Infectious Arthritis

Tuberculous bursitis with numerous ‘rice bodies'. The latter are mainly composed of fibrin and have no diagnostic significance. (Courtesy of Dr EF Lascano, Buenos Aires)

Definition

Diverse types of inflammatory changes of the joints due to different infectious agents such as bacteria, fungi or parasites.

Clinical Features

May be:
- bacterial
- fungal
- parasitic
Lyme disease:
- increasingly recognized and increasingly common
- arthropod-transmitted spirochetosis
- also involves:
  - skin
  - heart
  - nervous system1–4

Pathogenesis

Can reach joint by:
- contiguous extension from neighboring osteomyelitis (Fig. 1
  Fig. 1: Tuberculous bursitis with numerous ‘rice bodies'. The latter are mainly composed of fibrin and have no diagnostic significance. (Courtesy of Dr EF Lascano, Buenos Aires)
  )

Histopathology

Lyme disease:
- nonspecific chronic synovitis
- spirochete occasionally detected with Liederle stain5
- spirochetal antigens also demonstrated ultrastructurally if chronic6

Differential Diagnosis

Select up to 2 differential diagnoses to compare with Infectious Arthritis

References

1 Baumgarten JM, Montiel NJ, Sinha AA. Lyme disease-part 1: epidemiology and etiology. Cutis. 2002;69:349–352.

2 Meyerhoff J. Lyme disease. Am J Med. 1983;75:663–670.

3 Montiel NJ, Baumgarten JM, Sinha AA. Lyme disease-part II: clinical features and treatment. Cutis. 2002;69:443–448.

4 Steere AC. Lyme disease. N Engl J Med. 1989;321:586–596.

5 Johnston YE, Duray PH, Steere AC, Kashgarian M, Buza J, Malawista SE, et al. Lyme arthritis. Spirochetes found in synovial microangiopathic lesions. Am J Pathol. 1985;118:26–34.

6 Nanagara R, Duray PH, Schumacher HR. Ultrastructural demonstration of spirochetal antigens in synovial fluid and synovial membrane in chronic Lyme disease. Possible factors contributing to persistence of organisms. Hum Pathol. 1996;27:1025–1034.

Last updated: 6 Mar 2006