scholarly journals 241. A Comparison of Staphylococcal and Streptococcal Septic Arthritis with Lyme Arthritis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S230-S230
Author(s):  
Don Kannangara ◽  
Dhyanesh Pandya
Keyword(s):  
Lyme Disease ◽  
Synovial Fluid ◽  
Septic Arthritis ◽  
Cell Count ◽  
Sports Injury ◽  
Lyme Arthritis ◽  
Joint Fluid ◽  
Joint Surgery ◽  
Wbc Count ◽  
Fluid Cell

Abstract Background Septic arthritis is considered the most important differential diagnosis in suspected Lyme arthritis. The present study sheds light on the most frequent misdiagnoses in Lyme arthritis cases and clues for differentiation from Staphylococcal and Streptococcal septic arthritis. Methods We studied patients with positive joint fluid cultures with Staphylococcus aureus (SA) and streptococci and Lyme polymerase chain reaction (PCR) positive joint fluid in 9 hospitals in Eastern Pennsylvania and 1 in Warren county, New Jersey over a 3 year period. Results One hundred and thirty four out of 7000 SA and 21 out of 1321 streptococcal isolates were from joint fluid. Twenty nine had Lyme arthritis, ages 5-74 ( 24 males,5 females). Twelve out of 29 were ages 10-18 with 20/29 under age 40. Predominant joint affected was a single knee 27/29. All had pain with or without swelling and little erythema. Two had fever. One reported a tick bite. None had other manifestations of Lyme disease. The diagnosis at the initial visit was sprain or sports injury in 5, osteoarthritis in 5, inflammatory arthritis or gout in 2 each, i septic arthritis, 1 viral syndrome and 1 ruptured Baker's cyst. Joint fluid count range was 3500-77,360 with only 3 over 50,000. White blood cell count (wbc) range was 3200-14,580. SA arthritis involved knee in 66 (49.3%), hip 31(23.9%), elbow 19 (14.2%), shoulder 14 (10.4%) with 2 wrist, 1 ankle and 1 sterno-clavicular joint. Fifty seven had a history of joint surgery. Eighty six were male and 48 female. age range 14-95 with a median age 65. Synovial fluid cell count was 335-470,000 and wbc 5,200-28,410 . Streptococcal septic arthritis ( 13 male 8 female) involved the knee in 17/21 with one each of hip, elbow, shoulder. The ages were 36-86 with 15/21 over age 60. Synovial fluid count was15,242-641,425 . Wbc count 11,140-25,080 .Nine out 21 had prior joint surgery. Conclusion Lyme arthritis patients were younger, mostly involving 1 knee, majority male without other manifestations of Lyme disease. Highest synovial fluid count was 77,360 and highest wbc count 14,580. Most frequent misdiagnoses were sports injury/sprain or osteoarthritis. SA and Streptococcal arthritis were mostly in elderly, with higher joint fluid cell and wbc counts. Only 1/29 Lyme arthritis was initially misdiagnosed septic arthritis. Disclosures All Authors: No reported disclosures

scholarly journals Septic Arthritis and the Opioid Epidemic: 1465 Cases of Culture-Positive Native Joint Septic Arthritis From 1990–2018

2020 ◽  
Vol 7 (3) ◽  
Author(s):  
John J Ross ◽  
Kevin L Ard ◽  
Narath Carlile
Keyword(s):  
Staphylococcus Aureus ◽  
Drug Use ◽  
Synovial Fluid ◽  
Septic Arthritis ◽  
Injection Drug Use ◽  
Injection Drug ◽  
Facet Joints ◽  
Cell Counts ◽  
Culture Positive ◽  
Fluid Cell

Abstract Background The clinical spectrum of septic arthritis in the era of the opioid crisis is ill-defined. Methods This is a retrospective chart review of 1465 cases of culture-positive native joint septic arthritis at Boston teaching hospitals between 1990 and 2018. Results Between 1990–2008 and 2009–2018, the proportion of septic arthritis cases involving people who inject drugs (PWID) rose from 10.3% to 20% (P < .0000005). Overall, methicillin-sensitive Staphylococcus aureus (MSSA) caused 41.5% of cases, and methicillin-resistant Staphylococcus aureus (MRSA) caused 17.9%. Gram-negative rods caused only 6.2% of cases. Predictors of MRSA septic arthritis included injection drug use (P < .001), bacteremia (P < .001), health care exposure (P < .001), and advancing age (P = .01). Infections with MSSA were more common in PWID (56.3% vs 38.8%; P < .00001), as were infections with MRSA (24% vs 16.8%; P = .01) and Serratia sp. (4% vs 0.4%; P = .002). Septic arthritis in the setting of injection drug use was significantly more likely to involve the sacroiliac, acromioclavicular, and facet joints; 36.8% of patients had initial synovial fluid cell counts of <50 000 cells/mm3. Conclusions Injection drug use has become the most common risk factor for septic arthritis in our patient population. Septic arthritis in PWID is more often caused by MRSA, MSSA, and Serratia sp., and is more prone to involve the sacroiliac, acromioclavicular, sternoclavicular, and facet joints. Synovial fluid cell counts of <50 000 cells/mm3 are common in culture-positive septic arthritis.

Clinical Features and Outcomes of Children with Culture-Negative Septic Arthritis

2018 ◽  
Vol 8 (3) ◽  
pp. 228-234 ◽  
Author(s):  
Evangelos Spyridakis ◽  
Jeffrey S Gerber ◽  
Emily Schriver ◽  
Robert W Grundmeier ◽  
Eric A Porsch ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Septic Arthritis ◽  
Clinical Features ◽  
Inflammatory Marker ◽  
Lyme Arthritis ◽  
Joint Fluid ◽  
Duration Of Symptoms ◽  
Empiric Antibiotics ◽  
Negative Culture ◽  
Culture Negative

Abstract Background Septic arthritis is a serious infection, but the results of blood and joint fluid cultures are often negative in children. We describe here the clinical features and management of culture-negative septic arthritis in children at our hospital and their outcomes. Methods We performed a retrospective review of a cohort of children with septic arthritis who were hospitalized at Children’s Hospital of Philadelphia between January 2002 and December 2014. Culture-negative septic arthritis was defined as a joint white blood cell count of >50000/μL with associated symptoms, a clinical diagnosis of septic arthritis, and a negative culture result. Children with pretreatment, an intensive case unit admission, Lyme arthritis, immunodeficiency, or surgical hardware were excluded. Treatment failure included a change in antibiotics, surgery, and/or reevaluation because of a lack of improvement/worsening. Results We identified 157 children with septic arthritis. The patients with concurrent osteomyelitis (n = 28) had higher inflammatory marker levels at presentation, had a longer duration of symptoms (median, 4.5 vs 3 days, respectively; P < .001), and more often had bacteremia (46.4% vs 6.2%, respectively; P < .001). Among children with septic arthritis without associated osteomyelitis, 69% (89 of 129) had negative culture results. These children had lower C-reactive protein levels (median, 4.0 vs 7.3 mg/dL, respectively; P = .001) and erythrocyte sedimentation rates (median, 39 vs 51 mm/hour, respectively; P = .01) at admission and less often had foot/ankle involvement (P = .02). Among the children with culture-negative septic arthritis, the inpatient treatment failure rate was 9.1%, and treatment failure was more common in boys than in girls (17.1% vs 3.8%, respectively; P = .03). We found no association between treatment failure and empiric antibiotics or patient age. No outpatient treatment failures occurred during the 6-month follow-up period, although 17% of the children discharged with a peripherally inserted central catheter line experienced complications, including 3 with bacteremia. Conclusions The majority of septic arthritis infections at our institution were culture negative. Among patients with culture-negative infection, empiric antibiotics failed for 9% and necessitated a change in therapy. More sensitive diagnostic testing should be implemented to elucidate the causes of culture-negative septic arthritis in children.

Methods of assessing the synovial fluid cell count

1984 ◽  
Vol 3 (3) ◽  
pp. 319-322 ◽  
Author(s):  
D. O. Haskard ◽  
P. A. Revell
Keyword(s):  
Synovial Fluid ◽  
Cell Count ◽  
Synovial Fluid Cell ◽  
Fluid Cell

scholarly journals Predictive value of the usual clinical signs and laboratory tests in the diagnosis of septic arthritis

CJEM ◽  
2015 ◽  
Vol 17 (4) ◽  
pp. 403-410 ◽  
Author(s):  
Marion Couderc ◽  
Bruno Pereira ◽  
Sylvain Mathieu ◽  
Jeannot Schmidt ◽  
Olivier Lesens ◽  
...  
Keyword(s):  
Septic Arthritis ◽  
Univariate Analysis ◽  
Clinical Signs ◽  
University Hospital ◽  
Joint Fluid ◽  
Radiological Findings ◽  
Bacteriological Test ◽  
History Of ◽  
Wbc Count ◽  
Crystal Induced Arthritis

AbstractObjectiveTo determine the sensitivity and specificity of clinical and laboratory signs for the diagnosis of septic arthritis (SA).Patients and methodsThis prospective study included all adult patients with suspected SA seen in the emergency department or rheumatology department at the University Hospital, Clermont-Ferrand, France, over a period of 18 months.ResultsIn total, 105 patients with suspected SA were included, 38 (36%) presenting with SA (29 [28%] with bacteriologically documented SA). In the univariate analysis, chills (p=0.015), gradual onset (p=0.04), local redness (p=0.01), as well as an entry site for infection (p=0.01) were most often identified in SA. A history of crystal-induced arthritis (p=0.004) was more frequent in non-SA cases. An erythrocyte sedimentation rate (ESR)>50 mm (p=0.005), a C-reactive protein (CRP) level >100 mg/L (p=0.019), and radiological signs suggestive of SA (p=0.001) were more frequent in the SA cases. Synovial fluid appearance: purulent (p<0.001) and clear (p=0.007), synovial white blood cell (WBC) count >50,000/μL (p < 0.001), differentiated between SA and non-SA.In multivariate analysis, only chills (odds ration [OR]=4.7, 95% confidence interval [CI] 1.3–17.1), a history of crystal-induced arthritis (OR=0.09, 95% CI 0.01–0.9), purulent appearance of the joint fluid (OR=8.4, 95% CI 2.4–28.5), synovial WBC count >50,000/mm3 (OR=6.8, 95% CI 1.3–36), and radiological findings (OR=7.1, 95% CI 13–37.9) remained significant.ConclusionNo clinical sign or laboratory test (excluding bacteriological test), taken alone, is conclusive for the differentiation between SA and non-SA, but the association of several signs, notably chills, history of crystal-induced arthritis, radiological findings, and the appearance and cellularity of joint fluid may be suggestive.

scholarly journals Hip Synovial Fluid Cell Counts in Children From a Lyme Disease Endemic Area

PEDIATRICS ◽  
2018 ◽  
Vol 141 (5) ◽  
pp. e20173810 ◽  
Author(s):  
Arianna H. Dart ◽  
Kenneth A. Michelson ◽  
Paul L. Aronson ◽  
Aris C. Garro ◽  
Thomas J. Lee ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Synovial Fluid ◽  
Endemic Area ◽  
Synovial Fluid Cell ◽  
Cell Counts ◽  
Fluid Cell

Synovial Fluid Cell Count for Diagnosis of Chronic Periprosthetic Hip Infection

2017 ◽  
Vol 99 (9) ◽  
pp. 753-759 ◽  
Author(s):  
Carlos A. Higuera ◽  
Benjamin Zmistowski ◽  
Tennison Malcom ◽  
Wael K. Barsoum ◽  
Scott M. Sporer ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Cell Count ◽  
Synovial Fluid Cell ◽  
Hip Infection ◽  
Fluid Cell

Evaluation of automated synovial fluid total cell count and percent polymorphonuclear leukocytes on a Sysmex XN-1000 analyzer for identifying patients at risk of septic arthritis

2020 ◽  
Vol 510 ◽  
pp. 416-420
Author(s):  
Abdulrahman Saadalla ◽  
Jose Jara Aguirre ◽  
Amy M. Wockenfus ◽  
Brandon R. Kelley ◽  
Rebecca L. Swanson ◽  
...  
Keyword(s):  
At Risk ◽  
Synovial Fluid ◽  
Septic Arthritis ◽  
Cell Count ◽  
Polymorphonuclear Leukocytes ◽  
Total Cell ◽  
Total Cell Count ◽  
Patients At Risk

scholarly journals Borrelia burgdorferipeptidoglycan is a persistent antigen in patients with Lyme arthritis

2019 ◽  
Vol 116 (27) ◽  
pp. 13498-13507 ◽  
Author(s):  
Brandon L. Jutras ◽  
Robert B. Lochhead ◽  
Zachary A. Kloos ◽  
Jacob Biboy ◽  
Klemen Strle ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Synovial Fluid ◽  
Antibiotic Treatment ◽  
Mononuclear Cells ◽  
Inflammatory Responses ◽  
Human Peripheral Blood ◽  
Cell Envelope ◽  
Lyme Arthritis ◽  
Multisystem Disorder ◽  
Peripheral Blood Mononuclear

Lyme disease is a multisystem disorder caused by the spirocheteBorrelia burgdorferi. A common late-stage complication of this disease is oligoarticular arthritis, often involving the knee. In ∼10% of cases, arthritis persists after appropriate antibiotic treatment, leading to a proliferative synovitis typical of chronic inflammatory arthritides. Here, we provide evidence that peptidoglycan (PG), a major component of theB. burgdorfericell envelope, may contribute to the development and persistence of Lyme arthritis (LA). We show thatB. burgdorferihas a chemically atypical PG (PGBb) that is not recycled during cell-wall turnover. Instead, this pathogen sheds PGBbfragments into its environment during growth. Patients with LA mount a specific immunoglobulin G response against PGBb, which is significantly higher in the synovial fluid than in the serum of the same patient. We also detect PGBbin 94% of synovial fluid samples (32 of 34) from patients with LA, many of whom had undergone oral and intravenous antibiotic treatment. These same synovial fluid samples contain proinflammatory cytokines, similar to those produced by human peripheral blood mononuclear cells stimulated with PGBb. In addition, systemic administration of PGBbin BALB/c mice elicits acute arthritis. Altogether, our study identifies PGBbas a likely contributor to inflammatory responses in LA. Persistence of this antigen in the joint may contribute to synovitis after antibiotics eradicate the pathogen. Furthermore, our finding thatB. burgdorferisheds immunogenic PGBbfragments during growth suggests a potential role for PGBbin the immunopathogenesis of other Lyme disease manifestations.

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