POLYMERASE CHAIN REACTION-BASED METHODS FOR DETECTING MICROBIAL PATHOGENS IN PATIENTS WITH SEPTIC ARTHRITIS.

Participants: G. Krasan, C. Craig, J.M. Hall

Keywords: septic arthritis, PCR analysis, microbial pathogens

Introduction

The differentiation between septic arthritis and other acute inflammatory conditions of the joint, such as transient synovitis, is a diagnostic challenge. Pediatric patients with the presumptive diagnosis of septic arthritis are taken on an emergent basis to the operating room for open incision and drainage procedures. A subset of these patients will have negative synovial fluid cultures, thus complicating post-drainage therapeutic decisions (antibiotic coverage, duration of treatment). Preliminary evidence suggests that these individuals may have more subacute presentations, though it is unknown whether this is due to suppressed growth of routine bacterial pathogens or to new, as yet unidentified, causative agents.

We propose to use polymerase chain reaction (PCR)-based technology to improve our ability to identify microorganisms infecting these patients by directly amplifying bacterial genetic sequences from synovial fluid. To complement this study, we will also examine synovial fluid derived from patients with arthropathies presumed to be non-infectious. By using PCR-based approaches, we may also discover novel microbial pathogens that play a role in these diseases as well.

Materials and Methods

Samples of synovial fluid collected for diagnostic reasons or discarded during invasive joint procedures will be obtained from patients with 1) septic arthritis, 2) rheumatologic disorders, or 3) non-inflamed joints. The synovial fluid will be analyzed by routine bacterial culture and broad-range PCR techniques. All amplified genetic fragments will be sequenced to determine the phylogenetic group of the microbial species. Clinical signs, diagnosis and demographic information will be abstracted from these patients’ medical records and compared to the PCR analysis findings. Results will be used to generate hypotheses regarding the role of pathogens in different types of arthropathy.

Progress

IRB approval has been obtained for this study and synovial fluid samples are being collected for PCR analysis.