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Lyme and septic arthritis of the knee may have similar clinical presentations, septic arthritis requires prompt identification and treatment to avoid joint destruction. We sought to determine whether synovial fluid cell counts alone can discriminate between
Lyme, septic, and other inflammatory arthritis.
We conducted a retrospective cohort study of children aged 1 to 18 years with knee monoarthritis who presented to 1 of 2 pediatric emergency departments located in
Lyme endemic areas. We included children who had both a synovial fluid culture and an evaluation for
Lyme disease. Septic arthritis was defined as a positive synovial fluid culture or synovial fluid pleocytosis (white blood cell [WBC] ?40,000 cells/?L) with a positive blood culture.
Lyme arthritis was defined as positive
Lyme serology without a positive bacterial culture. All other children were considered to have other inflammatory arthritis. We compared the synovial fluid counts by arthritis type.
We identified 384 children with knee monoarthritis, of whom 19 (5%) had septic arthritis, 257 (67%) had
Lyme arthritis and 108 (28%) had other inflammatory arthritis. Children with other inflammatory arthritis had lower synovial WBC and absolute neutrophil count, as well as percent neutrophils, than those with either
Lyme or septic arthritis. There were no significant differences in the synovial fluid WBC, absolute neutrophil count, and percent neutrophils for children with
Lyme and septic arthritis.
Lyme endemic areas, synovial fluid results alone do not differentiate septic from
Lyme arthritis. Therefore, other clinical or laboratory indicators are needed to direct the care of patients with knee monoarthritis.