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Septic Arthritis

Septic Arthritis is a topic covered in the 5-Minute Pediatric Consult.

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Microbiologic infection and inflammation of the usually sterile joint space


  • Most common age: toddler and school age (2 to 6 years)
  • Predominant sex: male (2:1 female)
  • Most common location: lower extremities (hip, knee, and ankle) and large joints (hip, shoulder, elbow)


  • Entry of bacteria into joint space
    • Hematogenous spread (seeding during transient bacteremia) most common
    • Direct inoculation (penetrating trauma or during surgery)
    • Extension from bone infection (mainly in children <1 year old when vessels cross from metaphysis to epiphysis)
  • In response to cytokines, influx of inflammatory cells and release of proteolytic enzymes
  • Leads to destruction of synovium and cartilaginous structures


  • Most common causes by age:
    • Neonates: group B Streptococcus, Staphylococcus aureus, Escherichia coli, and Candida albicans
    • Older children: S. aureus, group A Streptococcus, Kingella kingae in toddlers, Haemophilus influenzae
  • Also consider
    • Salmonella: in patients with sickle cell
    • Neisseria gonorrhoeae: in sexually active adolescents and in neonates
    • Neisseria meningitidis
    • Mycobacterium tuberculosis
    • Anaerobes (rare)
    • Rubella
    • Parvovirus
    • Hepatitis B or C
    • Mumps
    • Herpesviruses (Epstein-Barr virus, cytomegalovirus, herpes simplex virus, varicella-zoster virus)
    • Fungal etiologies (e.g., coccidioidomycosis, rarely candida)

Commonly Associated Conditions

  • Sickle cell disease: Salmonella
  • Immunocompromised patients: Mycoplasma, Ureaplasma, Klebsiella, or Aspergillus infection

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Cabana, Michael D., editor. "Septic Arthritis." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617393/all/Septic_Arthritis.
Septic Arthritis. In: Cabana MD, ed. 5-Minute Pediatric Consult. 8th ed. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617393/all/Septic_Arthritis. Accessed April 24, 2019.
Septic Arthritis. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult. Available from https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617393/all/Septic_Arthritis
Septic Arthritis [Internet]. In: Cabana MD, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617393/all/Septic_Arthritis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Septic Arthritis ID - 617393 ED - Cabana,Michael D, BT - 5-Minute Pediatric Consult UR - https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617393/all/Septic_Arthritis PB - Wolters Kluwer ET - 8 DB - Pediatrics Central DP - Unbound Medicine ER -