Updated: 6/16/2019

Microbiology of Osteomyelitis and Arthritis

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  • A 26-year-old man presents to his primary care physician with pain in his knee, elbow, and wrist and reports subjective fever. He is sexually active with two partners and uses condoms inconsistently. On physical examination, there is tenderness of the tendon sheath upon palpation and a warm mildly swollen joint with asymmetric involvement of the knee, wrist, and elbow. (Gonococcal arthritis)
  • Clinical definition
    • osteomyelitis
      • infection of the bone and marrow
    • septic arthritis
      • infection of the joint
  • Pathophysiology
    • pathoanatomy
      • osteomyelitis
        • hematogenous spread
          • more common in children
          • usually monomicrobial
        • contiguous spread from adjacent infection
          • can be polymicrobial and monomicrobial
        • direct micro-organism inoculation
          • e.g., surgery and trauma
      • septic arthritis
        • hematogenous spread
          • most common
        • direct micro-organism inoculation
          • e.g., trauma and iatrogenically (surgery and arthrocentesis)
Select Microbes Causing Osteomyelitis
Select Microbes Causing Osteomyelitis
Microbe Comments
Staphylococcus aureus
  • Most common overall
  • Vertebral involvement
  • Intravenous drug use
  • Another common cause includes coagulase-negative staphylococci
Salmonella enteridis
  • Sickle cell anemia can also be due to S. aureus
Pseudomonas aeruginosa
  • Trauma (e.g., puncture wound to foot), diabetics, and intravenous drug users 
Neisseria gonorrhoeae
  • Sexually transmitted infections can lead to osteomyelitis, although septic arthritis is more common
Staphylococcus epidermidis
  • Prosthesis
Mycobacterium tuberculosis
  • Vertebral osteomyelitis (Pott's disease, also known as Tuberculous spondylitis)
Pasteurella multocida
  • Animal bites/scratches
Group B Streptococcus
  • Infants younger than 3 months
Select Microbes Causing Infectious Arthritis
Select Microbes Causing Infectious Arthritis
Microbes Comments
Staphylococcus aureus
  • Most common
    • arthritis can be mono- or poly-articular
    • can be accompanied with cellulitis, abscess, intravenous drug use, osteomyelitis, or endocarditis
Streptococci and other gram-positive organisms
  • Second most common cause
Pseudomonas aeruginosa
  • Can be seen in intravenous drug users
Neisseria gonorrhoeae
  • Seen in sexually active young adults
    • presents with polyarticular arthritis
  • Disseminated gonococcal infection

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