The diagnosis of septic arthritis was confirmed by synovial WBC count > 50,000/mL and positive synovial fluid culture. Oligoarthritis was diagnosed if there is arthritis affecting 1 to 4 joints during the first six months. Signs or symptoms must have been documented daily for at least three days and accompanied by one or more of the following: evanescent rash, generalized lymphadenopathy, hepato/splenomegaly, serositis. Systemic arthritis was diagnosed if there was arthritis in 1 or more joints with or preceded by fever of at least two weeks’ duration. JIA was diagnosed based on ILAR criteria of JIA, 2001 : We evaluated the synovial fluid specimens collected as part of the general diagnostic protocol from patients suspected of Juvenile Idiopathic arthritis or Septic Arthritis, during a period between December 2014 and April 2016 in pediatric rheumatology department at Mofid’s children hospital and orthopedic department at Akhtar Orthopedic Hospital. We designed this study to evaluate the diagnostic value of synovial LE test in the acute bacterial arthritis in children and differentiating them from inflammatory arthritides. So, based on the current literature, we cannot differentiate between inflammatory arthritis with elevated synovial WBC count and acute bacterial arthritis, which may be very similar clinically in children, solely on the result of the synovial LE test. Since the LE test shows elevated WBC count in the tested fluid, there is no study in children assessing the effect of inflammatory WBC on the LE test results. LE test has been proved accurate for diagnosis of meningitis, peritonitis and even cow mastitis. Synovial LE has a sensitivity of 81% and specificity of 97% using a 2-plus (++) reading as a threshold for bacterial arthritis. Synovial leukocyte esterase (LE) can be measured with a colorimetric strip (urinalysis dipstick), which is a quick, easy, simple and inexpensive test, providing immediate test results, being invaluable in the operative setting. Recently, new diagnostic markers have been investigated, including synovial leukocyte esterase, synovial alpha-defensin, serum interleukine-6, serum procalcitonin, serum D-dimer and molecular technologies. The cornerstone of the diagnosis is the evaluation of aspirated synovial fluid by gram stain, bacterial culture, and cell count with differential. However, none of these parameters are specific and sensitive enough to rule in or out the acute bacterial arthritis. Diagnosis of acute bacterial arthritis depends on clinical presentations, lab findings, imaging studies and arthrocentesis. If diagnosed late, acute bacterial septic arthritis can lead to chondral damage (as early as 8 h) and joint destruction (permanent joint damage can occur in < 3 days), and adjacent bone osteomyelitis, hence, urgent diagnosis and treatment are warranted. An infection is acute if the time between symptom onset and diagnosis is < 2 weeks. More than 80% of cases occur in lower extremities, knees, hips and ankles being the most commonly affected joints. The overall incidence of this condition is 4 to 10 per 100,000 children in developed countries and up to 200 per 100,000 in developing countries. ![]() Septic arthritis is a joint infection that can lead to significant acute and chronic morbidities. The synovial LE test can be used as an accurate test to rapidly rule in or out an acute articular bacterial infection, even in patients with concurrent inflammatory arthritis. The leukocyte esterase strip test can be used as a rapid, bedside method for diagnosing or excluding bacterial infections in different body fluids. Hence, the sensitivity of the synovial LE test was 80.8%, the specificity, PPV, and NPV were 78.6, 70.0, 86.8% respectively based on a positive culture. ![]() The LE test results were positive in 30 specimens, trace in 3 and negative in one in the first-time test and were positive in 31 specimens and trace in 3 in the second-time test, while it was negative in all patients with JIA. The mean ages of patients were 64.14 ± 31.27 and 50.88 ± 23.19 months in the JIA group and septic arthritis group, respectively. We compared the result of the synovial LE test with the result of the culture of each patient. ![]() We collected the synovial fluid specimens as part of the general diagnostic protocol for patients suspected of Juvenile Idiopathic Arthritis (JIA) or Septic Arthritis (SA). Since this test measures the esterase activity of leukocytes, there is always a dilemma for using this test in patients with inflammatory arthritis. Recently, a synovial leukocyte esterase (LE) test has been used for diagnosing septic arthritis. ![]() The current diagnostic cornerstone for septic arthritis contains gram stains, bacterial culture, and cell count with a differential of aspirated synovial fluid.
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