Arthritis, Infectious, Granulomatous



  • Invasion of joints by microorganisms; often as part of a systemic infection/disease
  • Curable type of arthritis
  • System(s) affected: musculoskeletal
  • Synonym(s): fungal arthritis; mycobacterial arthritis; subacute bacterial arthritis


  • 1–3% of patients with tuberculosis (TB) infections (1)
  • 10–30% of extrapulmonary TB presents with musculoskeletal involvement.
  • Predominant age: all ages
  • Predominant gender
    • Male > female (Brucella and Mycobacterium)
    • Female > male (fungal)

1 in 3 million in the general population

Pediatric Considerations
Infrequent in pediatric population

Etiology and Pathophysiology

  • Hematogenous invasion is most common.
  • Contiguous spread
  • Direct penetration via trauma
  • Fungal infections may disseminate from primary pulmonary involvement, particularly in immunocompromised hosts.
  • Direct contact with or consumption of infected animal products

Risk Factors

  • Concurrent extra-articular infection
  • Chronic inflammatory arthritis (e.g., rheumatoid arthritis [RA])
  • Trauma, especially penetrating
  • Prosthetic joint(s)
  • Prior antibiotic, corticosteroid, or immunosuppressive therapy
  • Serious chronic systemic illness (e.g., diabetes mellitus, liver disease, malignancy, primary immunodeficiency)
  • Defective phagocytosis (e.g., chronic granulomatous disease)
  • Injection drug use
  • Exposure to specific infectious agents (e.g., brucellosis, unpasteurized milk, farmers, butchers, veterinarians)
  • Gardening (sporotrichosis)
  • Aquatic exposure (e.g., fish hook puncture and Mycobacterium marinum)

Commonly Associated Conditions

  • Systemic infection
  • Immunodeficiency/immunosuppression (e.g., from HIV/AIDS, lymphoma, transplantation, medications)
  • Poncet disease (reactive arthritis associated with TB)

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