CAUSES OF INFECTIOUS ARTHRITIS

There are a number of causes of infectious arthritis. Gram-positive aerobes are implicated in the majority of cases of infectious arthritis and are seen in an estimated 70% to 80% of patients. Staphylococcus aureus is the most common pathogen in this group and is responsible for about 60% of infections in the joint space. The organism can also cause an acute septic bursitis following trauma. Streptococcal infections are also common and may be due to group A B-hemolytic streptococci as well as groups В, C, and G streptococci.
Gram-negative bacilli are responsible for about 9% to 20% of cases of infectious arthritis. These infections typically occur in the elderly and in patients with comorbid conditions such as immunocompromised states or chronic arthritis. Pseudomonas aeruginosa is often the underlying cause in intravenous drug users with sternoclavicular or sacroiliac infections. Brucella can also cause arthritis of the sacroiliac joint in patients exposed to unpasteurized dairy products. Pasteurella multocida should be considered in patients who present with an animal bite to a joint.
Neisseria gonorrhoeae remains the predominant cause in adults younger than 30 years of age. Disseminated gonococcal infection often manifests as a triad of polyarthritis, dermatitis (vesiculopustular skin lesions), and tenosynovitis. Synovial cultures yield the diagnosis in less than 50% of patients. N. gonorrhoeae can be recovered from pharyngeal, rectal, urethral, or cervical cultures. Gonococcal infection can also result in a monoarticular purulent arthritis without skin involvement. Synovial cultures are more often positive in these cases.
Chronic monoarticular arthritis of the large joints, most commonly the knee, can be present in the later stages of Lyme disease. The organism, Borrelia burgdoferi, is rarely detected in synovial fluid, and the diagnosis is made through serologic testing.
Mycobacterial infections can manifest as a more indolent and progressive monoarthritis. Tendon sheaths can be involved as well, particularly in infections with atypical mycobacteria. Potential organisms include Mycobacterium tuberculosis, Mycobacterium kansasii, and Mycobacterium marinum. Diagnosis is primarily made through culture of the synovial tissue.
Chronic monoarthritis can occasionally be caused by fungal organisms, usually in immunocompromised patients. Disseminated coccidioidomycosis, blastomycosis, and sporotrichosis (particularly in people exposed to soil) have all been reported. Candidal infections may also occur, typically via hematogenous seeding, and are more acute in onset.
Arthritis can be a significant feature of a number of viral illnesses. Polyarthritis can occur in patients with infection with mumps and parvovirus B19. It has also been reported during the preicteric period in patients with hepatitis B. Infections with rarer arthropod-borne alpha viruses endemic to East Africa, such as Chikungunya and O’nyong-nyong fever, are abrupt and can cause severe pain in large joints.
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CAUSES OF INFECTIOUS ARTHRITISThere are a number of causes of infectious arthritis. Gram-positive aerobes are implicated in the majority of cases of infectious arthritis and are seen in an estimated 70% to 80% of patients. Staphylococcus aureus is the most common pathogen in this group and is responsible for about 60% of infections in the joint space. The organism can also cause an acute septic bursitis following trauma. Streptococcal infections are also common and may be due to group A B-hemolytic streptococci as well as groups В, C, and G streptococci.Gram-negative bacilli are responsible for about 9% to 20% of cases of infectious arthritis. These infections typically occur in the elderly and in patients with comorbid conditions such as immunocompromised states or chronic arthritis. Pseudomonas aeruginosa is often the underlying cause in intravenous drug users with sternoclavicular or sacroiliac infections. Brucella can also cause arthritis of the sacroiliac joint in patients exposed to unpasteurized dairy products. Pasteurella multocida should be considered in patients who present with an animal bite to a joint.Neisseria gonorrhoeae remains the predominant cause in adults younger than 30 years of age. Disseminated gonococcal infection often manifests as a triad of polyarthritis, dermatitis (vesiculopustular skin lesions), and tenosynovitis. Synovial cultures yield the diagnosis in less than 50% of patients. N. gonorrhoeae can be recovered from pharyngeal, rectal, urethral, or cervical cultures. Gonococcal infection can also result in a monoarticular purulent arthritis without skin involvement. Synovial cultures are more often positive in these cases.Chronic monoarticular arthritis of the large joints, most commonly the knee, can be present in the later stages of Lyme disease. The organism, Borrelia burgdoferi, is rarely detected in synovial fluid, and the diagnosis is made through serologic testing.Mycobacterial infections can manifest as a more indolent and progressive monoarthritis. Tendon sheaths can be involved as well, particularly in infections with atypical mycobacteria. Potential organisms include Mycobacterium tuberculosis, Mycobacterium kansasii, and Mycobacterium marinum. Diagnosis is primarily made through culture of the synovial tissue.Chronic monoarthritis can occasionally be caused by fungal organisms, usually in immunocompromised patients. Disseminated coccidioidomycosis, blastomycosis, and sporotrichosis (particularly in people exposed to soil) have all been reported. Candidal infections may also occur, typically via hematogenous seeding, and are more acute in onset.Arthritis can be a significant feature of a number of viral illnesses. Polyarthritis can occur in patients with infection with mumps and parvovirus B19. It has also been reported during the preicteric period in patients with hepatitis B. Infections with rarer arthropod-borne alpha viruses endemic to East Africa, such as Chikungunya and O’nyong-nyong fever, are abrupt and can cause severe pain in large joints.*134/348/5*

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