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Joint fluid Gram stain

Definition

Joint fluid Gram stain is a laboratory test to identify bacteria in a sample of joint fluid using a special series of stains (colors). The Gram stain method is one of the most commonly used methods to rapidly identify the cause of bacterial infections.

Alternative Names

Gram stain of joint fluid

How the Test is Performed

A sample of joint fluid is needed. This may be done in a health care provider's office using a needle, or during an operating room procedure. Removing the sample is called joint fluid aspiration.

The fluid sample is sent to a lab where a drop of fluid is spread in a very thin layer onto a microscope slide. This is called a smear. Several different colored stains are applied to the sample. The laboratory personnel will look at the stained smear under a microscope to see if bacteria are present. The color, size, and shape of the cells help identify the bacteria.

How to Prepare for the Test

Your provider will tell you how to prepare for the procedure. No special preparation is needed. But, tell your provider if you're taking a blood thinner, such as aspirin, warfarin (Coumadin) or clopidogrel (Plavix). These medicines can affect test results or your ability to take the test.

How the Test will Feel

Sometimes, the provider will first inject numbing medicine into the skin with a small needle, which may sting. A larger needle is then used to draw out the synovial fluid.

This test may also cause some discomfort if the tip of the needle touches bone. The procedure usually lasts less than 1 to 2 minutes.

Why the Test is Performed

The test is performed when there is unexplained swelling, joint pain, and inflammation of a joint, or to check for suspected joint infection.

Normal Results

A normal result means no bacteria are present on the Gram stain.

What Abnormal Results Mean

Abnormal results mean bacteria were seen on the Gram stain. This may be a sign of a joint infection, for example, gonococcal arthritis due to bacteria called Neisseria gonorrhoeae or arthritis due to bacteria called Staphylococcus aureus.

Risks

Risks of this test include:

  • Infection of the joint -- unusual, but more common with repeated aspirations
  • Bleeding into the joint space

Gallery

Gram stain
A Gram stain is a test used to help identify bacteria. The tested sample can be taken from body fluids that do not normally contain bacteria, such as blood, urine, or cerebrospinal fluid. A sample can also be taken from the site of a suspected infection, such as the throat, lungs, genitals, or skin. Bacteria are classified as either Gram-positive or Gram-negative, based on how they color in reaction with the Gram stain. The Gram stain is colored purple. When combined with the bacteria in a sample, the stain will either stay purple inside the bacteria (Gram-positive), or it will turn pink (Gram-negative). Examples of Gram-positive bacteria include Streptococcus and Staphylococcus aureus, as well as bacteria that cause anthrax, diphtheria, and toxic shock syndrome. Examples of Gram-negative bacteria include Escherichia coli (E coli), Salmonella, Hemophilus influenzae, as well as many bacteria that cause urinary tract infections, pneumonia, or peritonitis.
Joint aspiration
Synovial fluid analysis is a series of tests performed on synovial (joint) fluid to help diagnose and treat joint-related abnormalities. To obtain a synovial fluid sample, a needle is inserted into the knee between the joint space. When the needle is in place the synovial fluid is then withdrawn. The sample is sent to the lab for analysis.

References

El-Gabalawy HS, Tanner S. Synovial fluid analyses, synovial biopsy, and synovial pathology. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelly's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 56.

Karcher DS, McPherson RA. Cerebrospinal, synovial, serous body fluids, and alternative specimens. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 30.

Last reviewed December 4, 2022 by Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team..

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