Organisms That Commonly Cause Acute Infectious Arthritis
Patient Group | Organism | Typical Sources |
|---|---|---|
Adults and adolescents | Staphylococcus aureus, beta-hemolytic streptococci, pneumococci, gonococci (in young adults of reproductive age), and rarely Neisseria meningitidis | Bacteremia (for staphylococci, streptococci, and pneumococci); cervical, urethral, rectal, or pharyngeal infection with bacteremic dissemination (for gonococci) |
Neonates | Group B streptococci, Escherichia coli (and other gram-negative enteric bacteria), S. aureus | Maternal-fetal transmission IV punctures or catheters with bacteremic dissemination |
Children ≤ 3 years | Streptococcus pyogenes, Streptococcus pneumoniae, S. aureus, Kingella kingae | Bacteremia (eg, otitis media, upper respiratory infections, skin infections, meningitis) |
Age 3 years to adolescence | S. aureus, streptococci, Neisseria gonorrhoeae, Pseudomonas aeruginosa, Kingella kingae | Bacteremia or contiguous spread |
Children with meningitis, bacteremia, or palpable purpura | N. meningitidis (uncommon) | |
All ages | Viruses (eg, parvovirus B19, hepatitis B, or hepatitis C virus, rubella virus [active infection and after immunization], togavirus, chikungunya virus, varicella virus, mumps virus [in adults], adenovirus, coxsackieviruses [A9, B2, B3, B4, and B6], retroviruses [including HIV], Epstein-Barr virus) | Viremia or immune complex deposition |
Patients with possible tick exposure | Borrelia burgdorferi (causing Lyme disease) | |
Patients with bite wounds (human, dog or cat, rat) | Often polymicrobial Human: Eikenella corrodens, group B streptococci, S. aureus, oral anaerobes (eg, Fusobacterium sp, peptostreptococci, Bacteroides sp) Dog or cat: S. aureus, Pasteurella multocida, Pseudomonas sp, Moraxella sp, Haemophilus sp Rat: S. aureus, Streptobacillus moniliformis, Spirillum minus | Direct joint penetration, usually of the small joints of the hands (See also Infected Bite Wounds of the Hand.) |
Older adults Patients with severe joint trauma or serious disease (eg, immunosuppression, hemodialysis, systemic lupus erythematosus, rheumatoid arthritis, diabetes, cancer) | Staphylococci (particularly in rheumatoid arthritis), gram-negative bacteria (eg, Enterobacter, P. aeruginosa, Serratia marcescens), Salmonella sp (particularly in systemic lupus erythematosus*) | Urinary tract, skin |
Patients with polyarticular infections | Streptococci, S. aureus | Pharyngitis, cellulitis, endocarditis, gastrointestinal and genitourinary infections |
Patients with joint penetration (caused by injury, arthrocentesis, or arthrotomy), contiguous infection, diabetes, or cancer | Streptococci, S. aureus Anaerobes (eg, Cutibacterium acnes, Peptostreptococcus magnus, Fusobacterium sp, Clostridium sp, Bacteroides sp); often as mixed infections with facultative or aerobic bacteria such as S. aureus, Staphylococcus epidermidis, E. coli | Skin, abdomen, genitals, odontogenic infections, sinuses, ischemic limbs, decubitus ulcers |
HIV-infected patients | S. aureus, streptococci, Salmonella sp, mycobacteria | Skin, mucous membranes, catheters |
Injection drug use, indwelling vascular catheters (eg, for hemodialysis, apheresis, chemotherapy, or parenteral nutrition) | Gram-negative bacteria, S. aureus, streptococci, Candida sp | Bacteremia, fungemia |
* Signs of inflammation can be blunted, so physicians need to have a lower threshold for aspiration and culture; some chronic conditions (eg, immunosuppression, hemodialysis, systemic lupus erythematosus, rheumatoid arthritis, diabetes, cancer) may increase risk of unusual infections (eg, fungal, mycobacterial). | ||
sp = species. | ||