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Harrison's Principles of Internal Medicine, 18e
| Part 15. Disorders of the Joints and Adjacent Tissues > Section 3. Disorders of the Joints and Adjacent Tissues > |
Chapter 334. Infectious Arthritis
Sections: Infectious Arthritis: Introduction, Acute Bacterial Arthritis, Spirochetal Arthritis, Mycobacterial Arthritis, Fungal Arthritis, Viral Arthritis, Parasitic Arthritis, Postinfectious or Reactive Arthritis, Infections in Prosthetic Joints, Acknowledgments, Further Readings.
Topics Discussed: arthritis, infectious.
Excerpt:"Although Staphylococcus aureus, Neisseria gonorrhoeae, and other bacteria are the most common causes of infectious arthritis, various mycobacteria, spirochetes, fungi, and viruses also infect joints (Table 334-1). Since acute bacterial infection can destroy articular cartilage rapidly, all inflamed joints must be evaluated without delay to exclude noninfectious processes and determine appropriate antimicrobial therapy and drainage procedures. For more detailed information on infectious arthritis caused by specific organisms, the reader is referred to the chapters on those organisms.Aspiration of synovial fluid an essential element in the evaluation of potentially infected joints can be performed without difficulty in most cases by the insertion of a large-bore needle into the site of maximal fluctuance or tenderness or by the route of easiest access. Ultrasonography or fluoroscopy may be used to guide aspiration of difficult-to-localize effusions of the hip and, occasionally, the shoulder and other joints. Normal synovial fluid contains <180 cells (predominantly mononuclear cells) per microliter. Synovial cell counts averaging 100,000/ L (range, 25,000–250,000/
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