ArticlePediatrics2018
Hip Synovial Fluid Cell Counts in Children From a Lyme Disease Endemic Area.
Article in Pediatrics, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 29 citations in OpenAlex.
- Bedside hip aspiration results in decrease in total general anesthesia time in pediatric patients: A multicenter study.Journal of children's orthopaedics · 2022Article
- Musculoskeletal manifestations of Lyme borreliosis - a review.Archives of medical science : AMS · 2022Article
- Acute Arthritis in Children: How to Discern between Septic and Non-Septic Arthritis?Children (Basel, Switzerland) · 2021Review
- Evaluation of the Modified Two-Tiered Testing Method for Diagnosis of Lyme Disease in Children.Journal of clinical microbiology · 2019Article
- Revisiting the Lyme Disease Serodiagnostic Algorithm: the Momentum Gathers.Journal of clinical microbiology · 2018Article
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Authors and funding
10 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundPatients with septic hip arthritis require surgical drainage, but they can be difficult to distinguish from patients with Lyme arthritis. The ability of synovial fluid white blood cell (WBC) counts to help discriminate between septic and Lyme arthritis of the hip has not been investigated.
methodsWe assembled a retrospective cohort of patients ≤21 years of age with hip monoarticular arthritis and a synovial fluid culture obtained who presented to 1 of 3 emergency departments located in Lyme disease endemic areas. Septic arthritis was defined as a positive synovial fluid culture result or synovial fluid pleocytosis (WBC count ≥50 000 cells per µL) with a positive blood culture result. Lyme arthritis was defined as positive 2-tiered Lyme disease serology results and negative synovial fluid bacterial culture results. All other patients were classified as having other arthritis. We compared median synovial fluid WBC counts by arthritis type.
resultsOf the 238 eligible patients, 26 (11%) had septic arthritis, 32 (13%) had Lyme arthritis, and 180 (76%) had other arthritis. Patients with septic arthritis had a higher median synovial fluid WBC count (126 130 cells per µL; interquartile range 83 303-209 332 cells per µL) than patients with Lyme arthritis (53 955 cells per µL; interquartile range 33 789-73 375 cells per µL). Eighteen patients (56%) with Lyme arthritis had synovial fluid WBC counts ≥50 000 cells per µL. Of the 94 patients who underwent surgical drainage, 13 were later diagnosed with Lyme arthritis.
conclusionsIn Lyme disease endemic areas, synovial fluid WBC counts cannot always help differentiate septic from Lyme arthritis. Rapid Lyme diagnostics could help avoid unnecessary operative procedures in patients with Lyme arthritis.
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