Laboratory Tests in Adults with Monoarticular Arthritis: Can They Rule Out a Septic Joint?

Li, S. F.

doi:10.1197/j.aem.2003.09.018

Cited by 70 publications

(36 citation statements)

References 22 publications

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“…1 A correct and early diagnosis of septic arthritis is challenging. 1,[5][6][7][8][9] Although international guidelines for diagnosis of septic arthritis exists, 8 there is still a lack of rapid and adequate diagnostic parameters to rule out or prove a bacterial joint infection. Physical examination findings and conventional laboratory test results have poor or limited diagnostic accuracies.…”

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confidence: 99%

“…1,[8][9][10] While arthrocentesis is a gold standard procedure, 10 synovial fluid white cell count is also increased in various inflammatory arthropathies and, therefore, not a very reliable index of joint infection unless very high levels appear. 5,6,[9][10][11] Neutrophils are the main types of effector cells in the innate immune system. In addition to the more traditional mechanism of phagocytosis to kill bacteria, it has recently been shown, that activation of neutrophils causes the release of web-like structures of DNA, called neutrophil-derived extracellular traps (NETs).…”

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Diagnostic accuracy of neutrophil‐derived circulating free DNA (cf‐DNA/NETs) for septic arthritis

Lögters

Paunel-Görgülü

Zilkens

et al. 2009

Journal Orthopaedic Research

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The release of ''neutrophil extracellular traps'' (NETs) has been identified as a novel immune response in innate immunity. NETs are composed of neutrophil-derived circulating free DNA (cf-DNA) and neutrophil cytoplasm-derived proteins such as proteases. In this study, we analyzed the putative diagnostic value of synovial cf-DNA/NETs for identification of septic arthritis. Forty-two patients with a joint effusion who had undergone arthrocentesis were included. From synovial fluid, cf-DNA/NETs (j-cf-DNA) levels were directly quantified. Diagnostic value of j-cf-DNA was compared with white blood cells (WBC), synovial white blood cells (j-WBC), C-reactive protein (CRP), j-IL-6, j-TNF alpha, j-IL-1 beta, and myeloperoxidase (j-MPO). Sensitivity, specificity, positive and negative predictive value, as well as ROC-curves for each parameter were calculated. Synovial fluid cf-DNA/NETs values from patients with septic arthritis (3,286 AE 386 ng/ ml, n ¼ 9) were significantly increased compared to patients with noninfectious joint inflammation (1,040 AE 208 ng/ml, n ¼ 17) or osteoarthritis (278 AE 34 ng/ml, n ¼ 16, p < 0.01). In conjunction with j-cf-DNA, j-IL-6 and j-IL-1 beta were significantly elevated (p < 0.01), but WBC, CRP, and j-WBC were not. At a cut-off of 300 ng/ml, j-cf-DNA had a sensitivity of 0.89, a specificity of 1.0, a positive predictive value of 1.0, and a negative predictive value of 0.97. Receiver operation curves revealed largest areas under the curve for cf-DNA/NETs (0.933) and j-IL-6 (0.951). cf-DNA/NETs seem to be a valuable additional marker for the diagnosis of septic arthritis or periprosthetic infections. However, this result should be confirmed in a large clinical trial. ß

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confidence: 99%

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confidence: 99%

Diagnostic accuracy of neutrophil‐derived circulating free DNA (cf‐DNA/NETs) for septic arthritis

Lögters

Paunel-Görgülü

Zilkens

et al. 2009

Journal Orthopaedic Research

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“…La probabilidad aumenta progresivamente con recuentos > 25.000/mm 3 (LR 2,9), > 50.000/mm 3 (LR 7,7) y > 100.000/mm 3 (LR 28). 8 Las pruebas de laboratorio general como leucocitosis (> 10.000/mm 3 ), elevación de la eritrosedimentación (> 30 mm/h) o aumento de la PCR (> 100 mg/L) no permiten acercarse al diagnóstico por su sensibilidad subóptima y especificidad limitada 1,8,14 . El diagnóstico oportuno de la artritis séptica es de suma importancia por las consecuencias devastadoras sobre la articulación y por la letalidad que ocasionalmente generan.…”

Section: Discussionunclassified

Artritis séptica en pacientes adultos en un hospital general de Chile

Florestano

Fíca

Gaete

et al. 2014

Rev. chil. infectol.

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100 mg/L in 90.6%. Gram positive cocci were the most frequently isolated microorganisms (81.5%), predominating S. aureus (48.1%), and with 4 isolates methicillin resistant isolates (26.7%). Resistant isolates trend to be associated with previous surgery (p = 0.055) and all cases caused by non-fermentative Gram negative bacilli had recent hospitalization or surgery, a feature that did not reach a significant difference. Nine events were associated to bacteremia (36%). Outcome analysis indicated 32% of events with full recovery, 28% with a favorable evolution, 20% with therapy failure and 16.7% patients that died. A total of 24% of the series remained with significant sequels. Conclusions: Septic arthritis is an infrequent disease that affects in most cases patients with predisposing conditions. Associated symptoms include pain and impaired joint movement, sometimes fever, hypotension, positive blood cultures and frequently a C-reactive protein > 100 mg/L. Predominant agents are Gram positive cocci, specially S. aureus, including methicillin resistant isolates. Case-fatality ratio, treatment failure and sequels are important.]]>

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“…Osteoarthritis is a chronic disease. WBC values increase in septic arthritis but generally do not change in osteoarthritis 24 . We also examined NLR and PLR levels, and found them to be significantly raised in the osteoarthritis patient group.…”

Section: Discussionmentioning

confidence: 99%

Osteoartrit hastalarında hematolojik parametrelerin tanısal değeri

Hira¹,

Tamam²

2017

Cukurova Medical Journal (Çukurova Üniversitesi Tıp Fakültesi Dergisi)

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Laboratory Tests in Adults with Monoarticular Arthritis: Can They Rule Out a Septic Joint?

Abstract: The WBC, ESR, and jWBC are extremely variable in adults with septic arthritis. Laboratory tests do not rule out septic arthritis with accuracy.

Cited by 70 publications

References 22 publications

Diagnostic accuracy of neutrophil‐derived circulating free DNA (cf‐DNA/NETs) for septic arthritis

Diagnostic accuracy of neutrophil‐derived circulating free DNA (cf‐DNA/NETs) for septic arthritis

Artritis séptica en pacientes adultos en un hospital general de Chile

Osteoartrit hastalarında hematolojik parametrelerin tanısal değeri

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