Reactive arthritis may be underdiagnosed in pediatric patients with C. difficile

A recently presented case-control study showed pediatric patients who experience infection with Clostridium difficile may develop reactive arthritis that is either unrecognized or misdiagnosed as septic arthritis.

Researchers using data from two pediatric care networks to identify 26 patients who were treated between 2004 and 2013 for C. difficile infection (CDI)-associated reactive arthritis, which was defined as the presence of acute arthritis and/or tenosynovitis between 4 weeks before and 12 weeks following the confirmed diagnosis of CDI with no other apparent cause and negative synovial cultures. Patients were matched for age and gender to a total of 94 control participants who developed CDI, but not have reactive arthritis.

Patients with CDI who developed reactive arthritis had a median onset of disease at 11 days following the onset of gastrointestinal symptoms. Multiple joints were infected in a migratory manor in 77% of patients, and hips and knees were most commonly affected. About half of all patients in the study group had a fever or a rash.

Septic hip arthritis was presumed and treated in 19% of the infected patients despite negative synovial cultures. Post-antibiotic diarrhea and involvement of other joints were present in all patients with presumed septic arthritis prior to surgical drainage.

When nosocomial infections were excluded, patients with CDI were most often treated in the emergency department or were hospitalized, despite the presence of fewer comorbidities and higher incidence of community-onset infection. A diagnosis of CDI-related reactive arthritis was made by treating providers in 36% of cases. - by Shirley Pulawski

Reference:

Horton D, et al. Paper #1450. Presented at: American College of Rheumatology Annual Meeting; Nov. 7-11, 2015; San Francisco.

Disclosure s : The researchers report no relevant financial disclosures.