Differential Diagnosis Of Septic Arthritis Research Articles

A case of septic arthritis of the hip in Central Plains, China, during the Western Han Dynasty (3rd century BCE–1st century CE)

ObjectiveSeptic arthritis is not commonly reported in paleopathology. This study aims to provide a differential diagnosis of septic arthritis by looking at a case from ancient China. We also aim to add to the current literature on septic arthritis in paleopathology. MaterialsOne adult male skeleton recovered from the Dapuzi Cemetery, Shaanxi, dating to the Western Han Dynasty (3rd century BCE–1st century CE). MethodsMacroscopic observations were conducted. ResultsThe lytic appearance and massive new bone formation on the left acetabulum of M142 are compatible with septic arthritis. The hip pathology greatly influenced his stature. The two femur shafts present different degrees of robusticity. He also showed severe osteoarthritis. ConclusionsThe individual suffered from septic arthritis of the hip, of unknown cause, for a long period, which greatly influenced his daily life. Complications included osteoarthritis, shortened stature, and difficulties in walking. SignificanceThis study offers a new case of septic arthritis and provides insight into the people who guarded the royal tombs in the West Han Dynasty. LimitationsThe skeleton is not well-preserved, limiting observations of bony changes to other areas of the body.

Familial Mediterranean fever with pseudo-septic arthritis: A case report and review of the literature.

Familial Mediterranean fever (FMF) is a hereditary auto-inflammatory disease resulting from mutations of the MEFV gene. The disease is characterised by recurrent attacks of abdominal pain and fever. Most FMF patients develop arthritis at some point in their life usually manifesting as self-limiting monoarthritis. On very rare occasions, arthritis in FMF can mimic septic arthritis (pseudo-septic arthritis) with very similar clinical and laboratory findings. We report a case of a young male patient who presented with recurrent attacks of prolonged monoarthritis. For 2 years, he had undergone multiple admissions and operations for drainage of suspected septic joints. The synovial aspiration showed culture-negative pus with very high synovial white blood cell counts highly suggestive of septic arthritis. The patient was later found to have FMF based on homozygous M694V mutation of the MEFV gene. He was treated with colchicine monotherapy with a quick improvement of arthritis and later good control of his disease. The literature review showed very few case reports with similar presentations, most of which responded well to colchicine. FMF can mimic septic arthritis resulting in unnecessary expensive and invasive interventions and prolonged courses of antibiotics. Pseudo-septic arthritis is usually associated with M694V homozygous mutation and can complicate FMF at any time throughout the disease course. It is important to consider FMF in the differential diagnosis of septic arthritis, particularly with a family history of FMF and in patients from communities with a high prevalence of MEFV gene mutation.

Hand Swelling in an Adolescent.

Hand Swelling in an Adolescent.

Diagnostic values of HNP 1-3 and procalcitonin levels in synovial fluid aspirates in the differential diagnosis between septic arthritis and noninfectious arthritis

IntroductionAlthough early diagnosis of septic arthritis may reduce mortality rates, and limit unnecessary surgical interventions, clinical parameters alone are not adequate for making the diagnosis of septic arthritis. Therefore, relevant laboratory parameters are used to enhance diagnostic sensitivity. The aim of our study was to assist in making the diagnosis of septic arthritis, and prevent delays in the diagnosis. For this purpose; we aimed to determine the diagnostic values of human neutrophil peptides 1-3 (HNP 1-3) and procalcitonin (PCT) in synovial fluids of patients with arthritis. By comparing the HNP 1-3 and procalcitonin levels, as well as CRP, in synovial fluid aspirates, we evaluated the significance of these data in the differential diagnosis of septic arthritis from noninfectious arthritis. MethodsA total of 67 adults consisting of 37 septic arthritis and 30 noninfectious arthritis patients were included in our study. As bioindicators; levels of HNP 1-3, PCT, synovial and serum CRP levels were found to have significant ROC areas in discriminating septic arthritis patients from noninfectious arthritis patients. ResultsAs a result, synovial fluid HNP 1-3 levels were significantly higher in septic arthritis patients compared to noninfectious arthritis patients (p < 0.001). The sensitivity, specificity, and accuracy of HNP 1-3 levels in the diagnosis of septic and noninfectious arthritis were found as 86%, 87%, and 87%, respectively (AUC of the ROC curve = 0.828). ConclusionsIt was decided that the level of HNP 1-3 in the synovial fluid can be used as an alternative indicator in the diagnosis of septic arthritis.

External validation of Gout-calculator performance on a cohort of acute arthritis (SYNOLACTATE) sparing distal joints such as hallux and midfoot. A cross-sectional study of 170 patients.

To evaluate the performance of the Gout-calculator in a cohort of consecutive acute arthritis affecting large and intermediate joints (without an attack on hallux or midfoot joints). A retrospective study. Gout-calculator data were collected in medical records of patients included in the prospective consecutive cohort of acute arthritis called SYNOLACTATE. The diagnosis of gout was defined by the presence of sodium urate crystals in synovial fluid. The diagnostic performance of the Gout-calculator was studied by performing an ROC curve with the calculation of its AUC (95% CI) as well as the calculation of Sensitivity (Se), Specificity (Sp), and positive likelihood ratio (LR+). 170 patients with acute arthritis were included. Variables associated with the diagnosis of gout were as follows: serum uric acid > 350 μmol/L (OR 5.52 (2.52-12.1), p < 0.001), joint redness (OR 5.08 (1.85-14.0), p = 0.001), previous patient-reported arthritis attack (OR 4.04 (1.92-8.49), p < 0.001), male (OR 3.00 (1.17-7.69), p = 0.02), hypertension or cardiovascular disease (OR 2.33 (1.07-5.06), p = 0.03). The median (IQR) of Gout-calculator was significantly higher in gouty arthritis (7.0 [5.5-8.1]) than in associated-CPP acute arthritis (4.0 [2.0-5.8]), septic arthritis (3.0 [2.0-5.1]), or others arthritis (3.5 [2.0-5.5]). The AUC was 0.833 (0.768-0.897) with for the threshold ≥ 8, a Se at 27.5% (0.161-0.428), Sp 97.7% (0.934-0.992), and LR+ 11.9 (3.5-40). Despite diagnostic performances close to those published, the use of the Gout-calculator is not sufficient for the diagnosis of gout or to exclude the differential diagnosis of septic arthritis in the SYNOLACTATE cohort. • For a Gout-calculator threshold of ≤ 4, Sensitivity is 92.5%, Specificity 50.8% and LR- 0.15 to the gout diagnosis. • For a Gout-calculator threshold of > = 8, Sensitivity is 27.5%, Specificity 97.7% and LR+ 11.9 to the gout diagnosis. • In a population of acute arthritis affecting large joints, Gout-calculator is not sufficient to discriminate between gouty arthritis and septic arthritis.

Misleading radiological diagnosis in recurrent septic arthritis

Systemic lupus erythematosus (SLE) is a rheumatologic disease characterized with relapses which may require long-term corticosteroid treatment. Avascular necrosis and septic arthritis of the joints can be seen in patients with SLE, secondary to the corticosteroid treatment. Because the disease itself and the corticosteroid treatment cause changes in the acute phase reactant levels, it is difficult to differentiate abscess from hematoma by using laboratory tests. Particularly in complicated cases, differentiation of abscess and hematoma is challenging even with the use of different radiological modalities. In this article, we report a 53-year-old male patient who was operated due to bilateral recurrent septic arthritis and received a final diagnosis of hematoma. The aim of this report is to emphasize that hematoma should be considered in the differential diagnosis of septic arthritis.

Septic Arthritis Secondary to Neisseria gonorrheae Without Genital Symptoms and After Presumed Prolonged Carriage

Abstract Septic arthritis remains an uncommon but not rare occurrence, with the potential for catastrophic morbidity if not recognized and treated early with appropriate antimicrobial agents. The role of Neisseria gonorrheae is well established in the differential diagnosis of septic arthritis in the young, sexually active population and particularly in monoarticular presentations. Gonococcal septic arthritis occurring without genital symptoms is not emphasized, although it has been described previously. The length of time from exposure to N. gonorrheae to the development of pyogenic arthritis is variable but usually is within 3 weeks. We report 4 cases of septic arthritis due to N. gonorrheae occurring in our hospital within 18 months (approximately 5.3% of septic arthritis), with prolonged intervals from initial exposure and with minimal to no genital symptoms.

Salmonella Typhi: A cause of septic arthritis knee: A Rare entity.

Salmonella species enterica subspecies enterica serovar Typhi infection may result in various presentations like enteric fever, septicaemia with and without local suppurative lesions, gastroenteritis and the carrier state. Arthritis is an uncommon and rare manifestation of salmonella infection. Here, we report a case of septic arthritis of knee in a patient with benign prostate hypertrophy and catheter in situ . The case is presented for its rarity and to highlight the atypical manifestations of Salmonella Typhi in endemic regions. Hence salmonella species must always be kept in mind for the differential diagnosis of septic arthritis in a clinically relevant setting. Although few case reports have been reported signifying Salmonella enteritidis as a cause of septic arthritis knee however this is the first report of septic arthritis knee caused by Salmonella Typhi .

Pyogenic arthritis, pyoderma gangrenosum, and acne (PAPA) syndrome: differential diagnosis of septic arthritis by regular detection of exceedingly high synovial cell counts.

Pyogenic arthritis, pyoderma gangrenosum and acne syndrome was diagnosed in a 42-year-old patient, after an unusual persistency of high synovial cell counts had been noticed. Clinical peculiarities and problems with diagnosing septic versus non-septic arthritis are discussed.

Coexistent Pseudogout and Mycobacterium avium-intracellulare Septic Arthritis in a Patient with HIV and ESRD.

Pseudogout is a crystal-induced arthropathy characterized by the deposition of calcium pyrophosphate dihydrate (CPPD) crystals in synovial fluid, menisci, or articular cartilage. Although not very common, this entity can be seen in patients with chronic kidney disease (CKD). Septic arthritis due to Mycobacterium avium-intracellulare (MAI) is a rare entity that can affect immunocompromised patients such as those with acquired immunodeficiency syndrome (AIDS) or those who are on immunosuppressive drugs. Here, we describe a 51-year-old female who presented with fever, right knee pain, swelling, warmth, and decreased range of motion for several days. The initial assessment was consistent with pseudogout, with negative bacterial and fungal cultures. However, due to high white blood cell (WBC) count in the synovial fluid analysis, she was empirically started on intravenous (IV) vancomycin and piperacillin-tazobactam and discharged on IV vancomycin and cefepime, while acid-fast bacilli (AFB) culture was still in process. Seventeen days later, AFB culture grew Mycobacterium avium-intracellulare (MAI), and she was readmitted for relevant management. This case illustrates that septic arthritis due to MAI should be considered in the differential diagnosis of septic arthritis in immunocompromised patients.

Procalcitonin levels in fresh serum and fresh synovial fluid for the differential diagnosis of knee septic arthritis from rheumatoid arthritis, osteoarthritis and gouty arthritis.

Whether the levels of procalcitonin (PCT) in the serum and synovial fluid are effective indicators for distinguishing septic arthritis (SA) from non-infectious arthritis remains controversial. The present study aimed to evaluate whether PCT levels in fresh serum or fresh joint fluid may be used in the differential diagnosis of SA from rheumatoid arthritis (RA), osteoarthritis (OA) and gouty arthritis (GA). From January 2012 to June 2013, 23 patients with knee SA, 21 patients with RA, 40 patients with OA and 11 patients with GA were enrolled in the current study. The levels of PCT were measured within 24 h after specimen collection at room temperature. An enzyme-linked fluorescence assay (ELFA) was used to detect the levels of PCT in the serum and synovial fluid. The correlations between the levels of PCT in the serum and synovial fluid and the arthritic patient groups were determined by the Nemenyi test. Areas under the receiver operating characteristic (ROC) curve were calculated to evaluate the accuracy of the correlations. The levels of PCT in the serum and joint fluid of the patients in the SA group were higher compared with those of the other groups (P<0.01) and there were no significant differences among the RA, OA and GA groups in these levels. A PCT level of <0.5 μg/l in the serum and synovial fluid had high specificity in the differential diagnosis of SA from RA, OA and GA. Synovial fluid PCT revealed significantly greater sensitivity than serum PCT. The accuracy of the differential diagnosis of SA by the serum levels of PCT was significantly lower than that by the synovial fluid levels of PCT. The levels of PCT in the serum and synovial fluid may be used as alternative laboratory indicators to distinguish between SA and the non-infectious types of arthritis; however, the PCT levels in fresh synovial fluid are more sensitive and accurate indicators than PCT levels in fresh serum.

Investigating gout: taking a new approach to an old disease

Gout is a very painful and common form of acute arthritis, which is becoming increasingly prevalent in many Western societies. Gout was first identified by the Egyptians and is caused by a disorder of the body’s purine metabolism, resulting in raised serum uric acid level, known as hyperuricaemia. Gout tends to affect the older population, particularly obese patients and others with rather negative lifestyle habits, such as a high alcohol intake. However, in the majority of patients suffering from idiopathic gout (75–90%) the evidence suggests that these patients may actually have a genetic disposition to the reduced renal excretion of urate acid. Gout has a rapid onset and the most commonly affected joint is the first metatarsophalangeal, although other joints can also be affected such as the mid-foot, ankle, knee, wrist, finger and elbow. Recommended gout treatment includes non-steroidal anti-inflammatory drugs, colchicine and corticosteroids. Preventative treatments include allopurinol, which aims to lower uric acid levels. The definitive diagnostic test for gout is the aspiration of the joint or tophus and the confirmed identification of monosodium urate crystals. The presence of urate crystals confirms a diagnosis of gout and the absence of evidence of infection will rule out the key differential diagnosis of septic arthritis.

Gout: A new focus on an old disease

Overview Gout is an increasingly common condition predominantly affecting middle aged men. Although commonly related to the intake rich foods, a raised serum uric acid level also causes gout. Gout may present in the pre-hospital setting due to the intensity of the key presenting symptom – that of pain. This Continuing Professional Development (CPD) module focuses at the aetiology and incidence of gout, discusses the presenting signs and symptoms likely and suggested management plan. Although patients with gout rarely require hospital admission, a differential diagnosis of septic arthritis should be excluded and patients may require referral to the Emergency Department to confirm or exclude this diagnosis. Learning Outcomes After completing this module you will: To provide an overview of the incidence and prevalence of gout in the UK To outline and identify the presenting symptoms and underlying aetiology To outline the therapeutic and nontherapeutic treatments To describe some lifestyle choices impacting on the prevalence of gout

Continuing Professional Development: Gout: A new focus on an old disease

Overview Gout is an increasingly common condition predominantly affecting middle aged men. Although commonly related to the intake rich foods, a raised serum uric acid level also causes gout. Gout may present in the pre-hospital setting due to the intensity of the key presenting symptom – that of pain. This Continuing Professional Development (CPD) module focuses at the aetiology and incidence of gout, discusses the presenting signs and symptoms likely and suggested management plan. Although patients with gout rarely require hospital admission, a differential diagnosis of septic arthritis should be excluded and patients may require referral to the Emergency Department to confirm or exclude this diagnosis. Learning Outcomes After completing this module you will: • To provide an overview of the incidence and prevalence of gout in the UK • To outline and identify the presenting symptoms and underlying aetiology • To outline the therapeutic and nontherapeutic treatments • To describe some lifestyle choices impacting on the prevalence of gout

Salmonella enteridisSeptic Arthritis: A Report of Two Cases

Introduction. Nontyphoidal salmonellosis causes significant morbidity, is transmitted via fecal-oral route, and is a worldwide cause of gastroenteritis, bacteremia, and local infections. Salmonella is a less common etiologic factor for septic arthritis compared with other gram-negative bacteria. Cases. We present two septic arthritis cases with Salmonella enteridis as a confirmed pathogen and also discuss the predisposing factors and treatment. Discussion. Septic arthritis is an orthopedic emergency. The gold standard treatment of septic arthritis is joint debridement, antibiotic therapy according to the culture results, and physiotherapy, which should start in the early postoperative period to prevent limitation of motion. Salmonella is an atypical agent for septic arthritis. It must be particularly kept in mind as an etiologic factor for the acute arthritis of a patient with sickle cell anemia and systemic lupus erythematosus. Clinicians should be cautious that the white blood cell count in synovial fluid can be under 50.000/mm3 in immune compromised individuals with septic arthritis. The inflammatory response can be deficient, or the microorganism may be atypical. Conclusion. Atypical bacteria such as Salmonella species in immune compromised patients can cause joint infections. Therefore, Salmonella species must always be kept in mind for the differential diagnosis of septic arthritis in a clinically relevant setting.

Pseudogout Mimicking Infection Following Total Knee Arthroplasty: A Report of Two Cases.

One of the most serious postoperative complications following total knee arthroplasty is periprosthetic infection, with a reported rate of 1% to 2%1. Early diagnosis of the infection is critical for successful treatment, but diagnosis can be difficult. An acute pseudogout attack, for instance, should be included in the differential diagnosis of septic arthritis because the two conditions can have similar presentations, including joint pain, swelling, fever, and elevations in serum inflammatory marker levels. Several pseudogout cases mimicking infection after total knee arthroplasty have been reported, but most of these developed years after the surgery2-5. We report two cases of pseudogout mimicking infection that arose within two weeks after total knee arthroplasty. The patients were informed that data concerning their cases would be submitted for publication, and they provided consent. Case 1. A sixty-four-year-old woman with a history of hypertension underwent a primary right total knee arthroplasty for osteoarthritis (OA). Two days after the surgery, she began rehabilitation therapy; thirteen days after the surgery, she developed a fever of 38.4°C. The right knee was swollen and warm to the touch, but the surgical wound was free of drainage and was healing well. She had no pain in the right knee and was not taking nonsteroidal anti-inflammatory drugs (NSAIDs). Both the C-reactive protein (CRP) level (22.5 mg/L; normal: <3 mg/L) and the erythrocyte sedimentation rate (ESR) (29 mm/h; normal: <10 mm/h) were elevated. The total white blood-cell count and neutrophil count were 6.4 × 108/L and 4.9 × 108/L, respectively. She walked with a cane and had a knee range of motion …

Acute rheumatic fever: an important differential diagnosis of septic arthritis

We present three cases of suspected septic arthritis in which the joint fluid was sterile. Subsequently all three patients were diagnosed with established moderate-severe rheumatic heart disease. In retrospect it is likely that the earlier presentations were in fact episodes of acute rheumatic fever but were not recognized as such. These cases underline the importance of acute rheumatic fever as a differential diagnosis of septic arthritis when the joint fluid is sterile, particularly in regions where there are high rates of acute rheumatic fever and rheumatic heart disease.

Aspergillose disséminée à point de départ articulaire après infiltrations

Bone and joint infections due to Aspergillus are rare and occur more commonly in immunosuppressed patients. We report the case of an 84-year-old woman who developed septic arthritis caused by Aspergillus fumigatus after corticosteroid infiltration. This patient had presented with arthritis of the left knee for several months but no microorganism had been found despite numerous arthrocenteses. This arthritis was resistant to treatment by numerous corticosteroid infiltrations. During an arthroscopy, analysis of the synovial fluid yielded A. fumigatus. Thereafter, other explorations showed disseminated aspergillosis with osteo-articular destruction, blood and urinary dissemination. A systemic treatment by voriconazole associated to intra-articular injections and surgical debridement was initiated but the patient died. Septic arthritis caused by A. fumigatus is very rare but must be considered as a differential diagnosis of septic arthritis after corticosteroid infiltration. Their complications can be very important and destructive.