[Septic arthritis? Gonococcal infection despite negative bacterial cultures].
Clinical signs of acute arthritis are non-specific. An acute painfull joint with effusion of unknown origin needs to be evaluated by puncture. The analysis of the synovial fluid will enable to divide an arthritis into three categories: crystal induced, rheumatological or septic arthritis. A bacterial infection should always be suspected. Cultures from blood, synovia and Gram stain do not reliably exclude a bacterial infection. If gonococcal, mycobacterial, borrelial and non-gonococcal-infective arthritis under antibiotic therapy is suspected, direct DNA-amplification can be helpful. A disseminated gonococcal infection (DGI) must be suspected on appearance of tenosynovitis, polyarthralgia and skin lesions. The clinical picture, diagnosis and therapy of a case with DGI is discussed.
Saur
M
M
Klinik und Poliklinik für Innere Medizin, Universitätsspital Zürich. Matthias.Saur@usz.ch
Distler
O
O
Müller
N
N
D000465:Algorithms; D000843:Ankle Joint; D001170:Arthritis, Infectious / Q000175:diagnosis*; D016470:Bacteremia / Q000175:diagnosis; D001431:Bacteriological Techniques; D003937:Diagnosis, Differential; D006069:Gonorrhea / Q000175:diagnosis* / Q000635:transmission; D006801:Humans; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D009344:Neisseria gonorrhoeae / Q000235:genetics; D016133:Polymerase Chain Reaction; D012725:Sexual Behavior