| Clinical features |
Gram-positive bacteria (most common cause in resource-rich countries) |
Staphylococcus aureus | - All ages
- May cause polyarticular infection
- Possible associated skin or soft tissue infection
- MRSA may be associated with venous thromboembolism and pulmonary disease
|
Coagulase-negative staphylococci | - Most common cause of bacterial arthritis associated with prosthetic joints
|
Group A Streptococcus (Streptococcus pyogenes) | - May occur as a complication of concurrent varicella-zoster virus infection
|
Streptococcus pneumoniae (pneumococcus) | - Children younger than 2 years of age, typically without risk factors for invasive pneumococcal disease and without extra-articular manifestations of pneumococcal disease
|
Group B Streptococcus (Streptococcus agalactiae) | - Infants younger than 3 months of age (usually 2 to 4 weeks)
|
Nocardia asteroides | - Chronic monoarticular arthritis with a granulomatous reaction
|
Gram-negative bacteria (less common cause in resource-rich countries) |
Kingella kingae | - Usually children 6 to 36 months
- Indolent onset
- Oral ulcers preceding musculoskeletal findings
|
Haemophilus influenzae type b (Hib) | - Incompletely immunized children in areas with low Hib immunization rates
|
Neisseria gonorrhoeae | - Newborns
- May cause polyarticular infection
- Often involves the hip and shoulder
|
- Sexually active adolescents
- Usually occurs as part of disseminated infection with fever and rash
- In females, occurs most often in the first week of the menstrual cycle
|
Neisseria meningitidis | - May cause polyarticular infection
- Petechial or purpuric rash
- Postinfectious immune complex-mediated arthritis may occur 2 to 3 weeks after initiation of treatment of N. meningitis infections
|
Salmonella species | - Children with sickle cell disease or related hemoglobinopathies
- Exposure to reptiles or amphibians
- Children with gastrointestinal symptoms
- Children in resource-limited countries
|
Non-Salmonella gram-negative bacilli | - Newborns
- Instrumentation of the gastrointestinal or urinary tract
- Immunocompromised host
|
Enterobacter cloacae | - Open or penetrating trauma
- Increased risk of complications
|
Pseudomonas aeruginosa | - Puncture wounds
- Injectable drug use
|
Streptobacillus moniliformis (rat bite fever) | - Rat bite
- Macular rash at time of presentation
|
Borrelia burgdorferi (Lyme disease) | - Tick bite
- History of erythema migrans rash
- Travel to or living in an endemic area
- Intermittent inflammatory arthritis
|
Brucella | - Travel to or living in an endemic area
- Ingestion of unpasteurized dairy products
- Chronic monoarticular arthritis with a granulomatous reaction
|
Granulomatous arthritis |
Both Mycobacterium tuberculosis and nontuberculous mycobacteria (uncommon in resource-rich countries) | - Chronic monoarticular arthritis with a granulomatous reaction (may be indolent)
|
Coccidioides infection | - Coccidioidomycosis may produce an indolent arthritis
|