Acute Arthritis in Children: How to Discern between Septic and Non-Septic Arthritis?

Lisa Gamalero,Teresa Giani,Giovanna Ferrara,Rolando Cimaz

doi:10.3390/children8100912

Lisa Gamalero, Teresa Giani + Show 2 more

Open Access

https://doi.org/10.3390/children8100912

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Abstract

The term septic arthritis refers to an infection of the synovial space. This is an infrequent condition in healthy children, but it should be considered a medical emergency potentially leading to irreversible articular damage. Therefore, prompt diagnosis and antimicrobial treatment play a crucial role in improving the prognosis. Although septic arthritis is the most common cause of acute arthritis, many other diseases may mimic a similar clinical picture, constituting a diagnostic challenge for the clinician who first approaches the patient. Herein we analyze the main features of septic arthritis, offering an overview of the main conditions involved in the differential diagnosis and suggesting a diagnostic workup plan.

Highlights

Septic arthritis is a medical emergency potentially leading to a rapid morbidity with irreversible articular damages; it represents one of the most concerning causes of arthritis.The term arthritis refers to an inflammation of the joint synovium regardless of its etiology
The most common cause of acute arthritis, especially of monoarthritis, is an infection of the joint space, known as septic arthritis, a broad differential diagnosis might represent a diagnostic challenge for the clinician who first approaches the patient
Belowwe we present present aa brief inin differential diagnosis with septic arthritis

Summary

Introduction

Septic arthritis is a medical emergency potentially leading to a rapid morbidity with irreversible articular damages; it represents one of the most concerning causes of arthritis. The most common cause of acute arthritis, especially of monoarthritis, is an infection of the joint space, known as septic arthritis, a broad differential diagnosis might represent a diagnostic challenge for the clinician who first approaches the patient. Staphylococcus aureus is considered the most frequent pathogen responsible for osteomyelitis and septic arthritis in any age group, mainly methicillin-sensitive strains (MSSA), as it is accountable for up to 70–90% of confirmed cases. Blood and joint fluid cultures should be required in the suspicion of septic arthritis before starting antibiotic therapy, even if they confirm the diagnosis only in 34–82% of cases [17,18,19]. WBC, ESR, and CRP that could be elevated both in septic and inflammatory arthritis, the response to antibiotic drugs and the evolution within the first 48 h will guide the clinician to confirm the correct diagnosis. Infection has been confirmed by isolation of an organism from synovial fluid

Differential Diagnosis

Orthopedic Conditions

Rheumatic Conditions

Tumors

Findings

Conclusions