Associate Professor of Orthopedic expert,Brigham Hostpital
The correct and short answer to this question is YES; septic bursitis can cause septicemia and lead to fetal outcomes. But fortunately, this is not the typical case in most patients with septic bursitis, and usually, this infection heals thoroughly without any problem or complication. Suppose you or anyone around you have septic bursitis. In that case, we highly recommend you to read the following article and get yourself familiar with this disease to get answers to the following questions:
- What is septic bursitis or infectious bursitis?
- Is purulent bursitis a severe and dangerous condition?
- Is septic bursitis life-threatening?
- Can septic bursitis cause death?
In the following, we will introduce you to bursitis and explain infectious or septic bursitis in more detail.
What does bursitis mean?
Between our tendons and bones, and especially around the joints, is a fluid-filled sac called the bursa that reduces the friction between the moving parts within the joints. The bursa also acts as a shock absorber.
The human body has about one hundred and sixty bursae around the shoulders, pelvis, knees, elbows, and the Achilles tendon in the foot. The walls of these fluid-filled sacs are covered by synovial cells, whose functions are to produce and secrete a fluid full of collagen and protein into the bursa.
The inflammation of the bursa is called bursitis. If the bursa’s wall becomes following inflamed exercise and improper physical activity, the patient will feel pain during joint movements. But this inflammation is aseptic, meaning no bacteria will be found when testing the bursa’s fluid. Non-infectious or aseptic bursitis will be relieved automatically by joint rest and cessation of heavy joint movements.
But sometimes, bursae that are close to the surface of our skin will become infectious. This is more common in patients:
- with diabetics
- with weakened immune systems
- who have been taking corticosteroids for a long time
- with kidney disease
- or suffering from liver disease
Statistics and epidemiology:
One out of five bursitides will become infectious and cause septic bursitis. Septic bursitis is more common in the superficial bursae of the body and often occurs following trauma and injury around the joint area. In these cases, the microbial agents and bacteria that cause the bursa infection enter through the damaged skin duct and cause infections in the superficial bursa. Cellulite or superficial infections of the skin damaged during trauma is responsible for fifty to seventy percent of all infectious bursitis.
Males are more likely to have septic bursitis than females. Eighty-five percent of all patients with septic bursitis are males. But let’s see why the bursa becomes inflamed.
What are the causes of bursitis?
There are many different types of bursitis classification in the medical literature. The most specific category of bursitis that is based on the properties of the etiologic factors is listed below:
- Bursitis caused by injury:
Inflammation of the bursa may happen if the bursa is injured directly or repeatedly by internal or external forces.
Based on the severity and duration of the force, bursitis in this group may further be classified into two groups. One group is bursitis, caused by small repetitive forces like wearing tight pants that may cause trochanteric bursitis, for example.
In the other group, bursitis will occur from a single but severe injury like a car accident or sports injury. In this group, almost always, bursitis is caused by the collection of blood inside the bursa.
In general, traumas can cause two types of bursitis:
- Acute bursitis:
Severe and direct trauma causes it to the bursa. For example, blunt trauma to the knee is accompanied by painful inflammation and swelling of the bursa around the knee.
- Chronic bursitis:
It occurred by repeated but minor traumas to the bursa. For example, shoulder bursitis may occur following repeated throwing of the ball by baseball or basketball players. Or bursitis around the knee due to repeated or prolonged kneeling.
Almost every rheumatic disease can cause bursitis. These types of bursitis later may become infectious and cause septic bursitis. For example, patients suffering from gout may develop inflammatory bursitis following the accumulation of urea crystals in the bursa.
The spread of infectious bacteria to bursa close to the skin can also cause infectious or septic bursitis. Bacteria may enter the bursa directly from the wound duct created following trauma to the skin adjacent to the bursa.
Bacteria that cause cellulite and skin infections may also reach the nearby bursa indirectly. People with immunodeficiency or weakened immune systems, such as diabetics and chronic users of corticosteroids and other immunosuppressive drugs, are more likely to develop infectious septicemia.
Which infectious agents cause infectious bursitis or septic?
Staphylococcus aureus is the most common cause of septic bursitis. Near eighty percent of all septic, bursitis is believed to be caused by Staphylococcus aureus.
The second bacterium that can cause infectious bursitis is Streptococcus pyogenes.
- Other bacteria and infectious agents:
Which bodies are bursae more vulnerable to septic bursitis?
Bursae located just below the skin surface are more prone to septic bursitis. For example:
The buccal bursa, the bursa around the knee patella, and Olecranon bursa, located just above the elbow bone, are all prone to infections caused by abrasion, scratches, wounds, scrapes, or even bug bites.
Signs and symptoms of infectious or septic bursitis
- Swelling at the joint site
- Localized pain at the joint site
- Increased temperature of the joint surface
- Regional redness
- Fever
- Generalized fatigue
Although death is not the outcome of septic bursitis in healthy regular patients, it still may occur in the first twelve hours after the spread of infection if left untreated. It mostly happens due to the spread of disease in the blood in patients with compromised immune systems.
Many people with rheumatoid arthritis, such as stable disease or a history of high dose corticosteroid consumption, are exposed to septic and sometimes life-threatening bursitis.
Diagnosis of septic bursitis
It is necessary to see a doctor in time to reduce the risks and eliminate the complications of infectious bursitis.
Septic bursitis is uncommon and most likely mistaken with non-infectious inflammatory bursitis or aseptic bursitis. When bursitis is suspected, especially when it is accompanied by swelling, heat, pain, and local redness, the fluid inside the bursa should be drained with a needle for testing.
Doctors call this process “aspiration,” A laboratory must analyze the discharged fluid to determine if the liquid is infectious. Accurate clinical examination along with the results of laboratory tests are critical in the correct and immediate diagnosis of septic bursitis.
Laboratory testing requires a complete blood cell count, analysis, and bacteria culture testing of the aspirated fluid. An increase in the number of white blood cells in the bursa fluid indicates the presence of infection. In addition, in the case of a disease, the amount of glucose in the joint fluid will be significantly reduced. Sometimes, the bursa fluid will be evaluated from other aspects, such as the presence of sedimentary crystals.
If the items and tests mentioned above are not helpful, your doctor may use ultrasound and, in some cases, MRI to better diagnose the problem. The reason is that many cases of infectious bursitis are often mistaken for arthritis. Remember that infectious bursitis is a medical emergency and should be treated ASAP.
Treatment of septic bursitis
Treatment for infectious bursitis should be started immediately. Sometimes, your doctor may prescribe an appropriate oral antibiotic for your condition. They may also recommend that the bursa be examined every three to five days by removing the infectious fluid for testing.
In cases where it is not possible to be treated with oral antibiotics or if the appropriate treatment response is not received orally, especially in people with weakened immune systems, the patient should be hospitalized and receive injectable antibiotics.
When these ineffective treatments, the next option may be surgical drainage with a needle that requires surgery.
You may be a candidate for surgery in some septic bursitis located deep inside the body, like those near hip and shoulder joints.
Can septic bursitis be fatal and life-threatening?
Yes, in case of delayed or improper treatment or misdiagnosis, especially in people with weakened immune systems, bacterial infections may enter the bloodstream and spread throughout the body, worsening the patient’s condition.
The infection enters the bloodstream and triggers an inflammatory reaction throughout the body.
In this stage, the infection in the blood affects the normal functions of vital organs such as the heart, brain, lung, kidney, etc.; the patient may experience dizziness, low blood pressure, loss of urine formation, and chills.
- third stage: Infectious shock or septic shock.
In this phase, following the secretion of specific chemical compounds in the process of infection and global inflammation, the vascular wall of vessels within the body begins to dilate progressively, resulting in a decrease in blood pressure.
A drop in blood pressure prevents enough blood from reaching the brain, kidneys, and other vital organs. Eventually, the lungs, brain, kidneys, and heart will fail and result in an unfortunate death of the patient.
At-risk groups for fetal septic bursitis
The following people are more likely to develop an infection in the blood (known as sepsis) which can result in shock and death following infectious bursitis:
- People living with AIDS
- Patients with rheumatoid arthritis, lupus, and psoriasis
- Patients with inflammatory bowel disease such as Crohn's disease and ulcerative colitis
- People undergoing chemotherapy
- People undergoing particular immunotherapy
- Diabetic people with uncontrolled sugar and insulin consumption
- People with chronic diseases
- People with malnutrition
Complications of spreading the infection in the blood
The spread of disease in the blood or sepsis is associated with severe and sometimes fatal complications such as:
- Kidney failure
- Lung failure
- Abnormal blood clot formation
- Liver failure
- Death
The only way to prevent these complications is to start treating any localized infection immediately.
The patient’s age, underlying diseases, general health of the affected person, location of infectious bursitis, and time of initiation of treatment will affect the patient’s survival rate.