Prevalence and Pattern of Infectious (Septic) Arthritis in Immunocompromised Patients in a Tertiary Institution in Southern Nigeria

Abstract

Background: Infectious (septic) Arthritis in immunocompromised (HIV/AIDS) patients can lead to mortality if not diagnosed early and treated properly.  The incidence of this condition across the globe is wide and varied. There is paucity of epidemiologic data in our environment.

Objectives: The purpose  of this study was therefore to evaluate the prevalence and pattern of presentation of infectious (septic) arthritis in our local environment and compare it  with the global trend.

Materials and Methods: Blood samples from 360 HIV/AIDS patients aged 19 to 67years suspected to have infectious (septic)  arthritis were analyzed for Full blood count, ESR, CD4 count, and blood culture. Synovial fluid from the involved joint was analyzed for white cell count,  microscopy culture and sensitivity, and assay for tuberculosis using the ZN stain technique. Mantoux test was done in those suspected to have  tuberculous arthritis. Data were analysed using SPSS version 25.

Results: Sixteen of the 360 participants had infectious (septic) arthritis involving twenty  joints of the appendicular skeleton, and three spinal involvements. 50% of these had acute septic arthritis, 25% had HIV associated arthritis, 12.5% had  tuberculosis of the spine, while 6.25% each had tuberculous arthritis, and tuberculous arthritis coexisting with tuberculosis of the spine. 62.5% had   staphylococcus aureus, 25% streptococcus pyogenes, while 12.5% were Klebsiella Species. ZN stain was positive in two cases.

Conclusion: The prevalence of  infectious (septic) arthritis in HIV/AIDS immunocompromised patients in our environment was 4.4%. Acute septic arthritis was commonest infectious  arthritis in this group of patients with Staphylococcus aureus being the commonest organism isolated. The knee joint was the most commonly affected  joint.