Viral infections are responsible for approximately 1% of all cases of infectious arthritis. These infections include parvovirus B19, HIV, hepatitis B, hepatitis C, hepatitis E, human T-lymphotrophic virus type-1, and arboviruses. Infectious arthritis can last for hours or days and is marked by pain, heat, rash, redness, and swelling. Some people, particularly the elderly, will experience fever and chills. Most infectious arthritis cases involve only one joint and more than half of these affect the knee. It can also affect the wrists, ankles, shoulders, hips, and spine.
According to Everyday Health, infectious arthritis occurs when germs invade the joint due to:
- animal or insect bites
- skin infections
- injury to the joint
- bacterial infection during surgery
- spread from a nearby infection
- blood stream infection
People with an increased risk of getting infectious arthritis include people who:
- are elderly (over 80) or very young (newborns)
- have diabetes mellitus, rheumatoid arthritis, osteoarthritis, gout, or pseudo gout
- have a prosthetic or artificial joint
- have recently had a joint surgery
- have a skin infection
- have a weakened immune system due to medication, HIV/AIDS, cancer
Infectious arthritis can lead to rapid joint destruction - it is important to seek treatment as soon as possible. Treatment often involves the draining of the infected fluid out of the joint and a full course of antibiotics. A delay in treatment increases the risk of permanent joint damage and loss of joint function. In serious cases, people may require amputation or joint surgery even after antibiotic treatment.
In an interview with Everyday Health, Kevin Deane, MD, assistant professor of medicine in the division of rheumatology at the University of Colorado Health Sciences Center in Denver, explained: "As rheumatologists, we basically consider infectious arthritis as a direct infection of the joint. They are most commonly from blood-borne infections, like staph or strep, which come from another site. These are the most devastating forms of arthritis because if you miss the diagnosis, a person can die. The risk of death due to infectious arthritis increases if you have heart or kidney problems, rheumatoid arthritis, or a weakened immune system."
Below are some common mosquito-borne viruses that can cause infectious arthritis:
Chikungunya (CKV) - Human CKV infection is initiated by the bite of an infected female mosquito. The virus has affected more than 1.5 million people worldwide, affecting 44 countries and territories in the Caribbean and Americas. Symptoms of infectious arthritis include fever over 390C, headache, myalgia, rash, and severe joint pain. The symptoms last for 7 to 10 days. During this time, chronic pain may resemble those from rheumatoid arthritis and seronegative spondyloarthrosis. The elderly and children are usually the most severely affected. Musculoskeletal symptoms may last for weeks or months. In some cases, about 5-10%, it may last for nearly 2 years.
Zika - Zika virus is an acute systemic infection. Symptoms include fever, rash, joint pain, myalgias and conjunctivitis. Zika have been reported in tropical Africa, Southeast Asia, Central America, South America, and the Pacific Islands. The symptoms last several days to weeks. According to the Center for Disease Control and Prevention, the risk to pregnant women was greatest in the first trimester of pregnancy, and continued into the second trimester. The virus can cause severe fetal brain defects, miscarriage and fetal death due to microcephaly.
Dengue Fever - Dengue fever is a leading cause of illness and death in tropics and subtropics, affecting as many as 400 million people annually. Symptoms include high fevers, severe headaches, eye pain, arthritis, myalgia, rash, bleeding (e.g., nose or gum bleed, petechiae, or easy bruising), and low white cell count. In severe cases, dengue can cause shock, internal bleeding and even death.
Currently, there is no vaccine for CKV, Zika or Dengue fever. The best way to protect yourself is to avoid exposure - wear bug repellents and wear long sleeved shirts and pants. To learn more about travelling and rheumatic and infectious diseases, please view the interview below between Kelly English, a member of the Arthritis Patient Advisory Board of Arthritis Research Canada, and Dr. Anne McCarthy from the Department of Medicine at the Ottawa Hospital (https://www.ottawahospital.on.ca).