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Infectious Disease – Bursitis
Bursitis is the inflammation of the bursae, which may involve pyogenic infections, crystal deposition due to trauma or gout, or arthritis, predominantly rheumatoid arthritis. This chapter will address septic bursitis.
There are more than 150 bursae in the human body. They are sac-like formations that safeguard the soft tissues from the bony protrusions.
Septic bursitis primarily affects the superficial bursae. The disease most frequently occurs in the subdeltoid, olecranon, ischial, trochanteric, and prepatellar bursae.
RISK FACTORS
The primary predisposing factor in septic bursitis is trauma, accounting for 70% of cases.
• Notable associations comprise ischial bursitis in individuals with spinal injuries, malleolar bursitis in ice skaters, and subdeltoid bursitis following injections.
• Diabetes mellitus, alcohol dependence, and chronic dermatological conditions circumstances may also render individuals susceptible
• The emergence of Methicillin-Resistant Staphylococcus aureus (MRSA) infections has been linked to acupuncture and joint injections.
• Intravenous drug use may correlate with septic bursitis.
ETIOLOGY
• The predominant organism identified in bursitis is Staphylococcus aureus. • The secondary organism, responsible for 5–30% of cases, is Streptococcus.
• Infections caused by gram-negative bacteria or fungi are uncommon.
Recently, Prototheca wickerhamii, an algae prevalent in nature, has been linked to bursitis in immunocompromised persons.
Brucellosis should be included in the differential diagnosis in endemic regions.
Tuberculous involvement may manifest as a component of systemic illness.
PHYSICAL EXAMINATION FOR DIAGNOSIS
• Painful swelling and erythema of the bursae may occur.
• Fevers may occur.
• Indications of cellulitis may radiate from the bursae.
Systemic indicators of infection and bacteremia are more frequently linked to infections of deep bursae.
DIAGNOSTIC TESTS AND INTERPRETATION LABORATORY
The aspiration of the infected bursa is the preferred diagnostic method.
White blood cell counts frequently below 20,000 cells/mm3 may indicate septic bursitis.
Gram stain positivity varies between 15% and 100%.
Aspirate cultures exhibit high sensitivity and specificity.
Culture in liquid media may enhance sensitivity.
Crystal analysis should yield negative results in bacterial bursitis; nevertheless, both crystal-induced and bacterial bursitis may coexist concur simultaneously.
Imaging
• Plain radiograph: Subcutaneous edema and soft tissue swelling. • Ultrasound: Fluid accumulation. • MRI: Poorly or well-defined fluid accumulation. Following gadolinium administration, a distinct rim of enhancement encircling the infected bursa is observed, but adjacent tissues remain unaffected.
DIFFERENTIAL DIAGNOSIS
• Cellulitis/Fasciitis • Acute Monoarthritis • Gout • Pseudogout • Trauma
TREATMENT MEDICATION
• Frequent aspiration with a needle and syringe, perhaps on a daily basis, may be required in approximately fifty percent of cases until the bursa ceases to be fluctuant.
• Antibiotics: Initial antimicrobial therapy should prioritize staphylococci and streptococci. The ultimate selection of antibiotics is contingent upon the culture and sensitivity of the aspirated specimen. For Staphylococcus aureus, administer oxacillin or nafcillin intravenously at a dosage of 2 grams every 6 hours. If the bacterium exhibits methicillin resistance, vancomycin (intravenous 750–1,000 mg every 12 hours) is warranted.
– Antibiotics must be administered for a minimum of 14 days.
– A recent study indicated that in cases with severe infected bursitis necessitating hospitalization, antibiotic treatment may be restricted to 7 days for non-immunosuppressed individuals.
– The choice between parenteral and oral antibiotics is contingent upon the severity of the clinical condition and the degree of systemic toxicity linked to the infection. - Stabilization of the impacted bursae.
• If antibiotics fail to manage the infection and swelling and pain continue, surgical incision and drainage is necessary. Excision of the bursa is performed when the infection is persistent and the fluid has become compartmentalized.
SUPPLEMENTARY THERAPY
Comprehensive Strategies
Patients necessitate follow-up with rehabilitation treatments to prevent the restriction of joint mobility.
Bursitis is the inflammation of the bursae, which may involve pyogenic infections, crystal deposition due to trauma or gout, or arthritis, predominantly rheumatoid arthritis. This chapter will address septic bursitis.
There are more than 150 bursae in the human body. They are sac-like formations that safeguard the soft tissues from the bony protrusions.
Septic bursitis primarily affects the superficial bursae. The disease most frequently occurs in the subdeltoid, olecranon, ischial, trochanteric, and prepatellar bursae.
RISK FACTORS
The primary predisposing factor in septic bursitis is trauma, accounting for 70% of cases.
• Notable associations comprise ischial bursitis in individuals with spinal injuries, malleolar bursitis in ice skaters, and subdeltoid bursitis following injections.
• Diabetes mellitus, alcohol dependence, and chronic dermatological conditions circumstances may also render individuals susceptible
• The emergence of Methicillin-Resistant Staphylococcus aureus (MRSA) infections has been linked to acupuncture and joint injections.
• Intravenous drug use may correlate with septic bursitis.
ETIOLOGY
• The predominant organism identified in bursitis is Staphylococcus aureus. • The secondary organism, responsible for 5–30% of cases, is Streptococcus.
• Infections caused by gram-negative bacteria or fungi are uncommon.
Recently, Prototheca wickerhamii, an algae prevalent in nature, has been linked to bursitis in immunocompromised persons.
Brucellosis should be included in the differential diagnosis in endemic regions.
Tuberculous involvement may manifest as a component of systemic illness.
PHYSICAL EXAMINATION FOR DIAGNOSIS
• Painful swelling and erythema of the bursae may occur.
• Fevers may occur.
• Indications of cellulitis may radiate from the bursae.
Systemic indicators of infection and bacteremia are more frequently linked to infections of deep bursae.
DIAGNOSTIC TESTS AND INTERPRETATION LABORATORY
The aspiration of the infected bursa is the preferred diagnostic method.
White blood cell counts frequently below 20,000 cells/mm3 may indicate septic bursitis.
Gram stain positivity varies between 15% and 100%.
Aspirate cultures exhibit high sensitivity and specificity.
Culture in liquid media may enhance sensitivity.
Crystal analysis should yield negative results in bacterial bursitis; nevertheless, both crystal-induced and bacterial bursitis may coexist concur simultaneously.
Imaging
• Plain radiograph: Subcutaneous edema and soft tissue swelling. • Ultrasound: Fluid accumulation. • MRI: Poorly or well-defined fluid accumulation. Following gadolinium administration, a distinct rim of enhancement encircling the infected bursa is observed, but adjacent tissues remain unaffected.
DIFFERENTIAL DIAGNOSIS
• Cellulitis/Fasciitis • Acute Monoarthritis • Gout • Pseudogout • Trauma
TREATMENT MEDICATION
• Frequent aspiration with a needle and syringe, perhaps on a daily basis, may be required in approximately fifty percent of cases until the bursa ceases to be fluctuant.
• Antibiotics: Initial antimicrobial therapy should prioritize staphylococci and streptococci. The ultimate selection of antibiotics is contingent upon the culture and sensitivity of the aspirated specimen. For Staphylococcus aureus, administer oxacillin or nafcillin intravenously at a dosage of 2 grams every 6 hours. If the bacterium exhibits methicillin resistance, vancomycin (intravenous 750–1,000 mg every 12 hours) is warranted.
– Antibiotics must be administered for a minimum of 14 days.
– A recent study indicated that in cases with severe infected bursitis necessitating hospitalization, antibiotic treatment may be restricted to 7 days for non-immunosuppressed individuals.
– The choice between parenteral and oral antibiotics is contingent upon the severity of the clinical condition and the degree of systemic toxicity linked to the infection. - Stabilization of the impacted bursae.
• If antibiotics fail to manage the infection and swelling and pain continue, surgical incision and drainage is necessary. Excision of the bursa is performed when the infection is persistent and the fluid has become compartmentalized.
SUPPLEMENTARY THERAPY
Comprehensive Strategies
Patients necessitate follow-up with rehabilitation treatments to prevent the restriction of joint mobility.
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