Merck Manual

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Chronic Infectious Arthritis

By

Steven Schmitt

, MD, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University

Medically Reviewed Jul 2022 | Modified Sep 2022
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Chronic infectious arthritis develops over weeks and is usually caused by mycobacteria, fungi, or bacteria with low pathogenicity.

Chronic infectious arthritis accounts for 5% of infectious arthritis. It can develop in healthy people, but patients at increased risk include those with

Examples of possible causes are Mycobacterium tuberculosis Tuberculosis (TB) Tuberculosis is a chronic, progressive mycobacterial infection, often with an asymptomatic latent period following initial infection. Tuberculosis most commonly affects the lungs. Symptoms include... read more Tuberculosis (TB) , M. marinum Nontuberculous Mycobacterial Infections There are over 170 recognized species of mycobacteria, mostly environmental. Environmental exposure to many of these organisms is common, but most exposures do not cause infection and many infections... read more , M. kansasii Nontuberculous Mycobacterial Infections There are over 170 recognized species of mycobacteria, mostly environmental. Environmental exposure to many of these organisms is common, but most exposures do not cause infection and many infections... read more , Candida Candidiasis (Invasive) Candidiasis is infection by Candida species (most often C. albicans), manifested by mucocutaneous lesions, fungemia, and sometimes focal infection of multiple sites. Symptoms depend... read more Candidiasis (Invasive) species, Coccidioides immitis Coccidioidomycosis Coccidioidomycosis is a pulmonary or hematogenously spread disseminated disease caused by the fungi Coccidioides immitis and C. posadasii; it usually occurs as an acute benign... read more Coccidioidomycosis , Histoplasma capsulatum Histoplasmosis Histoplasmosis is a pulmonary and hematogenous disease caused by Histoplasma capsulatum; it is often chronic and usually follows an asymptomatic primary infection. Symptoms are those... read more Histoplasmosis , Cryptococcus neoformans Cryptococcosis Cryptococcosis is a pulmonary or disseminated infection acquired by inhalation of soil contaminated with the encapsulated yeasts Cryptococcus neoformans or C. gattii. Symptoms... read more Cryptococcosis , Blastomyces dermatitidis Blastomycosis Blastomycosis is a pulmonary disease caused by inhaling spores of the dimorphic fungus Blastomyces dermatitidis. Occasionally, the fungi spread hematogenously, causing extrapulmonary... read more Blastomycosis , Sporothrix schenckii Sporotrichosis Sporotrichosis is a cutaneous infection caused by the saprophytic mold Sporothrix schenckii. Pulmonary and hematogenous involvement is uncommon. Symptoms are cutaneous nodules that spread... read more Sporotrichosis , Aspergillus fumigatus Aspergillosis Aspergillosis is an opportunistic infection that usually affects the lower respiratory tract and is caused by inhaling spores of the filamentous fungus Aspergillus, commonly present in... read more Aspergillosis , Actinomyces israelii Actinomycosis Actinomycosis is a chronic localized or hematogenous anaerobic infection caused by Actinomyces israelii and other species of Actinomyces. Findings are a local abscess with multiple... read more Actinomycosis , and Brucella Brucellosis Brucellosis is caused by Brucella species, which are gram-negative bacteria. Symptoms begin as an acute febrile illness with few or no localized signs and may progress to a chronic stage... read more species.

Unusual opportunistic organisms are possible in patients with hematologic cancers or HIV infection Human Immunodeficiency Virus (HIV) Infection Human immunodeficiency virus (HIV) infection results from 1 of 2 similar retroviruses (HIV-1 and HIV-2) that destroy CD4+ lymphocytes and impair cell-mediated immunity, increasing risk of certain... read more Human Immunodeficiency Virus (HIV) Infection or who are taking immunosuppressive drugs. A prolonged or recurrent illness and lack of response to conventional antibiotics suggest a mycobacterial or fungal cause.

In chronic infectious arthritis, the synovial membrane can proliferate and can erode articular cartilage and subchondral bone. Onset is often indolent, with gradual swelling, mild warmth, minimal or no redness of the joint area, and aching pain that may be mild. Usually a single joint is involved.

Patients should have fungal and mycobacterial cultures taken of synovial fluid or synovial tissue, as well as routine studies. Molecular testing techniques may also be useful, especially for detecting mycobacteria.

Mycobacterial and fungal joint infections require prolonged treatment. Mycobacterial infections are often treated with multiple antibiotics, guided by sensitivity testing results.

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