Types of Infectious Arthritis Etiologic Clinical Manifestations Duration/Onset Risk factors Laboratory findings Treatment Remarks

ACUTE BACTERIAL ARTHRITIS

Nongonococcal Bacterial Staphylococcal (S -Joint pain aggravated by Affected all age group Rheumatoid arthritis Acute bacterial infection – 25k – Antibiotics and drainage
Arthritis aureus) movement Glucocorticoid therapy 250 k/microliter
H influenzae -Joint swelling Vasculitic ulcer *>90% neutrophils Empiric therapy
Pneumococci -Erythema Diabetes mellitus Gram-stained smear - IV administer
Salmonella species -Single joint – 90% Hemodialysis - Presence of large bactericidal agents
Mc: knee Malignancy numbers of neutrophils - Gram (+) = Vancomycin
-Fever 38.3 – 38.9 Immunocompromised Blood culture (15-20 mg/kg/dose)
IV drug users - 50-70%  S aureus every 8-12 hours
NAA-based assay - If MRSA = Cefazolin 2g
- Useful in partially q 8 hrs, Oxacillin,
treated or culture- Nafcillin
negative bacterial - Gram (-) = Cefotaxime 1
arthritis g
Inflammatory markers
- Serum procalcitonin – Definitive therapy
50% elevation

Gonococcal Arthritis N gonorrhea DGI From asymptomatic Gonococcal infection DGI Ceftriaxone x 7 days with daily IM
- Fever, chills. Rash gonococcal mucosal - Cultures of synovila ceftriaxone given at 250 mg/daily
and articular colonization of the fluid are consistently Ciprofloxacin
symptoms urethra, cervix or negative, and blood Amoxicillin
- Small number of pharnyx cultures are positive - Azithromycin is recommended to
papules  <45% treat chlamydial infection
heamorrhagic Sexual partners should be offered
papules to extensor True Gonococcal septic arthritis treatment
surfaces of the - Culture of synovila fluid
distal extremities are positive - <40%
True Gonococcal septic cases. Blood cultures
arthritis are almost always
- Single joint such as negative
the hip, knee,
ankle, or wrist NAA-based assay are extremely
sensitive in detecting gonococcal
DNA in synovial fluid
SPIROCHETAL ARTHRITIS
Lyme Arthritis B burgdorferi Intermittent monoarthritis or Within days or weeks of Exposure to the vector Serologic test of IgG antibodies Doxycyline 100 mg BID x 28 days
oligoarthritis involving the inoculation of the Living in Europe and North are positive >90% Amoxicillin 500 mg TID x 28 days
knee and other large joints spirochetes by Ixodes America -or-
Waxing and waning tick NAA-based assay detects Borrelia Ceftriaxone 2g/d x 2-4 weeks
arthralgias DNA in 85% parenterally
Chronic inflammatory
synovitis
Syphilis Arthritis T pallidum Congenital syphilis: Pregnant mother with latent Antibody testing Penicillin G – drug of choice for Mononuclear and
Early – periarticular swelling syphilis infection RPR – test of choice for rapid all stages of syphilis neutrophilic synovial-
 and immobilization of Sexual contact serologic diagnosis fluid pleocytosis typical
involved limb (Parrot’s Blood transfusion VDRL – standard for examining cell count, 5 k – 15 k
pseudoparalysis) complicates Organ donation CSF and is superior to RPR for /microliter
osteochondritis of long bones this purpose

Late – chronic painless Both measures IgG and IgM

synovitis with effusion of directed against a cardiolipin
large joints particularly the lecithin-cholesterol antigen
knees and elbows (Clutton’s complex.
joint) – age 8-15 years old

Secondary syphilis –
arthralgias and symmetric
arthritis of knees and ankles

Tertiary syphilis – Charcot

joint results from sensory
loss due to tabes dorsalis
MYCOBACTERIAL ARTHRITIS Mycobacterium Chronic granulomatous Months or years – TB infection Blood culture – 80% Anti-tuberculous therapy (same
species monoarthritis – most progressive Immunocompromised Culture of synovial tissue – 90% with tuberculous pulmonary
common presentation monoarticular swelling HIV infection and shows granulomatous disease)
and arthralgia Trauma inflammation in most
Poncet’s disease – unusual Direct inoculation associated
sundrome, reactive with farming, gardening, or NAA method – 1-2 days’ time for
symmetric form of aquatic activities diagnosis
polyarthritis (with
disseminated TB)
FUNGAL ARTHRITIS Coccidioides Chronic monoarticular Gardeners and other persons Culture of synovial tissue – often Drainage Unusual case
immitis, arthritis – unusual who work with soil or confirms the diagnosis when Lavage of joint
Blastomyces sphagnum moss (S schenskii) synovial fluid is negative Anti-fungal agents directed to the
dermatitidis Articular Sporotrichosis DM specific pathogen
Histoplasma Hepatic/renal insufficiency Synovial fluid studies – usually
capsulatum Immunosuppressive therapy contain 10 k – 40 k Intraarticular instillation of
Candida alcoholic cells/microliter amphotericin B
Sporothrix schenskii *70% neutrophils
Aspergillus species’
Cryptococcus
neoformans
Pseudallescheria
boydii
VIRAL ARTHRITIS Viruses Arthralgias Arthritis within 3 days of Hepatitis ….. IV immunoglobulin Uncommonly recur >1
Frank arthritis the rash that follows Rubella year
Symmetric inflammation natural infection with Arthropod-borne viral infection
(fingers. wrist, knees) rubella virus (Zika, chikungunya, O nyong
Chronic fatigue nyong, Ross River, Mayaro, and
Low-grade fever Within 2-6 weeks after Barmah Forest viruses)
Headaches receipt of live-virus Enterovirus infection
Myalgias (which persists for vaccine
 months and years)
Self-limited
monoarticular or
migratory polyarthritis
Within 2 weeks of
parotitis of mumps

2 weeks before the

onset of jaundice in
acute hep B develops
arthritis (resolves at the
time jaundice develops)

Symmetric arthritis
involving the hands and
wrists may occur during
the convalescent phase
of infection with
lymphocytic
choriomeningitis virus

PARASITIC ARTHRITIS Dracunculus Monoarticular arthritis Rare

medinensis Reactive arthritis
Echinococcus
granulosos
Hookworm
Strongyloides
Cryptosporidium
Giardia infection
POSTINFECTIOUS/REACTIVE Develops several weeks
ARTHRITIS after 1% cases of
nongonococcal
urethritis and 2% of
enteric infections
particularly those
- Yersinia
enterocolitica,
- shigella
flexneri,
- C jejuni
- C difficile
- Salmonella
species
INFECTIONS IN PROTHETIC Total joint replacements Synovial fluid pleocytosis with a Surgery
JOINTS predominance of PMN High dosage of parenteral
leukocytes antibiotics – 4-6 weeks
Removal and replacement of
prosthesis
Drainage (open arthrotomy or
arthroscopically)