Late prosthetic shoulder joint infection due to Actinomyces neuii in an adult man

2020 ◽  
Vol 13 (9) ◽  
pp. e236350
Author(s):  
Benjamin C Chen ◽  
Takaaki Kobayashi ◽  
Bradley Ford ◽  
Poorani Sekar
Keyword(s):  
Shoulder Joint ◽  
Clinical Symptoms ◽  
Reverse Shoulder Arthroplasty ◽  
Joint Infection ◽  
Gram Stain ◽  
Prosthetic Joint ◽  
Irrigation And Debridement ◽  
History Of ◽  
The Right ◽  
Slow Growing

A 72-year-old man with a history of right reverse shoulder arthroplasty presented with a 1-month history of erythema, pain and drainage from the right shoulder. Arthrocentesis was performed and synovial fluid gram stain revealed gram-positive rods. Clinical diagnosis of prosthetic shoulder joint infection was made. Orthopaedic surgeons performed irrigation and debridement with resection of the right shoulder prothesis and implantation of an antimicrobial spacer. Operative cultures grew Actinomyces neuii. The patient was treated with 6 weeks of ceftriaxone with improvement in both clinical symptoms and laboratory values. Actinomyces species remain a rare cause of late prosthetic joint infection (PJI) due to their slow growing and indolent course. While generalised actinomycosis is often treated with 6–12 months of antibiotics, the treatment course of Actinomyces PJI is not well characterised, with some sources suggesting a minimum of 6 weeks of antimicrobial therapy.

scholarly journals Prosthetic joint infection: an extremely rare complication of intravesicular BCG therapy

2019 ◽  
Vol 12 (12) ◽  
pp. e232809 ◽  
Author(s):  
Michael Storandt ◽  
Avish Nagpal
Keyword(s):  
Rare Complication ◽  
Joint Infection ◽  
Acid Fast Bacillus ◽  
Joint Effusion ◽  
Urothelial Bladder Carcinoma ◽  
Prosthetic Joint ◽  
Bcg Therapy ◽  
Urothelial Bladder ◽  
History Of ◽  
The Right

A 66-year-old man was seen in clinic due to concerns of tuberculosis of the right hip. He had a history of urothelial bladder carcinoma, which was treated via transurethral resection followed by intravesicular instillations of Mycobacterium bovis BCG (BCG). A few months later, he developed slowly worsening pain over his prosthetic right hip, and it was recommended he undergo surgical revision. During surgery, joint effusion was noted and synovial fluid was sent for bacterial and mycobacterial cultures, growing an acid-fast bacillus after 3 weeks, identified as Mycobacterium tuberculosis complex via nucleic acid probe. Susceptibility testing revealed resistance to pyrazinamide, which is typically seen in M. bovis. PCR confirmed the diagnosis of BCG infection. The patient was treated with isoniazid, rifampin and ethambutol, which he tolerated well. This case highlights the challenges associated with diagnosis and management of this rare complication of a commonly used therapy.

scholarly journals Rhodococcus equi által okozott nagyízületi endoprotézis körül kialakult fertőzés

2017 ◽  
Vol 158 (27) ◽  
pp. 1071-1074
Author(s):  
Imre Sallai ◽  
Nóra Péterfy ◽  
Mohammad Sanatkhani ◽  
Zoltán Bejek ◽  
Imre Antal ◽  
...  
Keyword(s):  
Joint Infection ◽  
Rhodococcus Equi ◽  
Reactive Protein ◽  
First Case ◽  
Irrigation And Debridement ◽  
History Of ◽  
The Right ◽  
Immunocompromised Hosts

Abstract: Rhodococcus equi is a rare pathogen in humans causing infections mostly in immunocompromised hosts. We present the first case of periprosthetic joint infection caused by Rhodococcus equi. An 88-year-old male patient was referred to our clinic with a history of fever and right hip pain. The patient had multiple hip surgeries including total joint arthroplasty and revision for aseptic loosening on the right side. He was immunocompetent, but his additional medical history was remarkable for diabetes mellitus, diabetic nephropathy and stroke with hemiplegia resulting in immobilization. Radiography showed stable components, joint aspirate yielded Rhodococcus equi. Irrigation and debridement was proposed, but the patient refused any surgical intervention. Therefore antibiotic therapy was administered. At the last follow-up the patient is free of complaints but the C-reactive protein level is still elevated. This case illustrates the possible role of Rhodococcus equi in medical device-associated infections. Orv Hetil. 2017; 158(27): 1071–1074.

A case of Mycobacterium fortuitum prosthetic joint infection successfully treated medically without prosthesis explantation or joint debridement

2021 ◽  
Vol 14 (8) ◽  
pp. e243675
Author(s):  
Maya Ramanathan ◽  
Folusakin Ayoade
Keyword(s):  
Prosthetic Joint Infection ◽  
Hip Replacement ◽  
Joint Infection ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Mycobacterium Fortuitum ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Prosthetic Joint ◽  
The Right

A 58-year-old man with a history of end-stage degenerative joint disease developed a postsurgical infection at the right hip 4 weeks after hip replacement surgery. He underwent surgical washout of the right hip without opening the joint capsule. Arthrocentesis returned positive for Mycobacterium fortuitum. He was started on antibiotics with the recommendation to remove the prosthesis. The prosthesis was retained. Based on antimicrobial susceptibilities, he was treated with 4 weeks of intravenous therapy using cefoxitin and amikacin and later switched to oral ciprofloxacin and doxycycline for 5 additional months. Eighteen months from his initial hip replacement surgery, he continues to do well. Joint aspiration culture is important to make a diagnosis of prosthetic joint infection (PJI) when periprosthetic culture is not available. In the absence of serious systemic or comorbid joint conditions, PJI due to M. fortuitum can be managed medically without having to remove the prosthesis or debride the joint.

scholarly journals The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

2019 ◽  
Vol 8 (12) ◽  
pp. 2113 ◽  
Author(s):  
Deroche ◽  
Bémer ◽  
Valentin ◽  
Jolivet-Gougeon ◽  
Tandé ◽  
...  
Keyword(s):  
Joint Infection ◽  
Antimicrobial Treatment ◽  
Microbiological Diagnosis ◽  
Joint Infections ◽  
Time To Positivity ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Two Samples ◽  
The Right ◽  
Polymicrobial Infections

Currently, no guideline provides recommendations on the duration of empirical antimicrobial treatment (EAT) in prosthetic joint infection (PJI). The aim of our study was to describe the time to growth of bacteria involved in PJI, rendering possible decreased duration of EAT. Based on a French multicentre prospective cohort study, culture data from patients with confirmed hip or knee PJI were analysed. For each patient, five samples were processed. Time to positivity was defined as the first positive medium in at least one sample for virulent pathogens and as the first positive medium in at least two samples for commensals. Definitive diagnosis of polymicrobial infections was considered the day the last bacteria were identified. Among the 183 PJIs, including 28 polymicrobial infections, microbiological diagnosis was carried out between Day 1 (D1) and D5 for 96.7% of cases. There was no difference in the average time to positivity between acute and chronic PJI (p = 0.8871). Microbiological diagnosis was given earlier for monomicrobial than for polymicrobial infections (p = 0.0034). When an optimized culture of peroperative samples was carried out, almost all cases of PJI were diagnosed within five days, including polymicrobial infections. EAT can be re-evaluated at D5 according to microbiological documentation.

scholarly journals Is Gram staining still useful in prosthetic joint infections?

2019 ◽  
Vol 4 (2) ◽  
pp. 56-59 ◽  
Author(s):  
Marjan Wouthuyzen-Bakker ◽  
Noam Shohat ◽  
Marine Sebillotte ◽  
Cédric Arvieux ◽  
Javad Parvizi ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Joint Infection ◽  
Individual Case ◽  
Gram Stain ◽  
Reactive Protein ◽  
Joint Infections ◽  
Gram Staining ◽  
Causative Microorganism ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Abstract. Introduction: Staphylococcus aureus is an independent risk factor for DAIR failure in patients with a late acute prosthetic joint infection (PJI). Therefore, identifying the causative microorganism in an acute setting may help to decide if revision surgery should be chosen as a first surgical approach in patients with additional risk factors for DAIR failure. The aim of our study was to determine the sensitivity of Gram staining in late acute S. aureus PJI.Material and methods: We retrospectively evaluated all consecutive patients between 2005-2015 who were diagnosed with late acute PJI due to S. aureus. Late acute PJI was defined as the development of acute symptoms and signs of PJI, at least three months after the index surgery. Symptoms existing for more than three weeks were excluded from the analysis. Gram staining was evaluated solely for synovial fluid.Results: A total of 52 cases were included in the analysis. Gram staining was positive with Gram positive cocci in clusters in 31 cases (59.6%). Patients with a C-reactive protein (CRP) > 150 mg/L at clinical presentation had a significantly higher rate of a positive Gram stain (30/39, 77%) compared to patients with a CRP ≤ 150 mg/L (4/10, 40%) (p=0.02). A positive Gram stain was not related to a higher failure rate (60.6% versus 57.9%, p 0.85).Conclusion: Gram staining may be a useful diagnostic tool in late acute PJI to identify S. aureus PJI. Whether a positive Gram stain should lead to revision surgery instead of DAIR should be determined per individual case.

Prior hip or knee prosthetic joint infection in another joint increases risk three-fold of prosthetic joint infection after primary total knee arthroplasty

2019 ◽  
Vol 101-B (7_Supple_C) ◽  
pp. 91-97 ◽  
Author(s):  
B. P. Chalmers ◽  
J. T. Weston ◽  
D. R. Osmon ◽  
A. D. Hanssen ◽  
D. J. Berry ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Primary Total Knee Arthroplasty ◽  
Study Cohort ◽  
Study Group ◽  
Prosthetic Joint ◽  
Primary Tkas ◽  
History Of ◽  
Total Knee ◽  
Primary Total Knee

Aims There is little information regarding the risk of a patient developing prosthetic joint infection (PJI) after primary total knee arthroplasty (TKA) when the patient has previously experienced PJI of a TKA or total hip arthroplasty (THA) in another joint. The goal of this study was to compare the risk of PJI of primary TKA in this patient population against matched controls. Patients and Methods We retrospectively reviewed 95 patients (102 primary TKAs) treated between 2000 and 2014 with a history of PJI in another TKA or THA. A total of 50 patients (53%) were female. Mean age was 69 years (45 to 88) with a mean body mass index (BMI) of 36 kg/m2 (22 to 59). In total, 27% of patients were on chronic antibiotic suppression. Mean follow-up was six years (2 to 16). We 1:3 matched these (for age, sex, BMI, and surgical year) to 306 primary TKAs performed in 306 patients with a THA or TKA of another joint without a subsequent PJI. Competing risk with death was used for statistical analysis. Multivariate analysis was followed to evaluate risk factors for PJI in the study cohort. Results The cumulative incidence of PJI in the study cohort (6.1%) was significantly higher than the matched cohort (2.6%) at ten years (hazard ratio (HR) 3.3; 95% confidence interval 1.18 to 8.97; p = 0.02). Host grade in the study group was not a significant risk factor for PJI. Patients on chronic suppression had a higher rate of PJI (HR 15; p = 0.002), with six of the seven patients developing PJI in the study group being on chronic suppression. The new infecting microorganism was the same as the previous in only two of seven patients. Conclusion In this matched cohort study, patients undergoing a clean primary TKA with a history of TKA or THA PJI in another joint had a three-fold higher risk of PJI compared with matched controls with ten-year cumulative incidence of 6.1%. The risk of PJI was 15-fold higher in patients on chronic antibiotic suppression; further investigation into reasons for this and mitigation strategies are recommended. Cite this article: Bone Joint J 2019;101-B(7 Supple C):91–97

scholarly journals Mycobacterium bovis prosthetic joint infection following intravesical instillation of BCG for bladder cancer

2019 ◽  
Vol 12 (12) ◽  
pp. e231830 ◽  
Author(s):  
Ashka Patel ◽  
Joel Elzweig
Keyword(s):  
Bladder Cancer ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Fluid Collection ◽  
Acid Fast Bacillus ◽  
Intravesical Instillation ◽  
Susceptibility Data ◽  
Prosthetic Joint ◽  
Bcg Therapy ◽  
History Of

A 91-year-old man with a history of intravesicular BCG therapy for recurrent bladder cancer and bilateral total hip arthroplasty (THA) presented with left hip pain. He was noted to have a fluid collection over the left lateral hip and hip X-ray showed loosening of the prosthetic hip stem indicative of a prosthetic joint infection (PJI). He subsequently underwent removal of the THA and insertion of an antibiotic spacer. He was discharged on intravenous ceftriaxone for presumed culture negative PJI. Intraoperative acid fast bacillus culture later grew Mycobacterium tuberculosis complex, which was then differentiated to M. bovis. The M. bovis infection was thought to be a complication of the patient’s prior BCG therapy. He was initially started on isoniazid, rifampin, pyrazinamide and ethambutol pending cultures and sensitivities; pyrazinamide was discontinued after M. bovis was isolated on culture and susceptibility data confirmed the expected inherent resistance of M. bovis to pyrazinamide. The patient underwent successful THA revision and remains symptom-free at 1 year.

scholarly journals Healthy women with severe early life trauma show altered neural facilitation of emotion inhibition under acute stress

2019 ◽  
Vol 50 (12) ◽  
pp. 2075-2084
Author(s):  
Sabrina Golde ◽  
Katja Wingenfeld ◽  
Antje Riepenhausen ◽  
Nina Schröter ◽  
Juliane Fleischer ◽  
...  
Keyword(s):  
Response Inhibition ◽  
Early Life ◽  
Acute Stress ◽  
Clinical Symptoms ◽  
Inferior Frontal Gyrus ◽  
History Of Or ◽  
Fearful Faces ◽  
Early Life Trauma ◽  
History Of ◽  
The Right

AbstractBackgroundAcross psychopathologies, trauma-exposed individuals suffer from difficulties in inhibiting emotions and regulating attention. In trauma-exposed individuals without psychopathology, only subtle alterations of neural activity involved in regulating emotions have been reported. It remains unclear how these neural systems react to demanding environments, when acute (non-traumatic but ordinary) stress serves to perturbate the system. Moreover, associations with subthreshold clinical symptoms are poorly understood.MethodsThe present fMRI study investigated response inhibition of emotional faces before and after psychosocial stress situations. Specifically, it compared 25 women (mean age 31.5 ± 9.7 years) who had suffered severe early life trauma but who did not have a history of or current psychiatric disorder, with 25 age- and education-matched trauma-naïve women.ResultsUnder stress, response inhibition related to fearful faces was reduced in both groups. Compared to controls, trauma-exposed women showed decreased left inferior frontal gyrus (IFG) activation under stress when inhibiting responses to fearful faces, while activation of the right anterior insula was slightly increased. Also, groups differed in brain–behaviour correlations. Whereas stress-induced false alarm rates on fearful stimuli negatively correlated with stress-induced IFG signal in controls, in trauma-exposed participants, they positively correlated with stress-induced insula activation.ConclusionNeural facilitation of emotion inhibition during stress appears to be altered in trauma-exposed women, even without a history of or current psychopathology. Decreased activation of the IFG in concert with heightened bottom-up salience of fear related cues may increase vulnerability to stress-related diseases.

scholarly journals Benign cemento-ossifying fibroma: a rare case report

2018 ◽  
Vol 4 (2) ◽  
pp. 585
Author(s):  
Gurbax Singh ◽  
Jasmine Kaur ◽  
Jai Lal Davessar ◽  
Latika Kansal ◽  
Ajay Singh
Keyword(s):  
Sphenoid Sinus ◽  
Rare Case ◽  
Surgical Excision ◽  
Ossifying Fibroma ◽  
Computed Tomography Scan ◽  
Rare Case Report ◽  
History Of ◽  
The Right ◽  
Slow Growing ◽  
Tomography Scan

<p>Cemento-ossifying fibroma (COF) is a benign fibro-osseous lesion commonly seen in the head and neck regions. It is considered as a benign, locally aggressive neoplasm that requires surgical excision. COF has traditionally been considered to be slow growing. We report a case of 11 year-old girl who presented to the ENT Department of our hospital with 7 months history of nasal obstruction, proptosis and headache. Computed Tomography scan images showed a mass in the right nasal cavity. This case is notable because involvement of the sphenoid sinus is rare. </p>

scholarly journals A Rare Case of Vancomycin-Induced Linear Immunoglobulin A Bullous Dermatosis

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Pinky Jha ◽  
Kurtis Swanson ◽  
Jeremiah Stromich ◽  
Basia M. Michalski ◽  
Edit Olasz
Keyword(s):  
Joint Infection ◽  
Immunoglobulin A ◽  
Colchicine Treatment ◽  
Left Knee ◽  
Dermoepidermal Junction ◽  
Common Drug ◽  
Prosthetic Joint ◽  
Bullous Dermatosis ◽  
History Of ◽  
Linear Iga Bullous Dermatosis

Linear IgA bullous dermatosis (LABD) is an autoimmune vesiculobullous disease, which is typically idiopathic but can also rarely be caused by medications or infections. Vancomycin is the most common drug associated with LABD. Lesions typically appear 24 hours to 15 days after the first dose of vancomycin. It is best characterized pathologically by subepidermal bulla (blister) formation with linear IgA deposition at the dermoepidermal junction. Here we report an 86-year-old male with a history of left knee osteoarthritis who underwent a left knee arthroplasty and subsequently developed a prosthetic joint infection. This infection was treated with intravenous vancomycin as well as placement of a vancomycin impregnated joint spacer. Five days following initiation of antibiotic therapy, he presented with a vesiculobullous eruption on an erythematous base over his trunk, extremities, and oral mucosa. The eruption resolved completely when intravenous vancomycin was discontinued and colchicine treatment was begun. Curiously, complete resolution occurred despite the presence of the vancomycin containing joint spacer. The diagnosis of vancomycin-induced linear IgA bullous dermatosis was made based on characteristic clinical and histopathologic presentations.

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