Acute onset |
Neisseria gonorrhoeae | 2 weeks from primary infection | Sexual contact | Global | Synovial and blood C&S NAAT from any exposed sites (throat, urine, rectal) |
Chikungunya virus | Usually within 1 week Progresses to chronic arthropathy in 40% of patients | Aedes mosquito–borne | Africa, Asia, the Americas | Serology |
Subacute-chronic onset |
Burkholderia pseudomallei | 2–4 weeks; can have years-long latency | Soil and water via cutaneous inoculation, inhalation or ingestion | Tropics and subtropics Most cases from Thailand, northern Australia and Indian subcontinent | Synovial and blood C&S |
Mycobacterium tuberculosis | Reactivation years after primary infection | Inhalation from infectious contact | Global Most cases from Africa, Asia, Eastern Europe and South America | Synovial fluid or tissue mycobacterial culture |
Brucella spp. | 2–4 weeks; can have months-long latency | Contaminated sheep and goat milk Contact with infected animals | Global Most cases from Mediterranean, Balkans, Middle East and the Americas | Synovial and blood C&S Serology |
Borrelia burgdorferi (Lyme) | Months after initial infection | Ixodes spp. tick bite | North America and Europe | Serology ± synovial fluid PCR |
Coccidioides spp. | Weeks to months | Inhalation from environment | Southwestern US, Central and South America | Synovial fungal culture |
Blastomyces dermatitidis | Weeks to months | Inhalation from environment | US and Canada | Synovial fungal culture Urine antigen |