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Figure 1. Aedes albopictus , the Asian tiger mosquito. Photograph courtesy of James Gathany, CDC Public Health Image Library.
(Figure omitted. See article PDF.)
Figure 2. Rash associated with B19 virus infection in an older child. Photograph taken from the CDC Public Health Image Library.
(Figure omitted. See article PDF.)
Infectious arthritis may be caused by multiple pathogens including bacteria, viruses and fungi. Although most bacterial and viral infections produce an acute arthritis, while mycobacterial and fungal infections typically follow a more indolent course, determining the etiology of infectious arthritis can be challenging. There is considerable overlap and variability in the presentation of disease and noninfectious causes can complicate the diagnostic process.
Common causes of viral arthritis include Togaviridae (Ross River virus, Barmah Forest virus, Chikungunya virus, O'nyong-nyong virus and rubella virus), Parvoviridae (B19 virus), Flaviviridae (dengue and HCV), Hepadnaviridae (HBV) and Retroviridae (HIV and human T-cell lymphotropic virus type 1 [HTLV-1]). These pathogens can also be grouped into three epidemiologic categories: arboviruses, endemic or childhood viruses and blood-borne viruses.
A thorough history including contact history, geographic location, travel history, sexual history and intravenous drug use should be sought to help determine the underlying viral etiology. It can be difficult to distinguish the responsible virus on clinical examination alone, as the pattern of joint involvement is usually not specific to a particular virus. Arthritis may be the predominant feature in a viral infection, or occur as part of a syndrome that may include fever, rash, myalgia or hepatitis. Some viruses are location specific due to the associated vectors responsible for transmission of infection. Knowing the current local epidemiology of potential viral agents is also useful when differentiating sporadic from epidemic cases of viral arthritis.
In this article, we first describe the epidemiology and pathogenesis of each virus, followed by the clinical features and diagnostic modalities currently employed, and finally discuss some treatment options for viral arthritides.
Togaviridae
The members of the Togaviridae family associated with arthritides include the Alphavirus species Chikungunya, Ross River, Barmah Forest, O'nyong-nyong, Mayaro and Sindbis viruses and the Rubivirus species rubella virus. These viruses are enveloped and all possess a single-stranded, positive-sense RNA genome of 9-12 kb.
Viruses of the genus Alphavirus cause zoonotic infections and are transmitted by arthropod...