood leucocytosis and positive blood cultures does not rule out the possibility of bacterial arthritis. [ncbi.nlm.nih.gov]

  The clinical presentation is centered around three main complaints - joint pain, swelling, and fever (about 40% of patients have a fever of >39C). Either one (monoarticular) or more than one (polyarticular) joint can be affected. [symptoma.com]

  […] the infected joint (pseudoparalysis) Severe joint pain Joint swelling Joint redness Fever Chills may occur, but are uncommon. [nlm.nih.gov]

• Chills

  Constitutional symptoms such as fever, chills, and rigors are poorly sensitive for septic arthritis. [ncbi.nlm.nih.gov]

  […] diaper changes) Fever Not able to move the limb with the infected joint (pseudoparalysis) Fussiness Symptoms in children and adults: Not able to move the limb with the infected joint (pseudoparalysis) Severe joint pain Joint swelling Joint redness Fever Chills [nlm.nih.gov]

  Symptoms of infectious arthritis include Intense pain in the joint Joint redness and swelling Chills and fever Inability to move the area with the infected joint One type of infectious arthritis is reactive arthritis. [medlineplus.gov]

  With septic arthritis, patients may experience symptoms and signs that include fever, chills, as well as joint pain, swelling, redness, stiffness, and warmth. [medicinenet.com]

  The symptoms usually include fever (which may be quite high), chills, general weakness and headaches, followed by inflammation of one or more joints. [rarediseases.org]

• Reiter Syndrome

  “Reactive” (sterile) arthritis, formerly known as Reiter’s syndrome, may occur following chlamydial genital infection or bacterial gastroenteritis caused by campylobacter, salmonella, and other agents. [clinicaladvisor.com]

  […] onset Viral arthritis - usually with rash, usually polyarthritis HIV Infection - often with reactive arthritis, sterile acute synovitis Hemearthrosis - especially with trauma, coagulopathy, blood-thinners Lyme Disease Reactive Arthritis - compenents of Reiter's [enotes.tripod.com]

  Reactive arthritis (formerly Reiter syndrome) is associated with inflammation around the head of the penis (circinate balanitis). [medicinenet.com]

  It can also be caused by a type of arthritis known as reactive arthritis or Reiter’s syndrome, which can also affect the joints and the eyes. [webmd.com]

  Balanitis is a general term that includes specific skin conditions and infections that may affect the penis, including: Dermatitis of various kinds including contact allergy, e.g. to rubber condoms, fragrances or medicament Flexural psoriasis Reiter syndrome [dermnetnz.org]

• Rigor

  We conclude, that the absence of fever, rigors, blood leucocytosis and positive blood cultures does not rule out the possibility of bacterial arthritis. [ncbi.nlm.nih.gov]

  Sweats (sensitivity, 27%; 95% CI, 20%-34%) and rigors (sensitivity, 19%; 95% CI, 15%-24%) are less common findings in septic arthritis. [doi.org]

  Additional less common features of bacterial arthritis include erythema of the skin over the infected joint, rigors, excessive sweating, and constitutional symptoms. [symptoma.com]

• High Fever

  —Staphylococcal arthritis: Usually monarticular (seldom polyarticular), staphy-lococcal arthritis affects the knee, hip, shoulder, elbow, wrist, or ankle, and >90% of patients exhibit high fevers. [rheumaknowledgy.com]

  Neonates and infants may not appear that unwell and may not always have a high fever. Careful examination and clinical suspicion are important. [pmmonline.org]

• Failure to Thrive

  Clinical manifestations may include vague complaints like irritability, anxiety, failure to thrive, tachycardia and anemia. [omicsonline.org]

• Tachycardia

  […] on septicaemia large joint(esp hip)  Often in the superficialRather than joint pain joint(knee, wrist or ankle ) o Pseudoparesis Baby is irritable &  Joints painful, swollenrefuse to feed o Child is ill,rapid pulse & inflamed. and swingingfever Tachycardia [slideshare.net]

  […] vary from case to case, but the following are the most commonly seen signs and symptoms: Severe pain that worsens with movement Swelling of the joint Warmth and redness around the joint Fever Chills Fatigue Weakness Decreased appetite Rapid heart rate (tachycardia [belmarrahealth.com]

  Sleep Disturbance in the Hospitalized Patient -- Chapter 97: Nausea and Vomiting -- Chapter 98: Numbness: A Localization-Based Approach -- Chapter 99: Pain -- Chapter 100: Suspected Intoxication and Overdose -- Chapter 101: Syncope -- Chapter 102: Tachycardia [worldcat.org]

  Clinical manifestations may include vague complaints like irritability, anxiety, failure to thrive, tachycardia and anemia. [omicsonline.org]

• Skin Lesion

  Thirty eight of these were infected skin lesions, 10 of the feet. [doi.org]

  Other symptoms of the disease process, such as gastrointestinal or genitourinary symptoms, skin lesions, or uveitis, may yield diagnostic clues. [patient.info]

  Pseudoepitheliomatous keratotic and micaceous balanitis: characterized by scaly, wart-like skin lesions on the head of the penis. There are no real home remedies for balanitis, other than good hygiene: Clean the penis every day. [medicalnewstoday.com]

  Skin lesions are multiple but seldom number more than 12 (Note: skin lesions from N meningitidis meningococcemia usually are more numerous). The lesions evolve over a few days from papular to pustular or vesicular to necrotic. [atsu.edu]

• Papule

  The classic skin lesion manifests as small erythematous papules which progress to vesicular or pustular lesions and are often limited to the extremities and the trunk. [doi.org]

• Arthritis

  Almost any microorganism can be pathogenic in septic arthritis; however, septic arthritis is caused by nongonococcal pathogens (most commonly Staphylococcus species) in more than 80 percent of patients. [ncbi.nlm.nih.gov]

  Conclusions Clinical findings identify patients with peripheral, monoarticular arthritis who might have septic arthritis. [doi.org]

  A normal WBC count does not rule out septic arthritis. The erythrocyte sedimentation rate (ESR) is elevated in septic arthritis; it returns to normal levels with resolution of the infection. [emedicine.com]

  pyogenic) 711.0 Pyarthrosis (see also Arthritis, pyogenic) 711.0 tuberculous - see Tuberculosis, joint Pyemia, pyemic (purulent) (see also Septicemia) 038.9 arthritis (see also Arthritis, pyogenic) 711.0 joint (see also Arthritis, pyogenic) 711.0 Septic [icd9data.com]

• Joint Effusion

  […] on both sides of a joint if left untreated, reactive juxta-articular sclerosis and, in severe cases, ankylosis will develop Ultrasound useful in superficial joints and in children shows joint effusion echogenic debris may be present color Doppler may [radiopaedia.org]

  In a prospective diagnostic study, 102 consecutive patients with atraumatic joint effusion were included. Synovial fluid glucose concentrations were determined using both glucometer and automated analyzer respectively. [ncbi.nlm.nih.gov]

  Ultrasound: Useful in children, can be used to show joint effusion. CT: A detailed imaging test that is able to show fat-fluid levels as well as signs of trauma. [belmarrahealth.com]

  Ultrasonography is useful in confirming a joint effusion in a deeply placed joint such as the hip. It can also be used to guide joint aspiration. Magnetic resonance imaging (MRI) has no role in the initial workup. [emedicine.com]

  In the affected joint, there is moderate to severe pain accompanied by joint effusion, muscle spasm and decreased range of motion. There is also high-grade fever. [boneandspine.com]

• Joint Swelling

  […] the infected joint (pseudoparalysis) Severe joint pain Joint swelling Joint redness Fever Chills may occur, but are uncommon. [nlm.nih.gov]

  Joint pain (sensitivity, 85%; 95% confidence interval [CI], 78%-90%), a history of joint swelling (sensitivity, 78%; 95% CI, 71%-85%), and fever (sensitivity, 57%; 95% CI, 52%-62%) are the only findings that occur in more than 50% of patients. [doi.org]

• Arthralgia

  Early disseminated - weeks after infection with neurological features (facial nerve palsy, meningitis and rarely meningoencephalitis), heart conduction defects and arthralgia. [pmmonline.org]

  Tenosynovitis and migratory arthralgias are common, and characteristic pustular (often painful) lesions are found on the skin. Fever may be absent, and a minority will have genitourinary, pharyngeal, or rectal symptoms on presentation. [rheumaknowledgy.com]

  Gonococcal disease usually presents with fever, arthralgia, multiple skin lesions (dermatitis-arthritis syndrome) and tenosynovitis of the hand joints, knees, wrists, ankles and elbows. [patient.info]

  Tenosynovitis, dermatitis, and polyarthritis syndrome or dermatitis-arthritis syndrome; the initial manifestations include fever, malaise, and arthralgias following an infection of the cervix, urethra, or pharynx. [atsu.edu]

  The presenting symptoms in DGI may include migratory arthralgias, moderate fever, chills, dermatitis, and tenosynovitis. The large majority of these patients have asymptomatic genital, anal, or pharyngeal gonococcal infections ( 122 ). [doi.org]

• Joint Deformity

  In this disease, there is thickening of the soft tissues around the joints and extension of the synovial tissue over articular cartilage (which becomes eroded). A chronic and progressive course is common with joint deformities and disability. [kmle.co.kr]

  During the acute phase of bacterial arthritis, patient rest and optimal joint position are absolutely required to prevent the occurrence of joint deformation and deleterious contractures. [doi.org]

• Irritability

  Other irritants to avoid include: soap and shower gel bubble baths baby wipes latex condoms lubricants antiseptics hygiene sprays Read about preventing balanitis for more information on hygiene and avoiding irritants. [your.md]

  For example, having phimosis makes it easier to develop irritation of the glans and foreskin. Once this irritation occurs, symptoms such as pain and swelling may make it more difficult to retract the foreskin. [healthline.com]

• Confusion

  Multivariate analysis suggests that important predictors of death are: confusion at presentation, age > or = 65 years, multiple joint sepsis or involvement of the elbow joint, and of morbidity are: age > or = 65 years, diabetes mellitus, open surgical [ncbi.nlm.nih.gov]

  Multivariate analysis suggests that important predictors of death are: confusion at presentation, age ⩾65 years, multiple joint sepsis or involvement of the elbow joint, and of morbidity are: age ⩾ 65 years, diabetes mellitus, open surgical drainage, [doi.org]

  You have a fever and are confused. Seek care immediately if: You are urinating little or not at all. You have severe abdominal pain. You have sudden, severe joint pain. Contact your healthcare provider if: Your symptoms return. [drugs.com]

  1-year increment 1.09, P =0.023), high serum CRP level (OR per unit 1.01, P =0.002), bacteremia (OR 15.20, P =0.0015), skin involvement (OR 14.83, P =0.003), inflammatory rheumatic diseases (OR 9.60, P =0.021), diabetes mellitus (OR 7.18, P =0.028), confusion [medpagetoday.com]

  Balanoposthitis is often confused with two similar conditions: phimosis and balanitis. All three conditions affect the penis. However, each condition affects a different part of the penis. [healthline.com]

The physician's ability to recognize signs and symptoms of bacterial arthritis through a detailed patient history and a thorough physical examination is essential for making the diagnosis. Information regarding the onset and course of symptoms should be noted, whereas the assessment of preexisting comorbidities that could predispose individuals to this infection is mandatory. Joint pain and swelling, as principal complaints, need to be evaluated during a physical exam, and as soon as valid clinical suspicion is raised, a complete laboratory workup must be conducted. Serum inflammatory markers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), are often elevated in bacterial arthritis [4]. One of the key steps in solidifying the diagnosis is the analysis of synovial fluid [7]. Many studies have confirmed that the white blood cell count of > 50 × 109/L (with a predominance of polymorphonuclear cells, or PMNs) in synovial fluid is highly indicative of septic arthritis [2] [3] [4]. Furthermore, cultivation of synovial fluid is a definite method for identifying the causative agent of joint infection, and both anaerobic, but more importantly aerobic cultures should be drawn [7]. Gram staining is also described as an important microbiological method in the case of arthritis, but its variable sensitivity is an important limitation [1] [7].

• Joint Space Narrowing

  Radiograph of pelvis shows bony ankylosis of both SI joints, Symmetric joint space narrowing of both hip joints, bony proliferations (arrows) of both pelvic bones and both proximal femurs. [ekjm.org]

  In later stages, diffuse joint space narrowing due to cartilage destruction may be evident. [patient.info]

  Later findings include joint space narrowing due to destruction of the joint.Ultrasound is effective at detecting joint effusions.CT and MRI are not required for diagnosis; but if the diagnosis is unclear or the joints are hard to examine (ie.sacroiliac [en.wikipedia.org]

  Eventually, cartilage erosion occurs at the lateral margins of the joint. In time significant cartilage damage occurs followed by joint space narrowing. Significant damage to the joint can occur as soon as 3 days in untreated infections. [atsu.edu]

  As the infection progresses, radiographic detection of diffuse joint space narrowing due to cartilage destruction is possible. [doi.org]

• Chlamydia

  Different humoral immune response to Chlamydia trachomatis major outer membrane protein variable domains I and IV in Chlamydia-infected patients with or without reactive arthritis. [ard.bmj.com]

  Moulder JW (1991) Interaction of chlamydiae and host cells in vitro. Microbiol Rev 55: 143-190. [omicsonline.org]

  […] arthritis include the following: Salmonella enteritidis Salmonella typhimurium Yersinia enterocolitica Campylobacter jejuni Clostridium difficile Shigella sonnei Entamoeba histolytica Cryptosporidium Genitourinary infections, especially those due to Chlamydia [emedicine.com]

  The intracellular life of chlamydiae. Semin Pediatr Infect Dis. 2002;13:239-48. FROM THE INTERNET Peng S. Non-gonococcal (septic) bacterial arthritis, MedlinePlus. [web.archive.org]

• Chlamydia Trachomatis

  trachomatis, are the second most common cause of reactive arthritis. [emedicine.com]

  Different humoral immune response to Chlamydia trachomatis major outer membrane protein variable domains I and IV in Chlamydia-infected patients with or without reactive arthritis. [ard.bmj.com]

  Clinical or historical suspicion of sexual abuse also mandates evaluation for N. gonorrhoeae and C. trachomatis with Gram stain, cultures, DNA probes or other rapid antigen tests for Chlamydia. [journals.lww.com]

• Blood Culture Positive

  Blood cultures Positive in 50-70% of patients with nongonococcal bacterial arthritis Diagnostic if positive Limited usefulness but may be helpful when ruling out other diseases, particularly in children Lower rate of positivity in prosthetic joints Tissue [arupconsult.com]

  Other important diagnostic tests include blood cultures (positive in 50–70% of acute bacterial arthritides) (27), but in only 30% or less of gonococcal arthritis cases) (38), wound cultures (although these often correlate poorly with synovial fluid culture [the-hospitalist.org]

Abstract The key to successful treatment of acute bacterial arthritis is early diagnosis and initiation of empirical antibacterial therapy. Treatment includes antimicrobial therapy, debridement of the infected joint and treatment of pain. [ncbi.nlm.nih.gov]

Especially in infants, treatment delay or inappropriate treatment may result in cartilage destruction, avascular necrosis and physeal injury [ 5, 6 ], with an increased risk of severe deformation and functional impairment. [doi.org]

In contrast, gonococcal arthritis is often successfully treated with antimicrobial therapy alone and demonstrates a very low rate of complications and an excellent prognosis for full return of normal joint function. [ncbi.nlm.nih.gov]

If other specific etiologies are identifiable, directed therapy is warranted. [ncbi.nlm.nih.gov]

Epidemiology Common in uncircumcised newborns or uncircumcised men with poor hygiene and accumulation of smegma May be due to poor hygiene, sexual transmission or associated with dermatologic disorders Etiology Due to propensity of pathogenic bacteria [pathologyoutlines.com]

The common etiology for balanoposthitis is candida albicans, but it may be due to a variety of infective and non infective causes. The management of balanoposthitis is given in a simple and step by step approach for specific and non specific causes. [ijrhs.org]

Epidemiology Common in uncircumcised newborns or uncircumcised men with poor hygiene and accumulation of smegma May be due to poor hygiene, sexual transmission or associated with dermatologic disorders Etiology Due to propensity of pathogenic bacteria [pathologyoutlines.com]

Epidemiology The epidemiology is described above. Prognosis See above. Special considerations for nursing and allied health professionals. NA What's the evidence? Gupta, MN, Sturrock, RD, Field, M. [clinicaladvisor.com]

Epidemiology Information concerning the epidemiology of septic arthritis is limited due to several factors. [omicsonline.org]

Background Epidemiology Incidence – 2-10/100,000 in the U.S. 30-40/100,000 in patients with rheumatoid arthritis 40-70/100,000 in patients with prosthetic joints Transmission Most cases are hematogenously acquired Other mechanisms for infection Surgery [arupconsult.com]

Preventive measures directed to patients with prosthetic joints or osteosynthetic material, and a known haematogenous source would have prevented at most 8% of all cases. bacterial arthritis prosthetic joint infection epidemiology prevention Statistics [doi.org]

Polymerase chain reaction may be an important diagnostic test in culture-negative cases and may be very helpful in understanding the pathophysiology of gonococcal arthritis. [ncbi.nlm.nih.gov]

We review the pathophysiology of bacterial arthritis, clinical and microbiologic characteristics of its common forms, and current approaches to diagnosis and treatment of this condition.PathophysiologyBacterial arthritis is usually hematogenously acquired [nejm.org]

The pathophysiology of septic arthritis – or how the disease occurs – is when organisms such as viruses, bacteria, or fungi enter the joint space directly (as in the case of an injury or injection that breaks the skin) or through the bloodstream from [joybauer.com]

Pathophysiology The pathophysiology of bacterial (or fungal) arthritis differs according to the route of entry; that is: Hematogenous (either in the course of a primary bacteremic illness, including endocarditis, or from another focus such as urinary [clinicaladvisor.com]

Preventive measures directed to patients with prosthetic joints or osteosynthetic material, and a known haematogenous source would have prevented at most 8% of all cases. [ncbi.nlm.nih.gov]

Preventive measures directed to patients with prosthetic joints or osteosynthetic material, and a known haematogenous source would have prevented at most 8% of all cases. bacterial arthritis prosthetic joint infection epidemiology prevention Statistics [doi.org]

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2. Margaretten ME, Kohlwes J, Moore D, Bent S. Does this adult patient have septic arthritis? JAMA. 2007;297(13):1478-1488.
3. Carpenter CR, Schuur JD, Everett WW, Pines JM. Evidence-based Diagnostics: Adult Septic Arthritis. Acad Emerg Med. 2011;18(8):781-796.
4. Smith JW, Chalupa P, Shabaz Hasan M. Infectious arthritis: clinical features, laboratory findings and treatment. Clin Microbiol Infect. 2006;12(4):309-314.
5. Bardin T. Gonococcal arthritis. Best Pract Res Clin Rheumatol. 2003;17(2):201-208.
6. Al-Ahaideb A. Septic arthritis in patients with rheumatoid arthritis. J Orthop Surg. 2008;3:33.
7. Wilson ML, Winn W. Laboratory diagnosis of bone, joint, soft-tissue, and skin infections. Clin Infect Dis. 2008;46(3):453-457.