Introduction
The bursae is a small, thin, slippery sac containing lubricating fluid. The bursae around joints all over the body lessen soft tissue and bone friction. One out of every five bursitis turns septic. Differentiating regular bursitis from septic can be difficult, as both cause pain, tenderness, and swelling above the joint area. This article briefly discusses the causes and treatment for septic bursitis.
What Is Septic Bursitis?
Septic bursitis is when the bursa, a fluid-filled sac that cushions the joint, becomes infected by bacteria. The condition frequently affects the bursae beneath the skin, such as the prepatellar bursa of the kneecap and the olecranon bursa at the elbow joint. The knee and elbow bursa are called superficial bursae.
How Does the Bursa Become Infected?
The bursa becomes infected when bacteria enters the bursal sac and multiplies. The micro-organisms are from:
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Outside Body: The bursa becomes susceptible to bacteria after a cut, scratch, puncture, or bug bite. Infection can also develop without any obvious entry point through the skin.
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Inside Body: This mode of septic bursitis forming within the body is less common. The microorganisms from elsewhere in the body could enter the bursa. Bacteria causing tuberculosis or septic arthritis trigger the development of septic bursitis.
Some individuals with a needle puncture formed from aspiration or corticosteroid injection for treating aseptic bursitis could also develop septic bursitis.
What Is the Risk Factor for Developing Septic Bursitis?
Septic bursitis is higher among gardeners, carpenters, and athletes who spend most of their time on knees and elbows. Individuals who consume corticosteroids, other medications that weaken the immune system, or have medical conditions like HIV (Human Immunodeficiency Virus), cancer, and uncontrolled diabetes become highly susceptible to septic bursitis. Chronic obstructive pulmonary disease (COPD), Alcoholism, inflammatory arthritis like rheumatoid arthritis, and crystal deposit arthritis like gout and pseudogout are some medical conditions that can lead to septic bursitis. Additionally, individuals with skin infections develop septic bursitis. Individuals with significant immunosuppression developing septic bursitis are hard to treat and take longer to heal.
What Are the Symptoms of Septic Bursitis?
Septic bursitis causes pain, tenderness, and swelling in the joint. The affected individual exhibits extreme redness and warmth over the skin of the affected bursa, joint tenderness, fever, chills, and feeling sick. Fever was found in 77 percent of the affected patients because of septic bursitis. The infection can become life-threatening if it spreads into the bloodstream.
How to Diagnose Septic Bursitis?
Medical diagnosis is the only method to know if the individual has septic bursitis. Doctors suspecting septic bursitis may order blood tests and fluid analysis within the bursa. Bursa fluid analysis requires fluid removal from the affected bursa using a needle or syringe. The procedure is also known as bursal aspiration. The bursa fluid is checked for blood cell count, glucose levels, crystal analysis, and gram strain. A higher level of white blood cells in the bursal fluid indicates an infection. Glucose levels that are lower than usual are also indicative of an infection. The presence of crystals in the bursal fluid suggests gout or pseudogout. Gram-staining tests help assess whether bacteria are present.
Although bursa fluid analysis is considered a gold standard for septic bursitis diagnosis, it is not a foolproof test as some of the bursal fluid analysis tests can be negative. Some microorganisms may not present themselves during analysis. The doctor may prescribe antibiotics even if the bursa fluid study does not reveal the infection and the symptoms indicate septic bursitis. Additional tests on the bursal fluids or the patient’s blood can help diagnose or rule out other medical conditions, such as rheumatoid arthritis or gout.
How to Treat Septic Bursitis?
Septic bursitis requires prompt treatment with antibiotics. The antibiotics prevent the infection from bursa spreading into the bloodstream. Individuals with mild septic bursitis must take antibiotics for at least ten days. There is a need for repeated aspiration of infected fluids or surgical drainage and removal of infected bursa (bursectomy). Aspiration of infected bursa fluid and longer courses of antibiotics are required until the infection symptoms disappear.
1. Antibiotic Treatment
The type of antibiotic, dosage, and treatment duration for septic bursitis depends on the individual. Antibiotics are given intravenously if the infection is advanced or the presence of related risk factors. Staphylococcus aureus is the causative bacteria for septic bursitis in 80 percent of cases. Other bacteria causing septic bursitis are Streptococci, coagulase-negative Staphylococci, Enterococci, and Escherichia coli. In 10 percent of cases, more than one organism causes septic bursitis.
2. Needle Aspiration
Excess fluid within the bursa is drained with a needle or syringe. The procedure is called needle aspiration or arthrocentesis. The fluid aspirated helps confirm bacterial infection or strain of bacteria causing the infection. Removing fluid from the bursa can help relieve pressure and increase the patient’s comfort. Needle aspiration is not advised when the patient has a skin infection or wound at the needle insertion site, as it may cause the infection to spread further. If needle insertion is impossible, the doctor suggests a surgical procedure to drain the bursa.
3. Surgery
Surgery for septic bursitis includes:
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Incision and Drainage: Incision is made to the skin overlying the bursa, and its contents are drained. The procedure is performed if aspiration is impossible and septic bursitis is suspected. The doctor can clean and disinfect the open wound.
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Bursectomy: The surgeon removes the inflamed bursa through bursa resection or bursectomy. The procedure is done immediately after incision and drainage.
Incomplete treatment of the septic bursitis or infection with atypical microbe will cause the infection to return and become chronic. Chronic septic bursitis will affect the nearby tendons, ligaments, and other surrounding tissues, resulting in more pain and complications in the future. Chronic septic bursitis will not respond to traditional antibiotic treatment. Therefore, the affected individuals must continue taking antibiotics as the physician advises. If septic bursitis is left untreated, the infected fluid within the bursa becomes pus. The infection can also spread into the bloodstream and other body parts. As the infection spreads, the symptoms will worsen.
Conclusion
Septic bursitis is the bacterial infection of a fluid-filled sac that cushions and becomes a gliding surface to reduce friction between body tissues. Pain, swelling, and tenderness are common symptoms of the infection. Septic bursitis is treated with medication, fluid drainage, or surgery.
