You have been logged out of VisualDx or your session has expired.

Please reload this page and sign into VisualDx to continue.

..
  VisualDx Mobile   Select Language

Get VisualDx Mobile

There are VisualDx mobile apps available for iOS and Android devices.

You will need a VisualDx account to use the mobile apps.



Already have an account? Sign In or
sign up for a free trial.

Users with VisualDx accounts earn CME credits for using VisualDx.

Already have an account? Sign In or
sign up for a free trial.

Create a Personal Account

E-mail (username)
Password
Verify Password
First Name
Last Name

Personal Account Created

Mobile Access

You can now download VisualDx for your iOS and Android devices. Launch the VisualDx app from your device and sign in using your VisualDx personal account username and password.

CME Certification

Sign in with your personal account to earn and claim CME credits through VisualDx. Credits can be earned by building a differential or looking up a diagnosis.

Version: 7.09.1401   (build 62b8f0e)
Select Language


Select Region

Send us your feedback

E-mail
Message
This field is required

Oops! There was an issue during submission. Please try again. If the problem persists, email feedback@visualdx.com with your feedback.

Thank You!

We appreciate your feedback and you will be hearing from us soon.

OK

Share This Page

Thank You!

We have sent an e-mail with a link to the current page.

OK

E-mail This Patient Information Sheet

Thank You!

We have sent an e-mail with this patient information.

OK

Image Contributors

Individuals

  • Christine Ahn MD
    Carl Allen DDS, MSD
    Brandon Ayres MD
    Howard P. Baden MD
    Robert Baran MD
    Keira Barr MD
    Gregory J. Basura MD, Ph.D
    Donald Belsito MD
    Jeffrey D. Bernhard MD
    Jesse Berry MD
    Victor Blanco MD
    Benjamin R. Bohaty MD
    William Bonnez MD
    Sarah Brenner MD
    Robert A. Briggaman MD
    Robert Brodell MD
    Roman Bronfenbrener MD
    Walter Brooks MD
    William Buckley MD
    Philip Bulterys MD, PhD (candidate)
    Susan Burgin MD
    Sonya Burton MD
    Sean P. Bush MD, FACEP
    Jeffrey Callen MD
    Scott Camazine MD
    Michael Cardwell
    Shelley D. Cathcart MD
    Robert Chalmers MD, MRCP, FRCP
    Chia-Yu Chu MD, PhD
    Flavio Ciferri MD
    Maria Rosa Cordisco MD
    Noah Craft MD, PhD
    John T. Crissey MD
    Harold E. Cross MD, PhD
    Charles Crutchfield III MD
    Adriana Cruz MD
    Donna Culton MD, PhD
    Bart J. Currie MBBS, FRACP, DTM&H
    Chicky Dadlani MD
    Alexander Dane DO
    C. Ralph Daniel III MD
    Thomas Darling MD, PhD
    William Delaney MD
    Damian P. DiCostanzo MD
    Ncoza Dlova MD
    James Earls MD
    Libby Edwards MD
    Melissa K. Egge MD
    Charles N. Ellis MD
    Rachel Ellis MD
    David Elpern MD
    Nancy Esterly MD
    Stephen Estes MD
    E. Dale Everett MD
    Janet Fairley MD
    David Feingold MD
    Benjamin Fisher MD
    Henry Foong MBBS, FRCP
    David Foster MD, MPH
    Brian D. Foy PhD
    Michael Franzblau MD
    Vincent Fulginiti MD
    Sunir J. Garg MD, FACS
    Kevin J. Geary MD
    Lowell Goldsmith MD, MPH
    Sethuraman Gomathy MD
    Bernardo Gontijo MD, PhD
    Kenneth Greer MD
    Kenneth G. Gross MD
    Alan Gruber MD
    Nathan D. Gundacker MD
    Akshya Gupta MD
    Vidal Haddad MSC, PhD, MD
    Edward Halperin MD, MA
    Ronald Hansen MD
    John Harvey
    Rizwan Hassan MD
    Michael Hawke MD
    Jason E. Hawkes MD
    Peter W. Heald MD
    David G. Hicks MD
    Sarah Hocker DO
    Ryan J. Hoefen MD, PhD
    Li-Yang Hsu MD
    William Huang MD
    Sanjana Iyengar MD
    Alvin H. Jacobs MD
    Shahbaz A. Janjua MD
    Joshua J. Jarvis MD
    Kit Johnson
    Robert Kalb MD
    A. Paul Kelly MD
    Henry Kempe MD
    Loren Ketai MD
    Sidney Klaus MD
    Ashwin Kosambia MD
    Jessica A. Kozel MD
    Carl Krucke
    Mario E. Lacouture MD
    Joseph Lam MD
    Alfred T. Lane MD
    Edith Lederman MD
    Nahyoung Grace Lee MD
    Pedro Legua MD, PhD
    Robert Levin MD
    Bethany Lewis MD
    Sue Lewis-Jones FRCP, FRCPCH
    Taisheng Li MD
    Christine Liang MD
    Shari Lipner MD, PhD
    Jason Maguire MD
    Mark Malek MD, MPH
    Jere Mammino DO
    Ricardo Mandojana MD
    Lynne Margesson MD
    Thomas J. Marrie MD
    Maydel Martinez MD
    Ralph Massey MD
    Patrick McCleskey MD
    Karen McKoy MD
    Thomas McMeekin MD
    Josette McMichael MD
    Somchai Meesiri MD
    Joseph F. Merola MD
    Mary Gail Mercurio MD
    Anis Miladi MD
    Larry E. Millikan MD
    Dan Milner Jr. MD
    Zaw Min MD
    Stephanie Montero
    Alastair Moore MD
    Keith Morley MD
    Dean Morrell MD
    Samuel Moschella MD
    Taimor Nawaz MD
    Vic Newcomer MD
    John Nguyen MD
    Matilda Nicholas MD
    Thomas P. Nigra MD
    Steven Oberlender MD, PhD
    Maria Teresa Ochoa MD
    Art Papier MD
    Lawrence Parish MD
    Tanner Parrent MD
    Mukesh Patel MD
    Lauren Patty-Daskivich MD
    David Peng MD, MPH
    Robert Penne MD
    Nitipong Permpalung MD
    Doug Powell MD
    Harold S. Rabinovitz MD
    Christopher J. Rapuano MD
    Sireesha Reddy MD
    Angela Restrepo MD, PhD
    Bertrand Richert MD, PhD
    J. Martin Rodriguez, MD, FACP
    Theodore Rosen MD
    Misha Rosenbach MD
    Scott Schiffman MD
    Robert H. Schosser MD
    Glynis A. Scott MD
    Carlos Seas MD, MSc
    Deniz Seçkin MD
    Daniel Sexton MD
    Paul K. Shitabata MD
    Tor Shwayder MD, FAAP, FAAD
    Elaine Siegfried MD
    Gene Sienkiewicz MD
    Christye Sisson
    Mary J. Spencer MD, FAAP
    Sarah Stein MD
    William Van Stoecker MD
    Frances J. Storrs MD
    Erik J. Stratman MD
    Lindsay C. Strowd MD
    Erika Summers MD
    Belinda Tan MD, PhD
    Robert Tomsick MD
    Jenny Valverde MD
    Vishalakshi Viswanath MD
    Susan Voci MD
    Lisa Wallin ANP, FCCWS
    Douglas Walsh MD
    Ryan R. Walsh MD
    George Watt MD
    Clayton E. Wheeler MD
    Sally-Ann Whelan MS, NP, CWOCN
    Jan Willems MD, PhD
    James Henry Willig MD, MPH
    Karen Wiss MD
    Vivian Wong MD, PhD
    Sook-Bin Woo MS, DMD, MMSc
    Jamie Woodcock MD
    Stephen J. Xenias MD
    Lisa Zaba MD
    Vijay Zawar MD
    Bonnnie Zhang MD
    Carolyn Ziemer MD


Organizations

  • Am. Journal of Trop. Med & Hygiene
  • Armed Forces Pest Management Board
  • Blackwell Publishing
  • Bugwood Network
  • Centers For Disease Control and Prevention
  • Centro Internacional de Entrenamiento e Investigaciones Mèdicas (CIDEIM)
  • Dermatology Online Journal
  • East Carolina University (ECU), Division of Dermatology
  • International Atomic Energy Agency
  • Massachusetts Medical Society
  • Oxford University Press
  • Radiological Society of North America
  • Washington Hospital Center
  • Wikipedia
  • World Health Organization
ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyAssociated MedicationsReferencesInformation for PatientsView all Images (2)
Emergency: requires immediate attention
Septic arthritis
Print Captions OFF
Other Resources UpToDate PubMed
Emergency: requires immediate attention

Septic arthritis

Print Patient Handout Images (2)
Contributors: Neil Mendoza MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

An infection of a joint most frequently caused by bacteria (although fungi, parasites, and mycobacteria may also rarely cause this infection).

This infection occurs most commonly as a result of hematogenous seeding of the joint in the setting of bacteremia. A joint may be inadvertently inoculated with a pathogen at the time of surgery or trauma. In some patients, a severe soft tissue infection may spread to involve a nearby joint.

Common pathogens responsible for this infection include Staphylococcus aureus, Streptococcus species, gram-negative bacilli, and Neisseria gonorrhoeae.

Risk factors for this infection include old age, diabetes mellitus, recent joint surgery or procedure, skin infection, the presence of a prosthetic joint, or immunosuppression. Patients with rheumatoid arthritis or who abuse intravenous drugs are also at increased risk for this infection.

Patients present with a swollen, warm, stiff, and painful joint. Fever may be present. The majority of the time, a single joint (usually the knee) is involved. Symptoms develop over 1-2 weeks. If the infection is caused by N. gonorrhoeae, patients classically also present with a rash and tenosynovitis. If the infection is due to fungi or mycobacteria, the symptoms may be more subtle and may worsen more gradually.

Diagnosis can be made by arthrocentesis. Joint fluid should be sent for analysis including cell count, microscopic analysis for crystals, gram stain, and bacterial culture. Additional cultures of the joint fluid can be obtained if an atypical pathogen is suspected by history or examination.

Treatment requires drainage of the joint (surgically or by repeated needle aspiration) in combination with antimicrobial therapy.

Codes

ICD10CM:
M00.80 – Arthritis due to other bacteria, unspecified joint

SNOMEDCT:
396234004 – Infective arthritis

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

  • Arthritis due to viral infections (eg, parvovirus B19, rubella, human immunodeficiency virus, chikungunya, Zika virus) – Arthritis may affect multiple joints and be associated with rash and other symptoms of a viral syndrome including fever.
  • Lyme arthritis – May present with similar symptoms as septic arthritis, but usually with less pain. Serologic testing for Lyme disease may be performed in patients with a possible exposure history. Arthrocentesis to exclude septic arthritis due to typical pathogens should still be performed.
  • Rheumatoid arthritis – Classically presents with symmetrical involvement of peripheral joints.
  • Gout – Intracellular urate crystals seen in joint fluid (presence of crystals does not rule out concomitant septic arthritis).
  • Calcium pyrophosphate deposition disease – Calcium pyrophosphate crystals seen in joint fluid (presence of crystals does not rule out concomitant septic arthritis).
  • Reactive arthritis – Patients have a preceding illness (eg, diarrhea or urethritis) and may also present with enthesitis, dactylitis, or inflammatory back pain.
  • Osteoarthritis – Usually symptoms are chronic and there are not usually inflammatory findings (red, hot, swollen joint) on examination.
  • Injury (eg, meniscal tear) – Patient will usually relate a history of preceding trauma.
  • Hemarthrosis – Patient will usually have a history of trauma or a bleeding disorder.

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

Associated Medications

Subscription Required

References

Subscription Required

Last Updated: 03/02/2016
Copyright © 2018 VisualDx®. All rights reserved.
Emergency: requires immediate attention
Septic arthritis
Captions OFF Print 2 Images
View all Images (2)
(with subscription)
Septic arthritis : Fever, Joint swelling, Arthralgia, Limited range of motion
Imaging Studies image of Septic arthritis
Coronal CT view demonstrates large right hip joint effusion with foci of air and erosion of the femoral head and acetabulum. Findings are consistent with septic arthritis with associated osteomyelitis. Note that the femoral head is dislocated due to the underlying effusion and infection.
Copyright © 2018 VisualDx®. All rights reserved.