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Infections

  • There are many infections that can cause musculoskeletal problems including bone and joint infection, inflammatory arthritis and reactive arthritis (including acute rheumatic fever and post streptococcal arthritis).  
  • Musculoskeletal features may be accompanied by systemic and multi-system features.
    • Morbidity is high and there is potential mortality without diagnosis and access to the right specialist care and treatment. 
  • There is a wide range of infectious organisms that are be implicated - bacteria, mycobacteria, viruses, fungal diseases and parasitic infections. For some of these infections, the prevalence, risk factors and manifestations vary around the world.
    • A travel, environmental or occupational history are therefore sometimes relevant.
    • Some infections are transmitted by insects (e.g., arbovirus infections - Dengue, Chikungunya and Zika) or ticks (e.g., Lyme Disease) or through contact with animals or unpasteurised milks (e.g., Brucellosis) or following gastrointestinal infection (e.g., Shigella, Campylobacter, Yersinia). 
    • Some infections are spread through sexual activity (e.g., Gonorrhoea, Syphilis, chlamydia, Human Immunodeficiency Virus [HIV]) or through contact with blood products or intravenous drug abuse (e.g., HIV) or vertical transmission (e.g., pregnancy and HIV).  Sensitive enquiry may be needed to explore risk factors. 
  • The presentations of infection and musculoskeletal involvement are influenced by individual host factors and presence of immunosuppression (by disease including co-existent HIV infection or treatments).
    • Tuberculosis (TB) is common and needs to be considered in children who are living in endemic areas or have infection exposure or where children are immunosuppressed (due to disease including co-existent HIV infection or systemic immunosuppressive treatments). 
  • This modules covers important infections that can result in arthritis and other musculoskeletal features.
    • We include notes on Tuberculosis, Reactive Arthritis, Acute Rheumatic Fever, Post Streptococcal Arthritis, Arboviruses (Dengue, Chikungunya, Zika), HIV, Brucellosis, Lyme Disease.
    • Septic arthritis and osteomyelitis are covered elsewhere (Investigation and Limping child modules).
    • The cases also illustrate key points.
  • More information is available from the Centre for Communicable Diseases

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