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Updated: Nov 1, 2025
Knee Arthrocentesis in Adults
Published on: February 25, 2022
Septic arthritis of native joints due to Mycobacterium avium complex: A systematic review of case reports
Bibek Saha1, Kurtis Young1, Melissa Kahili-Heede1
1John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu HI, USA.
Introduction:
While MAC native joint septic arthritis is historically considered a rare entity, the number of reported cases have increased in recent decades. However, no comprehensive review of this topic has been conducted.
Objectives:
To conduct a systematic review of cases of MAC native joint septic arthritis reported in the literature and summarize the presentations, baseline characteristics, risk factors, diagnosis, treatment, and treatment outcomes.
Methods:
A systematic review was conducted by performing an extensive literature search through Medline, Google Scholar, and Web of Science, starting from their inception. Screening of articles, assessment of eligibility, and data synthesis from eligible articles were independently performed by two reviewers with input from a third reviewer to achieve consensus. Inclusion criteria to determine eligibility included articles in English, case reports/case series, adult patients who presented with MAC/MA/MI septic arthritis of a native joint. Statistical analyses were performed using Statistical Package for the Social Sciences.
Results:
Thirty-three cases of MAC native joint septic arthritis were reported since 1976. MAC septic arthritis affects immunocompetent and immunocompromised patients, most frequently as a monoarthritis involving the knees and wrist. MAC septic arthritis may present in the context of disseminated MAC infection and primary MAC septic arthritis. The average time to diagnosis from onset of symptoms was 20 months, where the majority of cases were initially misdiagnosed. Although arthrocentesis can be used to make the diagnosis, a synovial biopsy is necessary in many cases to confirm the diagnosis. A combination of surgery and antimycobacterial drug treatment has the highest chance of achieving complete resolution.
Conclusion:
The diagnosis of septic arthritis of native joints due to MAC can be challenging and/or delayed. A high level of suspicion is needed in high-risk patients and also when atypical presentations occur. Therefore, understanding the presentation, risk factors, and pitfalls in diagnosing MAC septic arthritis are essential. MAC septic arthritis literature is scarce, necessitating further research of this rare condition to increase awareness, diagnostic accuracy and determine the optimal treatment strategy to improve patient outcomes.
Insights
Mycobacterium avium complex (MAC) native joint septic arthritis, though rare, is increasingly reported. Diagnosis is often delayed, highlighting the need for increased awareness and improved diagnostic strategies for this challenging condition.
Area of Science:
- Infectious Diseases
- Rheumatology
- Microbiology
Background:
- Mycobacterium avium complex (MAC) native joint septic arthritis is an increasingly recognized, yet historically rare, condition.
- A comprehensive review of this specific entity has been lacking, hindering a unified understanding of its characteristics and management.
Observation:
- A systematic review identified 33 reported cases of MAC native joint septic arthritis since 1976.
- The condition most commonly presents as monoarthritis, particularly affecting the knee and wrist joints, in both immunocompetent and immunocompromised individuals.
- Diagnosis is frequently delayed, with an average delay of 20 months, and often requires synovial biopsy in addition to arthrocentesis.
Findings:
- MAC septic arthritis can occur in the context of disseminated MAC infection or as primary septic arthritis of a native joint.
- A combination of surgical intervention and antimycobacterial drug treatment demonstrated the highest success rate for complete resolution.
- High-risk patients and atypical presentations warrant a heightened clinical suspicion for MAC septic arthritis.
Implications:
- Enhanced awareness and understanding of MAC septic arthritis presentations, risk factors, and diagnostic challenges are crucial for timely diagnosis and effective management.
- Further research is needed to optimize treatment strategies and improve patient outcomes for this rare condition.
- Accurate and prompt diagnosis is essential, as delays can lead to poorer prognoses and increased morbidity.
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