Role of bacteriological analysis of the joint fluid in the diagnosis of the septic arthritis in adults in low-income countries such as Madagascar.

Septic arthritis is a serious disease and its treatment remains a major challenge. Demonstration of the microorganism is the key to diagnosis according to all international guidelines. In developing countries such as Madagascar, where access to basic health services is still difficult, bacteriological analysis of the joint fluid is not yet available in most healthcare facilities. We propose effective solutions that are scientifically valid, adapted to the country's socioeconomic conditions and current health situation, while taking international recommendations into consideration. We propose that the few university hospitals with rheumatology departments and good reference laboratories should be supported to participate in a pilot program to compile data to establish the clinical and bacteriological profiles of septic arthritis here. In lower level health centers where bacteriological examinations of the joint fluid and other complementary tests are more or less impossible, a diagnosis of septic arthritis is mainly based on clinical findings. Accordingly, all diagnosis and management should be centralized in these reference centers, which will allow the adaptation and progressive update of guidelines for the management of septic arthritis.