{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:18:23Z","timestamp":1790831903854,"version":"4.1.0"},"reference-count":32,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,5,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND:<\/jats:title>\n                  <jats:p>Patients with septic hip arthritis require surgical drainage, but they can be difficult to distinguish from patients with Lyme arthritis. The ability of synovial fluid white blood cell (WBC) counts to help discriminate between septic and Lyme arthritis of the hip has not been investigated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>We assembled a retrospective cohort of patients \u226421 years of age with hip monoarticular arthritis and a synovial fluid culture obtained who presented to 1 of 3 emergency departments located in Lyme disease endemic areas. Septic arthritis was defined as a positive synovial fluid culture result or synovial fluid pleocytosis (WBC count \u226550\u2009000 cells per \u00b5L) with a positive blood culture result. Lyme arthritis was defined as positive 2-tiered Lyme disease serology results and negative synovial fluid bacterial culture results. All other patients were classified as having other arthritis. We compared median synovial fluid WBC counts by arthritis type.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>Of the 238 eligible patients, 26 (11%) had septic arthritis, 32 (13%) had Lyme arthritis, and 180 (76%) had other arthritis. Patients with septic arthritis had a higher median synovial fluid WBC count (126\u2009130 cells per \u00b5L; interquartile range 83\u2009303\u2013209\u2009332 cells per \u00b5L) than patients with Lyme arthritis (53\u2009955 cells per \u00b5L; interquartile range 33\u2009789\u201373\u2009375 cells per \u00b5L). Eighteen patients (56%) with Lyme arthritis had synovial fluid WBC counts \u226550\u2009000 cells per \u00b5L. Of the 94 patients who underwent surgical drainage, 13 were later diagnosed with Lyme arthritis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>In Lyme disease endemic areas, synovial fluid WBC counts cannot always help differentiate septic from Lyme arthritis. Rapid Lyme diagnostics could help avoid unnecessary operative procedures in patients with Lyme arthritis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2017-3810","type":"journal-article","created":{"date-parts":[[2018,4,18]],"date-time":"2018-04-18T07:30:28Z","timestamp":1524036628000},"source":"Crossref","is-referenced-by-count":26,"title":["Hip Synovial Fluid Cell Counts in Children From a Lyme Disease Endemic Area"],"prefix":"10.1542","volume":"141","author":[{"given":"Arianna H.","family":"Dart","sequence":"first","affiliation":[{"name":"Divisions of Emergency Medicine and"},{"name":"Macalester College, St Paul, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth A.","family":"Michelson","sequence":"additional","affiliation":[{"name":"Divisions of Emergency Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul L.","family":"Aronson","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and"},{"name":"Emergency Medicine, Yale School of Medicine, Yale Unviersity, New Haven, Connecticut;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aris C.","family":"Garro","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J.","family":"Lee","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly M.","family":"Glerum","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Nigrovic","sequence":"additional","affiliation":[{"name":"Immunology, and"},{"name":"Division of Rheumatology, Immunology, and Allergy, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mininder S.","family":"Kocher","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Boston Children\u2019s Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard G.","family":"Bachur","sequence":"additional","affiliation":[{"name":"Divisions of Emergency Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lise E.","family":"Nigrovic","sequence":"additional","affiliation":[{"name":"Divisions of Emergency Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2018,5,1]]},"reference":[{"issue":"6","key":"2021121021514879600_B1","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1097\/00006454-198611000-00014","article-title":"Pyogenic arthritis in infants and children: a review of 95 cases.","volume":"5","author":"Welkon","year":"1986","journal-title":"Pediatr Infect Dis"},{"issue":"5","key":"2021121021514879600_B2","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1097\/BPO.0000000000000664","article-title":"Pediatric Lyme arthritis of the hip: the great imitator?","volume":"37","author":"Cruz","year":"2017","journal-title":"J Pediatr Orthop"},{"issue":"3","key":"2021121021514879600_B3","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2012-2531","article-title":"Distinguishing Lyme from septic knee monoarthritis in Lyme disease-endemic areas.","volume":"131","author":"Deanehan","year":"2013","journal-title":"Pediatrics"},{"issue":"1","key":"2021121021514879600_B4","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/PEC.0000000000000028","article-title":"Synovial fluid findings in children with knee monoarthritis in lyme disease endemic areas.","volume":"30","author":"Deanehan","year":"2014","journal-title":"Pediatr Emerg 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