Info

🌱 來自: infectious arthritis and bursitis

etiologies and diagnosis of infectious arthritis

Etiologies (Curr Rheumatol Rep 2013;15:332)

• Bacterial (nongonococcal): early diagnosis and treatment essential
• Gonococcal (N. gonorrhea): consider in sexually active young adults
• Viral:
  • parvovirus,
  • HCV,
  • HBV,
  • acute HIV,
  • Chikungunya; mainly polyarticular,
  • may mimic RA
• Mycobacterial: monoarticular or axial (Pott’s disease)
• Fungal: Candida (esp. prosthetic joints), coccidiomycosis (valley fever), histoplasmosis
• Other: Lyme, Mycoplasma, Salmonella, Brucellosis, T. whipplei

Diagnosis (JAMA 2007;297:1478)

• H&P w/ poor sensitivity and specificity for septic arthritis
• Arthrocentesis in acute onset inflammatory monoarthritis to r/o septic arthritis; if possible, obtain fluid sample prior to starting antibiotics
• Do not tap through overlying infected area to prevent introducing infxn into joint space
  • ✓ Fluid cell count w/ diff, Gram stain, bacterial culture, crystal analysis;
  • WBC >50k w/ PMN predominance suspicious for bact. infxn;
  • crystals do not r/o septic arthritis!